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Timing of Coping Instruction Presentation for Real-time Acute Stress Management: Potential Implications for Improved Surgical Performance

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Abstract

Individual performance on complex healthcare tasks can be influenced by acutely stressful situations. Real-time biofeedback using passive physiological monitoring may help to better understand an individual’s progression towards acute stress-induced performance decrement. Providing biofeedback at an appropriate time may provide learners within an indicator that their current performance is susceptible to a decrement, and offer the opportunity to intervene. We explored the presentation timing of coping instructions during an acutely stressful task. In this pilot study, we recorded and analyzed electrocardiography data surrounding coping instruction presentation on various time schedules while participants played a first-person shooter computer game. Around times of significantly elevated heart rate, an indicator of acute stress, presenting a coping instruction tended to result in an increase in heart rate variability (HRV) following its presentation, with a more marked effect in high-stress conditions; not presenting a coping instruction at this time tended to result in a decrease in HRV in high-stress conditions, and no change in low-stress conditions. HRV following instruction presentation tended to increase in both high- and low-stress conditions when the instruction was presented at times of elevated heart rate; there was very little change in HRV when instruction presentation was not bound to physiology. Performance data showed that better performance was associated with greater adherence to coping instructions, compared to when zero instructions were followed. Implications for healthcare are significant, as acute stress is constant and it is necessary for providers to maintain a high level of performance.

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References

  1. Allen RJ (1983) Human stress: its nature and control. Burgess, Minneapolis

    Google Scholar 

  2. Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. Springer Publishing Co, New York City

    Google Scholar 

  3. Zhai J, Barreto A (2006) Stress recognition using non-invasive technology. Proc 19th Int Florida Artif Intell Res Soc Conf 395–400

  4. Venables L, Fairclough SH (2004) Establishing the psychophysiological variables that can identify & predict operator subjective state. Proc Hum Factors Ergon Soc Annu Meet 48:90–94

    Article  Google Scholar 

  5. LeBlanc VR (2009) The effects of acute stress on performance: implications for health professions education. Acad Med 84:S25–S33

    Article  Google Scholar 

  6. Tanev G, Saadi DB, Hoppe K, Sorensen, HBD (2014) Classification of acute stress using linear and non-linear heart rate variability analysis derived from sternal ECG. Proc Annu Int Conf IEEE Eng Med Biol Soc 3386–3389. https://doi.org/10.1109/EMBC.2014.6944349

  7. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability. Eur Heart J 17:354–381

    Article  Google Scholar 

  8. Schaaff K, Adam MTP (2013) Measuring emotional arousal for online applications: evaluation of ultra-short term heart rate variability measures. Hum Assoc Conf Affect Comput Intell Interact 362–368

  9. Ortiz-Vigon Uriarte I, Garcia-Zapirain B, Garcia-Chimeno Y (2015) Game design to measure reflexes and attention based on biofeedback multi-sensor interaction. Sensors 15:6520–6548

    Article  Google Scholar 

  10. Schwartz MS (2010) A new improved universally accepted official definition of biofeedback: where did it come from? Why? Who did it? Who is it for? What’s next? Biofeedback 38:88–90

    Article  Google Scholar 

  11. Lehrer PM, Gevirtz R (2014) Heart rate variability biofeedback: how and why does it work? Front Psychol 5:1–9

    Article  Google Scholar 

  12. Eddie D, Vaschillo E, Vaschillo B, Lehrer P (2015) Heart rate variability biofeedback: theoretical basis, delivery, and its potential for the treatment of substance use disorders. Addict Res Theory 23:266–272

    Article  Google Scholar 

  13. Lehrer P (2007) Principles and practice of stress management: advances in the field. Biofeedback 35:82–84

    Google Scholar 

  14. Scheeler MC, Ruhl KL, McAfee JK (2004) Providing performance feedback to teachers: a review. Teach Educ Spec Educ 27:396–407

    Article  Google Scholar 

  15. Kontogiannis T, Kossiavelou Z (1999) Stress and team performance: principles and challenges for intelligent decision aids. Saf Sci 33:103–128

    Article  Google Scholar 

  16. Wilson GF, Russell CA (2007) Performance enhancement in an uninhabited air vehicle task using psychophysiologically determined adaptive aiding. Hum Factors 49:1005–1018

