Can eye-tracking technology improve situational awareness in paramedic clinical education?

Application of eye-tracking in nursing research: A scoping review

AIMS

To map the themes and methods of nursing researches involving eye-tracking as a measurement, and offer suggestion for future nursing research using eye-tracking.

DESIGN

We conducted a scoping review following the methodology outlined in the JBI Manual for Evidence Synthesis on scoping reviews.

METHODS

Eligibility criteria were established based on Population (involving nursing or nursing students), Concept (utilizing eye-tracking as a research method), and Context (in any setting). Articles were retrieved from the PubMed, Web of Science, Embase, CINAHL, APA PsycInfo, and Scopus databases, spanning from database inception to November 17, 2023. The included studies were analysed using descriptive statistics and content analysis.

RESULTS

After duplicates were removed, 815 citations were identified from searches of electronic databases and other resources, and 66 met the inclusion criteria finally. Thirty-eight studies were conducted in a simulated environment. Five application domains were identified, and most of the studies (N = 50) were observational. The domains found in our review did not cover all topics of nursing research in the same depth. Additionally, 39 studies did not solely explicate eye-tracking data but instead integrated behavioural measures, scales/questionnaires, or other physiological data.

CONCLUSIONS

Eye-tracking emerges as a significant research tool in uncovering visual behaviour, particularly in nursing research focused on nursing education. This study not only summarized the application and interpretation of eye-tracking data but also recognized its potential in advancing clinical nursing research and practice. To effectively harness the capabilities of eye-tracking in elucidating cognitive processes, future research should aim for a clearer grasp of the theoretical underpinnings of the addressed research problems and methodological choices. It is crucial to emphasize the standardization of eye-tracking method reporting and ensuring data quality. No Patient or Public Contribution.

Eye-Tracking-Based Analysis of Situational Awareness of Nurses

BACKGROUND

Nurses are responsible for comprehensively identifying patient conditions and associated environments. We hypothesize that gaze trajectories of nurses differ based on their experiences, even under the same situation.

METHODS

An eye-tracking device monitored the gaze trajectories of nurses with various levels of experience, and nursing students during the intravenous injection task on a human patient simulator.

RESULTS

The areas of interest (AOIs) were identified in the recorded movies, and the gaze durations of AOIs showed different patterns between experienced nurses and nursing students. A state transition diagram visualized the recognition errors of the students and the repeated confirmation of the vital signs of the patient simulator. Clustering analysis of gaze durations also indicated similarity among the participants with similar experiences.

CONCLUSIONS

As expected, gaze trajectories differed among the participants. The developed gaze transition diagram visualized their differences and helped in interpreting their situational awareness based on visual perception. The demonstrated method can help in establishing an effective nursing education, particularly for learning the skills that are difficult to be verbalized.

Eye-tracking during simulation-based neonatal airway management

BACKGROUND

Eye-tracking devices help to understand provider behavior during medical tasks. The aim of this study was to assess participants' gaze behavior and usability of eye-tracking glasses during airway management in a simulated neonatal resuscitation.

METHODS

This study was an observational simulation-based study. The team member assigned to airway management wore head-mounted eye-tracking glasses. Main outcome measures were airway providers' gaze, dwell time (total amount of time a participant fixates certain areas of interest), and usability of eye-tracking glasses.

RESULTS

Data from 13 participants were included. There were significant differences in dwell time during the scenario (p < 0.001), with participants spending twice as much time on the newborn and instruments as on the monitor and other staff. Participants spent about 25% more time focusing on another provider while the provider was inserting the umbilical vein catheter than in all other times of interest (intervals of time with meaningful events) (p = 0.04). The use of the glasses was perceived easy and not disturbing.

CONCLUSIONS

Eye-tracking glasses enhance our understanding of providers' gaze and perspective during simulated neonatal airway management. Future studies will better characterize the ideal use in real situations.

Eye Tracking for Assessment of Situational Awareness in Bridge Resource Management Training

The purpose of this study is to experiment eye tracking in situational awareness assessment in Bridge Resource Management training of ship officers who play a critical role in maritime accidents. The maritime industry focuses on human factor developing and improving regulations including training requirements to prevent marine casualties. The mandatory Bridge Resource Management training as per international regulations includes assessment of situational awareness of trainees in full mission ship bridge simulators. The study involves capturing and analyzing eye movement data from maritime cadets and ship officers with sea experience in a simulation exercise. An eye tracking analysis software and eye tracking glasses are used for the study. Inferential and descriptive analyses were both used to validate the results. Significant differences were found between fixation duration measurements of novice cadets and experienced officers. Heat map visualizations also revealed differences in focuses of attention among participants. The evaluations of the certified simulator assessors are considered as the ground truth, and the results were compared to and discussed accordingly. The results show that the eye tracking technology is a valuable complementary tool for assessment of situational awareness in a simulator environment, utilized with the existing conventional observation and performance measurement methods. The study reveals that eye tracking provides the assessor with novel data in simulator based maritime training, such as focus of attention, which contributes to the evaluation of the situational awareness. The study, therefore, contributes to maritime education aiming to improve the effectiveness of Bridge Resource Management training. It also contributes to scientific research on eye movement in maritime field by proposing the integration of eye tracking in the Bridge Resource Management training.

