Evaluation of a 3M (mistakes, mentoring, and mastery) training program for transfer of control situations in a level 2 automated driving system

Drivers must actively supervise automation as it can only function in limited conditions. A failure to supervise the system has negative consequences in terms of missed requests to take over control and may cause crashes or jeopardize safety. The objective of this study is to determine the effect of a novel, 3M (Mistakes, Mentoring, and Mastery) training program on drivers' behavior while using level 2 driving automation systems. To achieve this, 36 participants were assigned randomly to three different training programs (3M training, User manual, and Placebo) and drove through scenarios on a fixed-based driving simulator. The results showed that drivers in the 3M training group took back control more effectively when the driving automation system reached its limits compared to drivers who received User manual or Placebo training. Drivers in the 3M training Group also had higher situation awareness and improved trust in automation. The results indicate that an interactive approach to training with regards to vehicle automation can help drivers more safely interact with automation systems.

Physiological records-based situation awareness evaluation under aviation context: A comparative analysis

Situational Awareness (SA) assessment is of paramount importance in various domains, with particular significance in the military for safe aviation decision-making. It involves encompassing perception, comprehension, and projection levels in human beings. Accurate evaluation of SA statuses across these three levels is crucial for mitigating human false-positive and false-negative rates in monitoring complex scenarios in the aviation context. This study proposes a comprehensive comparative analysis by involving two types of physiological records: electroencephalogram (EEG) signals and brain electrical activity mapping (BEAM) images. These two modalities are leveraged to automate precise SA evaluation using both conventional machine learning and advanced deep learning techniques. Benchmarking experiments reveal that the BEAM-based deep learning models attain state-of-the-art performance scores of 0.955 for both SA perception and comprehension levels, respectively. Conversely, the EEG signals-based manual feature extraction, selection, and classification approach achieved a superior accuracy of 0.929 for the projection level of SA. These findings collectively highlight the potential of deploying diverse physiological records as valuable computational tools for enhancing SA evaluation throughout aviation decision-making safety.

Exploring eye-tracking data as an indicator of situational awareness in nursing students during a cardiorespiratory arrest simulation

AIM

To examine the components of visual attention that maintain situational awareness during simulation training in undergraduate nursing students with different instruction levels.

BACKGROUND

Eye-tracking can provide deep insight into the nurses' attention during simulated practice. Knowing which gaze patterns promote situational awareness can significantly improve nurse instruction.

DESIGN

A comparative observational study investigated the role of visual attention on the performance quality, psychophysiological parameters (vital signs, anxiety and stress) and socioemotional competencies (cognitive workload, motivation and self-efficacy) of nursing students with various experience levels.

METHODS

Thirty nursing students divided into two groups according to their academic level: first cycle (n=14) and second-cycle (n=16) faced a clinical simulation scenario to resolve a cardiorespiratory arrest event. Eye tracking-based analysis required the selection of six areas of interest. The monitorization of vital signs included measuring blood pressure, heart rate, respiratory rate and oxygen saturation before and after the simulation practice. Participants completed the socioemotional questionnaire (NASA-TLX). They answered the state subscale of the State-Trait Anxiety Inventory (STAI), the Visual Analogue Scale (VAS) of stress, the Situational Motivation Scale (SIMS) and the Baessler and Schwarzer General Self-Efficacy Scale.

RESULTS

The first-cycle group displayed higher vital sign scores than the second cycle, apart from the post-simulation respiratory rate. All physiological parameters increased in mean value after the clinical simulation, except oxygen saturation. Anxiety was the only parameter in the socioemotional domain to present a statistically significant difference between the groups. First-year nursing students showed greater anxiety, stress, mental workload, identified regulation and intrinsic motivation, while second-year students showed higher levels of amotivation, external regulation and perceived self-efficacy. Eye-tracking data (revisits, gaze and duration of fixations) exhibited statistically significant differences depending on the area of interest in both groups (p =. 05). The performance outcomes showed a negative and moderate association with gaze the total number of gazes in the second-cycle group (rho = -0.640, p = 0.010).

CONCLUSION

Eye-tracking-based analysis can help to predict performance quality while maintaining situational awareness during nursing instruction.

Effect of a looming visual cue on situation awareness and perceived urgency in response to a takeover request

This study aimed to investigate the effect of a looming visual cue on situation awareness and perceived urgency in response to a takeover request (TOR), and to explore the underlying mechanisms of this effect through three experiments. In Experiment 1, the optimal size and speed of a red disk were determined, which were effective in capturing looming motion and conveying the urgency of the situation. The results indicated that both looming speed and size ratio had significant effects on situation awareness and perceived urgency. In Experiment 2, the effects of looming stimuli were compared with dimming stimuli, and the results showed that the looming visual cue was more effective in promoting perceived urgency and situation awareness. The results also indicated that the looming visual cue attracted more visual attention than the dimming visual cue, in line with previous studies. Experiment 3 utilized a driving simulator to test the effectiveness of the looming visual cue in promoting fast and appropriate responses to TORs in complex driving scenarios. The results showed that the looming visual cue was more effective in promoting perceived urgency and enhancing situation awareness, especially in highly complex driving situations. Overall, the findings suggest that the looming visual cue is a powerful tool for promoting fast and appropriate responses to TORs and enhancing situation awareness, particularly in complex driving scenarios. These results have important implications for designing effective TOR systems and improving driver safety on the road.

"What we talk about is creating a probability": Exploring the interaction between the anticipation and decision-making processes of professional bowlers and batters in Twenty20 cricket

Expert performers in time constrained sports use a range of information sources to facilitate anticipatory and decision-making processes. However, research has often focused on responders such as batters, goalkeepers, defenders, and returners of serve, and failed to capture the complex interaction between opponents, where responders can also manipulate probabilities in their favour. This investigation aimed to explore the interaction between top order batters and fast or medium paced bowlers in cricket and the information they use to inform their anticipatory and decision-making skills in Twenty20 competition. Eleven professional cricketers were interviewed (8 batters and 3 bowlers) using semi-structured questions and scenarios from Twenty20 matches. An inductive and deductive thematic analysis was conducted using the overarching themes of Situation Awareness (SA) and Option Awareness (OA). Within SA, the sub-themes identified related to information sources used by bowlers and batters (i.e., stable contextual information, dynamic contextual information, kinematic information). Within OA, the sub-themes identified highlighted how cricketers use these information sources to understand the options available and the likelihood of success associated with each option (e.g., risk and reward, personal strengths). A sub-theme of 'responder manipulation' was also identified within OA to provide insight into how batters and bowlers interact in a cat-and-mouse like manner to generate options that manipulate one another throughout the competition. A schematic has been developed based on the study findings to illustrate the complex interaction between the anticipation and decision-making processes of professional top order batters and fast or medium paced bowlers in Twenty20 cricket.

