Psychometric properties of the Persian version of Nursing Work Interruption Scale

Nursing, a cornerstone of healthcare systems, plays a critical role in the delivery of patient care [1‐3]. However, nurses frequently encounter numerous challenges in their work environments that can negatively impact both the quality of care and their own well-being. One such challenge is the occurrence of work interruptions. Due to the dynamic and complex nature of healthcare settings, where patient needs and service demands fluctuate constantly, work interruptions have become a pervasive issue [4].

Nursing work interruptions, common occurrences that frequently disrupt the workflow of nurses, can lead to errors, delays, and omissions in patient care [5‐7]. These interruptions, defined as external events that interfere with or delay nurse-patient interactions, can divert attention during the provision of healthcare services [8]. Nursing work interruptions can stem from various sources, including human and technical factors. Human sources encompass healthcare personnel, patients, and families, while technical sources involve equipment malfunctions [9], operational failures, and resource shortages [10]. Interruptions can occur through different communication channels, such as face-to-face interactions or technological means like telephones, pagers, and monitoring devices [11]. To effectively address work interruptions, it is crucial to identify their underlying causes. Categorizing interruptions based on factors such as duration [7], physical location, and primary and secondary task types [7, 10] can provide valuable insights.

Numerous studies have demonstrated a high prevalence of work interruptions across various hospital settings, including intensive care units (ICUs) [12, 13], emergency departments (EDs) [14], post-anesthesia care units (PACUs) [15], and pediatric wards [16]. Work interruptions are prevalent in various nursing tasks, particularly during medication administration [17]. A study by Wang et al. investigated work interruptions during medication administration in a Chinese hospital. Over 270 h of observation, nurses experienced 3424 interruptions, resulting in a rate of 12.68 interruptions per hour, which accounted for 9.87% of the total observation time [18].

Work interruptions in nursing have been associated with a range of negative consequences. These disruptions can prolong task completion times, reduce efficiency, and increase the risk of errors and omissions in patient care. By diverting nurses’ attention, interruptions can compromise patient safety and quality of care [19]. Furthermore, interruptions can negatively impact the work environment [20], leading to increased stress, burnout, and psychological distress among nurses. These factors can ultimately contribute to increased healthcare costs. In conclusion, work interruptions pose significant challenges to both nurses and patients [21]. Therefore, the development and utilization of standardized tools for measuring and assessing work interruptions can aid in identifying patterns, implementing targeted interventions, and evaluating their effectiveness. Ultimately, this process will improve nurse well-being and enhance patient safety.

A comprehensive literature review revealed a limited number of self-report measures designed to assess workplace interruptions. While tools like the four-item scale for assessing intrusions [22] and the Workplace Interruptions Measure (WIM) [23] have been developed, their generalizability to the unique demands of nursing practice may be limited. Based on Jett and George’s [24] four-factor conceptual typology of interruptions—intrusions, distractions, discrepancy detections, and breaks—the WIM offers a generalizable tool for evaluating work interruptions across various work settings [23]. However, due to the unique characteristics of healthcare settings and nursing work, some items of this instrument may not be entirely suitable for such environments. Therefore, there is a critical need for a tool specifically designed to assess work interruptions in nursing contexts, tailored to the unique demands and challenges of the nursing profession. To address this gap, Yu and Lee developed the Nursing Work Interruption Scale (NWIS) in 2022 [25]. This 12-item self-report measure is specifically designed to assess work interruptions in nursing settings, focusing on both human and environmental factors. By accurately capturing the specific challenges faced by nurses, the NWIS can provide valuable insights for improving patient safety, enhancing nurse well-being, and optimizing organizational efficiency.

