Investigating the prevalence of nurses' workflow interruptions and the factors affecting them in the general hospitals affiliated with Kashan University of Medical Sciences in 2024

Investigating the prevalence of nurses' workflow interruptions and the factors affecting them in the general hospitals affiliated with Kashan University of Medical Sciences in 2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigating the prevalence of nurses' workflow interruptions and the factors affecting them in the general hospitals affiliated with Kashan University of Medical Sciences in 2024 seyyed mohammad abbaszadeh, newsha poursaadat, nahid dehghan nayeri This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5295942/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and objective: Workflow interruptions significantly decrease productivity and are among the top five causes of medication errors. They are also linked to nursing errors, posing risks to the quality and effectiveness of patient care and safety. Therefore, this study aimed to investigate the prevalence of interruptions in nurses' workflow and the factors influencing them in general hospitals affiliated with Kashan University of Medical Sciences (KUMS) in 2024. Method: This is a descriptive and analytical quantitative study that focused on all nurses working in six general hospitals affiliated with KUMS. The sample size for this study was 300 individuals, who were randomly and proportionally selected from each hospital. Data collection involved using a demographic information and a self-report questionnaire on nursing workflow interruptions, which were administered in person at the research sites. The collected data was then analyzed using the SPSS version 21. Findings: The majority of participants are female, married, native, with a bachelor's degree, and have an average age of 34.4 (±7.758). On average, they have 10.88(±7.508) years of work experience and work 62.03(±37.395) hours of overtime per month. The highest rate of interruptions was related to answering the wards phone, with a prevalence of 51.7% occurring at least 5 times a day. The lowest rate of interruptions was related to emergency situations (safety, accident, fire, theft), with 74.7% of people reporting "almost never." The wards with the highest frequency of interruptions were the operating room, surgery, psychiatric, and ICU. There is also a significant relationship between the occurrence of interruptions, family income, the amount of overtime, and types of wards. Conclusion: The presence of interruptions in nursing work is unavoidable due to nature and complexity of nurses' responsibilities. However, through increased awareness, education, and policy making by nursing managers, the frequency of interruptions can be reduced. This study highlights that within Iran's healthcare organizations, establishing policies to prevent interruptions not only improves the quality of nursing care and patient safety, but also has positive effects on the overall health outcomes for nurses. workflow interruptions patient safety Introduction Interruption is defined as an "unexpected, temporary or definitive cessation of a human activity initiated by an internal or external source. The interruption disrupts the course of the activity and impedes the completion of the initial activity."(1). Interruptive processes are frequent in the nursing team's practice, leading to disruptions in workflow continuity, loses of control over the rational flow of activities by personnel and a impact on the quality of care provided(2). In addition, Interruptions interfere with productivity and efficiency and In healthcare, it contribute to missed care or care delays with adverse consequences. emergency, acute care, intensive care, and operating rooms، exemplify the most common healthcare settings that this phenomenon occurs in them(3). Some studies have shown that interruptions can take up to 22% of professionals' working time(4), and it is estimated that nurses spend up to 11% of their time managing interruptions during medication administration(5). In other words, the longest duration and highest frequency of interruptions occurred during the administration of medication. Additionally, actual time taken to carry out nursing tasks such as "consultation and education", "safety", and "nursing management and patient information management" also increased significantly due to interruptions(6). This increase results in higher healthcare costs, increased workload, and interference with productivity ,because Interruptions can reduce desired productivity by 40% and pose a threat to patient safety(7) Various sources have defined interruptions in different categories. For example, in nursing, an interruption can be caused by the nurse themselves (spontaneously), another person, or the work environment (such as an alarm)(8). According to this classification, common nurse interruptions include distractions, patients, other healthcare providers, phone calls, and events that occur near the nursing duties(9). In another classification, interruptions are divided into two types: external and internal. External interruptions are caused by an outside source(10), while internal interruptions, also known as "self-interruptions," are created by the individual's own thought processes and cause them to stop the primary activity to focus on something else(11). However, self-interruptions are more noticeable. Common self-interruptions for nurses include starting a conversation with a coworker and retrieving forgotten supplies(10), the need for communication and the supply of materials(12), as well as environmental factors such as telephones, televisions, mobile phones, and equipment(4) and attending to a patient's immediate needs(4, 12). Jett and George have categorized interruptions in different ways, including " Intrusions", "distractions", Breaks and discrepancies. intrusions are unexpected encounters by someone else that affect the flow and continuity of the task, causing a temporary halt, while Distractions are described as psychological reactions triggered by external stimuli which interrupt the nurses' focus. Breaks are described as planned or spontaneous recesses from the task, which affect flow and continuity. Discrepancies were described as the inconsistencies that nurses perceive between their own knowledge and expectations and the observations they make that are relevant to the work they are performing. Analysis of their study data revealed that 52% of observed interruptions were distractions, while 35% were intrusions(5). The results of a study on the initiators and causes of interruptions indicate that communication with patients, families, and nurses was the primary factor related to interruptions(6). Additionally, the role of colleagues in nursing is a common cause of interruptions, with asking questions and consulting with colleagues being significant factors. Conversely, questions account for more than a third of interruptions, with their answers typically being brief, specific, and related to professional issues (13). Studies have shown a clear relationship between interruptions and errors. For example, interruptions during the medication administration process are often linked to medication errors(14) as there is a heightened risk of forgetting or repeating certain steps(15). The reason for this is that people's active memory needs time to remember where it was before the interruption when returning to the previous activity(16). Therefore, various studies emphasize the importance of managing workflow interruptions to prevent errors during nursing activities, particularly administration of medication. It is important to note that not all interruptions automatically result in errors, and the assumption that interruptions always have a negative impact has been questioned in some fields. In fact, only a small percentage (approximately 11%) of interruptions actually assist the nurse or lead to outcomes that enhance safety, comfort, and accuracy(17). For example, alarms, warning lights, and signals that redirect a nurse's attention back to the patient from outside the room can be beneficial. While interruptions within a patient's room are often seen as detrimental because they can disrupt the delivery of routine care and attention, there are instances where interruptions that refocus the nurse on the patient, facilitate patient-doctor communication, and provide support from doctors can be valuable(18). Nursing management of healthcare organizations should recognize interruptions as an important factor that can potentially impact patient safety, and implement management interventions to address them. Strategies to reduce interruptions or manage them have been introduced(19), but they will only be effective if interdisciplinary individuals, both those who experience interruptions and those who cause them, are aware of the prevalence of interruptions, their types, priorities, Know when interruptions should be avoided?!(20), and And when there is a greater risk for patient safety?!