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Author ORCID Identifier



Open Access Dissertation

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program

Industrial Engineering & Operations Research

Year Degree Awarded


Month Degree Awarded


First Advisor

Donald L. Fisher

Second Advisor

Elizabeth A. Henneman

Third Advisor

Jenna Marquard

Subject Categories

Cognitive Psychology | Engineering | Industrial Engineering | Nursing | Operational Research


Safety critical systems in medicine utilize alarms to signal potentially life threatening situations to professionals and patients. In particular, in the medical field multiple alarms from equipment are activated daily and often simultaneously. There are a number of alarms which require caregivers to take breaks in complex, primary tasks to attend to the interruption task which is signaled by the alarm. The motivation for this research is the knowledge that, in general, interrupting tasks can have a potentially negative impact on performance and outcomes of the primary task.

The focus of this research is on the effect of an interrupting task on the cognitive behavior of nurses on a primary task: administering medication to a simulated patient. Fifty-eight student nurses were monitored with eye-tracking technology as they perform direct patient care and a medication administration task. There are four hypotheses. First, it is hypothesized that an interruption generated by an alarm during medication administration significantly increases errors because it causes caregivers to forget components of the original task. These errors result when the primary task is suspended in memory, as a result of the intervening task, and because of this suspension, memory for the original task can decay. Second, it is hypothesized that interrupting tasks result in time delays on the primary task (the time during which the caregiver is performing the interrupting task is not included in the time to perform the original task). Third, it is hypothesized that metacognition training will mitigate the negative effects of the interrupting task on the primary task. The metacognition training is based on knowledge of how memory processes are affected by interruptions and how modifying these processes can potentially result in a reduction of errors. Fourth, it is hypothesized that the intervention strategy will lead to improvements in the memory for the material that is required to resume and complete the primary task. This improvement will be measured by increases in the number of eye fixations to the primary task before attending to the secondary task. Furthermore, this measurement will correlate with a reduction in errors.