Poster No:
901
Submission Type:
Abstract Submission
Authors:
Koki Ono1, Kelssy Hitomi dos Santos Kawata1, Wey Guan Lem1, Shoichiro Amari1, Mihoko Sasaka2, Kimikazu Kashiwagi3, Hiroshi Oyama1
Institutions:
1The University of Tokyo, Tokyo, Japan, 2Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan, 3National College of Nursing, Japan, Tokyo, Japan
First Author:
Koki Ono
The University of Tokyo
Tokyo, Japan
Co-Author(s):
Mihoko Sasaka
Tokyo Ariake University of Medical and Health Sciences
Tokyo, Japan
Introduction:
Novice nurses frequently encounter difficulties in multitasking due to the discrepancy between the educational training they received as students and the reality of practical clinical setting demands [1]. Previous neuroscience studies in related medical fields, such as surgery, have found that as a surgeon's technical skills increase, there is decreased brain activity in the anterior cingulate cortex (ACC) [2]. The ACC is broadly divided into areas involved in behavior monitoring and behavioral regulation, social cognition, and emotion, particularly in humans. The multitasking capability of nurses in clinical settings may be associated with the behavioral monitoring and behavioral regulation functions of the ACC. While it is established that clinical experience enhances a nurse's multitasking capability [3], the specific neural mechanisms that support a nurse's capacity to understand the situation and prioritize actions remain unclear. We hypothesized that the ACC, which monitors the consequences of actions and mediates subsequent changes in behavior [4], would respond to multitasking within a simulated Immersive Virtual Reality (IVR) clinical setting differently for nursing students compared to experienced nurses.
Methods:
The study involved 15 final-year nursing students without clinical experience and 11 experienced nurses with a minimum of five years working in clinical practice. Participants engaged in a First-Person Perspective (1PP) IVR multitasking scenario designed to simulate a high-pressure nursing environment which required understanding the situation and prioritizing actions. The 1PP IVR multitasking experience tasked nurses with simultaneously addressing a patient's call for assistance and observing another patient displaying signs of distress. Participants had to understand the context and choose among three decision options with varying degrees of appropriateness and were scored accordingly (maximum score = 2). A Wilcoxon rank-sum test was performed to compare the difference in the 1PP IVR multitasking experience scores between nursing students and experienced nurses.
The participants' brain activity was measured via functional magnetic resonance imaging (fMRI) before and after the 1PP IVR multitasking scenario. During the fMRI scanning, participants were instructed to listen to the auditory content of the 1PP IVR multitasking scenario to mentally re-engage their understanding and decision-making process of the multitasking task they experienced earlier. Participants were required to verbally provide their response as to which decision option they thought to be most appropriate while in the fMRI. Neural activation was examined using one-sample t-tests (post > baseline), with age, sex, and intelligence quotient via the Japanese Adult Reading Test score as covariates, applying an uncorrected p-value of < 0.005 for the cluster-forming threshold and a FWE-corrected threshold p-value of < 0.05 for cluster extent.
Ethical approval was obtained from The University of Tokyo Research Ethics Committee (2019107NI).
Results:
No significant difference in the 1PP IVR multitasking scenario score was observed between the nursing students (mean = 1.27, SD = 0.59) and experienced nurses (mean = 1.55, SD = 0.52). However, although both groups may have reached the same decision option, fMRI results showed that a significant activation was observed in the right ACC only for nursing students. As activity in the ACC is known to increase with uncertainty during evidence accumulation [5], these results suggest that nursing students experienced and utilized a different control demand strategy during the multitasking scenario compared to experienced nurses.
Conclusions:
These insights into the neural basis of clinical multitasking may contribute to the development of targeted educational interventions aimed at bridging the gap between theoretical knowledge and practical clinical skills for nurses.
This work was supported by JSPS KAKENHI Grant Number JP20H00558.
Higher Cognitive Functions:
Decision Making 1
Executive Function, Cognitive Control and Decision Making 2
Keywords:
Cognition
FUNCTIONAL MRI
Other - Virtual Reality
1|2Indicates the priority used for review
Provide references using author date format
1. Imai, T. (2021), 'Factors That Lead to Errors While Multitasking in Newly Graduated Nurses Simultaneously Caring for More Than One Patient: Analyzing the Interview Data of Newly Graduated Nurses Using the KJ Method', Journal of Japan Society of Nursing Research, vol. 44, no. 2, pp. 195–209
2. Leff, D. R. (2008), 'Could Variations in Technical Skills Acquisition in Surgery Be Explained by Differences in Cortical Plasticity?', Annals of Surgery, vol. 247, no. 3, pp. 540–543
3. Hoffman, K. A. (2009), 'A comparison of novice and expert nurses’ cue collection during clinical decision-making: Verbal protocol analysis', International Journal of Nursing Studies, vol. 46, no. 10, pp. 1335–1344
4. Allman, J. M. (2001), 'The Anterior Cingulate Cortex', Annals of the New York Academy of Sciences, vol. 935, no. 1, pp. 107–117
5. Stern, E. R. (2010), 'Updating Beliefs for a Decision: Neural Correlates of Uncertainty and Underconfidence', Journal of Neuroscience, vol. 30, no. 23, pp. 8032–8041