(21). Given the above considerations and the significance of managing nursing workflow interruptions in enhancing patient safety and nurse productivity, and the lack of studies on this topic in Iran, this study aimed to investigate the prevalence of nurses' workflow interruptions and the factors influencing them in general hospitals affiliated with Kashan University of Medical Sciences in 2024. This research aims to establish the foundation for effective interruption management in the country. Methods This is a descriptive-analytical quantitative study that collected data in March 2024. The research population consisted of all the nurses working in the general hospitals affiliated with KUMS. This university is located in Kashan city, Isfahan province, and includes a total of six general hospitals, four private hospitals, and a social security maternity hospital, serving a population of 500 thousand people in its two subordinate cities. Sampling was conducted randomly and proportionally. The study included a total of 1200 nurses working in the six general hospitals. The number of nurses in these hospitals ranges from 70 to 700. To determine the sample size, a pilot study was conducted on 20 nurses. Using the sample size formula for descriptive studies with 5% level of error and 90% test power, the sample size was calculated to be 330 people, accounting for a 10% attrition probability. Ultimately, 300 questionnaires were returned. Data collection was conducted by filling out a demographic information questionnaire and self-reporting workflow interruptions. The demographic information questionnaire consisted of 23 questions regarding the personal and professional characteristics of the participants. For the main research tool which focused on workflow interruptions, researchers began by reviewing existing tools in the field. This included reviewing literature related to interruptions and utilizing tools such as the self-reporting questionnaire of nursing workflow interruptions by Eun-Jeong Yu and Eun-Nam Lee(22), Theresa (Tess) M. Pape medication interruptions tool(23) and the Abdel-aleem interruption resources tool(24),Then, by translating these tools into Persian and seeking expert views, it became the primary tool for psychometric. The identified items were then subjected to face and content validity. This designed tool underwent construct validity examining, resulting in a final tool with 20 items across three dimensions (human, environment, and human-environment). The tool utilized a five-choice Likert scale, with options ranging from one to five (ranging from At least five times a day, three to four times a day, one to two times a day, three to four times a week, one to two times a week, almost never). To assess the reliability of the questionnaire, it was administered to 20 nurses and Cronbach's alpha was measured (0.918). The questionnaire was utilized to identify the causes of interruptions in three dimensions: human, environmental, and human-environmental. It included questions about sudden requests by individuals (7 questions), the occurrence of sudden changes and emergencies (4 questions), departmental equipment (2 questions), answering the phone (2 questions), resistance to treatment measures (1 question), delay of medical staff in attendance and visits (2 questions), patient transfer (1 question), and forgetfulness (1 question). This study investigates interruptions caused by answering cell phones, colleagues arriving late, forgetting tasks, sudden questions or requests from nurse colleagues, employees from other departments, guards, or several people at the same time. These interruptions can be considered "human factors" that disrupt nurses' work. Emergency conditions such as safety issues, accidents, fires, theft, etc., sudden noises from the patient or their guardian, sudden changes in the patient's condition, sudden increases in the number of patients (admission of new patients), alarms from medical devices or equipment, device disorders, failure to make timely visits by doctors, patient transfers to other departments, resistance from the patient or their family to treatment and care measures, are "environmental factors". Other categorie of interruptions include answering the department's phone, responding to requests or questions from patients' companions, patient or doctor. These interruptions are considered "human-environmental factors" that affect nursing work. In order to conduct this research, the ethics approval code (IR.TUMS.FNM.REC.1402.147) was obtained from the Ethics Committee of the Faculty of Nursing and Midwifery at Tehran University of Medical Sciences. Permission to conduct the research was also obtained from Kashan University of Medical Sciences. After receiving the letter of introduction to the hospitals, the researcher coordinated with the nursing offices of all three shifts (morning, evening, and night) to visit the departments in person and collect data. The researcher explained the objectives of the research, the working method, and the confidentiality of people's information during these visits. After obtaining agreement from the participants, questionnaires were delivered to them and collected at the end of the same shift. Descriptive statistics, including frequency, frequency percentage, mean and standard deviation, were used to analyze the data of the study. Inferential statistical tests were then used to investigate the relationship between all personal and occupational characteristics of nurses with interruption factors (see Table 1 ). The data obtained from the study were analyzed using SPSS version 21 software and descriptive and analytical statistics. Table 1 Demographic information of participants Variables Classification Frequency Percentage age 45 36 12 work experience < 5 81 27 6–10 63 21 11–15 54 18 16–20 46 15.3 < 20 31 10.3 missing 25 8.4 sex Female 238 79.3 Male 62 20.7 Native status native 275 91.7 No native 21 7 missing 2 1.3 Employment status Permanent 198 66 Contractual 39 13 Temporary 7 2.3 Corporate recruitment 16 5.3 service obligation 40 13.4 Head of household yes 63 21 no 237 79 marital status Married 230 76.7 Single 63 21 Divorce/widow 7 2.3 education BS 247 82.3 MS 18 6 others 45 11.7 Wards Emergency 80 26.6 ICU 40 13.3 CCU 17 5.7 Medical 38 12.7 Surgical 19 6.3 Psychiatric 25 8.3 Operating room 23 7.7 Pediatric 36 12 others 22 7.4 Table 2 correlation between interruption and personal and occupational characteristics of nurses Main variable Dependent variable p-value Workflow interruption family income p = 0/004 Department of service p < 0.001 Average overtime p < 0.001 age p = 0/557 sex p = 0/101 marital status p = 0/110 being native p = 0/064 education p = 0/221 Employment status p = 0/691 Number of children p = 0/258 Housing situation p = 0/498 Findings The demographic characteristics of participating nurses are shown in Table 1. The majority of participants were female (79.3%), married (76.7%), native (91.7%), and held a bachelor's degree (82.3%). More than a third of participants were less than 30 years old (37.3%), with an average age of 34.4 years (±7.758). Additionally, more than a third of participants were childless (39.7%). Most of the people were not heads of households(78.3%) and had their own housing(90%). They often declared the total family income to be less than 20 million Tomans (60.3%)(approximately equivalent to 330 dollars per month). Additionally, the majority of participants (89%) had no other source of income than nursing, and the average income was 14.43 million Tomans (approximately equivalent to 240 dollars per month). 27% of participants had 5 years or less of nursing work experience, and the average work experience of the people was 10.88 years (± 7.508). Additionally, the majority of participants (60%) had five years of experience or less in their current department. Most individuals worked in rotating shifts (88.7%), with similar frequencies of morning, evening, and night shifts (24-28%). The average amount of overtime worked per month was 62.03 hours (±37.395). Over a quarter of participants (26.6%) worked in emergency departments, followed by those in the ICU (13.3%). Analytical findings from the research using Pearson's correlation test and analysis of variance indicate that only some demographic factors are significantly related to the prevalence of interruption. For example, the family income of nurses (r=0.129; p=0.004) was found to be related to interruption factors. The department where nurses work (F=4.869; df=13,286; p<0.001) showed a significant positive correlation with interruption factors. Interestingly, the amount of nurses’ overtime was negatively correlated with interruption factors (r= 0.225, p<0.001). However, factors such as age, sex, marital status, education, number of children, being native, housing status, employment status, and other variables showed no significant relationship with interruption factors (p>0.05). The highest number of interruptions in nursing work are related to operating room departments (87.26%), surgery (80.63%), Psychiatric inpatient department (78.76%), and ICU (76.47%). (See Table 3) According to statistical findings, the highest rate of interruption in the "human factors" category was related to delays caused by the presence of colleagues, with a prevalence of 41.7%. This was followed by sudden requests from employees from other departments, with a prevalence of 38.3%. Both of these interruptions were reported to occur 1-2 times a week. In the "environmental factors" category, the highest interruption was related to the failure of a device with a prevalence (41%) followed by patient or family resistance to treatment and care measures at 39.7%, Both of these interruptions were reported to occur 1-2 times a week. In the "human - environmental factors" category, answering the ward phones was prevalent (51.7%) followed by sudden request from the patient was prevalent (40%) both of which were the most effective interruption factors in nursing work with the option of atleast 5 times a day. Table 3: Frequency of occurrence of interruptions according to the department of the wards Wards Mean N Std. Deviation medical 67.18 38 14.189 surgical 80.63 19 17.599 Emergency 70.11 80 16.79 infant 71.75 36 17.96 CCU 72.05 17 8.48 ICU 76.47 40 17.48 psychologic inpatient 78.76 25 14.21 others 