Iranian nurses frequently encounter a multitude of challenges within their profession. These challenges include, but are not limited to, nursing shortages [26], equipment deficiencies [27], and excessive workload [28]. Such factors can significantly disrupt the delivery of quality and safe patient care, leading to numerous interruptions in nursing processes. To date, there has been a dearth of research investigating nursing work interruptions in Iran, and no validated tools exist to measure this phenomenon. The absence of such a tool hinders the accurate assessment of work interruptions and limits the potential for evidence-based interventions to improve nursing practice. Given the increasing recognition of the impact of work interruptions on nurse well-being and patient safety, the development and validation of a culturally appropriate tool is crucial. However, the existing tools are not efficient enough to accurately measure this phenomenon. To address this gap, the present study aimed to adapt and validate the Nursing Work Interruption Scale (NWIS) into Persian for use in the Iranian nursing context.

In this study, the instrument developed by Yu and Lee in 2022 was culturally translated and adapted into Persian for use in Iran [25]. The final version of the instrument consisted of two factors and 12 items, with satisfactory cultural adaptation. These factors included Human Factors (6 items) and Environmental Factors (6 items). Content validity was assessed through a combination of expert feedback and quantitative indices. The Content Validity Ratio (CVR) and the Scale-level Content Validity Index (S-CVI) were 0.90 and 0.95, respectively, both of which exceed the accepted thresholds, indicating strong content validity. In this study, the high CVR and S-CVI values reflect the expert panel’s consensus on the relevance and clarity of the items. These findings support the conclusion that the NWIS effectively identifies and measures key dimensions of interruptions in nursing workflows, demonstrating both robust content validity and cultural adaptability.

In this study, the two factors accounted for 63.58% of the variance, and the model fit indices were satisfactory. Yu and Lee [25] reported an explained variance of 55.73%. The comparison of explained variances between the two studies suggests that the Nursing Work Interruption Scale (NWIS) items were able to measure the target construct in both Iranian and South Korean cultures.

In this study, the “Human factors” component accounted for 32.88% of the total variance explained by the instrument. Similarly, Yu and Lee [25] reported that “Human factors” contributed 27.1% of the total variance. This component, comprising six items, refers to individuals who unexpectedly interrupt nurses’ work. “Intrusions” are defined as disruptions that reduce the time available for primary tasks, leading to longer task completion times. Previous studies [22‐24, 47] have identified “intrusions” as a crucial feature of workflow disruptions, with examples including sudden requests for new tasks or requests from colleagues. Individuals interrupting nurses include patients, physicians, fellow nurses, other staff, and security personnel, reflecting the unique characteristics of hospital environments. It is important to note that in healthcare settings, nurses frequently need to pause their activities to respond to phone calls or sudden requests from patients, the treatment team, and other staff. These interruptions, especially in care-oriented work environments, are not always perceived as workflow disruptions [25]. Therefore, it is essential to inform patients and hospital visitors about the negative impact of interruptions on nursing workflow and the quality of care. Additionally, while raising awareness, hospital management should implement strategies to create interruption-free zones or allocate dedicated staff to handle such requests.

The second component of the instrument, “Environmental Factors,” accounted for 30.7% of the total variance in this study. This component included items that assess environmental factors such as patient and staff noise, equipment alarms, equipment malfunctions, sudden changes in patient condition, sudden increases in patient volume, and safety emergencies. Essentially, “Environmental Factors” denote changes and stimuli that can distract nurses and disrupt their focus [23, 48]. Distractions are defined as cognitive shifts resulting from environmental stimuli or secondary tasks and can lead to workflow disruptions [49, 50]. Noise, particularly arising from constant communication among doctors, nurses, patients, and families, as well as medical equipment operation, has emerged as a significant distraction in healthcare settings. These noises can be frequent and loud, disrupting staff concentration [51, 52]. Previous studies, including Wilkes et al. [23], have primarily focused on noise as a distractor. However, the Nursing Work Interruption Scale (NWIS) encompasses a broader range of environmental distractions, including sudden changes in patient condition, equipment malfunctions, and increased patient volume. Identifying environmental factors that disrupt nurses’ workflow can enhance our understanding of these factors and facilitate the development of effective strategies to mitigate disruptions.

