Inter-brain Synchronization between Nurse and Patient During

Drawing Blood

Tsuneo Kawano

, Yukie Majima

, Yasuko Maekawa

, Mako Katagiri

and Atsushi Ishigame

Faculty of Science and Engineering, Setsunan University, Ikeda-Nakamachi, Neyagawa, Osaka, Japan

Graduate School of Engineering, Osaka Prefecture University, Naka-ku Gakuencho, Sakai, Osaka, Japan

Faculty of Nursing, Kansai University of Social Welfare, Shinden, Ako, Hyogo, Japan

Technology Research Institute of Osaka Prefecture, Ayumino, Izumi, Osaka, Japan

Keywords: Nursing Skills, Tacit Knowledge, Blood Drawing, Nurse and Patient, EEG, Alpha Wave Band,

Synchronization.

Abstract: Tacit knowledge such as "proficient skills" and "knacks" in nursing skills seems not to be applied by nurse

alone but by the interaction between nurse and patient. The purpose of this study is to analyze their

interaction from the point of interbrain synchrony. In this study blood drawing technique was adopted as

nursing skills and experiments of drawing blood were carried out in nurse-patient pairs. Experimental

participants were 4 nurses and 6 patients. The brain waves in the occipital portion of nurse and patient were

simultaneously measured using portable EEG devices during drawing blood. The ratios of alpha-band

power were calculated for each of the nurse and patient, and the cross-correlations were obtained between

every pairs of them. The results indicated that the brain waves of patient were synchronized with those of

nurse by several seconds behind. Furthermore the synchronization was not recognized in abnormal

circumstances that nurses failed in the drawing blood.

1 INTRODUCTION

Tacit knowledge such as "proficient skills" and

"knacks" in nursing skills seems not to be applied by

nurse alone but by the interaction between nurse and

patient. Evaluation of nursing skills is assumed to

depend on the interaction. Therefore, it is important

to reveal the interaction between nurse and patient in

order to build a learning support system for the

nursing skills. The purpose of this study is to

analyze their interaction from the point of interbrain

synchrony.

The perfect nursing skills could ease patient’s

pain or fears by the proficient technique and good

communications with the patient. If the relations

between the perfect nursing skills and interbrain

synchrony of nurse and patient are successfully

quantified, proficiency level of beginning nurse can

be evaluated by the interbrain synchrony. It means

that quantification of the interbrain synchrony

between nurse and patient could contribute to

establish entirely-new learning support system for

beginning nurses. Thereby decrease of medical

errors and increase of patient’s safety are also

expected.

Recently the research regarding "inter-brain

synchronization" came to be conducted. Dumas et al.

discovered that states of interactional synchrony

correlate with the emergence of an interbrain

synchronizing network between two persons who

are engaged in spontaneous imitation of hand

movements (Dumas et al., 2010). Regarding the

persons who are watching a movie, Kauppi et al.,

suggested that several regions within the frontal and

temporal lobes showed inter-subject correlation

predominant-ly at low frequency bands, whereas

visual cortical areas exhibited inter-subject

correlation also at higher frequencies (Kauppi et al.,

2010). Hari et al. introduced the synchrony of brains

and bodies during implicit interpersonal face-to-face

interaction (Hari et al., 2013).

Neurobehavioral studies of interaction of nurse

and patient are few because of difficulties to

measure brain waves during working. Our previous

study has successfully attempted to measure the

brain waves of nurse and patient simultaneously

Kawano, T., Majima, Y., Maekawa, Y., Katagiri, M. and Ishigame, A.

Inter-brain Synchronization between Nurse and Patient During Drawing Blood.

DOI: 10.5220/0005825605070511

In Proceedings of the 9th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2016) - Volume 5: HEALTHINF, pages 507-511

ISBN: 978-989-758-170-0

507

during blood drawing task (Maekawa et al., 2013).

The differences in the changing state of tension or

concentration between nurses and beginners from

the EEG data were discussed. One of the remarks

was that nurses were in a state of concentration with

calm during the injection performance. In another

study it concluded that the increase of alpha-band

power had to do with the successful injection

operation (Kishida et al., 2015).

In this study blood drawing technique was

adopted as nursing skills and experiments of

drawing blood were carried out in nurse-patient pairs.

The brain waves in the occipital portion of nurse and

patient were simultaneously measured using portable

EEG devices during drawing blood. The ratios of

alpha-band power were calculated for each of the

nurse and patient, and the cross-correlations were

obtained between every pairs of them.

2 EXPERIMENTAL METHODS

Participants for nurses were 4 women in their thirties

and forties. They have over 8 years of nursing

experience. Participants for patients (5 men and 1

woman) were in their twenties.

After the ethical committee of the institute

reviewed the study protocol, the authors explained

ethical considerations to participants and obtained

written consent before the study.

Blood drawing was actually conducted using

three kind of intravenous injection trainers

(Adam,Rouilly Limited) instead of actual arm of the

patients. One of them was a type of arm shape. It

was an easy trainer model A to draw the blood

because a blood vessel had come to the surface of

the skin. Another one was a same type but it was a

difficulty trainer model B because of invisible vein.

The other one C was a fit-on type of wrapping

human arm, which had a realistic feeling. These

types of arm model were employed to investigate the

effect of the nurse’s performance to the synchro-

nization between nurse and patient.

There were 14 pairs in combinations of nurse and

patient. The trials of drawing blood were repeated 5

times with each pair. Muse Brain System (Digital

Medic, Inc.) was used to measure the brain waves.