84.11 17 17.19 newborn 74.40 5 14.19 operating room 87.26 23 16.89 Total 74.46 300 17.05 Discussion The findings of the current study showed that there is no statistically significant relationship between demographic variables (such as age, sex, marital status, educational level, number of children, being native, housing status, employment status, overall experience, and the length of experience in the current position) and interruptions in nurses' work flow. A study by Altamimi et al. (2022) also found no significant relationship between interruptions and gender, which aligns with the findings of the current study. However, they did discover a relationship between interruptions and marital status, as well as level of education. Specifically, the study showed that single nurses are more likely to experience interruptions compared to married nurses. Also, nurses with a nursing diploma experience the highest level of interruptions(25). A study by Tóthová et al. (2023) also demonstrated a correlation between factors such as ward type, age, overall experience, experience in the current department and level of education with interruptions during drug therapy(26). Additionally, a study by Bonafide et al. (2020) indicated that the risk of errors due to telephone interruptions varies depending on the nurse's work shift and their experience(27). The discrepancy in findings between these studies and the current study may be due to differences in the research population, as the context and work patterns in Iranian hospitals differ from those in the countries where the other studies were conducted. Based on the statistical findings, the highest rate of interruption in the present study was related to answering the phone of the department with a prevalence of 51.7%. This is followed by delays in the presence of colleagues (41.7%), defects in a device (41%), sudden requests from patients (40%), resistance from patients or their families to treatment and care measures (39.7%), and sudden noise from a patient or their guardian (36.7%). Requests or questions from patient companions accounted for 36% of interruptions. The lowest rate of interruption was related to emergency situations (safety, accidents, fire, theft) and after that, a sudden request from the guard, which respectively 74.7% and 51.4% of participants reported the option almost never occurred. Reviewing the literature related to interruptions revealed that other common sources of interruption include nursing personnel(14, 28, 29), other patients(30, 31) and the self-interruption(32) which in the present study does not include cases with high prevalence. Answering the department's phone from human-environmental factors was the most common interruption factor in this study. This result is in line with the study of Sassaki and Perroca, who reported that the most common cause of interruption (87%) was the ringing of the department's phone(33). Youns et al. (2020) have also mentioned the department telephone as one of the most common causes of work interruptions(34). Additionally, in the study of Matthias et al. (2017), the telephone factor, along with communication with colleagues, accounted for 75% of nursing interruptions in the emergency department(35). Angela (2019) mentioned in a study the various factors that can interrupt workflow through phone calls. These factors include the nature of calls, call length, unanswered calls, language barriers, poor connection or network problems, and misuse of phone lines(36). However, in the current research environment, various structural and process factors contribute to phone issues such as secretary not being available to answer phone calls at certain hours, the phone ringing inappropriately, phone lines not being properly connected to the relevant department and many Paraclinic departments or clinics being unresponsive; and patients' lack of access to follow-up care to answer questions after discharge cause an excessive increase in phone calls to wards. In addition to the cases mentioned previously, hospitals are facing a shortage of nursing staff, causing nurses to take on multiple roles and tasks. This increased workload results in more telephone communication being necessary. Studies have shown that telephone interruptions can lead to errors(27, 37) and delays in carrying out nursing duties, ultimately reducing the quality of medical services. Iran has been experiencing a shortage of nurses for many years, which is often addressed by nurses working overtime(38). Guchait 's study (2018) also notes that the lack of human resources results in more forced overtime, leading to job burnout and ultimately contributing to errors(39). The findings of the present study demonstrated a significant and negative relationship between nurses' overtime and the prevalence of clinical interruptions. This means that individuals with more overtime reported experiencing fewer interruptions. However, we found a significant and negative relationship between the amount of overtime with gender (p < 0.001), and age (p < 0.001). Therefore, the highest amount of overtime work has been done by men and young people. According to Sadra et al.'s study (2023), male nurses reported higher work ability than women(40). also, Despite the higher job stress reported by female nurses and the increase in job stress with age(41), this study suggests that the decrease in reported interruptions may be linked to differences in age and gender among participants. Also, in the study by Cucolo et al. (2024), which examines factors influencing the rise in nurses' workload, quantitative factors like nurses' overtime were identified as contributors to increased workload, leading to cognitive effects on nurses' mental well-being(42). As a result, nurses may inaccurately report fewer interruptions due to heightened fatigue, mental strain, and increased workload resulting from overtime. This is in line with the study by Namadi et al. (2024), which showed that mental confusion caused by personal problems, fatigue, unexpected acceptance of a new patient, and deterioration of the patient's condition lead to nurses making more mistakes and experiencing work interruptions(38). In addition to the significant relationship between overtime and the prevalence of nursing interruptions, economic problems, along with the subsequent mental conflict, can be recognized as sources of self-interruption for nurses. The present study found a significant positive relationship between nurses’ family income and the prevalence of nursing interruptions. A study conducted in Nigeria revealed that salaries and wages play a crucial role in determining job satisfaction among nurses(43). However, the insufficient compensation for nurses in comparison to other professions ranks as the third leading cause of nurse shortages in Iran and the seventh globally, highlighting the relatively low salaries received by Iranian nurses(44). In the present study, a majority of nurses reported a monthly family income ranging from 11–20 million Tomans (Approximately equivalent to 165–330 dollars per month), a figure that is notably low given the current inflation rates and its impact on their families' financial well-being. Therefore, in Iran, due to economic problems, nurses are often forced to have two or more jobs related to or unrelated to nursing. As a result, while they may be able to meet their financial needs by increasing their workload, they may also experience additional problems such as family issues and exhaustion (resulting from long working hours without adequate rest), which can lead to interruptions in their nursing duties . The findings have shown a significant relationship between the ward that nurses work and the prevalence of work interruptions. The highest frequency of nursing workflow interruptions was related to the operating room, surgery, inpatient, and ICU departments, respectively (see Table 3 ). Göras et al.'s study (2019) demonstrates that nurses in the operating room team constantly face multiple tasks and interruptions, impacting patient safety. In the operating room, there is an expectation for personnel to answer phones and pagers, which are themselves factors that cause interruptions(45). The most common interruptions and distractions observed in operating rooms are "small talk" and the entry and exit of staff, while the most severe distractions are caused by faulty or unavailable equipment. Using the phone and pager, in particular, can be distracting(46). These interruptions can stem from both internal sources, like surgical equipment alarms and surgery-related conversations, and external sources, such as phone rings, calls, and interactions with personnel from other departments(47). In the operating room, interruptions can impact all members of a surgical team, including anesthesia personnel, nurses, surgeons, and operating room technicians. This can reduce the effectiveness of teamwork, increase the surgeon's stress, and lead to an increase in workload(48). A study by Tóthová et al. also found that nurses in surgical departments often experience interruptions(26). Therefore, the role of the environment (ward) and its characteristics in determining the type of interruptions and subsequently the occurrence of errors is evident. The ward has unique characteristics in terms of human and structural elements that can contribute to interruptions occurring. Altamimi et al. (2022) in medical-surgical and intensive care units found that visitors are the primary cause of nursing interruptions in these wards, while equipment failure is the main factor of nursing interruptions in intensive care units(25). The results of this study align with the current study in terms