Work interruptions and nearby-falls in geriatric nurses: attention failure as a mediator and job tenure as moderator
Authors: Elfering Achim , Zimmermann Tobias 
Published: June 2024

In industrial countries, caring for the elderly in geriatric nursing homes is rapidly growing. Caregivers face intensive demands and often suffer from high workloads and frequent work interruptions. Not only in patients but also in geriatric nurses, slips, trips, and falls (STF) are frequent. We expect work interruptions to increase attentional failure, and attentional failure to increase the risk of STF (hypothesis 1). Moreover, we expect caregiver’s job tenure to moderate the indirect effect of work interruptions via attention failure on STF. The indirect mediation path should to be stronger in caregivers with less job tenure compared to caregivers who are rather tenured (hypothesis 2). With increasing job experience task regulation in many tasks has become automatic and less resource consuming and therefore more experienced caregivers attention capacity is less likely to be overcharged by work interruptions. Purpose: The current study tests a mediation model with attentional failure as a mediator between work interruptions and STF and job tenure as a potential moderator of such mediation. The sample comprised 45 geriatric nurses. Methods: All measures were self-report. Interruptions of work were assessed by a shortened version of the Instrument for Stress- Oriented Task Analysis (Semmer et al., 1995). Attention failure at work was assessed with the subscale of attention failure from the Workplace Cognitive Failure Scale (Wallace & Chen, 2005) in the German-validated translation). STFs at work were assessed with a scale from Elfering et al. (2013). Job tenure was assessed with a single item. The moderated mediation model was based on OLS regression analyses. The mediation tests were done using the PROCESS SPSS macro tool (Hayes, 2018). Results: The test of the mediation model showed significant path coefficients for the path between task interruptions and attention failure and the path between attention failure and STF. Variance explanation in the prediction of attentional failure (33% variance explanation, p = 002) and prediction of STF (27% variance explained, p = .003) was satisfactory. Moreover, the strength of the indirect path (path a * path b) was significant for the mean of job tenure (B = 0.10, SE = .06, CI = 0.02 to 0.21), but higher with low job tenure and smaller with high job tenure. The indirect path for those participants with low job tenure was stronger (PR 16% or 1 year of job tenure: B = 0.16, SE = .09, CI = 0.04 to 0.32). For those participants with the highest job tenure (PR 84% or 5 years of job tenure), the indirect path was smaller and not significant anymore (B = 0.04, SE = .07, CI = -0.04 to 0.18). Hence, the strength of mediation did depend on job tenure, but the test of moderation failed to reach statistical significance, although the interaction of job tenure * task interruptions explained 4% of the variation in attentional failure (p = .085). In sum, the mediation model (hypothesis 1) was confirmed while the moderated mediation (hypothesis 2) was rejected but data showed a tendency that pointed in the expected direction. Conclusions: The study needs replication in a larger sample and preliminary evidence should be consolidated by use of a longitudinal and/or experimental design. The preliminary evidence suggests that interruptions should be targeted not only in the prevention of work stress and efforts to increase patient safety but also in the prevention of STF in geriatric nurses. Training should address nurses, managers, and residents on how to reduce interruptions and how to cope with task interruptions.