Ethan Gossett, BS, University of Connecticut Robert Henning, PhD, University of Connecticut Martin Cherniak, MD, MPH, UConn Health Mazen El Ghaziri, PhD, University of Massachusetts-Lowell Insoo Kim, PhD, UConn Health Hossein Hamadi Shishavan, MSE, University of Connecticut Yuan Zhang, PhD, University of Massachusetts-Lowell

The present study tests the feasibility of collecting detailed and continuous measures of multiple physiological responses (e.g., heart rate variability [HRV], electrodermal activity [EDA], and pulse transit time [PTT]) and seeks to link self-identified workplace violence (WPV) incidents to physiological stress responses in a population of registered nurses. Hypothesis 1: Exposure to WPV will have a positive direct effect on nurse distress as indicated by (a) greater perceived stress, (b) EDA, (c) HR, and PTT and (d) lower HRV. Hypothesis 2: The severity of WPV incidents will be incrementally associated with greater physiological responses

Although the relationship between job characteristics, stress, and health has been well-documented over the past 100 years (Bliese, Edwards, & Sonnentag, 2017), precise and unbiased measurement of the stress response in occupational settings is still lacking (Akinola, 2010; Epel, Crosswell, Mayer, Prather, Slavich, Puterman, & Mendes, 2018; Ganster, Crain, & Brossoit, 2018), and the mechanism through which repeated exposure to acute stressors leads to pathological changes in health and wellbeing remains poorly understood (Kivimaki et al., 2018; Rohleder, 2019). Self-reported ratings of stress have a weak association with physiological reactivity and down-stream health outcomes, possibly due to an unwillingness to report stress out of fear of appearing weak or fragile, a lack of conscious awareness, cultural differences, and/or retrospective recall bias (Epel et al., 2018). In addition, self-report surveys are poorly suited for capturing momentary changes in stress given the time and effort (i.e., demands characteristics) required by participants and the transient nature of the primary stress response (Akinola, 2010; Berntson, Quigley, Norman, & Lozano, 2017). Sampling during work may disrupt workflow, bias responses, and in some contexts, is not feasible due to the emergent and high-stakes nature of the task (e.g., urgent patient care). Thus, there is a critical need to measure physiological responses to changing job conditions passively, continuously, and with high resolution for extended periods of time. Workplace Violence (WPV) in Nursing Nurses face repeated exposure to job stressors, such as assaults (i.e., WPV), shiftwork and extended work hours, and incivility (American Nurses Association, 2019). In addition to acute injuries from physical assaults, nurses are at an elevated risk for multiple chronic illness, such as musculoskeletal disorders and cardiovascular disease, possibly due to prolonged exposure to stress and poor recovery associated with working conditions (Bureau of Labor Statistics, 2015). According to the Allostatic Load Model, prolonged exposure to stressors and activation of effector systems (e.g., cardiovascular and immune systems) leads to changes in physiological set point (e.g., resting blood pressure) and tertiary disease outcomes (e.g., cardiovascular disease; Ganster et al., 2018). Understanding the relationship between WPV exposure and stress depends on a measurement protocol capable of capturing the dynamic and transient stress response, which has not been accomplished in prior work utilizing ?off-the-shelf? wearable sensors (e.g., wristband photoplethysmography).

Twelve registered nurses (N=12) in a university hospital emergency department were recruited to participate through the joint efforts of a Department of Nursing and a University of Health Professionals (UHP) Local. Each participant wore two noninvasive (wearable) sensors which continuously monitored physiological activity 24 hours per day for seven consecutive days. Participants were instructed to log the occurrence of workplace violence incidents. Thus, this study utilized an intensive, repeated-sampling approach (ecological momentary assessment) composed of multimodal physiological recordings and event-contingent experience sampling. Measures and Materials. Heart rate, heart rate variability, changes in pulse transit time (i.e., an analog to changes in blood pressure), electrodermal activity, skin temperature, and physical activity were measured continuously via a custom-built armband and a commercially available wristband which also contained an ?event-marker? button synchronized to sensor recordings. Participants were instructed to push a button on the wristband to mark when critical incidents occurred, and as soon as was practical afterwards to complete an incident survey using a smartphone app to capture their perceived stress level and incident details such as source (patient, coworker, supervisor) and if the incident was formally reported and documented. Data Analysis. All data to be used for this presentation have been collected and are in the early stages of analysis. Multilevel modeling will be performed with physiological features (Level 1 variable) nested within events (Level 2 variable), nested within days (Level 3 variable), nested within individuals (Level 4 variable) using the R statistical package. Additionally, proof-of-concept testing using a machine learning classifier of stress, and data mining (cluster analysis, anomaly detection, and dependencies) are also planned.



A primary objective of the present study is to demonstrate the feasibility of a protocol for detailed and continuous assessment of physiological signals among nurses using a wearable physiological sensor system along with event-contingent experience sampling of critical incidents. The ability to objectively quantify stress responses over the course of the workday could serve as a valuable tool in planning Total Worker Health? interventions.

Tags: Applied research, Empirical study, Health care and social assistance, Practitioner report or field study, Psychological and Biological Effects of Job Stress, Research and Intervention Methods, Theoretical and Conceptual Issues in Job Stress, Violence, Workplace Mistreatment and Threats, Workplace Mistreatment; Threats; and Violence, Workplace Stress; Outcomes; and Recovery