Sharing imagery and analysis tools in a simulated submarine control room

We examined the impact of sharing periscope imagery and analysis tools in eighteen five-member teams (Sonar, Periscope, 2xTrack Motion Analysts, Track Manager) who undertook simulated submarine patrol tasks. Compared to a baseline condition, sharing imagery to team members increased perceived individual workload, with no improvement to team performance (tactical picture accuracy). When both imagery and analysis tools were shared, perceived workload increased and tactical picture compilation was more accurate. Despite this improved tactical picture for the imagery and analysis tools condition, there was no advantage to mission completion (rendezvous/close contact detection) or situation awareness. In contrast to the increased subjective workload, individuals in teams provided with shared imagery (with or without tools) had a lower physiological response (heart rate, electrodermal) to task demands compared to the baseline condition. Sharing imagery and analysis tools likely benefited tactical picture compilation by enabling dynamic task redistribution and multiple streams of concurrent data analysis.

Identifying firefighters' situation awareness requirements for fire and non-fire emergencies using a goal-directed task analysis

A firefighter's situation awareness (SA) is considered crucial to making effective tactical decisions and actions at the scene. Despite the importance of the firefighter's SA, there have been limited research efforts to understand what cues and information firefighters use to assess ongoing situations and predict future conditions. In addition to fire events, contemporary firefighters respond to an increasing volume of non-fire incidents. Thus, this study aims to identify firefighters' SA during three fire incidents (single house fire, vehicle fire, and passenger aircraft fire) and three non-fire incidents (medical emergency, hazardous materials, and urban search and rescue). A goal-directed task analysis was conducted via focus group discussions with eight career firefighters. Findings indicate that firefighters build their SA by processing various cues from hazards (e.g., fire, ignition source), humans (e.g., occupants, bystanders, drivers, passengers), spatial elements (e.g., building structure, location of hazards), and surrounding conditions (e.g., traffic, weather). Our findings provide insights into SA measurement, SA-oriented work processes, training for SA, and designing technologies to support firefighters' SA during all-hazard responses.

Anticipatory information makes the difference: Behavioral effects and user assessments of a cyclist warning system to enhance cyclists' situation awareness

PROBLEM

Increasing numbers of crashes involving pedelecs, and particularly older pedelec users, induce a need to enhance cycling safety. We evaluated a prototype cyclist warning system (CWS) that aims to increase situation awareness (SA) by alerting to safety critical events (SCE) with trimodal (auditory, visual, tactile).

METHOD

To investigate the effects of CWS usage, we conducted a 2x2 mixed design bicycle simulator study with factors (1) CWS usage (within: rides WITH vs. WITHOUT CWS) and (2) age group (between: younger vs. older cyclists) on braking reaction time, gaze behavior, mental workload, and perceived safety. In sum, N = 64 participants (n = 32 younger, 18-40 years; n = 32 older, ≥ 55 years) took part in the study and experienced two balanced blocks of short rides including SCE of particular relevance for cycling safety.

RESULTS

CWS usage resulted in earlier braking reactions to all investigated SCE and partly earlier fixation on the critical interaction partners (CIP) indicating increased cyclists' SA. Consistently to behavioral measures, participants' assessments regarding perceived safety further supported the safety improvements derived from CWS independently of age group. Moreover, CWS usage did not add to mental workload ratings. Age effects were selectively found for gaze data showing that across all SCE, older adults fixated longer and more frequently on street alignment, and less frequently on other road users.

DISCUSSION

Taken together, the CWS evaluation showed promising results indicating the potential of the tested CWS to increase SA and enhance cyclists' safety both on a behavioral level and regarding subjective assessments. Further research should address the systems' safety potential under real-world conditions and for situations of higher complexity.

PRACTICAL APPLICATIONS

Understanding the potential impact of road safety measures such as CWS is important to contribute effectively to reducing SCE.

Human-centered visualization technologies for patient monitoring are the future: a narrative review

Medical technology innovation has improved patient monitoring in perioperative and intensive care medicine and continuous improvement in the technology is now a central focus in this field. Because data density increases with the number of parameters captured by patient-monitoring devices, its interpretation has become more challenging. Therefore, it is necessary to support clinicians in managing information overload while improving their awareness and understanding about the patient's health status. Patient monitoring has almost exclusively operated on the single-sensor-single-indicator principle-a technology-centered way of presenting data in which specific parameters are measured and displayed individually as separate numbers and waves. An alternative is user-centered medical visualization technology, which integrates multiple pieces of information (e.g., vital signs), derived from multiple sensors into a single indicator-an avatar-based visualization-that is a meaningful representation of the real-world situation. Data are presented as changing shapes, colors, and animation frequencies, which can be perceived, integrated, and interpreted much more efficiently than other formats (e.g., numbers). The beneficial effects of these technologies have been confirmed in computer-based simulation studies; visualization technologies improved clinicians' situation awareness by helping them effectively perceive and verbalize the underlying medical issue, while improving diagnostic confidence and reducing workload. This review presents an overview of the scientific results and the evidence for the validity of these technologies.

Dynamical biomarkers in teams and other multiagent systems

Effective team behavior in high-performance environments such as in sport and the military requires individual team members to efficiently perceive the unfolding task events, predict the actions and action intents of the other team members, and plan and execute their own actions to simultaneously accomplish individual and collective goals. To enhance team performance through effective cooperation, it is crucial to measure the situation awareness and dynamics of each team member and how they collectively impact the team's functioning. Further, to be practically useful for real-life settings, such measures must be easily obtainable from existing sensors. This paper presents several methodologies that can be used on positional and movement acceleration data of team members to quantify and/or predict team performance, assess situation awareness, and to help identify task-relevant information to support individual decision-making. Given the limited reporting of these methods within military cohorts, these methodologies are described using examples from team sports and teams training in virtual environments, with discussion as to how they can be applied to real-world military teams.

