Predictors of Situation Awareness in Graduate Student Registered Nurse Anesthetists

摘要

ABSTRACT PREDICTORS OF SITUATION AWARENESS IN GRADUATE STUDENT REGISTERED NURSE ANESTHETISTS Suzanne M. Wright, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2009 Major Director: J. James Cotter, Ph.D. Situation awareness (SA) is defined as one’s perception of the elements of the environment, the comprehension of their meaning, and the projection of their status in the near future. Stated more simply, SA is knowing what is going on around you. The concept of SA is well known in the field of aviation which is characterized by complexity and dynamism. The discipline of anesthesia shares these same characteristics, yet the study of SA in this setting is in its infancy. Human error has been implicated in nearly 80% of all preventable medical errors. It is well documented that lack of SA frequently contributes to human error. Although the discipline of anesthesia has led the medical field in patient safety through rigorous study of human error and adverse events in the operating room, crises in anesthesia still exist. Nurse anesthetists should possess the ability to acquire and maintain SA at all times during clinical situations in the operating room, yet there are no studies examining SA in this population. Guided by Endsley’s theory of situation awareness, the purpose of this study was to provide nurse anesthesia educators with a best evidence predictor model of SA in GSRNAs for curricular implementation. The study objectives are to determine: a) the extent to which memory, cognition, and automaticity are related to situation awareness, b) the extent to which any relationship amongst memory, cognition, and automaticity mediates their relationship with situation awareness, and c) the extent to which Endsley’s theory of situation awareness is supported in the GSRNA population. After IRB approval, 71 GSRNAs were randomly selected from each of three universities chosen for this study. A non-experimental, correlational design was used to measure the relationship between memory, cognition, and automaticity and SA. Situation awareness was measured by the WOMBAT-CS, a computer-based assessment tool for evaluating SA in complex-system operators such as pilots, air traffic controllers, and anesthetists. A stepwise multiple regression was performed between the GSRNA attributes and SA scores. Beta-weights were used to identify the magnitude each relationship. Findings from this study revealed that cognition best predicts SA in the population of Graduate Student Registered Nurse Anesthetists, with the addition of memory and automaticity contributing no additional predictive value to the model. The results of this study have the potential to make a positive impact on the education and training of GSRNAs. Additionally, this study may provide foundational support for further research directed at assessing the effectiveness of high-fidelity simulated operating room environments in promoting SA in GSRNAs.