Prue Andrus

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.

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.

Curriculum re-design in entry to practice nursing degrees requires a rigorous and multifaceted approach to align the needs of students, professional and industry stakeholders, community needs, the faculty’s vision and university and regulator requirements. This paper relates the initial steps in the process taken to achieve this re-design in one Australian university’s Bachelor of Nursing program, and describes our experiences in two parts. The first part outlines the context in which the need for curriculum renewal was triggered and the ensuing processes undertaken in the development of our new course aim, course outcomes and graduate attributes. The second part discusses how undertaking these activities then came to influence the adoption of Complexity Thinking in the design of our conceptual model, which then guided our program structure and overarching learning and teaching approaches. We share these experiences to illustrate the steps we undertook on this journey, to outline and example the program we created, and to continue the scholarly discussions around the design of baccalaureate nursing program structures, especially those that implement pedagogies inspired by the concepts related to Complexity Theory. The choice of complexity thinking as a guiding theory was key in providing the lens through which we were inspired to graduate nurses with the skills to provide care in complex situations and value the learning that comes through uncertainty, reflection, adaptation and emergence.

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.