Abstract
When nurses make natural decisions in practical settings, appropriate actions to decrease errors and improve patient safety follow decisions based on proper situational awareness that includes integration of past experiences, the current situation, and future predictions. We established an observational setting where nurses performed environmental arrangement to serve as a setting where they could practice routine situational awareness. This provided an opportunity to consciously practice situational awareness during observation in this setting and then measure cerebral blood flow in the same setting. The aims of this design were to elucidate the effects on cerebral blood flow by comparing different methods of practicing situational awareness and to investigate effective methods of practicing situational awareness. We performed a randomized, comparative study of different situational awareness methods with 61 nurses with experience of working in hospital wards. These nurses were randomly assigned to one of three groups according to the different situational awareness methods (writing, oral, and implicit groups). We measured cerebral blood flow changes using the near infrared spectroscopy device placed at two positions on the participant's forehead. A visual analog scale was used for the subjective evaluation of participant characteristics. For statistical analyses, we used a Wilcoxon test to compare the results for each group before and after implementing situation awareness methods; Kruskal–Wallis or Mann–Whitney tests and Bonferroni procedure were used to compare the results between three groups. The provision of opportunities to practice situational awareness had the following effects on cerebral blood flow: (1) left and right total Hb values increased after situational awareness in both the writing and oral groups; (2) right total Hb values in the pre-situational awareness task in the oral group were high; and (3) left and right total Hb values during situational awareness were high in the oral group. The use of writing and oral methods by nurses for situational awareness was found to promote the brain activity not only during the process of situational awareness but also during the observations after situational awareness.
Highlights
Healthcare professionals make various natural decisions based on their experiences and knowledge to decrease errors and improve patient safety [1]
The provision of opportunities to practice situational awareness had the following effects on cerebral blood flow: (1) left and right total Hb values increased after situational awareness in both the writing and oral groups; (2) right total Hb values in the pre-situational awareness task in the oral group were high; and (3) left and right total Hb values during situational awareness were high in the oral group
The effects that providing opportunities to practice situational awareness had on cerebral blood flow were identified when we compared pre- and post-situational awareness values
Summary
Healthcare professionals make various natural decisions based on their experiences and knowledge to decrease errors and improve patient safety [1]. When nurses make natural decisions in practical settings, decisions that are based on proper situational awareness, including the integration of past experiences, the current situation, and future predictions, lead to appropriate actions [3]. Situational awareness cannot be achieved unconsciously by the individual on the basis of previous individual knowledge or experience. It is not dependent on the individual’s abilities or responsibilities. It is important to encourage appropriate behavior by creating opportunities to promote appropriate situational awareness. There have been previous reports that have measured situational awareness using an assessment tool [4] and that have discussed the importance of integrating information [1] and the necessity for education and training [5]. The effects of creating opportunities for situational awareness and methods to promote situational awareness have not been clarified
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