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Nurses are exposed to incidents of workplace violence involving patients and their family members, and also coworkers. Studies of occupational stressors generally rely on subjective self-reports, questionnaires, or biometric and biochemical markers in long-cycle time intervals, but such assessments offer little guidance to HF/E intervention efforts. This study examined the viability of using wearable sensors to detect workplace violence incidents, and included measurement of pulse transit time (PTT) as a biomarker of continuous blood pressure. Six nurses were monitored over seven days. The electrocardiogram, PTT, and activity level were measured using a custom-designed armband. Participants used a wristwatch (Empatica E4) to log incidents, and a smartphone survey app to rate incident severity. Results show PTT was a more reliable indicator of workplace incidents than low- to high-frequency (LF/LH) ratio heart rate variability, offering a more robust way to continuously monitor critical events noninvasively over long periods in demanding work environments.

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Repeated exposure to acute occupational stressors and violence poses significant mental and physical risks to workers. However, current methods for assessing the impact of these stressors, such as subjective self-reports and single-modal wearable technologies, do not capture continuous physiological and psychological responses to workplace stressors. To address this issue, we developed a multi-modal wearable armband that can non-invasively monitor physiological signals without interfering with work requirements. The armband can continuously record electrocardiogram, photoplethysmography, activity levels, and pulse transit time (PTT) -a biomarker of cuffless blood pressure. We conducted a study with sixteen nurses working 12-hour shifts at Intensive Care Unit, where they reported incidents of violence while wearing the armband for seven consecutive days. We analyzed the ratio of low-and high-frequency components of inter-beat-intervals of heart beats (LF/HF ratio) and PTT for one hour before and after the incidents to capture physiological responses and recovery patterns. Our results showed that the LF/HF ratio increased after the incident occurrence and reached baseline within 30 minutes, while the PTT decreased and persisted for more than an hour. This finding suggests that PTT can be a reliable biomarker for stress recovery. Continuous PTT measurement can be used to optimize individual and team performances based on recovery patterns in demanding work environments. In summary, our study highlights the importance of continuous physiological monitoring in assessing the impact of workplace stressors and provides a new method for measuring stress recovery using PTT.