of the frequency of interruption factors. Environmental factors, such as device or equipment failure, are the most common cause of interruptions. Additionally, human-environmental factors, like requests and questions from patients' companions, including visitors, are also common causes of interruptions in the nursing workflow. Youns et al. (2022), in their study, mentioned the lowest factors of interruption prevalence as factors related to the patient (34). The factors related to the patient in the current study such as “sudden changes in the patient's condition and the transfer of the patient to another department for diagnostic measures” were categorized as environmental factors. Also, sudden request from the patient was examined in the category of human-environmental factors. Contrary to expectations, factors related to the patient were not the least prevalent in this study. In fact, sudden requests from the patients were among the most common human-environmental factors and ranked fourth overall among all the interruption factors investigated. Conclusion In this study، Answering the ward phone is widely recognized as the most significant factor contributing to nurses work interruptions. Also, the operating room was the most common place where nursing interruptions occur. Therefore, studying the prevalence of interruptions is crucial due to the high sensitivity and importance of the operating room in providing critical and emergency medical services. These findings highlight the importance of effective time and resource management in hospital environments. Therefore, the findings point to the need to adopt management and policy measures in the field of reducing interruptions and improving the quality of care.. In general, it should be acknowledged that the sources of interruption and their impact are different according to the working conditions, wards and culture of each society. Therefore, nurses may be affected by different factors due to varying working conditions. Declarations Acknowledgements researchers would like to express sincere appreciation to all the nurses and individual who contributed to this project. Author contributions: SMA collected the data and wrote the manuscript with NP. NDN supervised and controlled the entire process, including editing the manuscript. NP analyzed the data and provided statistical section. All authors read and approved the final manuscript. Funding: No funding was received for this work. Data availability: All data generated or analyzed during this study are included in this published article Ethics: approval and consent to participate We obtain approval from the Joint Committee of Organizational Ethics of Tehran University of Medical Sciences. (Code: IR.TUMS.FNM.REC.1402.147).Informed consent was obtained from the nurses to participate in the study. Consent for publication : Not applicable. Competing interests: The authors declare no competing interests. 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Central European Journal of Nursing and Midwifery. 2022;13(2):640-7. Tóthová V, Prokešová R, Malý J, Doseděl M, Tesař O, Vlček J. ReasONs aND CONTexT fOR DIsRUpTINg NURses DURINg The aDmINIsTRaTION Of meDICINes. context.37:20-64. Bonafide CP, Miller JM, Localio AR, Khan A, Dziorny AC, Mai M, et al. Association between mobile telephone interruptions and medication administration errors in a pediatric intensive care unit. JAMA pediatrics. 2020;174(2):162-9. Monteiro C, Avelar AFM, Pedreira MLG. Interruptions of nursing activities: contributions to patient and professional safety. Acta Paulista de Enfermagem. 2020;33:eAPE20190042. Sassaki RL, Cucolo DF, Perroca MG. Interruptions and nursing workload during medication administration process. Revista Brasileira de Enfermagem. 2019;72(4):1001-6. Kavanagh A, Donnelly J. A lean approach to improve medication administration safety by reducing distractions and interruptions. Journal of nursing care quality. 2020;35(4):E58-E62. Dall'Oglio I, Fiori M, Di Ciommo V, Tiozzo E, Mascolo R, Bianchi N, et al. Effectiveness of an improvement programme to prevent interruptions during medication administration in a paediatric hospital: a preintervention–postintervention study. BMJ open. 2017;7(1):e013285. de Freitas Junior WC, Alves VC, Silva Ramos J, Rodrigues Garbis Chagas S, Ferreira da Mata LR, Carrilho Menezes A, et al. Distractions and interruptions in medication preparation and administration in inpatient units. Revista Eletronica de Enfermagem. 2019;21. Sassaki RL, Perroca MG. Interruptions and their effects on the dynamics of the nursing work. Revista gaucha de enfermagem. 2017;38:e67284. Youns E, Elsabahy H, Kassem A. Workflow Interruptions and Nursing errors among staff nurses in Intensive Care Units at Oncology Center Mansoura University. Mansoura Nursing Journal. 2022;9(1):201-12. Weigl M, Beck J, Wehler M, Schneider A. Workflow interruptions and stress atwork: a mixed-methods study among physicians and nurses of a multidisciplinary emergency department. BMJ open. 2017;7(12):e019074. Otto-Ryan AM. Telephone triage: identifying the nature of the high volume of telephone calls disrupting workflow in a pediatric ambulatory care setting: Rutgers University-School of Nursing-RBHS; 2021. Shahbaz N, Hussain M, Afzal M, Amir Gilani M. The impact of interruptions on medication errors in hospitals: a direct observational study of nurses. J Intensive Crit Care Nurs. 2020;3:1-11. Namadi F, Alilu L, Habibzadeh H. Challenges of maintaining patient safety among Iranian nurses: A qualitative study. 2024. Guchait P, Zhao X, Madera J, Hua N, Okumus F. Can error management culture increase work engagement in hotels? The moderating role of gender. Service Business. 2018;12:757-78. Imenpanah M, Abargouei NS, Esfahani AS. Investigating the relationship between demographic characteristics, job stress and work ability in nurses: A cross-sectional descriptive study. Occupational Medicine. 2023. Babapour A-R, Gahassab-Mozaffari N, Fathnezhad-Kazemi A. Nurses’ job stress and its impact on quality of life and caring behaviors: a cross-sectional study. BMC nursing. 2022;21(1):75. Cucolo DF, de Campos Oliveira JL, Rossit RAS, Mininel VA, Perroca MG, Silva JAMd. Effects of interprofessional practice on nursing workload in hospitals: A systematic review. The International Journal of Health Planning and Management. 2024;39(3):824-43. Akinwale OE, George OJ. Work environment and job satisfaction among nurses in government tertiary hospitals in Nigeria. Rajagiri Management Journal. 2020;14(1):71-92. Shamsi A, Peyravi H. Nursing shortage, a different challenge in Iran: A systematic review. Medical journal of the Islamic Republic of Iran. 2020;34:8. Göras C, Olin K, Unbeck M, Pukk-Härenstam K, Ehrenberg A, Tessma MK, et al. Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study. BMJ open. 2019;9(5):e026410. Gui JL, Nemergut EC, Forkin KT. Distraction in the operating room: a narrative review of environmental and self-initiated distractions and their effect on anesthesia providers. Journal of Clinical Anesthesia. 2021;68:110110. Hasanshahi M, Rakhshan M, Fereidouni A, Moayedi SA, Torabizadeh C. Development and psychometric evaluation of a questionnaire for measuring distraction due to mobile phone use in operating rooms. Journal of Perioperative Nursing. 2022;35(2):e3-e13. Riutort KT. Distractions in the operating room. Current Anesthesiology Reports. 2020;10:456-62. Additional Declarations No competing interests reported. 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The interruption disrupts the course of the activity and impedes the completion of the initial activity.\"(1). Interruptive processes are frequent in the nursing team's practice, leading to disruptions in workflow continuity, loses of control over the rational flow of activities by personnel and a impact on the quality of care provided(2). In addition, Interruptions interfere with productivity and efficiency and In healthcare, it contribute to missed care or care delays with adverse consequences. emergency, acute care, intensive care, and operating rooms، exemplify the most common healthcare settings that this phenomenon occurs in them(3). Some studies have shown that interruptions can take up to 22% of professionals' working time(4), and it is estimated that nurses spend up to 11% of their time managing interruptions during medication administration(5). In other words, the longest duration and highest frequency of interruptions occurred during the administration of medication. Additionally, actual time taken to carry out nursing tasks such as \"consultation and education\", \"safety\", and \"nursing management and patient information management\" also increased significantly due to interruptions(6). This increase results in higher healthcare costs, increased workload, and interference with productivity ,because Interruptions can reduce desired productivity by 40% and pose a threat to patient safety(7)\u003c/p\u003e \u003cp\u003eVarious sources have defined interruptions in different categories. For example, in nursing, an interruption can be caused by the nurse themselves (spontaneously), another person, or the work environment (such as an alarm)(8). According to this classification, common nurse interruptions include distractions, patients, other healthcare providers, phone calls, and events that occur near the nursing duties(9).