    Article  Google Scholar 

  17. Buchanan TW, Tranel D, Adolphs R (2006) Impaired memory retrieval correlates with individual differences in cortisol response but not autonomic response. Learn Mem 13:382–387

    Article  Google Scholar 

  18. Buchanan TW, Lovallo WR (2001) Enhanced memory for emotional material following stress-level cortisol treatment in humans. Psychoneuroendocrinology 26:307–317

    Article  Google Scholar 

  19. Lupien SJ, Gillin CJ, Hauger RL (1999) Working memory is more sensitive than declarative memory to the acute effects of corticosteroids: a dose-response study in humans. Behav Neurosci 113:420–430

    Article  Google Scholar 

  20. Bohnen N, Houx P, Nicolson N, Jolles J (1990) Cortisol reactivity and cognitive performance in a continuous mental task paradigm. Biol Psychol 31:107–116

    Article  Google Scholar 

  21. de Quervain DJ, Roozendaal B, Nitsch RM, McGaugh JL, Hock C (2000) Acute cortisone administration impairs retrieval of long-term declarative memory in humans. Nat Neurosci 3:313–314

    Article  Google Scholar 

  22. Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R (2010) The impact of stress on surgical performance: a systematic review of the literature. Surg 147:318–330.e6

    Article  Google Scholar 

  23. Pluyter JR, Buzink SN, Rutkowski AF, Jakimowicz JJ (2010) Do absorption and realistic distraction influence performance of component task surgical procedure? Surg Endosc Other Interv Tech 24:902–907

    Article  Google Scholar 

  24. Weigl M, Stefan P, Abhari K, Wucherer P, Fallavollita P, Lazarovici M, Weidert S, Euler E, Catchpole K (2016) Intraoperative disruptions, surgeon’s mental workload, and technical performance in a full-scale simulated procedure. Surg Endosc Other Interv Tech 30:559–566

    Article  Google Scholar 

  25. Yurko YY, Scerbo MW, Prabhu AS, Acker CE, Stefanidis D (2010) Higher mental workload is associated with poorer laparoscopic performance as measured by the NASA-TLX tool. Simul Healthc 5:267–271

    Article  Google Scholar 

  26. Mazur LM, Mosaly PR, Hoyle LM, Jones EL, Marks LB (2013) Subjective and objective quantification of physician’s workload and performance during radiation therapy planning tasks. Pract Radiat Oncol 3:e171–e177

    Article  Google Scholar 

  27. Mazur LM, Mosaly PR, Hoyle LM, Jones EL, Chera BS, Marks LB (2014) Relating physician’s workload with errors during radiation therapy planning. Pract Radiat Oncol 4:71–75

    Article  Google Scholar 

  28. Moorthy K, Munz Y, Dosis A, Bann S, Darzi A (2003) The effect of stress-inducing conditions on the performance of a laparoscopic task. Surg Endosc Other Interv Tech 17:1481–1484

    Google Scholar 

  29. Wetzel CM, Kneebone RL, Woloshynowych M, Nestel D, Moorthy K, Kidd J, Darzi A (2006) The effects of stress on surgical performance. Am J Surg 191:5–10

    Article  Google Scholar 

  30. Joseph B, Parvaneh S, Swartz T, Haider AA, Hassan A, Kulvatunyou N, Tang A, Latifi R, Najafi B, Rhee P (2016) Stress among surgical attendings and trainees: a quantitative assessment during trauma activation and emergency surgeries. J Trauma Acute Care Surg 81:1

    Article  Google Scholar 

  31. Arora S, Sevdalis N, Aggarwal R, Sirimanna P, Darzi A, Kneebone R (2010) Stress impairs psychomotor performance in novice laparoscopic surgeons. Surg Endosc Other Interv Tech 24:2588–2593

    Article  Google Scholar 

  32. Kennedy L, Parker SH (2017) Making MATB-II medical: pilot testing results to determine a novel lab-based, stress-inducing task. In: International Symposium on Human Factors and Ergonomics in Health Care

  33. Sweller J (1988) Cognitive load during problem solving: effects on learning. Cogn Sci 12:257–285

    Article  Google Scholar 

  34. Galy E, Cariou M, Mélan C (2012) What is the relationship between mental workload factors and cognitive load types? Int J Psychophysiol 83:269–275

    Article  Google Scholar 

  35. Van Merriënboer JJG, Sweller J (2010) Cognitive load theory in health professional education: design principles and strategies. Med Educ 44:85–93

