Adaptation and Validation of the Situation Awareness Global Assessment Technique for Nurse Anesthesia Graduate Students

Development of a Questionnaire Assessing Nurses' Situational Awareness to Missed Care

This study aimed to develop and validate the Situational Nursing Awareness Probe-Missed Nursing Care Edition (SNAP-MNC) questionnaire, a novel tool designed to assess nurses' situational awareness in the context of missed nursing care. Data were collected from March to October 2022, following a rigorous five-phase questionnaire development process. The five-item questionnaire was developed through literature review and expert evaluation, establishing face and content validity. It was tested with 190 nurses across three shifts. Construct validity was assessed via confirmatory factor analysis, reliability via Cronbach's alpha, and criterion validity by correlating with the MISSCARE survey. The final five-item questionnaire demonstrated suitability for assessing personal situational awareness. The findings established content, construct, criterion validity, and good internal reliability. Confirmatory factor analysis displayed suitable loadings and an excellent fit to a one-dimensional model. Nurses received, on average, low situational awareness scores. The SNAP-MNC effectively assesses nurses' situational awareness, focusing on missed nursing care. This tool evaluates the identification of relevant clinical factors, understanding their implications, and projecting strategies to address challenges, offering actionable insights for improving nursing care quality and outcomes.

Human-computer interaction interface design of flight simulator based on situation awareness

To meet the comprehensive requirements of drivers for Human-Computer Interaction (HCI) during operation and to enhance situation awareness (SA), this paper proposes a design and evaluation method for flight simulator HCI interfaces grounded in SA. Firstly, the widely adopted Endsley's SA model, which comprehensively covers processes relevant to individual drivers was selected as the foundational framework. The study concentrates on flight, cruise, and landing scenarios within the simulator, analyzing and restructuring the information architecture of the HCI interface. Secondly, a self-assessment scale was developed based on the three-level model of information processing for SA to measure drivers' SA cognitive levels. The core scenarios of the simulation training were analyzed to establish a design-making process. Thirdly, invite participants were invited to engage in simulated driving sessions on the flight simulator, where their SA cognitive levels were assessed. An analysis of detail features was performed on samples with high SA cognitive levels. Subsequently, drivers' requirements for the control layout features of the HCI interface design were gathered through surveys. The design detail features of the HCI interface associated with high SA cognitive levels were identified and synthesized into four distinct dimensions to guide the detailed design process. Finally, participants engaged in simulated driving using the finalized interface design, and their SA cognitive levels were reassessed. The results demonstrated that the HCI interface design derived from this method significantly improved SA cognitive levels compared to the original design.

Improved recall of handover information in a simulated emergency - A randomised controlled trial

Background

Handovers during medical emergencies are challenging due to time-critical, dynamic and oftentimes unorderly and distracting situations. We evaluated the effect of distraction-reduced clinical surroundings during handover on (1) the recall of handover information, (2) the recall of information from the surroundings and (3) self-reported workload in a simulated in-hospital cardiac arrest scenario.

Methods

In a parallel group design, emergency team leaders were randomly assigned to receive a structured handover of a cardio-pulmonary resuscitation (CPR) either inside the room ("inside group") right next to the ongoing CPR or in front of the room ("outside group") with no audio-visual distractions from the ongoing CPR. Based on the concept of situation awareness, the primary outcome was a handover score for the content of the handover (0-19 points) derived from the pieces of information given during handover. Furthermore, we assessed team leaders' perception of their surroundings during the scenario (0-5 points) and they rated their subjective workload using the NASA Task Load Index.

Results

The outside group (n = 30) showed significant better recall of handover information than the inside group (n = 30; mean difference = 1.86, 95% CI = 0.67 to 3.06, p = 0.003). The perception of the surroundings (n = 60; mean difference = -0.27, 95% CI = -0.85 to 0.32, p = 0.365) and the NASA Task Load Index (n = 58; mean difference = 1.1; p = 0.112) did not differ between the groups.

Conclusions

Concerning in-hospital emergencies, a structured handover in a distraction reduced environment can improve information uptake of the team leader.