Supervising the self-driving car: Situation awareness and fatigue during highly automated driving

Vehicle automation promises to reduce the demands of the driving task, making driving less fatiguing, more convenient, and safer. Nevertheless, Level 3 automated vehicles rely on a human driver to be ready to resume control, requiring the driver to reconstruct situation awareness (SA) and resume the driving task. Understanding the interaction between non-driving-related task (NDRT) use, SA, and takeover capacity is important because an effective takeover is entirely dependent on, and scaffolds from, effectively reconstructed SA. While a number of studies have looked at the behavioural impact of being 'in- or on-the-loop', fewer consider the cognitive impact, particularly the consequences for SA. The present study exposed participants to an extended simulated automated drive involving two critical takeover scenarios (early- and late-drive). We compared automated vehicle (AV) operators who were required to passively monitor the vehicle to those engaging with self-selected NDRTs. Monitoring operators demonstrated lower total- and schema-specific SA count scores following a fatiguing drive compared to those engaging with self-selected NDRTs. NDRT engagement resulted in no significant difference in SA count scores early- and late-drive. Assessment of differences in the type and sensory modality of NDRTs indicated operators make fundamentally different selections about the NDRTs they engage with in an automated driving environment compared to a manual environment. The present study provides further evidence linking SA and AV operator behaviour and underscores the need to understand the role of SA in takeover capacity. Our findings suggest that although SA declines over time regardless of driving task requirements (Monitoring versus NDRT engagement), NDRT use may facilitate better SA construction, with implications for the regulation of NDRT use in AVs as the technology progresses.

Measuring situation awareness in health care providers: a systematic review of measurement properties using COSMIN methodology

BACKGROUND

Situation awareness (SA) is a key factor in accountability and ensuring patient safety in health care. SA is an essential element to research on human factors in healthcare. It is essential to identify valid instruments for measuring this concept and assessing how it is affected by interventions and educational methods.

METHODS

This systematic review aimed to assess the measurement properties of situation awareness instruments in health care providers' (HCP_S) using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Four databases (Medline (through PubMed), Embase, Scopus, and Web of Science) were systematically searched. A manual search was also conducted on Google Scholar and the reference list of the included primary studies to supplement the electronic search. Studies aiming to determine the measurement properties of SA instruments or non-technical skills in HCP_S were included. The overall results for each measurement property were reported as sufficient, insufficient, inconsistent, or indeterminate, and the quality of evidence was reported as high, moderate, low, or very low.

RESULTS

A total of 25 studies and 15 instruments were included in the study. More than one measurement property was reported in some of the studies, and none of the studies presented all measurement properties. The most common measurement properties were content validity (12/25) and internal consistency (12/25). Cross-cultural validity and responsiveness were not investigated in any study. Evidence quality for the measurement properties was not high in any of the 15 instruments.

CONCLUSIONS

None of the instruments can be recommended as the most suitable instrument, and all instruments were classified as promising instruments in need of further psychometric assessment. This systematic review proves the dire need for the development and psychometric evaluation of instruments to measure SA in HCPs in clinical settings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020147349.

Influencing factors of novice pilot SA based on DEMATEL-AISM method: From pilots' view

Pilot situation awareness (SA) regulates flight safety, and inexperience may impair novice pilot reliability in SA. This study aims to determine the key influencing factors of novice pilot SA and to analyze the interrelationship and interaction mechanism of the factors. We investigated 55 novice pilots trained at aviation schools and identified the influencing factor index system by the Delphi survey. The method of Decision Making Trial and Evaluation (DEMATEL) combined with Adversarial Interpretive Structure Modeling (AISM) was adopted. The results show that: (1) The influencing factor index system includes 18 factors, divided into four categories: individual factors, team factors, task and human-machine system factors, and cockpit environment factors. (2) Team communication, team cooperation, basic cognitive ability, interface design, occupational age and experience, and authority gradient are the six crucial influencing factors. The former three have the greatest association with other factors, while the latter three are most likely to affect other factors. (3) Team communication, basic cognitive ability, and interface design are root-cause factors, of which team communication is the most fundamental. (4) The results of DEMATEL and AISM are consistent, both disclosing team communication as the fundamental factor with the highest priority, and cockpit environmental factors as the direct influencing factors but most susceptible to other factors. The present study can be viewed as a conducive attempt to extract vital influencing factors of novice pilot SA, and to provide ergonomic insights for determining the priorities to improve novice pilot SA in training and aircraft design for flight safety.

Enhancing cybersecurity situation awareness through visualization: A USB data exfiltration case study

Employees who have legitimate access to an organization's data may occasionally put sensitive corporate data at risk, either carelessly or maliciously. Ideally, potential breaches should be detected as soon as they occur, but in practice there may be delays, because human analysts are not able to recognize data exfiltration behaviors quickly enough with the tools available to them. Visualization may improve cybersecurity situation awareness. In this paper, we present a dashboard application for investigating file activity, as a way to improve situation awareness. We developed this dashboard for a wide range of stakeholders within a large financial services company. Cybersecurity experts/analysts, data owners, team leaders/managers, high level administrators, and other investigators all provided input to its design. The use of a co-design approach helped to create trust between users and the new visualization tools, which were built to be compatible with existing work processes. We discuss the user-centered design process that informed the development of the dashboard, and the functionality of its three inter-operable monitoring dashboards. In this case three dashboards were developed covering high-level overview, file volume/type comparison, and individual activity, but the appropriate number and type of dashboards to use will likely vary according to the nature of the detection task). We also present two use cases with usability results and preliminary usage data. The results presented examined the amount of use that the dashboards received as well as measures obtained using the Technology Acceptance Model (TAM). We also report user comments about the dashboards and how to improve them.