This was a portable EEG device with a single

electrode for occipital cortex. The electrode was set

at the midoccipital point (Oz in the International 10-

20 System) (Teplan, 2002).

Figure 1 shows general concept of inter-brain

synchronization between nurse and patient. Firstly,

original brain waves were measured simultaneously

Figure 1: General concept of inter-brain synchronization

between nurse and patient.

for the nurse and patient during drawing blood. The

original data were transformed into a frequency

domain signal by Fourier transform every second.

Secondly, the ratios of alpha, beta, delta band power

were calculated every second. Thirdly, the ratio data

were smoothed by a second-order Butterworth filter

to distinguish the trend. The cut off frequency was

set to 0.1Hz. Finally, the relation of the alpha-band

between nurse and patient was evaluated by using

the following cross-correlation function C(τ) in

every pair (Watanabe et al., 2004).

{() }{( ) }

()

{() } {() }

xi yi

μτμ

μμ

−

−+−

−−

∑

∑∑

(1)

Where μ

and μ

are the mean values of x and y,

respectively, x and y is for nurse and patient,

respectively, n is the number of data, and τ is time

delay.

In general the changes of ratios of alpha and beta

band power are in opposite phases like a seesaw.

Therefore human state of tension or relax can be

investigated with either of the alpha or beta band

power. In this study alpha band power is taken into

consideration. Actual measured data of alpha band

power are discussed in the next chapter.

Figure 2 shows experimental appearance. The

nurse is going to prick with a needle to the arm

model. The patient gazes at the arm model.

HEALTHINF 2016 - 9th International Conference on Health Informatics

508

3 RESULTS AND DISCUSSION

Figure 3 shows the changes of ratio of the alpha and

beta band power measured from a nurse n1 during

drawing blood. As mentioned before, it is found that

their changes have mutually reverse-phase relations.

Figure 4 shows an example of time variation of

ratio of alpha band power in pairs of nurse n2 and

patient p2. In this case time delay τ is 9 seconds, and

cross correlation coefficient becomes maximum

0.326. The graph indicates that the ratio of alpha

band power (component of relaxation) of patient is

almost synchronized with that of nurse by 9 seconds

behind.

Figure 5 shows examples of cross correlation

function. Figure (a) is the successful case in drawing

blood. The functions become largest at τ =2, 3, 7,

respectively. It means that alpha band of the brain

waves is synchronized between nurse and patient at

that delay. Figure (b) is the case of the first trial in a

pair of nurse and patient and the failure case in

drawing blood. In these cases large plus cross-

correlation values do not exist. Due to the nerves of

nurse and patient at first trial and the failure of

drawing blood with repeated insertion of the needle,

it is assumed that the brain rhythms are disturbed.

Table 1 shows the results of all trials in pairs of

nurse and patient. In the table success or failure of

the drawing blood, synchronization or non-

synchronization, and time delay are listed.

Synchronization or non-synchronization is decided

by 5% significance level. In table 1 on the trials of

synchronization due to the success, the marks of the

double circle are displayed. On the trials of non-

synchronization due to the failure, the marks of the

single circle are displayed. The marks of dotted

circle are displayed in case of the first trial and non-

synchronization in spite of the success. In the 9 trials

synchronizations do not occur due to the failure of

drawing blood. In the first trials in pairs of nurse and

patient, synchronizations do not often occur even if

the trials are successful. It is considered that it is

caused by the tension of nurse and patient because of

the first combination. The percentage of non-

synchronization in case of the first trials or failure

drawing blood is 76.5%.

In the case of the 32 trials, synchronizations

occur due to the success of drawing blood. When the

patient felt anxious or fearful, synchronization did

not occur even if the drawing blood was successful.

The marks of “anxious” or “fearful” are displayed

on the table. The patients tend to feel fearful when

using a fit-on type arm model C because of the

realistic feeling. The percentage of synchronization

Figure 2: Simultaneous measurement of brain waves for

nurse and patient during drawing blood.

Figure 3: Changes of ratio of the alpha and beta band

power measured from a nurse n1 during drawing blood.

Figure 4: Example of time variation of ratio of alpha band

power in pairs of nurse n1 and patient p1 (τ = 9).

in case of the successful drawing blood without the

first trials and the case of anxious or fearful feeling

is 69.0%.

The time delay of cross correlation was 6.18

seconds in average. Therefore, the brain waves of

patient are synchronized with those of nurse by

about 6 seconds behind.

EEG

electrode

EEG

electrode

Inter-brain Synchronization between Nurse and Patient During Drawing Blood

509

(a) Example of successful case in drawing blood

(b) Example of failure in drawing blood

Figure 5: Cross-correlation of alpha band power between

nurse and patient.

4 CONCLUSIONS

In order to analyze nurse-patient interaction from the

point of interbrain synchrony, in this study blood

drawing technique was adopted as nursing skills and

experiments of drawing blood were carried out in

nurse-patient pairs. The brain waves in the occipital

portion of nurse and patient were simultaneously

measured using portable EEG devices during

drawing blood. The ratios of alpha-band power were

calculated for each of the nurse and patient, and the

cross-correlations were obtained between every pairs

of them. The results indicated that the brain waves

of patient were synchronized with those of nurse by

several seconds behind. Furthermore the synchro-

nization was not recognized in abnormal

circumstances that nurses failed in the drawing

blood. It is suggested that the proficiency level of

beginning nurse can be evaluated by the interbrain

synchrony. In the future data accumulation for more

experimental participants will be an issue to validate

the findings.

Table 1: Relation between success of drawing blood and

inter-brain synchronization.

Synchronization due to the success of drawing blood

Non-synchronization due to the failure of drawing blood

Non-synchronization due to the first trials in pairs of nurse

and patient

Patient felt anxious or fearful

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