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Objective Present a collection of papers focusing on improving healthcare practice through the implementation of human factors and ergonomics principles that were presented at the International Ergonomics Association (IEA) 2021 international conference. Background The mission of the IEA is to elaborate and advance ergonomics science and practice and to expand its scope of application. Method We reviewed papers that were submitted for presentation at the IEA 2021 international conference and focused on improving healthcare practice through the implementation of human factors and ergonomics principles. Results The eight papers that are included in this special issue cover varied aspects of human factors application and implementation. Conclusion This special issue provides clear evidence that the science of human factors is relevant and is continuing to grow and so is its implementation in healthcare. Application This special issue offers a selection of applied works, providing a wide scope of human factors guidelines, methods, and theories in healthcare work environments.

Objective (1) To assess mental workloads of intensive care unit (ICU) nurses in 12-hour working shifts (days and nights) using eye movement data; (2) to explore the impact of stress on the ocular metrics of nurses performing patient care in the ICU. Background Prior studies have employed workload scoring systems or accelerometer data to assess ICU nurses’ workload. This is the first naturalistic attempt to explore nurses’ mental workload using eye movement data. Methods Tobii Pro Glasses 2 eye-tracking and Empatica E4 devices were used to collect eye movement and physiological data from 15 nurses during 12-hour shifts (252 observation hours). We used mixed-effect models and an ordinal regression model with a random effect to analyze the changes in eye movement metrics during high stress episodes. Results While the cadence and characteristics of nurse workload can vary between day shift and night shift, no significant difference in eye movement values was detected. However, eye movement metrics showed that the initial handoff period of nursing shifts has a higher mental workload compared with other times. Analysis of ocular metrics showed that stress is positively associated with an increase in number of eye fixations and gaze entropy, but negatively correlated with the duration of saccades and pupil diameter. Conclusion Eye-tracking technology can be used to assess the temporal variation of stress and associated changes with mental workload in the ICU environment. A real-time system could be developed for monitoring stress and workload for intervention development.

Objective We aimed to identify opportunities for application of human factors knowledge base to mitigate disaster management (DM) challenges associated with the unique characteristics of the COVID-19 pandemic. Background The role of DM is to minimize and prevent further spread of the contagion over an extended period of time. This requires addressing large-scale logistics, coordination, and specialized training needs. However, DM-related challenges during the pandemic response and recovery are significantly different than with other kinds of disasters. Method An expert review was conducted to document issues relevant to human factors and ergonomics (HFE) in DM. Results The response to the COVID-19 crisis has presented complex and unique challenges to DM and public health practitioners. Compared to other disasters and previous pandemics, the COVID-19 outbreak has had an unprecedented scale, magnitude, and propagation rate. The high technical complexity of response and DM coupled with lack of mental model and expertise to respond to such a unique disaster has seriously challenged the response work systems. Recent research has investigated the role of HFE in modeling DM systems’ characteristics to improve resilience, accelerating emergency management expertise, developing agile training methods to facilitate dynamically changing response, improving communication and coordination among system elements, mitigating occupational hazards including guidelines for the design of personal protective equipment, and improving procedures to enhance efficiency and effectiveness of response efforts. Conclusion This short review highlights the potential for the field’s contribution to proactive and resilient DM for the ongoing and future pandemics.

Objective: Interruptions to secondary tasks resulting in multiple tasks to resume may tax working memory. The objective of this research is to study such interruptions experienced by intensive care unit (ICU) nurses. Background: ICU nurses are frequently interrupted, resulting in a switch from primary to secondary tasks. In two recent studies, we observed that some of these secondary tasks also get interrupted, resulting in multiple tasks that have to be resumed, a phenomenon we refer to as nested interruptions. Although completing multiple secondary tasks in a serial fashion during an interruption period can create context-switching costs, we hypothesize that nested interruptions tax the working memory even more than just performing multiple secondary tasks sequentially because the nurse would have to encode in working memory the resumption goals for both the primary and the interrupted secondary tasks. Method: We conducted a laboratory study with 30 ICU nurses, who performed an electronic order-entry task under three interruption conditions: (a) baseline—no secondary task during the interruption period; (2) serial—performance of two tasks one after the other during the interruption period; and (3) nested—performance of two tasks during the interruption period, one of which was also interrupted. Results: Nested interruptions resulted in significantly longer primary-task resumption lag and less accurate task resumption compared with both the serial interruption and baseline conditions. Conclusion: The nested nature of interruptions adds to the resumption lag and diminishes resumption accuracy by likely populating the working memory with goals associated with interrupted secondary tasks.