Towards pilot's situation awareness enhancement: A framework of adaptive interaction system and its realization

Adaptive interaction system in flight control always aims to enhance the pilot's situation awareness (SA) to achieve human-in-the-loop control. Most adaptive interaction systems are always activated according to the pilot's current workload state. However, the pilot may already lose important information during a high workload, and thus the corresponding reaction of the adaptive interaction system would lag. Moreover, most adaptive interaction systems adopt the expert's knowledge as a reference to generate information. Still, the tacit knowledge that reveals the information interrelationship is seldom studied, despite being the foundation of the interactive information display. To solve the above problems, we proposed an adaptive interaction system architecture with three subsystems. Firstly, we developed a workload level prediction subsystem, where physiological parameters are used to predict future workload levels, thus avoiding interaction system lag; Secondly, we developed a tacit expert knowledge mining subsystem to discover the interrelationship hidden in the expert's perceived information, which will guide the interactive information interface. Thirdly, we developed a tips information inference subsystem to provide the lost SA information based on expert knowledge and the pilot's online perceived information. The effectiveness of the proposed system is verified via a comparative experiment utilizing the control interface of a remotely piloted aircraft.

The Effects of Stress Mindset, Manipulated Through Serious Game Intervention, on Performance and Situation Awareness of Elite Female Football Players in the Context of a Match: An Experimental Study

Background: Performance levels in football are ever more important and no longer are just physical, technical, and tactical skills, the ones that make an athlete stand out. Cognitive variables, such as stress-coping, become more important and seem to be explaining differences in performance, for example, through reaching an optimal level of arousal. In addition, it is suggested that stress-coping skills also affect situation awareness (SA), important for decision-making in the complex and dynamic situations in football. Objective: This study was conducted to examine how stress-coping skills, such as stress mindset, affect performance and SA in the context of a football match. Methods: Twenty elite female football players participated in the study. The final sample size consisted of 15 players for the Stress Mindset Measure (SMM) analysis and 8 players for the multilevel model analyses. Two types of intervention were used to manipulate stress mindset and control over heart rate variability (HRV); a serious game called "Stressjam," and a reflection tool called "Brainjam." Questionnaires for stress mindset and SA and video analysis for performance were used. A total of three matches were assessed. Results: The "Stressjam" intervention resulted in significant differences in stress mindset throughout the intervention [F(1,5) = 7.357, P = 0.008]. Subsequently, multilevel analysis showed a positive, strong, and significant correlation between stress mindset, manipulated through "Stressjam" and SA [r(14) = 0.69, P = 0.014]. A correlation of practical interest, given the confidence intervals, was found between stress mindset, manipulated through "Stressjam," and performance. Conclusion: Cognitive variables, such as stress-coping, correlate significantly with SA in football. A correlation of practical interest was found between stress-coping and performance. Further research is needed to study the relationship between stress-coping and performance in football.

Situation awareness in intensive care unit nurses: A qualitative directed content analysis

Background

Situation awareness (SA) is an essential cognitive construct to create positive patient safety outcomes. SA of the nurses in the intensive care unit (ICU), where conditions may change rapidly, is particularly important. The present study aimed to explain the perception and experience of SA in ICU nurses based on Endsley's SA model.

Materials and methods

This qualitative directed content analysis was conducted on nurses in six hospitals in Tehran, Iran, from December 2020 to July 2021. Twenty-seven ICU nurses were selected using purposive sampling. Data were collected by semi-structured interviews and field observations. The data were analyzed based on the Elo and Kyngas method modified by Assarroudi et al. COREQ checklist was used to report the research.

Results

The concept of SA in ICU nurses, based on Endsley's model, includes perception of patients' clinical cues, perception of the human environment, perception of the physical environment, and perception of the organizational environment as generic categories of the perception of the elements in the environment. SA in ICU nurses also includes the main categories of comprehension the current situation through a sense of salience and interpretation of cues and projection the future situation through the prediction of patient status into the near future and environmental foresight.

Conclusion

Findings have further developed the concept of SA in ICU nurses based on Endsley's SA model. The insights and knowledge gained from this study can be useful for future practice, education, and research on SA among ICU nurses.

Assessing Team Effectiveness by How Players Structure Their Search in a First-Person Multiplayer Video Game

People working as a team can achieve more than when working alone due to a team's ability to parallelize the completion of tasks. In collaborative search tasks, this necessitates the formation of effective division of labor strategies to minimize redundancies in search. For such strategies to be developed, team members need to perceive the task's relevant components and how they evolve over time, as well as an understanding of what others will do so that they can structure their own behavior to contribute to the team's goal. This study explored whether the capacity for team members to coordinate effectively can be related to how participants structure their search behaviors in an online multiplayer collaborative search task. Our results demonstrated that the structure of search behavior, quantified using detrended fluctuation analysis, was sensitive to contextual factors that limit a participant's ability to gather information. Further, increases in the persistence of movement fluctuations during search behavior were found as teams developed more effective coordinative strategies and were associated with better task performance.

The effect of working memory training on situation awareness in a flight simulator

The close relationship between working memory and situation awareness (SA) has been confirmed and further empirical investigations are lacking. The main aim of this study was to demonstrate the feasibility of working memory training for improving SA. Thirty-eight participants completed a challenging flight scenario in a high-fidelity flight simulator and were randomized into a training group (n = 20) or a control group (n = 18). The training group engaged in an adaptive dual N-back task for 2 weeks, while the control group was given a negative control task. Three-dimensional situation awareness rating technique (3D-SART) scores and situation awareness global assessment technique (SAGAT) scores were recorded to evaluate pretest and posttest SA. The results showed that both situational understanding dimension scores in the 3D-SART and SAGAT scores were significantly increased from the pretest to the posttest in the training group, while the control group showed no significant differences. It was concluded that working memory training can effectively improve individuals' SA, which has important implication for future research.

Markers of cognitive skills important for team leaders in emergency medical services: a qualitative interview study

Background

Cognitive skills and other non-technical skills are key for emergency medical services (EMS); however, there have been a limited number of their markers identified. This study aims to identify markers of cognitive skills—situation awareness and decision making—important for team leaders in EMS. The focus is on any markers of cognitive skills that are associated with quality and safety at EMS work.

Method

In-depth semi-structured interviews were conducted with 20 EMS team leaders (10 EMS physician team leaders and 10 paramedic team leaders) and analysed by the structured approach utilising the known framework of cognitive skill elements.

Results

The data analysis revealed a set of 50 markers falling into elements of situation awareness (gathering information, interpreting information, anticipating states), elements of decision making (identifying options, implementing decisions, re-evaluating decisions), and an additional cognitive element (maintaining standards). These markers represented cognitive processes, acts, and communications, therefore, some of them can be observable and others rather unobservable. The identified markers were not too specific, applicable mostly in various challenging situations with patients’ medical problems and in EMS team leaders working in ground ambulances in urban and rural/remote areas.