\u003c/p\u003e \u003cp\u003eIn another classification, interruptions are divided into two types: external and internal. External interruptions are caused by an outside source(10), while internal interruptions, also known as \"self-interruptions,\" are created by the individual's own thought processes and cause them to stop the primary activity to focus on something else(11). However, self-interruptions are more noticeable. Common self-interruptions for nurses include starting a conversation with a coworker and retrieving forgotten supplies(10), the need for communication and the supply of materials(12), as well as environmental factors such as telephones, televisions, mobile phones, and equipment(4) and attending to a patient's immediate needs(4, 12). Jett and George have categorized interruptions in different ways, including \" Intrusions\", \"distractions\", Breaks and discrepancies. intrusions are unexpected encounters by someone else that affect the flow and continuity of the task, causing a temporary halt, while Distractions are described as psychological reactions triggered by external stimuli which interrupt the nurses' focus. Breaks are described as planned or spontaneous recesses from the task, which affect flow and continuity. Discrepancies were described as the inconsistencies that nurses perceive between their own knowledge and expectations and the observations they make that are relevant to the work they are performing. Analysis of their study data revealed that 52% of observed interruptions were distractions, while 35% were intrusions(5). The results of a study on the initiators and causes of interruptions indicate that communication with patients, families, and nurses was the primary factor related to interruptions(6). Additionally, the role of colleagues in nursing is a common cause of interruptions, with asking questions and consulting with colleagues being significant factors. Conversely, questions account for more than a third of interruptions, with their answers typically being brief, specific, and related to professional issues (13).\u003c/p\u003e \u003cp\u003eStudies have shown a clear relationship between interruptions and errors. For example, interruptions during the medication administration process are often linked to medication errors(14) as there is a heightened risk of forgetting or repeating certain steps(15). The reason for this is that people's active memory needs time to remember where it was before the interruption when returning to the previous activity(16). Therefore, various studies emphasize the importance of managing workflow interruptions to prevent errors during nursing activities, particularly administration of medication. It is important to note that not all interruptions automatically result in errors, and the assumption that interruptions always have a negative impact has been questioned in some fields. In fact, only a small percentage (approximately 11%) of interruptions actually assist the nurse or lead to outcomes that enhance safety, comfort, and accuracy(17). For example, alarms, warning lights, and signals that redirect a nurse's attention back to the patient from outside the room can be beneficial. While interruptions within a patient's room are often seen as detrimental because they can disrupt the delivery of routine care and attention, there are instances where interruptions that refocus the nurse on the patient, facilitate patient-doctor communication, and provide support from doctors can be valuable(18).\u003c/p\u003e \u003cp\u003eNursing management of healthcare organizations should recognize interruptions as an important factor that can potentially impact patient safety, and implement management interventions to address them. Strategies to reduce interruptions or manage them have been introduced(19), but they will only be effective if interdisciplinary individuals, both those who experience interruptions and those who cause them, are aware of the prevalence of interruptions, their types, priorities, Know when interruptions should be avoided?!(20), and And when there is a greater risk for patient safety?!(21).\u003c/p\u003e \u003cp\u003eGiven the above considerations and the significance of managing nursing workflow interruptions in enhancing patient safety and nurse productivity, and the lack of studies on this topic in Iran, this study aimed to investigate the prevalence of nurses' workflow interruptions and the factors influencing them in general hospitals affiliated with Kashan University of Medical Sciences in 2024. This research aims to establish the foundation for effective interruption management in the country.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis is a descriptive-analytical quantitative study that collected data in March 2024. The research population consisted of all the nurses working in the general hospitals affiliated with KUMS. This university is located in Kashan city, Isfahan province, and includes a total of six general hospitals, four private hospitals, and a social security maternity hospital, serving a population of 500 thousand people in its two subordinate cities. Sampling was conducted randomly and proportionally. The study included a total of 1200 nurses working in the six general hospitals. The number of nurses in these hospitals ranges from 70 to 700. To determine the sample size, a pilot study was conducted on 20 nurses. Using the sample size formula for descriptive studies with 5% level of error and 90% test power, the sample size was calculated to be 330 people, accounting for a 10% attrition probability. Ultimately, 300 questionnaires were returned.\u003c/p\u003e \u003cp\u003eData collection was conducted by filling out a demographic information questionnaire and self-reporting workflow interruptions. The demographic information questionnaire consisted of 23 questions regarding the personal and professional characteristics of the participants. For the main research tool which focused on workflow interruptions, researchers began by reviewing existing tools in the field. This included reviewing literature related to interruptions and utilizing tools such as the self-reporting questionnaire of nursing workflow interruptions by Eun-Jeong Yu and Eun-Nam Lee(22), Theresa (Tess) M. Pape medication interruptions tool(23) and the Abdel-aleem interruption resources tool(24),Then, by translating these tools into Persian and seeking expert views, it became the primary tool for psychometric. The identified items were then subjected to face and content validity. This designed tool underwent construct validity examining, resulting in a final tool with 20 items across three dimensions (human, environment, and human-environment). The tool utilized a five-choice Likert scale, with options ranging from one to five (ranging from At least five times a day, three to four times a day, one to two times a day, three to four times a week, one to two times a week, almost never). To assess the reliability of the questionnaire, it was administered to 20 nurses and Cronbach's alpha was measured (0.918).\u003c/p\u003e \u003cp\u003eThe questionnaire was utilized to identify the causes of interruptions in three dimensions: human, environmental, and human-environmental. It included questions about sudden requests by individuals (7 questions), the occurrence of sudden changes and emergencies (4 questions), departmental equipment (2 questions), answering the phone (2 questions), resistance to treatment measures (1 question), delay of medical staff in attendance and visits (2 questions), patient transfer (1 question), and forgetfulness (1 question).\u003c/p\u003e \u003cp\u003eThis study investigates interruptions caused by answering cell phones, colleagues arriving late, forgetting tasks, sudden questions or requests from nurse colleagues, employees from other departments, guards, or several people at the same time. These interruptions can be considered \"human factors\" that disrupt nurses' work.\u003c/p\u003e \u003cp\u003eEmergency conditions such as safety issues, accidents, fires, theft, etc., sudden noises from the patient or their guardian, sudden changes in the patient's condition, sudden increases in the number of patients (admission of new patients), alarms from medical devices or equipment, device disorders, failure to make timely visits by doctors, patient transfers to other departments, resistance from the patient or their family to treatment and care measures, are \"environmental factors\". Other categorie of interruptions include answering the department's phone, responding to requests or questions from patients' companions, patient or doctor. These interruptions are considered \"human-environmental factors\" that affect nursing work.\u003c/p\u003e \u003cp\u003e In order to conduct this research, the ethics approval code (IR.TUMS.FNM.REC.1402.147) was obtained from the Ethics Committee of the Faculty of Nursing and Midwifery at Tehran University of Medical Sciences. Permission to conduct the research was also obtained from Kashan University of Medical Sciences. After receiving the letter of introduction to the hospitals, the researcher coordinated with the nursing offices of all three shifts (morning, evening, and night) to visit the departments in person and collect data. The researcher explained the objectives of the research, the working method, and the confidentiality of people's information during these visits.\u003c/p\u003e \u003cp\u003eAfter obtaining agreement from the participants, questionnaires were delivered to them and collected at the end of the same shift. Descriptive statistics, including frequency, frequency percentage, mean and standard deviation, were used to analyze the data of the study. Inferential statistical tests were then used to investigate the relationship between all personal and occupational characteristics of nurses with interruption factors (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The data obtained from the study were analyzed using SPSS version 21 software and descriptive and analytical statistics.