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Trends in nursing are multifactorial and associated with changes in society, within the nursing profession, and in other professions. Notably, telehealth and remote nursing contribute to successful healthcare delivery for numerous patients and help reduce stress for nurses due to nursing shortages. Nurses can reach patients, monitor their conditions, and interact with them using computers, audio, visual accessories, and telephones—for example, remote patient monitoring systems. Likewise,...

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Development of a Virtual Reality Assessment of Everyday Living Skills

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Association of Virtual Nurses' Workflow and Cognitive Fatigue During Inpatient Encounters: Cross-Sectional Study.

Saif Khairat^1,2,3,4, Jennifer Morelli², Wan-Ting Liao²

¹Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

JMIR Human Factors

|April 22, 2025

Summary

Virtual nurses experience cognitive fatigue early in their shifts, with instances detected within minutes during patient admissions and discharges. This research highlights the need to optimize virtual nursing workflows to mitigate fatigue.

Keywords:

EHR USA United States cognitive cognitive fatigue communication cross-sectional study delivery model design electronic health record eye eye tracking eye-tracking technology fatigue inpatient nurse nursing pupil pupil size technology telemedicine tracking virtual virtual care virtual nurse virtual nursing workflow

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Area of Science:

Nursing Informatics
Human Factors Engineering
Cognitive Science

Background:

Virtual nursing models deliver expert care remotely using technology like audio/video, remote monitoring, and EHRs.
Virtual nurses spend significant computer time, raising concerns about potential cognitive fatigue.
The impact of virtual nursing workflows on cognitive fatigue remains understudied.

Purpose of the Study:

To investigate cognitive fatigue in virtual nurses using eye tracking and pupil size variation.
To identify specific workflow points contributing to cognitive fatigue in virtual nursing.

Main Methods:

A cross-sectional study analyzed virtual nurse encounters using eye tracking technology.
Data was collected during 12-hour shifts at a US health center.
Pupil size variation was monitored to detect cognitive fatigue.

Main Results:

Cognitive fatigue was observed in 75% (22/29) of virtual nursing encounters.
The first instance of fatigue occurred at 9.8 minutes during patient discharges.
Fatigue onset was noted at 11.9 minutes during patient admissions.

Conclusions:

Eye tracking and pupil dilation effectively identify cognitive fatigue in virtual nurses.
Findings offer insights for designing virtual nursing workflows to reduce cognitive load.
This study emphasizes the importance of addressing nurse fatigue in remote care settings.