Conclusion

The findings provide a better understanding of EMS team leaders’ cognitive skills, and can aid in the development of assessment and training tools suited particularly to them.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-022-00629-1.

The effects of takeover request lead time on drivers' situation awareness for manually exiting from freeways: A web-based study on level 3 automated vehicles

Conditional automation systems allow drivers to turn their attention away from the driving task in certain scenarios but still require drivers to gain situation awareness (SA) upon a takeover request (ToR) and resume manual control when the system is unable to handle the upcoming situation. Unlike time-critical takeover situations in which drivers must respond within a relatively short time frame, the ToRs for non-critical events such as exiting from a freeway can be scheduled way ahead of time. It is unknown how the ToR lead time affects driver SA for resuming manual control and when to send the ToR is most appropriate in non-critical takeover events. The present study conducted a web-based, supervised experiment with 31 participants using conditional automation systems in freeway existing scenarios while playing a mobile game. Each participant experienced 12 trials with different ToR lead times (6, 8, 10, 12, 14, 16, 18, 20, 25, 30, 45, and 60 s) for exiting from freeways in a randomized order. Driver SA was measured by using a freeze probe technique in each trial when the participant pressed the spacebar on the laptop to simulate the takeover action. Results revealed a positive effect of longer ToR lead times on driver SA for resuming control to exit from freeways and the effect leveled off at the lead time of 16-30 s. The participants tended to postpone their takeover actions further when they were given a longer ToR lead time and it did not level off up to 60 s. Nevertheless, not all drivers waited till the last moment to take over AVs even though they did not get sufficient SA. The ToR lead time of 16-30 s was recommended for better SA; and it could be narrowed down to 25-30 s if considering the subjective evaluations on takeover readiness, workload, and trust. The findings provide implications for the future design of conditional automation systems used for freeway driving.

State-of-the-art of situation recognition systems for intraoperative procedures

One of the key challenges for automatic assistance is the support of actors in the operating room depending on the status of the procedure. Therefore, context information collected in the operating room is used to gain knowledge about the current situation. In literature, solutions already exist for specific use cases, but it is doubtful to what extent these approaches can be transferred to other conditions. We conducted a comprehensive literature research on existing situation recognition systems for the intraoperative area, covering 274 articles and 95 cross-references published between 2010 and 2019. We contrasted and compared 58 identified approaches based on defined aspects such as used sensor data or application area. In addition, we discussed applicability and transferability. Most of the papers focus on video data for recognizing situations within laparoscopic and cataract surgeries. Not all of the approaches can be used online for real-time recognition. Using different methods, good results with recognition accuracies above 90% could be achieved. Overall, transferability is less addressed. The applicability of approaches to other circumstances seems to be possible to a limited extent. Future research should place a stronger focus on adaptability. The literature review shows differences within existing approaches for situation recognition and outlines research trends. Applicability and transferability to other conditions are less addressed in current work.

Effects of noise and music on situation awareness, anxiety, and the mental workload of nurses during operations

This study aims to explore the effects of noise and music types on nurses' anxiety, mental workload and situation awareness during an operation. Participants included 20 circulating nurses (CNs) and 16 nurse anesthetists (NAs) who completed a total of 70 operations in which each operation required one CN and one NA. The experiment was separated into a control group (operating noise only) vs. an experimental group (3 different music types-between subjects and 2 music volume levels-within-subjects). Results showed that all participants had excellent situation awareness performance despite their mental workload showing significant differences in various phases of the surgery. Music at 55-60 dB caused lower mental workloads and anxiousness for nurses than those exposed to levels of 75-80 dB. When Mozart's music was played, the participants' mental workload and situation anxiety were lower than when exposed to other music types. Music played at 60 dB during an operation may be a feasible solution to mitigate the negative effects of extra noise and thus improve the nurses' performance.

Distributed situation awareness: From awareness in individuals and teams to the awareness of technologies, sociotechnical systems, and societies

A large component of Neville Stanton's work has focused on situation awareness in domains such as defence, transport, and process control. A significant contribution has been to initiate a shift from considering individual human operator situation awareness to considering the situation awareness of human and non-human teams, organisations, and even sociotechnical systems. Though controversial when introduced, the distributed situation awareness model has become increasingly relevant for modern day systems and problems. In this article we reflect on Stanton's contribution and point to a pressing need to consider a. The situation awareness of advanced technologies, and b. situation awareness at a sociotechnical system, societal and even global level. This is demonstrated via discussion on two contemporaneous issues: automated vehicles and the COVID-19 pandemic. It is concluded that, given advances such as artificial intelligence, the increased connectedness of society, emerging issues such as disinformation, and an increasing set of global threats, Stanton's distributed situation awareness model and associated analysis framework provide a useful toolkit for future Human Factors and Ergonomics applications.

Identifying objective behavioural measures of expert driver situation awareness

Efforts to reduce road crash rates depend on a clear understanding of the factors that contribute to driver risk. Not all drivers are at equivalent risk. It is critical to identify the factors that contribute to the development of expertise in the driving environment. The rapid development of a driver's situation awareness (SA) is central to the safe performance of the driving task. Therefore, SA must be clearly operationalised in order to better assess its role in the development of expertise. This study employs an existing scheme based on the Perceptual Cycle Model (PCM) used for post hoc incident analysis and adapts it to the driving context. We attempted to correlate performance on coded verbalisations indicative of SA with non-invasive objective gaze metrics. Gaze metrics and the verbal counts were shown to differentiate between both expert and experienced (non-expert) drivers, but these measures failed to correlate with one another. Findings indicate differences in the way expert and experienced drivers update their schema of the driving task, with equivalent effort required to do so. The novel adaptation demonstrated in this paper allows for a domain-specific assessment of SA which reliably differentiates between drivers of varying expertise levels. Although selected gaze metrics were shown to be inadequate predictors of SA, additional analysis demonstrated key differences in gaze content. Combined, these findings enhance an understanding of expert SA development contributing to reduced crash risk.

