Measuring the Cognitive Workload of Medication Administration for Nurses Using Two Different Nursing Care Delivery Models: A Mixed Methods Study

BACKGROUND: The COVID-19 pandemic further strained nursing staff, with many nurses experiencing severe stress and burnout. These factors may impact the cognitive workload associated with medication administration (MA). Adequate nursing workload may be achieved by identifying appropriate care delivery models to promote positive patient and staff outcomes. Currently, a gap in the research exists in identifying the cognitive workload for nurses during MA when implementing different care delivery models.

METHODS: This study used an explanatory sequential Quan → QUAL mixed methods design to explore differences in nurses' cognitive workload during MA while working in two different nursing care delivery models. The study was conducted on a nursing unit transitioning from a primary registered nurse care delivery model (RNCDM) to a care-based delivery model (CBDM). The quantitative sample included 15 nurses at baseline, 18 at five months post-transition, and 19 at eight months. Data collected included completing the National Aeronautics and Space Administration Task Load Index (NASA-TLX) and The MISSCARE Survey. The NASA-TLX provided a rating of cognitive workload during MA, and data for outcome measures of nurse job satisfaction, teamwork satisfaction, and missed MA care were collected from The MISSCARE Survey. Descriptive statistics were used to analyze the quantitative data using R version 4.3.1. A subsample of 10 nurses participated in semi-structured qualitative interviews, transcribed verbatim and analyzed using thematic analysis with Qualitative Software and Research (QSR) Nvivo 14 ©.

RESULTS: The mean rating of cognitive workload from baseline to eight months after transitioning was higher but not statistically significant (39.8 ± 19.4 vs 43.6 ± 18.7, p = .9442, Cohen's d = 0.05). After transitioning to the CBDM, the outcome measures of nurse job satisfaction and missed MA care reflected improvement. Three overarching themes emerged from the qualitative analysis: 1) "Demands and Resources at the Task Level," 2) "Demands and Resources at the Unit Level," and 3) "Nurses' Perceptions of the Care-Based Delivery Model."

CONCLUSION: Implementing the CBDM may improve the MA process for nurses and decrease the workload associated with this task.