Nurses' cognitive and perceptual bias in the identification of clinical deterioration cues
- Authors: Al-Moteri, Modi , Cooper, Simon J. , Symmons, Mark , Plummer, Virginia
- Date: 2020
- Type: Text , Journal article
- Relation: Australian Critical Care Vol. 33, no. 4 (2020), p. 333-342
- Full Text: false
- Reviewed:
- Description: Background: Perception and processing of clinical cues have rarely been investigated in the nursing literature despite their relevance to the early identification and management of clinical deterioration. Aim: This study used a hypovolemic shock scenario from the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACT) virtual simulation program, equipped with an eye tracker, to investigate cue processing during the management of patient deterioration. Result: The study revealed that attention deviation distorted interpretation of subsequent cues, causing 63% of participants to exhibit a cognitive bias (heightened sensitivity to specific but noncritical cues) and 65% to exhibit at least one episode of nonfixation on clinically relevant cues. Attention deviation and distorted interpretations of clinical cues will have an impact on patient safety. Conclusion: The findings are likely to have important implications for understanding error and associated training implications. © 2019 Australian College of Critical Care Nurses Ltd
Inattentional blindness and pattern-matching failure : The case of failure to recognize clinical cues
- Authors: Al-Moteri, Modi , Symmons, Mark , Cooper, Simon J. , Plummer, Virginia
- Date: 2018
- Type: Text , Journal article
- Relation: Applied Ergonomics Vol. 73, no. (2018), p. 174-182
- Full Text: false
- Reviewed:
- Description: Eye-tracking methodology was used to investigate lapses in the appropriate treatment of ward patients due to not noticing critical cues of deterioration. Forty nursing participants with different levels of experience participated in an interactive screen-based simulation of hypovolemic shock. The results show that 65% of the participants exhibited at least one episode of non-fixation on clinically relevant, fully visible cues that were in plain sight. Thirty-five percent of participants dwelt for sufficient time (>200 ms) on important cues for perception to take place, but no action followed, indicating they had pattern-matching failure. When participants fail to notice what, they should notice in patient status until it is too late, this can have serious consequences. Much work needs to be done, since these human perceptual limitations can affect patient safety in general wards.
Eye tracking to investigate cue processing in medical decision making : A scoping review
- Authors: Al-Moteri, Modi , Symmons, Mark , Plummer, Virginia , Cooper, Simon J.
- Date: 2017
- Type: Text , Journal article , Review
- Relation: Computers in Human Behavior Vol. 66, no. (2017), p. 52-66
- Full Text: false
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- Description: Eye-tracking techniques have been adopted as a research tool for a wide range of applications in healthcare studies. Recently, healthcare researchers have started to show interest in using eye-tracking techniques to study medical decision-making. Mapping the literature pertaining to eye tracking using a systematic approach is valuable at this point to bring together all the studies to date on how medical decision-makers make decisions, and the results may contribute to clinical training. This review follows Arksey and O'Malley's scoping review framework to improve our understanding of visual cue processing in medical decision-making. A diverse range of studies was identified, and the results are presented descriptively to develop a more coherent understanding of different aspects of cue processing and errors in medical decision-making. The review shows the need for more extensive investigations of cue processing and medical decision-making. Crown Copyright (C) 2016 Published by Elsevier Ltd. All rights reserved.
Clinical deterioration of ward patients in the presence of antecedents : A systematic review and narrative synthesis
- Authors: Al-Moteri, Modi , Plummer, Virginia , Cooper, Simon J. , Symmons, Mark
- Date: 2019
- Type: Text , Journal article , Review
- Relation: Australian Critical Care Vol. 32, no. 5 (2019), p. 411-420
- Full Text: false
- Reviewed:
- Description: Aim: The aim of this review was to identify and synthesise published accounts of recognising and responding to patient deterioration in the presence of deterioration antecedents. Design: The systematic review canvassed four electronic databases/ search engines for studies of adult ward patients who had altered physiological parameters before developing major adverse events. Synthesis Methods: The findings were synthesised using a narrative approach. Results: Clinical deterioration can be missed by nurses, even with adequate charting. Delays in recognising and responding to patient deterioration remains an international patient safety concern, and strategies to enhance recognition of patient deterioration have not achieved consistent improvements. The lack of significant and sustained improvement through targeted training suggests the problem may be rooted in human behaviour and local ward culture. Nurses play a pivotal role in recognising and responding to patient deterioration; however, patient records do not facilitate tracking of all nurse decisions and actions, and any undocumented care cannot be easily captured by auditing processes. Conclusion: Failure to recognise clinical deterioration was evident even with adequate charting. It is not clear if nurses do not recognise clinical deterioration because they failed to interpret the signs of deterioration or they made a conscious decision not to escalate based on their clinical judgement or they lacked attention at the time of the event. Whatever the reason, focus is warranted for nurses' decisionmaking after the recording of clinical deterioration signs and the role of human factors in delayed recognition, before maximum benefit of any strategy can be achieved.