The Cognitive Relevance of a Formal Pre-incision Time-out in Surgery

Surgical time-outs are designed to promote situation awareness, teamwork, and error prevention. The pre-incision time-out in particular aims to facilitate shared mental models prior to incision. Objective, unbiased measures to confirm its effectiveness are lacking. We hypothesized that providers’ mental workload would reveal team psychophysiological mirroring during a formal, well-executed pre-incision time-out. Heart rate variability was collected during cardiac surgery cases from the surgeon, anesthesiologist, and perfusionist. Data were analyzed for six cases from patient arrival until sternal closure. Annotation of surgical phases was completed according to previously developed standardized process models of aortic valve replacement and coronary artery bypass graft procedures, producing thirteen total surgical phases. Statistical analysis revealed significant main effects. Tukey HSD post hoc tests revealed significant differences across provider roles within various phases, including Anesthesia Induction, Heparinization, Initiation of Bypass, Aortic Clamp and Cardioplegia, Anastomoses or Aortotomy, Separation from Bypass, and Sternal Closure. Despite these observed differences between providers over various surgical phases, the Pre-incision Time-out phase revealed almost negligible differences across roles. This preliminary work supports the utility of the pre-incision safety checklist to focus the attention of surgical team members and promote shared team mental models, measured via psychophysiological mirroring, using an objective mental workload measure. Future studies should investigate the relationship between psychophysiological mirroring among surgical team members and the effectiveness of the pre-incision time-out checklist.

Situation awareness and the mitigation of risk associated with patient deterioration: A meta-narrative review of theories and models and their relevance to nursing practice

BACKGROUND

Accurate situation awareness has been identified as a critical component of effective deteriorating patient response systems and an essential patient safety skill for nursing practice. However, situation awareness has been defined and theorised from multiple perspectives to explain how individuals, teams and systems maintain awareness in dynamic task environments.

AIM

Our aim was to critically analyse the different approaches taken to the study of situation awareness in healthcare and explore the implications for nursing practice and research as it relates to clinical deterioration in ward contexts.

METHODS

We undertook a meta-narrative review of the healthcare literature to capture how situation awareness has been defined, theorised and studied in healthcare. Following an initial scoping review, we conducted an extensive search of ten electronic databases and included any theoretical, empirical or critical papers with a primary focus on situation awareness in an inpatient hospital setting. Included papers were collaboratively categorised in accordance with their theoretical framing, research tradition and paradigm with a narrative review presented.

RESULTS

A total of 120 papers were included in this review. Three overarching narratives reflecting philosophical, patient safety and solution focussed framings of situation awareness and seven meta-narratives were identified as follows: individual, team and systems perspectives of situation awareness (meta-narratives 1-3), situation awareness and patient safety (meta-narrative 4), communication tools, technologies and education to support situation awareness (meta-narratives 5-7). We identified a concentration of literature from anaesthesia and operating rooms and a body of research largely located within a cognitive engineering tradition and a positivist research paradigm. Endsley's situation awareness model was applied in over 80% of the papers reviewed. A minority of papers drew on alternative situation awareness theories including constructivist, collaborative and distributed perspectives.

CONCLUSIONS

Nurses have a critical role in identifying and escalating the care of deteriorating patients. There is a need to build on prior studies and reflect on the reality of nurse's work and the constraints imposed on situation awareness by the demands of busy inpatient wards. We suggest that this will require an analysis that complements but goes beyond the dominant cognitive engineering tradition to reflect the complex socio-cultural reality of ward-based teams and to explore how situation awareness emerges in increasingly complex, technologically enabled distributed healthcare systems.

Nurses' use of auditory alarms and alerts in high dependency units: A field study

A fieldwork study conducted in six units of a major metropolitan Australian hospital revealed that nurses' attitudes towards alarms are influenced by each unit's physical layout and caseload. Additionally, nurses relied heavily on both non-actionable and actionable alarms to maintain their awareness of the status of their patients' wellbeing, and used auditory alarms beyond the scope of their intended design. Results suggest that before reducing or removing auditory alarms from the clinical environment to improve patient safety, it is important to understand how nurses in different clinical contexts use current alarm systems to extract meaningful information. Such an understanding could guide appropriate alarm reduction strategies and guide alternative design solutions to support nurses' situation awareness during monitoring.

Learner drivers (and their parent-supervisors) benefit from an online hazard perception course incorporating evidence-based training strategies and extensive crash footage

We previously found that a six-session online hazard perception training course, which incorporates evidence-based learning strategies and footage of over a hundred real crashes, improved hazard perception skill and reduced risk-taking intentions in novice drivers who had passed their on-road driving test within the previous three years. However, one issue with targeting crash-prevention training at individuals who are already driving unsupervised is that drivers are at their highest crash risk immediately after they pass their on-road driving test. That is, the training may arrive too late to protect drivers while they are at their most vulnerable. It is also possible that it may prove difficult to persuade drivers to complete an unsupervised training course if they are already licensed to drive independently. Given that learner drivers cannot drive unsupervised, and that they are typically supervised by a parent, one potential strategy is to target the training at learners and to ask their parents to provide one-on-one mentoring throughout the course. We therefore recruited learner driver/parent-supervisor dyads to participate in a randomized control study, with the objective of examining the effects of the hazard perception training course on aspects of driving behaviour associated with crash risk (as measured using validated computer-based tests). Outcome measures included two hazard perception skill assessments (a response time hazard perception test and a verbal response hazard prediction test), and three tests assessing aspects of risk-taking propensity in driving (speed choice, following distance, and gap acceptance). Learners who completed the course (N = 26) significantly improved their scores on both hazard perception skill measures, and also chose safer following distances, compared with a waitlist control group (N = 23). However, the training did not significantly reduce learners' speed choice or gap acceptance propensity. The hazard perception skill of parent-supervisors, who observed the course but did not complete it, also improved on both hazard perception measures, relative to controls. Additionally, both learners and their parent-supervisors reported a range of positive effects on the learners' real-world driving performance. These results suggest that this type of hazard perception training could be beneficial if deployed during the learner phase of driver licensing.