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic information of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eage\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31–35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36–40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41–45\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt; 45\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003ework experience\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6–10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11–15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16–20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt; 20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emissing\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003esex\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eNative status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enative\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e275\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo native\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emissing\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePermanent\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContractual\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTemporary\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorporate recruitment\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eservice obligation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHead of household\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003emarital status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e230\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorce/widow\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eeducation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBS\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMS\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eothers\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eWards\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.6\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eICU\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCCU\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychiatric\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperating room\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediatric\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eothers\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ecorrelation between interruption and personal and occupational characteristics of nurses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain variable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDependent variable\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003eWorkflow interruption\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efamily income\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep = 0/004\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepartment of service\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep \u0026lt; 0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage overtime\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep \u0026lt; 0.001\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eage\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep = 0/557\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esex\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep = 0/101\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emarital status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep = 0/110\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebeing native\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep = 0/064\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eeducation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep = 0/221\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep = 0/691\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of children\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep = 0/258\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousing situation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep = 0/498\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eThe demographic characteristics of participating nurses are shown in Table 1. The majority of participants were female (79.3%), married (76.7%), native (91.7%), and held a bachelor\u0026apos;s degree (82.3%). More than a third of participants were less than 30 years old (37.3%), with an average age of 34.4 years (\u0026plusmn;7.758). Additionally, more than a third of participants were childless (39.7%). Most of the people were not heads of households(78.3%) and had their own housing(90%). They often declared the total family income to be less than 20 million Tomans (60.3%)(approximately equivalent to 330 dollars\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eper month). Additionally, the majority of participants (89%) had no other source of income than nursing, and the average income was 14.43 million Tomans (approximately equivalent to 240 dollars per month). 27% of participants had 5 years or less of nursing work experience, and the average work experience of the people was 10.88 years (\u0026plusmn; 7.508). \u0026nbsp;Additionally, the majority of participants (60%) had five years of experience or less in their current department. Most individuals worked in rotating shifts (88.7%), with similar frequencies of morning, evening, and night shifts (24-28%). The average amount of overtime worked per month was 62.03 hours (\u0026plusmn;37.395). Over a quarter of participants (26.6%) worked in emergency departments, followed by those in the ICU (13.3%).\u003c/p\u003e\n\u003cp\u003eAnalytical findings from the research using Pearson\u0026apos;s correlation test and analysis of variance indicate that only some demographic factors are significantly related to the prevalence of interruption. For example, the family income of nurses (r=0.129; p=0.004) was found to be related to interruption factors. The department where nurses work (F=4.869; df=13,286; p\u0026lt;0.001) showed a significant positive correlation with interruption factors. Interestingly, the amount of nurses\u0026rsquo; overtime was negatively correlated with interruption factors (r= 0.225, p\u0026lt;0.001). However, factors such as age, sex, marital status, education, number of children, being native, housing status, employment status, and other variables showed no significant relationship with interruption factors (p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eThe highest number of interruptions in nursing work are related to operating room departments (87.26%), surgery (80.63%),\u0026nbsp;Psychiatric inpatient department\u0026nbsp;(78.76%), and ICU (76.47%). (See Table 3)\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eAccording to statistical findings, the highest rate of interruption in the \u0026quot;human factors\u0026quot; category was related to delays caused by the presence of colleagues, with a prevalence of 41.7%. This was followed by sudden requests from employees from other departments, with a prevalence of 38.3%. Both of these interruptions were reported to occur 1-2 times a week.\u003c/p\u003e\n\u003cp\u003eIn the \u0026quot;environmental factors\u0026quot; category, the highest interruption was related to the failure of a device with a prevalence (41%) followed by patient or family resistance to treatment and care measures at 39.7%, \u0026nbsp; Both of these interruptions were reported to occur 1-2 times a week.\u003c/p\u003e\n\u003cp\u003eIn the \u0026quot;human - environmental factors\u0026quot; category, answering the ward phones was prevalent (51.7%) followed by sudden request from the patient was prevalent (40%) both of which were the most effective interruption factors in nursing work with the option of atleast 5 times a day.\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 100%;\"\u003e\n \u003cp\u003eTable 3: Frequency of occurrence of interruptions according to the department of the wards\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 23%;\"\u003e\n \u003cp\u003eWards\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17%;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34%;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23%;\"\u003e\n \u003cp\u003emedical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e67.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34%;\"\u003e\n \u003cp\u003e14.189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23%;\"\u003e\n \u003cp\u003esurgical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e80.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34%;\"\u003e\n \u003cp\u003e17.599\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23%;\"\u003e\n \u003cp\u003e\u0026nbsp;Emergency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e70.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34%;\"\u003e\n \u003cp\u003e16.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23%;\"\u003e\n \u003cp\u003e\u0026nbsp;infant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e71.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34%;\"\u003e\n \u003cp\u003e17.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23%;\"\u003e\n \u003cp\u003e\u0026nbsp;CCU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e72.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34%;\"\u003e\n \u003cp\u003e8.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23%;\"\u003e\n \u003cp\u003e\u0026nbsp;ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e76.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34%;\"\u003e\n \u003cp\u003e17.