SA is defined as an individual’s cognitive capacity to perceive components in his/her surroundings, comprehend the ensuing information, and utilize the acquired facts to forecast future events (Wright, Teakman, & Endsley, 2004). Maintaining SA is an essential skill in medical settings that can be developed over time to improve patient care and ensure patient safety. Although human factors research pertaining to SA has been dominated by military and industry applications, Farnan (2016) noted that SA would “undoubtedly” improve the quality and safety of patient care by reducing errors. For instance, Schulz et al. (2016) found errors in SA were responsible for 81.5% of the cases from the German Anesthesia critical incident reporting system.
The results of Schulz et al. (2016) show much research is needed in the medical field pertaining to SA in order to improve patient care and safety. The present SA training involves a hands-on, dynamic training process that utilizes a realistic scenario that requires nurses to use their expertise to: 1) recognize key situational elements (e.g., a patient presenting symptoms of a stroke) at a particular time and place, 2) understand/interpret this information to rule out alternative causes of the symptoms, and 3) predict future events based on the acquired patient information, despite distractions. This scenario-based SA training and subsequent practice in situation assessment can serve as an effective weapon for nurses to combat medical errors.
The participants were ten nurses with less than two years of work experience employed at a local hospital. The nurses participated in a single-day educational session that lasted for approximately six hours. During the training session, the nurses completed two simulation scenarios, received a lecture on situation awareness, participated in group discussions, and received mindfulness training. The nurses completed two 12-15 minute scenarios in a simulated hospital setting (one at the beginning of the educational session and one at the end of the session) to measure their SA during patient care.
At the start of the educational session, the nurses entered individually to begin care for the simulated patient in a simulated hospital room. They interacted with a patient, an “intelligent manikin,” which was programmed to exhibit vital signs and symptoms of a patient suffering from a femur fracture that transitioned into a stroke (simulation scenario A). At three points during the exercise, the simulation was stopped and the nurse participants were verbally questioned with their responses being recorded about the current situation to assess their current levels of SA. Specifically, without the information visible to them, the participants were asked to recall the latest patient vital signs (e.g., blood pressure, temperature, heart rate), the current state of the patient (e.g., stable, deteriorating), and what will likely happen to the patient if the trend continues (e.g., will become dehydrated, will need pain medications, cardiac arrest). After the nursing simulation session, the nurse participants were debriefed regarding their performance.
After completion of the simulation exercise, the nurses attended a workshop on SA that included various hands-on activites to help demonstrate key concepts and strategies. For example, brief videos were shown depicting a nurse actor demonstrating either good or poor SA while caring for a patient. Following each video, the participants engaged in a group discussion about the actor’s performance in the video by answering questions pertaining to SA. The questions were designed to foster discussion among the participants (e.g., “What information does the nurse have about the patient’s condition?” and “What should the nurse be doing next?”). Toward the end of the workshop, the nurses were instructed on breathing exercises designed to increase mindfulness and concentration skills.
The program concluded with a second exercise in the nursing simulation lab. The nurses attended to the “intelligent manikin” patient programmed to exhibit vital signs and symptoms of pneumonia that transitioned into sepsis (simulation scenario B). Following the same procedures as Simulation Scenario A, the simulation was paused at three time points and the participants were verbally questioned about the current situation to assess their current levels of SA. The participants were debriefed regarding their performance and dismissed from the training.
In addition to post training participant survey data, the training will be evaluated using a pre-post design comparing SA maintenance skills at the start of the workshop (scenario A) to that at the end of the workshop (scenario B). Data will be analyzed using a non-parametric test of mean differences. It is anticipated that the training will increase the SA of nurses, which will equip them to act optimally when caring for patients in various medical situations.