Using eye-tracking to investigate the effects of pre-takeover visual engagement on situation awareness during automated driving

Automated driving systems are becoming increasingly prevalent throughout society. In conditionally automated vehicles, drivers may engage in non-driving-related tasks (NDRTs), which can negatively affect their situation awareness (SA) and preparedness to resume control of the vehicle, when necessary. Previous work has investigated engagement in NDRTs, but questions remain unanswered regarding its effect on drivers' SA during a takeover event. The objective of the current study is to use eye-tracking to aid in understanding how visual engagement in NDRTs affects changes in SA of the driving environment after a takeover request (TOR) has been issued. Thirty participants rode in a simulated SAE Level 3 automated driving environment and engaged in three separate pre-TOR tasks (Surrogate Reference Task, Monitoring Task, and Peripheral Detection Task) until presented with a TOR. Situation Awareness Global Assessment Technique (SAGAT) scores and gaze behavior were recorded during the post-TOR segment. Overall, longer times spent viewing the driving scene, and more dispersed visual attention allocation, were observed to be associated with better overall SA. Also, location-based eye tracking metrics show most promise in differentiating between task conditions with significantly different SAGAT scores. Findings from this work can inform the development of real-time SA assessment techniques using eye movements and ultimately contribute to improved operator roadway awareness for next-generation automated transportation.

Do team and task performance improve after training situation awareness? A randomized controlled study of interprofessional intensive care teams

Background

When working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes.

Method

Twenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrument), task performance (ABCDE checklist) and situation awareness (Situation Awareness Global Assessment Technique (SAGAT)). Generalized estimating equation were used to analyse the changes from case 0 to case 2, and from case 1 to case 2.

Results

Education in situation awareness in the intervention group improved TEAM leadership (p = 0.003), TEAM task management (p = 0.018) and TEAM total (p = 0.030) when comparing cases 1 and 2; these significant improvements were not found in the control group. No significant differences were observed in the SAGAT or the ABCDE checklist.

Conclusions

This intervention study shows that a 2-h education in situation awareness improved parts of team performance in an acute care situation. Team leadership and task management improved in the intervention group, which may indicate that the one or several of the components in situation awareness (perception, comprehension and projection) were improved. However, in the present study this potential increase in situation awareness was not detected with SAGAT. Further research is needed to evaluate how educational programs can be used to increase situation awareness in interprofessional ICU teams and to establish which components that are essential in these programs.

Trial registration

This randomized controlled trial was not registered as it does not report the results of health outcomes after a health care intervention on human participants.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13049-021-00878-2.

Fear of Hospital-Acquired Infections: The Combined Impact of Patient's Hygiene Sensitivity and Perceived Staff Preventive Behavior

Over the years, the public has paid growing attention to hospital-acquired infections (HAIs). Currently, infection prevention and control are considered a number one national priority in leading developed countries. However, while some hospital visitors are knowledgeable of the topic, others may be ignorant or careless as regards sterility and hygiene-related matters. This study, conducted in Israel, compared people cognizant of hygiene-related issues to those who are less so, in an attempt to account for differences in terms of attitudes and perceptions regarding the hospital environment. Based on Endsley's (in: Proceedings of the IEEE 1988 national aerospace and electronics conference, IEEE, 1988, 1995) situation awareness concept, we hypothesized that people attending the hospital with different hygiene schema would react differently when faced with HAI-related triggers. Based on a survey of 208 respondents, the results support the hypotheses, and showed a significant moderating effect of hygiene-sensitivity on the relationship between the staffs' hospital acquired infection-related proactive behavior and avoidance tendencies among hospital visitors. Theoretical as well as practical recommendations are discussed.

Subject matching for cross-subject EEG-based recognition of driver states related to situation awareness

Situation awareness (SA) has received much attention in recent years because of its importance for operators of dynamic systems. Electroencephalography (EEG) can be used to measure mental states of operators related to SA. However, cross-subject EEG-based SA recognition is a critical challenge, as data distributions of different subjects vary significantly. Subject variability is considered as a domain shift problem. Several attempts have been made to find domain-invariant features among subjects, where subject-specific information is neglected. In this work, we propose a simple but efficient subject matching framework by finding a connection between a target (test) subject and source (training) subjects. Specifically, the framework includes two stages: (1) we train the model with multi-source domain alignment layers to collect source domain statistics. (2) During testing, a distance is computed to perform subject matching in the latent representation space. We use a reciprocal exponential function as a similarity measure to dynamically select similar source subjects. Experiment results show that our framework achieves a state-of-the-art accuracy 74.32% for the Taiwan driving dataset.

Training situational awareness for scrub nurses: Error recognition in a virtual operating room

Virtual reality simulation provides interesting opportunities to train nurses in a safe environment. While the virtual operating room has proven to be a useful training tool for technical skills, it has been less studied for non-technical skills. This study aimed to assess "Error recognition in a virtual operating room", using a simulation scenario designed to improve situation awareness. Eighteen scrub-nurse students and 8 expert scrub-nurses took part in the experiment. They were immersed in a virtual operating room and reported any errors they observed. There were nineteen errors with various degrees of severity. Measures were retrieved from logs (number of errors, time for detection, movements) and from questionnaires (situation awareness, subjective workload, anxiety and user experience). The results showed that the participants who detected most errors had a higher level of situation awareness, detected high-risk errors faster and felt more immersed in the virtual operating room than those detecting fewer errors. They also felt the workload was lighter and experienced more satisfaction. Students explored the operating room more than experts did and detected more errors, especially those with moderate risk. Debriefings confirmed that virtual simulation is acceptable to trainees and motivates them. It also provides useful and original material for debriefings.

Impact of a shared decision-making mHealth tool on caregivers' team situational awareness, communication effectiveness, and performance during pediatric cardiopulmonary resuscitation: study protocol of a cluster randomized controlled trial

Background

Effective team communication, coordination, and situational awareness (SA) by team members are critical components to deliver optimal cardiopulmonary resuscitation (CPR). Complexity of care during CPR, involvement of numerous providers, miscommunication, and other exogenous factors can all contribute to negatively influencing patient care, thus jeopardizing survival. We aim to investigate whether an mHealth supportive tool (the Interconnected and Focused Mobile Apps on patient Care Environment [InterFACE]) developed as a collaborative platform to support CPR providers in real-time and share patient-centered information would increase SA during pediatric CPR.

