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BACKGROUND: No instruments are currently available to assess nursing students' maintenance of situation awareness. The aim of this study was to develop and validate the Performance-Based Situation Awareness Observation Schedule for measuring nursing students' use of situation awareness. METHOD: Twelve expert clinicians participated in a qualitative, reiterative consensus-driven process to establish the content validity of the tool. The tool was then piloted during the delivery of a situation awareness education program for final-year nursing students. Cohen's kappa was used to assess the interrater reliability. RESULTS: The resultant tool comprised 54 items, which captured strategies to maintain situation awareness and task errors that would infer the presence of situation awareness. The values obtained for Cohen's kappa indicated that the level of agreement was at least substantial for approximately 80% of the items. CONCLUSION: This study developed a valid and reliable tool to measure nursing students' use of situation awareness. [J Nurs Educ. 2019;58(8):468-473.].

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This study compared final year nursing students' error rate and use of strategies to maintain SA when undertaking specific nursing care in a simulated clinical environment pre and 10 weeks post a planned SA education intervention. Students were observed using a Performance Based Situation Awareness Observation Schedule (PBSAOS) undertaking two tasks in a simulated clinical environment pre and post the SA education. For task 1, post educational intervention, there was no significant increase in the error rate for any performance measures, and there were significant decreases in the error rates for three performance measures. For task 2, post educational intervention, there was a significant decrease in the error rate for two measures and a significant increase in the error rates for seven performance measures. In considering the overall group error rate when excluding uncompleted tasks, there was a significant (x = .0001) decrease in the error rate for task 1 post educational intervention (41.4% compared to 26.6%), and significant (x = 0.01) increase in the error for task 2 post educational intervention (39.6% compared to 47.3%). The findings of this study demonstrate that the implementation of an intervention designed to increase SA actually appear to have resulted in hyper-vigilance and subsequent non-completion of required tasks.

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Background: Increasing health professional student numbers in Australia, in response to looming predicted workforce shortages, resulted in a Federal Government call for action to provide clinical supervision education to health professionals. Objectives: This research aimed to develop, implement and evaluate the programme, 'The Art of Clinical Supervision' (ACS), designed to support nurses facilitate a positive learning environment for student nurses. Method: The ACS programme was presented (n = 199) across Western Australia as a doctoral study, with participants from both the public and private healthcare sector working in a variety of specialties. A triangulation approach of surveys, reflective entries and interviews was utilised to determine its impact. Results: The data indicated that participants improved their understanding of supervision and attitude towards students and supervision after attending the ACS. Conclusions: Health service managers are encouraged to evaluate their staffs' knowledge and attitude towards students with findings used to facilitate a positive learning culture.Impact Statement: The Art of Clinical SupervisionThe purpose of the research was to develop, implement and review a new education programme that could support the development of clinical supervision knowledge and attitude to support student nurse learning. This occurred in an environment of increased student numbers as a strategy to correct a predicted looming workforce shortage.The study findings determined that the programme improved both participant knowledge about how to provide effective clinical supervision (teaching) in the clinical environment, and improved staff attitudes towards students and their place as a learner in the clinical areas.The type of impact was therefore within the domain of quality by improving student learning through effective education strategy.As a result of the doctoral research, involving 200 participants, a Federal Government grant of approx. $500,000 was received to facilitate the training of additional educators to provide the programme across the state of Western Australia. This grant was a partnership between the programme author (researcher) and the Western Australian Government Department of Health. This involved four educators presenting the programme to over 3,000 health professionals in a 3-year period. Despite the cessation of funds with the closure of HWA the programme continues to be delivered through The University of Notre Dame Australia School of Nursing and Midwifery, with only a cost recovery charge.

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Medication errors involving patients are a serious concern in healthcare practice. Nurses, more than any other healthcare professional group, are principally involved in medicines administration. This article recognises the complexity of why medication errors occur and considers the many factors involved, including those from an individual and organisational system perspective. It adopts a solution-focused approach, based on the evidence underpinning the knowledge of medication errors.

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Purpose The purpose of this paper is to understand the perceptions and experiences of healthcare managers working within a community and ambulatory health service who manage poorly performing staff and, to identify the supports, and gaps in supports, that are available to these managers. Design/methodology/approach Data were collected via two focus groups using a semi-structured schedule. The data were transcribed, themed and conclusions summarised. Findings On analysis of the discussion of the line managers' experiences and perceptions of competence, six themes were identified, five themes common to both groups. When discussing the availability and gaps in supports available when managing poor performance, managers were aware of the majority of the supports available to them in the workplace but there was a disconnect between managers and the HR department. Research limitations/implications Though the results of this study are not generalisable, as the participants came from programs within a single hospital, they may be transferrable to other healthcare environments. Future research should attempt to replicate these findings using other research techniques. Practical implications The findings in this paper indicate that methods should be identified to build better relationships between managers and HR departments, develop clear management learning pathways, and to support managers to manage their emotional responses. These strategies will support organisations to achieve improved outcomes from the performance management processes. Originality/value This study contributes to the current literature by identifying key themes that may have an impact on the outcome of performance management processes. These themes would benefit from further exploration.

