NSG 633 Unit 6 interruption and workload study example

Nine Breaks in a Twenty-Minute Task: An Interruption Count During One Heart Failure Discharge Teaching Session, With a Baseline and a Review Date

Student Name

Department of Nursing, Herzing University

NSG 633: Safety and Quality

Instructor Name

February 18, 2026

Nine Breaks in a Twenty-Minute Task: An Interruption Count During One Heart Failure Discharge Teaching Session, With a Baseline and a Review Date

What Counts as an Interruption Here

The definition comes before any count, because every number below depends on it. For this study, an interruption is an event that starts outside the task and causes the nurse to stop the task, by speaking, moving, or turning attention away, for any length of time. Three things are excluded. Questions from the patient or the family member being taught are not interruptions; they are the teaching. Background noise the nurse did not respond to, such as an alarm down the corridor, is a distraction rather than an interruption and is noted separately. And breaks the nurse chose, such as stepping out to get a printed medication list she had forgotten, are counted as self-initiated and kept apart from the total. Reviews of the interruption literature note that studies define the term in incompatible ways, which makes their counts impossible to compare (Rivera-Rodriguez & Karsh, 2010); stating the definition is the only way to make this count repeatable.

The Observed Stretch

The task was one discharge teaching session on the composite medical floor used throughout this course, on a Thursday from 1105 to 1143. The patient was a man in his seventies going home after four days of treatment for worsening heart failure, with two new medications, a daily weight routine, and a low-sodium diet. His daughter was present. The nurse, who had four other patients, had planned the session for 20 minutes and had told the charge nurse she would be in the room until about 1125. The floor had one admission arriving and two other discharges pending, which is a normal late morning on this floor, not an unusual one. The observer sat in the room with the agreement of the nurse, the patient, and his daughter, and recorded the time of each break with a watch.

The Count

Each break is recorded by source, by whether it needed an answer at that moment, and by roughly how long the nurse took to return to the teaching. Return time was measured from the start of the break to the next sentence of teaching.

Reading the Count

Nine interruptions occurred during a 38-minute session planned for 20, and the total return time was about 18 minutes, which accounts for nearly all of the overrun. Two self-initiated breaks, both to fetch printed materials, are not included. Four distractions, mostly alarms from other rooms that the nurse did not act on, are also excluded.

The count should not be read as nine pieces of waste. Four of the nine needed an answer at that moment: the pharmacist's call was about this very patient's discharge, the critical lab value and the insulin double-check are safety requirements, and the pump alarm protected another patient's antibiotic dose. Theoretical accounts of interruptions point out that some interruptions carry information that makes care safer, and that the aim is to manage them rather than eliminate them (Grundgeiger & Sanderson, 2009). The other five, including three that could have gone to the charge nurse or the clerk, are the ones a floor could reduce.

The cost of the breaks is also different in teaching than in medication preparation. When a nurse preparing or giving medications is broken off, errors become more frequent and more severe (Westbrook et al., 2010). In teaching the risk is quieter: the daughter asked the same question about daily weights twice, which suggests the thread had been lost after the 1117 break. Nurse-rated quality of discharge teaching has been linked to readiness for discharge and to lower readmission use (Weiss et al., 2011), which makes an interrupted session a quality issue, not only a time issue.

Baseline, Indicator, and Review Point

Baseline: 9 interruptions in one observed discharge teaching session, 5 of them not needing an answer at that moment, with the session running 18 minutes over plan. This is one session, so it is a starting point, not a rate.

Indicator: the number of interruptions not needing an immediate answer per discharge teaching session, counted with the definition above. A second indicator, the length of the session compared with the planned length, would show whether any change freed time.

Review point: ten further sessions, spread across days and times, observed over the next four weeks, with the count read again at the end of that period. If the floor then introduces a change, such as a sign on the door marking a teaching session in progress and routing phone calls for that nurse to the charge nurse, the same indicator would be counted for another ten sessions after the change. Without the second count, any improvement would be a guess.

References

Grundgeiger, T., & Sanderson, P. (2009). Interruptions in healthcare: Theoretical views. International Journal of Medical Informatics, 78(5), 293-307. https://doi.org/10.1016/j.ijmedinf.2008.10.001

Rivera-Rodriguez, A. J., & Karsh, B.-T. (2010). Interruptions and distractions in healthcare: Review and reappraisal. Quality and Safety in Health Care, 19(4), 304-312. https://doi.org/10.1136/qshc.2009.033282

Weiss, M. E., Yakusheva, O., & Bobay, K. L. (2011). Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization. Health Services Research, 46(5), 1473-1494. https://doi.org/10.1111/j.1475-6773.2011.01267.x

Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T. M., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine, 170(8), 683-690. https://doi.org/10.1001/archinternmed.2010.65