Dealing with Interruptions: Determinants of Nurses’ Intentions to Address Avoidable Breaks

Purpose Nursing units are complex environments prone to work interruptions, with ward nurses being the hub in a network of continuous interaction between disciplines. Too many interruptions are detrimental to workflow, may lead to errors, and can add to nurses’ feelings of busyness. Previous researchers have advocated for raising awareness about communicative patterns, signalling that some interruptions seem of little value. This research focused on potentially avoidable interruptions in hospital wards, mapping the determinant structure of nurses’ intentions to address this issue in their team using the framework of the reasoned action approach. Design An online cross-sectional survey was conducted to assess intention, recognition of avoidable interruptions, perceived norms, perceived behavioural control, attitudinal beliefs, and preferences in challenging interruptive practice. Items were tested using the response process evaluation (RPE) method, which uses meta-questions to check whether items are unproblematic.Method and analysisThree hundred and eighty-seven ward nurses from approximately 20 different Dutch hospitals with over one year of experience filled out the questionnaire. The association with intention was analysed using confidence interval-based estimations of relevance (CIBER) plots,which visualised the various determinant structures and their respective univariate distributions. The relevance of determinants and subdeterminants was then determined based on these univariate distributions, and the effect sizes of their associations were calculated based on intention. Finally, the strength of the association between attitude towards performing the target behaviour and learning preferences was computed.FindingsAlthough the intention to perform the target behaviour (addressing avoidable interruptions, e.g., saying you want to do something about it) was low at the start of the survey, nurses subsequently acknowledged that avoidable interruptions occur frequently. On average, respondents gave high estimates on all direct and indirect determinants included in the survey. Examples of avoidable interruptions may have made salient dormant beliefs and (temporarily) increased awareness among the respondents, but no determinant showed strong positive correlations with intention. Low individual awareness about the problem of avoidable interruptions may have led to low intention. ConclusionsThis study recommends to take behavioural principles of change into account when designing interventions to impact the culture of interrupting, as nurses’ beliefs regarding the desired behaviour may affect the outcome of those interventions. Initiatives to further explore redundant interactions between disciplines in a hospital ward may want to raise awareness about inefficient communication patterns on the individual level first. Clinical relevanceThe concept of avoidable interruptions helps to focus on the appropriateness and relevance of the communication without risking to discourage the sharing of urgent or important messages simultaneously. Challenging inefficient communicative patterns increases consciousness of one’s own behaviour, creates an understanding of what is avoidable, and prompts ideas of how these issues could be addressed differently.