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BACKGROUND: Several studies report that patient safety skills, especially non-technical skills, receive scant attention in nursing curricula. Hence, there is a compelling reason to incorporate material that enhances non-technical skills, such as situation awareness, in nursing curricula in order to assist in the reduction of healthcare related adverse events. OBJECTIVES: The objectives of this study were to: 1) understand final year nursing students' confidence in their patient safety skills; and 2) examine the impact of situation awareness training on final year nursing students' confidence in their patient safety skills. METHODS: Participants were enrolled from a convenience sample comprising final year nursing students at a Western Australia university. Self-reported confidence in patient safety skills was assessed with the Health Professional in Patient Safety Survey before and after the delivery of a situation awareness educational intervention. Pre/post educational intervention differences were examined by repeated measures ANOVA. RESULTS: No significant differences in confidence about patient safety skills were identified within settings (class/clinical). However, confidence in patient safety skills significantly decreased between settings i.e. nursing students lost confidence after clinical placements. CONCLUSION: The educational intervention delivered in this study did not seem to improve confidence in patient safety skills, but substantial ceiling effects may have confounded the identification of such improvement. Further studies are required to establish whether the findings of this study can be generalised to other university nursing cohorts.

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Effective management of the deteriorating patient requires early recognition of the signs of deterioration, timely review and appropriate interventions. However, this does not always occur. Errors in the recognition and management of a deteriorating patient are rarely related to a single factor; rather they are a complex interaction of system and human factors. This article presents a case study focusing on understanding the factors that led to errors resulting in the death of a patient. Understanding the complex interaction of system and human factors enables the identification of strategies that could be used to decrease the likelihood of a similar incident occurring.

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The Art of Clinical Supervision program was developed, implemented, and evaluated to determine nursing staff knowledge of and attitudes toward nursing students and the clinical supervision thereof. A key point of the program was the inclusion of strategies to promote one's attitude toward working with students. A mixed methods approach of surveys, online reflections, and interviews was used to determine the program's effect. The findings highlighted a positive impact on participants' self-knowledge and attitudes toward students and student clinical supervision.

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Situation awareness describes an individual's perception, comprehension and subsequent projection of what is going on in the environment around them. The concept of situation awareness sits within the group of non-technical skills that include teamwork, communication and managing hierarchical lines of communication. The importance of non-technical skills has been recognised in safety-critical industries such as aviation, the military, nuclear, and oil and gas. However, health care has been slow to embrace the role of non-technical skills such as situation awareness in improving outcomes and minimising the risk of error. This article explores the concept of situation awareness and the cognitive processes involved in maintaining it. In addition, factors that lead to a loss of situation awareness and strategies to improve situation awareness are discussed.

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Learning from adverse events and errors is important if systems and processes are to be improved and to minimise the likelihood of similar events in the future. This article uses the report from a coroner's inquest into the death of a seven-year-old child in hospital to examine errors that contributed to the child's death. These errors are reviewed from a human factors perspective. The article provides an overview of error causation concepts and offers strategies that healthcare organisations can implement to reduce the incidence of such errors.

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Patient-centred care is a model of care that respects the patient's experience, values, needs and preferences in the planning, co-ordination and delivery of care. A central component of this model is a therapeutic relationship between the patient and the team of healthcare professionals. The implementation of a patient-centred care model has been shown to contribute to improved outcomes for patients, better use of resources, decreased costs and increased satisfaction with care. This article provides an overview of the barriers to providing patient-centred care and identifies strategies that can be implemented to overcome them.

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Teamwork requires co-operation, co-ordination and communication between members of a team to achieve desired outcomes. In industries with a high degree of risk, such as health care, effective teamwork has been shown to achieve team goals successfully and efficiently, with fewer errors. This article introduces behaviours that support communication, co-operation and co-ordination in teams. The central role of communication in enabling co-operation and co-ordination is explored. A human factors perspective is used to examine tools to improve communication and identify barriers to effective team communication in health care.

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Healthcare-associated infections (HCAIs) continue to be a challenge in developed and developing countries. Hand hygiene practice is considered to be the most effective strategy to prevent HCAIs, but healthcare workers' compliance is poor. Using a human factors perspective, this article explores elements that affect healthcare workers' hand hygiene compliance. Slips, lapses and mistakes can occur depending on the worker's skills and knowledge levels. Violations of protocols may also occur, and these may be associated with the intention to provide care efficiently. Strong leadership and an understanding of why non-compliance with hand hygiene occurs assists with developing strategies to improve compliance.

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Human beings are error prone. A significant component of human error is flaws inherent in human cognitive processes, which are exacerbated by situations in which the individual making the error is distracted, stressed or overloaded, or does not have sufficient knowledge to undertake an action correctly. The scientific discipline of human factors deals with environmental, organisational and job factors, as well as human and individual characteristics, which influence behaviour at work in a way that potentially gives rise to human error. This article discusses how cognitive processing is related to medication errors. The case of a coronial inquest into the death of a nursing home resident is used to highlight the way people think and process information, and how such thinking and processing may lead to medication errors.

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AIM: This paper reports the first part of a case study investigation to examine the changes at King Edward Memorial Hospital (KEMH) following an inquiry established to review the quality of obstetric and gynaecological services. BACKGROUND: Common findings from a range of health inquiries in recent times include that there have been inadequate adverse event reporting systems, the absence of transparent systems for staff and patients to report concerns about quality of patient care, and an ineffective medical credentialing and performance review system. The similarity of findings from many health inquiries raises the question of whether an inquiry does lead to changes to improve patient care and safety. There has been very little reported in the literature about this. METHOD: Using a case study strategy the areas of medical credentialing, performance review and involvement of consumers in care were chosen as the KEMH clinical governance processes to be examined for changes post inquiry. Documents, archives and interviews were used as data sources for this case study. Documents were examined using a normative analytic approach and the Miles and Huberman framework was used for data analysis of the interviews. FINDINGS: There were significant changes in the area of credentialing and performance review evident in analysis of all sources of data. There were some improvements in the processes of involving consumers in care, but deficits were identified in regard to the provision of training and upskilling for clinicians to improve their communication skills and interactions with patients and families.

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