Situation Awareness-Oriented Dashboard in ICUs in Support of Resource Management in Time of Pandemics

In a pediatric intensive care unit (PICU) of 32 beds, clinicians manage resources 24 hours a day, 7 days a week, from a large-screen dashboard implemented in 2017. This resource management dashboard efficiently replaces the handwriting information displayed on a whiteboard, offering a synthetic view of the bed's layout and specific information on staff and equipment at bedside. However, in 2020 when COVID-19 hit, the resource management dashboard showed several limitations. Mainly, its visualization offered to the clinicians limited situation awareness (SA) to perceive, understand and predict the impacts on resource management and decision-making of an unusual flow of patients affected by the most severe form of coronavirus. To identify the SA requirements during a pandemic, we conducted goal-oriented interviews with 11 clinicians working in ICUs. The result is the design of an SA-oriented dashboard with 22 key indicators (KIs): 1 on the admission capacity, 15 at bedside and 6 displayed as statistics in the central area. We conducted a usability evaluation of the SA-oriented dashboard compared to the resource management dashboard with 6 clinicians. The results showed five usability improvements of the SA-oriented dashboard and five limitations. Our work contributes to new knowledge on the clinicians' SA requirements to support resource management and decision-making in ICUs in times of pandemics.

The Validity of the SEEV Model as a Process Measure of Situation Awareness: The Example of a Simulated Endotracheal Intubation

OBJECTIVE

In the context of anesthesiology, we investigated whether the salience effort expectancy value (SEEV) model fit is associated with situation awareness and perception scores.

BACKGROUND

The distribution of visual attention is important for situation awareness-that is, understanding what is going on-in safety-critical domains. Although the SEEV model has been suggested as a process situation awareness measure, the validity of the model as a predictor of situation awareness has not been tested.

METHOD

In a medical simulation, 31 senior and 30 junior anesthesiologists wore a mobile eye tracker and induced general anesthesia into a simulated patient. When inserting a breathing tube into the mannequin's trachea (endotracheal intubation), the scenario included several clinically relevant events for situation awareness and general events in the environment. Both were assessed using direct awareness measures.

RESULTS

The overall SEEV model fit was good with no difference between junior and senior anesthesiologists. Overall, the situation awareness scores were low. As expected, the SEEV model fits showed significant positive correlations with situation awareness level 1 scores.

CONCLUSION

The SEEV model seems to be suitable as a process situation awareness measure to predict and investigate the perception of changes in the environment (situation awareness level 1). The situation awareness scores indicated that anesthesiologists seem not to perceive the environment well during endotracheal intubation.

APPLICATION

The SEEV model fit can be used to capture and assess situation awareness level 1. During endotracheal intubation, anesthesiologists should be supported by technology or staff to notice changes in the environment.

Can a targeted educational approach improve situational awareness in paramedicine during 911 emergency calls?

BACKGROUND

Paramedics must be situationally aware in order to avoid human error and protect themselves, their partner, their patient, and the public. Previous research has suggested that paramedics lack situational awareness (SA), possibly due to a lack of an organized approach, distraction, and a poor understanding of SA. There is no educational approach provided to paramedics that is known to improve their levels of SA. If such an approach were provided, it could possibly reduce human error and lead to improved outcomes.

OBJECTIVE

The aim of this study is to determine whether providing paramedics with a targeted educational approach, including aspects from crew resource management (CRM) such as sterile cockpit and Endsley's model for SA, can improve overall SA during emergency calls.

METHODS

A prospective, quasi-experimental before-and-after study was used, in which out-of hospital paramedics were observed during 911 emergency calls. Baseline SA was measured using the situational awareness global assessment technique (SAGAT). Paramedics were then given a targeted educational lesson focusing on elements of SA and CRM as well as a novel quick reference tool to utilize during 911 calls. Post intervention SA was then measured again, and before-and-after results were compared for difference of mean scores.

RESULTS

The overall baseline SA was 62% increasing to 86% following the educational intervention. The Wilcoxon Ranked Sum was used to assess for statistically significant differences between mean SA performance in the same group of paramedics before and after the intervention. The increase in SA was found to be statistically significant where p = 0.011.

CONCLUSIONS

A targeted educational approach focusing on CRM and a novel quick reference tool may increase SA levels of paramedics during 911 emergency calls. Further studies are needed with bigger cohorts. Paramedicine educational institutions and out-of-hospital agencies should consider implementing this targeted approach with their students and currently practicing providers.