Ayako Nishimura
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.