In addition to exploratory factor analysis, confirmatory factor analysis was conducted in this study. The findings confirmed a two-factor structure in the sample, aligning with the original instrument. Each item is loaded onto a single factor as hypothesized. Furthermore, model fit indices were calculated, indicating a good fit for the model. In the study by Yu and Lee [25], the confirmatory factor analysis results showed satisfactory model fit indices (GFI = 0.88, TLI = 0.89, CFI = 0.91, NFI = 0.86, RMSEA = 0.09). These findings suggest that the relationship between items and dimensions is consistent [53].

In this study, internal consistency was assessed using Cronbach’s alpha and McDonald’s omega, yielding coefficients of 0.896 and 0.892, respectively, indicating acceptable reliability. Furthermore, all subscales exhibited Cronbach’s alpha values above 0.82. Consistent with these findings, Yu and Lee [25] reported Cronbach’s alpha coefficients of 0.88 for the 12 items, 0.84 for Factor 1 (human factors), and 0.83 for Factor 2 (environmental factors), suggesting high reliability. Overall, Cronbach’s alpha and McDonald’s omega coefficients in the present study indicate that the Persian version of the Nursing Work Interruption Scale (NWIS) is a reliable instrument for measuring interruptions in nursing work.

The Nursing Work Interruption Scale (NWIS) is recognized as the first self-report measure specifically designed to assess interruptions in nursing workflows, capturing the unique characteristics of the nursing work environment. This instrument not only addresses the distinct challenges faced by nursing professionals but also accounts for the broader nature of work interruptions in general organizational settings. By offering valuable insights into the causes and dynamics of interruptions, the NWIS facilitates a deeper understanding of the problems and challenges inherent in nursing workflows.

Among the scale’s items, “I had to stop what I was doing due to a patient suddenly asking for something” and “I had to stop what I was doing due to a malfunction of equipment” exhibited the highest factor loadings. These findings highlight the critical role of unplanned patient demands and equipment malfunctions in disrupting nursing workflows, emphasizing their significance in understanding and addressing work interruptions.

The NWIS serves as a tool for identifying the causes of nursing work interruptions across various hospital departments. By providing a comprehensive assessment of workflow disruptions, the scale enables researchers and healthcare administrators to collect baseline data on the frequency, causes, and patterns of these interruptions. This data is pivotal in designing targeted interventions to address specific challenges in nursing workflows.

To evaluate the effectiveness of these interventions, the NWIS can be utilized in pre- and post-intervention assessments. For example, comparing NWIS scores before and after implementing strategies such as workflow redesigns or enhanced equipment maintenance protocols allows for an objective measure of intervention success. Moreover, reductions in NWIS scores can correlate with tangible improvements in related outcomes, including reduced medical errors, lower stress levels, and decreased burnout among nurses. This makes the NWIS an invaluable tool for offering a comprehensive evaluation of intervention effectiveness and its broader implications for healthcare delivery.

Despite its significant utility, there remains a paucity of research investigating the psychometric properties of the NWIS across diverse contexts and healthcare systems. While the findings of this study align with the scale’s original conceptual framework, they underscore the need for further cross-cultural validations and comparative studies. Such efforts are essential to enhance the scale’s generalizability and applicability in diverse healthcare settings, ensuring its effectiveness in addressing the complexities of nursing work interruptions on a global scale.

This study psychometrically evaluated the Persian version of the Nursing Work Interruption Scale (NWIS), a valid and reliable tool designed for assessing interruptions in nursing work within the Iranian cultural context. By identifying both human and environmental factors that disrupt nursing workflows, the NWIS provides valuable insights into the causes of work interruptions. While primarily designed to assess these disruptions, the scale’s findings can also guide efforts to improve nurses’ working conditions. These insights may contribute to optimizing efficiency and supporting targeted interventions aimed at reducing interruptions, which can have a positive impact on both staff well-being and patient care.