    Article  Google Scholar 

  36. Galy E, Melan C (2015) Effects of cognitive appraisal and mental workload factors on performance in an arithmetic task. Appl Psychophysiol Biofeedback 40:313–325

    Article  Google Scholar 

  37. Schnotz W, Kürschner C (2007) A reconsideration of cognitive load theory. Educ Psychol Rev 19:469–508

    Article  Google Scholar 

  38. Böhm B, Rötting N, Schwenk W, Grebe S, Mansmann U (2001) A prospective randomized trial on heart rate variability of the surgical team during laparoscopic and conventional sigmoid resection. Arch Surg 136:305–310

    Article  Google Scholar 

  39. Taelman J, Vandeput S (2011) Instantaneous changes in heart rate regulation due to mental load in simulated office work. Eur J Appl Physiol 111:1497–1505

    Article  Google Scholar 

  40. Brünken R, Plass JL, Leutner D (2003) Direct measurement of cognitive load in multimedia learning. Educ Psychol 38:53–61

    Article  Google Scholar 

  41. Salahuddin L, Cho J, Jeong MG, Kim D (2007) Ultra short term analysis of heart rate variability for monitoring mental stress in mobile settings. 29th Annu Int Conf IEEE Eng Med Biol Soc 4656–4659. https://doi.org/10.1109/IEMBS.2007.4353378

  42. Nussinovitch U, Elishkevitz KP, Katz K, Nussinovitch M, Segev S, Volovitz B, Nussinovitch N (2011) Reliability of ultra-short ECG indices for heart rate variability. Ann Noninvasive Electrocardiol 16:117–122

    Article  Google Scholar 

  43. Kim D, Seo Y, Kim, Jung S (2008) Short term analysis of long term patterns of heart rate variability in subjects under mental stress. Int Conf Biomed Eng Informatics 1411–1415. https://doi.org/10.1109/BMEI.2008.272

  44. Thong T, Li K, McNames J, Aboy M, Goldstein B (2003) Accuracy of ultra-short heart rate variability measures. Proc 25th Annu Int Conf IEEE Eng Med Biol Soc 3:2424–2427

  45. Munoz ML, van Roon A, Riese H, Thio C, Oostenbroek E, Westrik I, de Geus EJC, Gansevoort R, Lefrandt J, Nolte IM, Snieder H (2015) Validity of (ultra-)short recordings for heart rate variability measurements. PLoS One 10:1–15

    Google Scholar 

  46. Schroeder EB, Whitsel EA, Evans GW, Prineas RJ, Chambless LE, Heiss G (2004) Repeatability of heart rate variability measures. J Electrocardiol 37:163–172

    Article  Google Scholar 

  47. Healy S, Tyrrell M (2011) Stress in emergency departments: experiences of nurses and doctors. Emerg Nurse 19:31–37

    Article  Google Scholar 

  48. Makary MA, Daniel M (2016) Medical error—the third leading cause of death in the US. Br Med J 353:1–5

    Google Scholar 

  49. Gruen RL, Jurkovich GJ, McIntyre LK, Foy HM, Maier RV (2006) Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg 244:371–380

    Google Scholar 

  50. Mentis HM, Chellali A, Manser K, Cao CGL, Schwaitzberg SD (2016) A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training. Surg Endosc Other Interv Tech 30:1713–1724

    Article  Google Scholar 

  51. Jalink MB, Goris J, Heineman E, Pierie JPEN, ten Cate Hoedemaker HO (2014) The effects of video games on laparoscopic simulator skills. Am J Surg 208:151–156

    Article  Google Scholar 

  52. Harbin AC, Nadhan KS, Mooney JH, Yu D, Kaplan J, McGinley-Hence N, Kim A, Gu Y, Eun DD (2016) Prior video game utilization is associated with improved performance on a robotic skills simulator. J Robot Surg 1–8. https://doi.org/10.1007/s11701-016-0657-x

  53. Shane MD, Pettitt BJ, Morgenthal CB, Smith CD (2008) Should surgical novices trade their retractors for joysticks? Videogame experience decreases the time needed to acquire surgical skills. Surg Endosc Other Interv Tech 22:1294–1297

    Article  Google Scholar 

  54. Rosser JC Jr, Gentile DA, Hanigan K, Danner OK (2012) The effect of video game ‘warm-up’ on performance of laparoscopic surgery tasks. J Soc Laparoendosc Surg 16:3–9