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23%;\"\u003e\n \u003cp\u003epsychologic inpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e78.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34%;\"\u003e\n \u003cp\u003e14.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23%;\"\u003e\n \u003cp\u003eothers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e84.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34%;\"\u003e\n \u003cp\u003e17.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23%;\"\u003e\n \u003cp\u003e\u0026nbsp;newborn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e74.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34%;\"\u003e\n \u003cp\u003e14.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23%;\"\u003e\n \u003cp\u003eoperating room\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17%;\"\u003e\n \u003cp\u003e87.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34%;\"\u003e\n \u003cp\u003e16.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.4694%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.3469%;\"\u003e\n \u003cp\u003e74.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24.4898%;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.6939%;\"\u003e\n \u003cp\u003e17.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of the current study showed that there is no statistically significant relationship between demographic variables (such as age, sex, marital status, educational level, number of children, being native, housing status, employment status, overall experience, and the length of experience in the current position) and interruptions in nurses' work flow. A study by Altamimi et al. (2022) also found no significant relationship between interruptions and gender, which aligns with the findings of the current study. However, they did discover a relationship between interruptions and marital status, as well as level of education. Specifically, the study showed that single nurses are more likely to experience interruptions compared to married nurses. Also, nurses with a nursing diploma experience the highest level of interruptions(25). A study by T\u0026oacute;thov\u0026aacute; et al. (2023) also demonstrated a correlation between factors such as ward type, age, overall experience, experience in the current department and level of education with interruptions during drug therapy(26). Additionally, a study by Bonafide et al. (2020) indicated that the risk of errors due to telephone interruptions varies depending on the nurse's work shift and their experience(27). The discrepancy in findings between these studies and the current study may be due to differences in the research population, as the context and work patterns in Iranian hospitals differ from those in the countries where the other studies were conducted.\u003c/p\u003e \u003cp\u003eBased on the statistical findings, the highest rate of interruption in the present study was related to answering the phone of the department with a prevalence of 51.7%. This is followed by delays in the presence of colleagues (41.7%), defects in a device (41%), sudden requests from patients (40%), resistance from patients or their families to treatment and care measures (39.7%), and sudden noise from a patient or their guardian (36.7%). Requests or questions from patient companions accounted for 36% of interruptions. The lowest rate of interruption was related to emergency situations (safety, accidents, fire, theft) and after that, a sudden request from the guard, which respectively 74.7% and 51.4% of participants reported the option almost never occurred. Reviewing the literature related to interruptions revealed that other common sources of interruption include nursing personnel(14, 28, 29), other patients(30, 31) and the self-interruption(32) which in the present study does not include cases with high prevalence.\u003c/p\u003e \u003cp\u003eAnswering the department's phone from human-environmental factors was the most common interruption factor in this study. This result is in line with the study of Sassaki and Perroca, who reported that the most common cause of interruption (87%) was the ringing of the department's phone(33). Youns et al. (2020) have also mentioned the department telephone as one of the most common causes of work interruptions(34). Additionally, in the study of Matthias et al. (2017), the telephone factor, along with communication with colleagues, accounted for 75% of nursing interruptions in the emergency department(35). Angela (2019) mentioned in a study the various factors that can interrupt workflow through phone calls. These factors include the nature of calls, call length, unanswered calls, language barriers, poor connection or network problems, and misuse of phone lines(36). However, in the current research environment, various structural and process factors contribute to phone issues such as secretary not being available to answer phone calls at certain hours, the phone ringing inappropriately, phone lines not being properly connected to the relevant department and many Paraclinic departments or clinics being unresponsive; and patients' lack of access to follow-up care to answer questions after discharge cause an excessive increase in phone calls to wards. In addition to the cases mentioned previously, hospitals are facing a shortage of nursing staff, causing nurses to take on multiple roles and tasks. This increased workload results in more telephone communication being necessary. Studies have shown that telephone interruptions can lead to errors(27, 37) and delays in carrying out nursing duties, ultimately reducing the quality of medical services.\u003c/p\u003e \u003cp\u003eIran has been experiencing a shortage of nurses for many years, which is often addressed by nurses working overtime(38). Guchait 's study (2018) also notes that the lack of human resources results in more forced overtime, leading to job burnout and ultimately contributing to errors(39). The findings of the present study demonstrated a significant and negative relationship between nurses' overtime and the prevalence of clinical interruptions. This means that individuals with more overtime reported experiencing fewer interruptions. However, we found a significant and negative relationship between the amount of overtime with gender (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and age (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Therefore, the highest amount of overtime work has been done by men and young people. According to Sadra et al.'s study (2023), male nurses reported higher work ability than women(40). also, Despite the higher job stress reported by female nurses and the increase in job stress with age(41), this study suggests that the decrease in reported interruptions may be linked to differences in age and gender among participants. Also, in the study by Cucolo et al. (2024), which examines factors influencing the rise in nurses' workload, quantitative factors like nurses' overtime were identified as contributors to increased workload, leading to cognitive effects on nurses' mental well-being(42). As a result, nurses may inaccurately report fewer interruptions due to heightened fatigue, mental strain, and increased workload resulting from overtime. This is in line with the study by Namadi et al. (2024), which showed that mental confusion caused by personal problems, fatigue, unexpected acceptance of a new patient, and deterioration of the patient's condition lead to nurses making more mistakes and experiencing work interruptions(38).\u003c/p\u003e \u003cp\u003eIn addition to the significant relationship between overtime and the prevalence of nursing interruptions, economic problems, along with the subsequent mental conflict, can be recognized as sources of self-interruption for nurses. The present study found a significant positive relationship between nurses\u0026rsquo; family income and the prevalence of nursing interruptions. A study conducted in Nigeria revealed that salaries and wages play a crucial role in determining job satisfaction among nurses(43). However, the insufficient compensation for nurses in comparison to other professions ranks as the third leading cause of nurse shortages in Iran and the seventh globally, highlighting the relatively low salaries received by Iranian nurses(44). In the present study, a majority of nurses reported a monthly family income ranging from 11\u0026ndash;20\u0026nbsp;million Tomans (Approximately equivalent to 165\u0026ndash;330 dollars per month), a figure that is notably low given the current inflation rates and its impact on their families' financial well-being. Therefore, in Iran, due to economic problems, nurses are often forced to have two or more jobs related to or unrelated to nursing. As a result, while they may be able to meet their financial needs by increasing their workload, they may also experience additional problems such as family issues and exhaustion (resulting from long working hours without adequate rest), which can lead to interruptions in their nursing duties .\u003c/p\u003e \u003cp\u003eThe findings have shown a significant relationship between the ward that nurses work and the prevalence of work interruptions. The highest frequency of nursing workflow interruptions was related to the operating room, surgery, inpatient, and ICU departments, respectively (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). G\u0026ouml;ras et al.'s study (2019) demonstrates that nurses in the operating room team constantly face multiple tasks and interruptions, impacting patient safety. In the operating room, there is an expectation for personnel to answer phones and pagers, which are themselves factors that cause interruptions(45). The most common interruptions and distractions observed in operating rooms are \"small talk\" and the entry and exit of staff, while the most severe distractions are caused by faulty or unavailable equipment. Using the phone and pager, in particular, can be distracting(46). These interruptions can stem from both internal sources, like surgical equipment alarms and surgery-related conversations, and external sources, such as phone rings, calls, and interactions with personnel from other departments(47).