Effects of Blindfold on Leadership in Pediatric Resuscitation Simulation: A Randomized Trial

Background: Pediatric resuscitations are rare events. Simulation-based training improves clinical and non-clinical skills, as well as survival rate. We assessed the effectiveness of using blindfolds to further improve leadership skills in pediatric simulation-based training. Methods: Twelve teams, each composed of 1 pediatric emergency fellow, 1 pediatric resident, and 2 pediatric emergency nurses, were randomly assigned to the blindfold group (BG) or to the control group (CG). All groups participated in one session of five simulation-based resuscitation scenarios. The intervention was using a blindfold for the BG leader for the scenarios B, C, and D. Three evaluators, who were blinded to the allocation, assessed leadership skills on the first and last video-recorded scenarios (A and E). Questionnaires assessed self-reported changes in stress and satisfaction about skills after the first and the last scenarios. Results: Improvement in leadership skills doubled in the BG compared with the CG (11.4 vs. 5.4%, p = 0.04), whereas there was no increase in stress or decrease in satisfaction. Conclusion: Blindfold could be an efficient method for leadership training during pediatric resuscitation simulated scenarios. Future studies should further assess its effect at a follow-up and on clinical outcomes after pediatric resuscitation.

Evaluation of emotional excitation during standardized endotracheal intubation in simulated conditions

Objective

To assess how stressful conditions in endotracheal intubation could induct emotional excitation in a population of acute care physicians.

Materials and methods

Two situations were randomly tested: one in standard and easy intubation conditions the other under difficult conditions presumed to induce stress (monitoring alarms, manikin lying on the floor, difficult intubation). Emotional excitation was assessed using several physiological (cardiac patterns, electrodermal activity and eye-tracking) and psycho-cognitive patterns. Auto-evaluations of video recordings and mental workload were performed immediately after simulation.

Results

Significant physiological parameter modifications were observed under the stressful intubation conditions (SDNN 35 ± 15 vs. 42 ± 21; p = 0.035—AVNN 514 ± 94 vs. 548 ± 110; p < 0.0001). Emotional excitation was demonstrated to lead a higher mental workload (NASA-TLX = 39 ± 18 vs. 63 ± 15; p = 0.001), frustration and effort dimensions being its determinant components (p < 0.01). Video recording auto-evaluations depicted significant emotional excitation occurrence under the difficult conditions, with few differences according to the operator’s experience.

Conclusion

This study highlights the fact that a stress condition during ETI on a simulation model leads to an important emotional excitation as compared to the neutral condition.

Mindfulness Meditation and Interprofessional Cardiopulmonary Resuscitation: A Mixed-Methods Pilot Study

PROBLEM

Mindfulness training includes mindfulness meditation, which has been shown to improve both attention and self-awareness. Medical providers in the intensive care unit often deal with difficult situations with strong emotions, life-and-death decisions, and both interpersonal and interprofessional conflicts. The effect of mindfulness meditation training on healthcare providers during acute care tasks such as cardiopulmonary resuscitation remains unknown. Mindfulness meditation has the potential to improve provider well-being and reduce stress in individuals involved in resuscitation teams, which could then translate into better team communication and delivery of care under stress. A better understanding of this process could lead to more effective training approaches, improved team performance, and better patient outcomes.

INTERVENTION

All participants were instructed to use a mindfulness meditation device (Muse™ headband) at home for 7 min twice a day or 14 min daily over the 4-week training period. This device uses brainwave sensors to monitor active versus relaxing brain activity and provides real-time feedback.

CONTEXT

We conducted a single-group pretest-posttest convergent mixed-methods study. We enrolled 24 healthcare providers, comprising 4 interprofessional code teams, including physicians, nurses, respiratory therapists, and pharmacists. Each team participated in a simulation session immediately before and after the mindfulness training period. Each session consisted of two simulated cardiopulmonary arrest scenarios. Both quantitative and qualitative outcomes were assessed.

OUTCOME

The median proportion of participants who used the device as prescribed was 85%. Emotional balance, as measured by the critical positivity ratio, improved significantly from pretraining to posttraining (p = .02). Qualitative findings showed that mindfulness meditation changed how participants responded to work-related stress, including stress in real-code situations. Participants described the value of time for self-guided practice with feedback from the device, which then helped them develop individual approaches to meditation not reliant on the technology. Time measures during the simulated scenarios improved, specifically, time to epinephrine in Scenario 1 (p = .03) and time to defibrillation in Scenario 2 (p = .02), improved. In addition, team performance, such as teamwork (p = .04), task management (p = .01), and overall performance (p = .04), improved significantly after mindfulness meditation training. Physiologic stress (skin conductance) improved but did not reach statistical significance (p = .11).

LESSONS LEARNED

Mindfulness meditation practice may improve individual well-being and team function in high-stress clinical environments. Our results may represent a foundation to design larger confirmatory studies.

Defibrillation safety: an examination of paramedic perceptions using eye-tracking technology

Objective

The importance of access to early defibrillation for patients in cardiac arrest has been emphasised as a critical part of the chain of survival by resuscitation bodies internationally; as such defibrillation has become a key procedure for many out-of-hospital emergency healthcare providers. However, little research has been undertaken specifically addressing students’ safety during defibrillation procedures. The objective of this study was to examine visual and verbal safety checks prior to defibrillation utilising eye-tracking technology.

Methods

This was an observational study of student safety during cardiac rhythm analysis, defibrillator charging and immediately prior to defibrillation during a resuscitation attempt using a medium fidelity mannequin. The participants completed two 10 min simulations each requiring three defibrillation attempts. The κ statistic was used to determine the agreement by the student of their perceived safety performance and that viewed in the video.

Results

In both scenarios the student's level of agreement for their perceived defibrillation safety performance and what was observed in the video decreased from defibrillation one to three in both scenarios. However, there was agreement in their overall defibrillation safety performance for both scenarios.

Conclusions

Student perceptions of their actions during defibrillation are not always an accurate representation of their actual actions.