    Article  Google Scholar 

  55. Jalink MB, Heineman E, Pierie JPEN, ten Cate Hoedemaker HO (2015) The effect of a preoperative warm-up with a custom-made Nintendo video game on the performance of laparoscopic surgeons. Surg Endosc Other Interv Tech 29:2284–2290

    Article  Google Scholar 

  56. Schlickum MK, Hedman L, Enochsson L, Kjellin A, Felländer-Tsai L (2009) Systematic video game training in surgical novices improves performance in virtual reality endoscopic surgical simulators: a prospective randomized study. World J Surg 33:2360–2367

    Article  Google Scholar 

  57. Graafland M (2014) Serious games in surgical education. Br J Surg 99:1322–1330

    Article  Google Scholar 

  58. Graafland M, Vollebergh MF, Lagarde SM, van Haperen M, Bemelman WA, Schijven MP (2014) A serious game can be a valid method to train clinical decision-making in surgery. World J Surg 38:3056–3062

    Article  Google Scholar 

  59. Wattanasoontorn V (2013) Serious games for health and medicine: a cardiopulmonary resuscitation (CPR) case. Thesis 1–155

  60. Graafland M, Schraagen JM, Schijven MP (2012) Systematic review of serious games for medical education and surgical skills training. Br J Surg 99:1322–1330

    Article  Google Scholar 

  61. Kindermann H, Javor A, Reuter M (2016) Playing counter-strike versus running: the impact of leisure time activities and cortisol on intermediate-term memory in male students. Cogn Syst Res 40:1–7

    Article  Google Scholar 

  62. Maass A, Klöpper KM, Michel F, Lohaus A (2011) Does media use have a short-term impact on cognitive performance? J Media Psychol 23:65–76

    Article  Google Scholar 

  63. Kennedy L, Parker SH (2016) Timing of coping instruction presentation for real-time acute stress management: long-term implications for improved surgical performance. 2016 I.E. Int. Conf. on Healthc Inform 32–34

  64. Arora S, Sevdalis N, Nestel D, Tierney T, Woloshynowych M, Kneebone R (2009) Managing intraoperative stress: what do surgeons want from a crisis training program? Am J Surg 197:537–543

    Article  Google Scholar 

  65. Anton NE, Montero PN, Howley LD, Brown C, Stefanidis D (2015) What stress coping strategies are surgeons relying upon during surgery? Am J Surg 210:846–851

    Article  Google Scholar 

  66. Fisk AD, Ackerman PL, Schneider W (1987) Automatic and controlled processing theory and its applications to human factor problems. In: Hancock PA (ed) Human factors psychology. Elsevier, North-Holland, pp 159–197

    Chapter  Google Scholar 

  67. Pappada SM, Papadimos TJ, Lipps JA, Feeney JJ, Durkee KT, Galster SM, Winfield SR, Pfeil SA, Bhandary SP, Castellon-Larios K, Stoicea N, Moffatt-Bruce SD (2016) Establishing an instrumented training environment for simulation-based training of health care providers: an initial proof of concept. Int J Acad Med 2:32–40

    Article  Google Scholar 

  68. MacLean D, Roseway A, Czerwinski M (2013) MoodWings: a wearable biofeedback device for real-time stress intervention. Proc 6th Int Conf PErvasive Technol Relat to Assist Environ - PETRA ‘13 1–8

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Acknowledgements

The authors would like to thank David F. Nichols, PhD, of Roanoke College.

Funding

This study was funded by Agency for Healthcare Research and Quality R18HS023465-02 (PI-Parker).

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Authors and Affiliations

  1. Department of Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA

    Lauren Kennedy

  2. Department of Basic Science Education, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VA, USA

    Sarah Henrickson Parker

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  1. Lauren Kennedy
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Correspondence to Lauren Kennedy.

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The authors declare that they have no conflict of interest.

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This research involved human participants. The experiments were approved by and conducted in accordance with the guidelines of the Roanoke College Institutional Review Board with subjects providing written informed consent.

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Kennedy, L., Parker, S.H. Timing of Coping Instruction Presentation for Real-time Acute Stress Management: Potential Implications for Improved Surgical Performance. J Healthc Inform Res 2, 111–131 (2018). https://doi.org/10.1007/s41666-018-0016-y

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