\u003c/p\u003e \u003cp\u003eIn the operating room, interruptions can impact all members of a surgical team, including anesthesia personnel, nurses, surgeons, and operating room technicians. This can reduce the effectiveness of teamwork, increase the surgeon's stress, and lead to an increase in workload(48). A study by T\u0026oacute;thov\u0026aacute; et al. also found that nurses in surgical departments often experience interruptions(26). Therefore, the role of the environment (ward) and its characteristics in determining the type of interruptions and subsequently the occurrence of errors is evident. The ward has unique characteristics in terms of human and structural elements that can contribute to interruptions occurring.\u003c/p\u003e \u003cp\u003eAltamimi et al. (2022) in medical-surgical and intensive care units found that visitors are the primary cause of nursing interruptions in these wards, while equipment failure is the main factor of nursing interruptions in intensive care units(25). The results of this study align with the current study in terms of the frequency of interruption factors. Environmental factors, such as device or equipment failure, are the most common cause of interruptions. Additionally, human-environmental factors, like requests and questions from patients' companions, including visitors, are also common causes of interruptions in the nursing workflow.\u003c/p\u003e \u003cp\u003eYouns et al. (2022), in their study, mentioned the lowest factors of interruption prevalence as factors related to the patient (34). The factors related to the patient in the current study such as \u0026ldquo;sudden changes in the patient's condition and the transfer of the patient to another department for diagnostic measures\u0026rdquo; were categorized as environmental factors. Also, sudden request from the patient was examined in the category of human-environmental factors. Contrary to expectations, factors related to the patient were not the least prevalent in this study. In fact, sudden requests from the patients were among the most common human-environmental factors and ranked fourth overall among all the interruption factors investigated.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study، Answering the ward phone is widely recognized as the most significant factor contributing to nurses work interruptions. Also, the operating room was the most common place where nursing interruptions occur.\u003c/p\u003e \u003cp\u003eTherefore, studying the prevalence of interruptions is crucial due to the high sensitivity and importance of the operating room in providing critical and emergency medical services. These findings highlight the importance of effective time and resource management in hospital environments. Therefore, the findings point to the need to adopt management and policy measures in the field of reducing interruptions and improving the quality of care.. In general, it should be acknowledged that the sources of interruption and their impact are different according to the working conditions, wards and culture of each society. Therefore, nurses may be affected by different factors due to varying working conditions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eresearchers would like to express sincere appreciation to all the nurses and individual who contributed to this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e SMA collected the data and wrote the manuscript with NP. NDN supervised and controlled the entire process, including editing the manuscript. NP analyzed the data and provided statistical section. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funding was received for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e All data generated or analyzed during this study are included in this published article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics:\u003c/strong\u003e approval and consent to participate We obtain approval from the Joint Committee of Organizational Ethics of Tehran University of Medical Sciences. (Code: IR.TUMS.FNM.REC.1402.147).Informed consent was obtained from the nurses to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication :\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests: \u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo patient or public contribution :\u003c/strong\u003eOur manuscript is a descriptive article, in which the necessary data was obtained by filling out a questionnaires, and at the beginning of the questionnaires, informed consent was obtained from the nurses to participate in the study. Participants were assured of the confidentiality of the information.This study is not an interventional study, so did not require any intervention on nurses or patients or anyone else.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTeigné D, Cazet L, Mabileau G, Terrien N. 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Medical journal of the Islamic Republic of Iran. 2020;34:8.\u003c/li\u003e\n\u003cli\u003eGöras C, Olin K, Unbeck M, Pukk-Härenstam K, Ehrenberg A, Tessma MK, et al. Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study. BMJ open. 2019;9(5):e026410.\u003c/li\u003e\n\u003cli\u003eGui JL, Nemergut EC, Forkin KT. Distraction in the operating room: a narrative review of environmental and self-initiated distractions and their effect on anesthesia providers. Journal of Clinical Anesthesia. 2021;68:110110.\u003c/li\u003e\n\u003cli\u003eHasanshahi M, Rakhshan M, Fereidouni A, Moayedi SA, Torabizadeh C. Development and psychometric evaluation of a questionnaire for measuring distraction due to mobile phone use in operating rooms. Journal of Perioperative Nursing. 2022;35(2):e3-e13.\u003c/li\u003e\n\u003cli\u003eRiutort KT. Distractions in the operating room. Current Anesthesiology Reports. 2020;10:456-62.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"workflow interruptions, patient safety","lastPublishedDoi":"10.21203/rs.3.rs-5295942/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5295942/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and objective:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWorkflow interruptions significantly decrease productivity and are among the top five causes of medication errors. They are also linked to nursing errors, posing risks to the quality and effectiveness of patient care and safety. Therefore, this study aimed to investigate the prevalence of interruptions in nurses' workflow and the factors influencing them in general hospitals affiliated with Kashan University of Medical Sciences (KUMS) in 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a descriptive and analytical quantitative study that focused on all nurses working in six general hospitals affiliated with KUMS. The sample size for this study was 300 individuals, who were randomly and proportionally selected from each hospital. Data collection involved using a demographic information and a self-report questionnaire on nursing workflow interruptions, which were administered in person at the research sites. The collected data was then analyzed using the SPSS version 21.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of participants are female, married, native, with a bachelor's degree, and have an average age of 34.4 (±7.758). On average, they have 10.88(±7.508) years of work experience and work 62.03(±37.395) hours of overtime per month. The highest rate of interruptions was related to answering the wards phone, with a prevalence of 51.7% occurring at least 5 times a day. The lowest rate of interruptions was related to emergency situations (safety, accident, fire, theft), with 74.7% of people reporting \"almost never.\" The wards with the highest frequency of interruptions were the operating room, surgery, psychiatric, and ICU. There is also a significant relationship between the occurrence of interruptions, family income, the amount of overtime, and types of wards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe presence of interruptions in nursing work is unavoidable due to nature and complexity of nurses' responsibilities. However, through increased awareness, education, and policy making by nursing managers, the frequency of interruptions can be reduced. This study highlights that within Iran's healthcare organizations, establishing policies to prevent interruptions not only improves the quality of nursing care and patient safety, but also has positive effects on the overall health outcomes for nurses.\u003c/p\u003e","manuscriptTitle":"Investigating the prevalence of nurses' workflow interruptions and the factors affecting them in the general hospitals affiliated with Kashan University of Medical Sciences in 2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-06 12:02:25","doi":"10.21203/rs.3.rs-5295942/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"908876fc-cb2b-4bf4-9c9c-21c8dc9148d2","owner":[],"postedDate":"November 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-11T20:53:24+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-06 12:02:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5295942","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5295942","identity":"rs-5295942","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}