Methods

We will conduct a prospective, cluster randomized controlled trial by groups of 6 participants in a tertiary pediatric emergency department (33,000 consultations/year) with pediatric physicians and nurses. We will compare the impact of the InterFACE tool with conventional communication methods on SA and effective team communication during a standardized pediatric in-hospital cardiac arrest and a polytrauma high-fidelity simulations. Forty-eight participants will be randomized (1:1) to consecutively perform two 20-min video-recorded scenarios using either the mHealth tool or conventional methods. The primary endpoint is the SA score, measured with the Situation Awareness Global Assessment Technique (SAGAT) instrument. Enrollment will start in late 2020 and data analysis in early 2021. We anticipate that the intervention will be completed by early 2021 and study results will be submitted in mid 2021 for publication.

Discussion

This clinical trial will assess the impact of a collaborative mHealth tool on increasing situational awareness and effective team communication during in-hospital pediatric resuscitation. As research in this area is scarce, the results generated by this study may become of paramount importance in improving the care of children receiving in-hospital CPR, in the era of increasing communication technology.

Trial registration

ClinicalTrials.gov NCT04464603. Registered on 9 July 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05170-3.

A thousand years of crash experience in three hours: An online hazard perception training course for drivers

A key goal of driver training is to teach drivers to avoid crashes. However, in traditional driver training, drivers are unlikely to see even a single example of the class of event that we want them to learn to avoid. We developed a six-session automated online hazard perception training course for drivers, which incorporates a range of evidence-based strategies and employs extensive video footage of real crashes. We evaluated this course in a randomized control trial by examining its effects on previously-validated computer-based measures of hazard perception, hazard prediction, speed choice, following distance, and gap acceptance propensity, as well as self-rated measures of driver skill, safety, and real world transfer. We found that the course resulted in significant improvements in hazard perception response time and hazard prediction scores, and significantly longer vehicle following distances. Additionally, all participants in the trained group reported that their real world driving behaviour had improved. No significant training effects were found for the other measures. The results suggest that the course can improve key behaviours associated with crash risk.

Attending Surgeons Demonstrate Greater Correlations of Skill Assessment and Anticipation of Adverse Events Than Residents During Laparoscopic Cholecystectomy

BACKGROUND

Surgical training includes the development of technical and nontechnical skills. While technical skills are more easily quantified, nontechnical skills such as situation awareness (SA) are more difficult to measure and quantify. This study investigated the relationships between different SA elements and expertise.

METHODS

Twenty attending and resident surgeons rated their anticipation of an impending adverse event while watching 20 videos of laparoscopic cholecystectomies with and without adverse events. After watching each video, they assessed surgeon skills and self-assessed their anticipation ratings. All participants answered a general confidence questionnaire before and after the study.

RESULTS

Videos with adverse events led to significantly higher anticipation of adverse events (P < 0.001), lower surgeon skill rating (P < 0.001), and higher self-assessment in their anticipation ratings (P < 0.001) across both participant groups. General confidence was significantly lower for residents than that for attending surgeons (P < 0.001). Compared with the residents, attendings exhibited stronger and more stable correlations between measurements of SA. When viewing videos with adverse events, attendings showed significantly higher correlation between anticipation of an impending adverse event and skill assessment of the surgeon (P = 0.005).

CONCLUSIONS

This study investigated how different elements of SA and their relationships were influenced by experience. The results indicated that attendings had stronger and more stable correlations between SA elements than residents, demonstrating how measurement correlations could be meaningful and sensitive indicators of expertise and autonomy readiness.

Surgeon stress negatively affects their non-technical skills in the operating room

BACKGROUND

Poor surgeons' non-technical skills (NTS) and excessive stress and workload are known contributors to surgical errors. Our aim was to examine the relationship between surgeons' stress and workload, and their observed NTS intraoperatively.

METHODS

Surgeon's NTS were rated in the operating room (OR) by trained observers. Surgeon stress, workload, familiarity with the OR team, prior experience, and case difficulty were captured. Relationships between variables were assessed.

RESULTS

Fifteen surgeons participated in our study. Agreement among raters was high for NTS observations (ICC range = 0.56-0.96). Stress was negatively correlated with situation awareness, and workload was negatively correlated with decision making. Less familiarity among the team was correlated with higher stress.

CONCLUSIONS

Surgeons' stress and workload negatively affected their NTS in the OR. Further, unfamiliarity with the surgical team contributed to surgeon's stress. Methods to reduce surgeons' stress and workload such as mental skills training should be considered.

Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

Background

Multitasking is a key skill for emergency department (ED) providers. Yet, potentially beneficial or debilitating effects for provider functioning and cognition are underexplored. We therefore aimed to investigate the role of multitasking for ED physicians’ work stress and situation awareness (SA).

Methods

Two consecutive, multi-source studies utilizing standardized expert observations in combination with physicians’ self-reports on stress and SA were set out in an academic ED. To control for ED workload, measures of patient acuity, patient counts, and ED staff on duty were included. Regression analyses estimated associations between observed proportion of time spent in multitasking with matched ED physicians’ reports on stress (study 1) and SA (study 2).

Results

ED physicians engaged between 18.7% (study 1) and 13.0% (study 2) of their worktime in multitasking. Self-reported as well as expert-observed multitasking were significantly associated. This confirms the internal validity of our observational approach. After controlling for ED workload, we found that physicians who engaged more frequently in multitasking perceived higher work stress (Beta = .02, 95%CI .001–.03; p = .01). In study 2, ED physicians with more frequent multitasking behaviors reported higher SA (B = .08, 95%CI .02–.14; p = .009).

Conclusions

Multitasking is often unavoidable in ED care. Our findings suggest that ED physicians’ multitasking increases stress experiences, yet, may facilitate professional’s experiences of situation awareness. Our results warrant further investigation into potentially ambivalent effects of ED providers’ multitasking in effectively sharing time between competing demands while maintaining performance and safety.

Workflow disruptions and provider situation awareness in acute care: An observational study with emergency department physicians and nurses

BACKGROUND

The fast-paced and rapidly changing environment of an Emergency Department (ED) requires providers to have a high level of situation awareness (SA). However, acute clinical care also encompasses a multitude of interruption-laden work processes that might degrade SA. It is therefore important to understand how frequent interruptions affect ED provider cognition in general and SA in particular.

OBJECTIVE

We aimed to examine how sources and contents of provider workflow interruptions influence situation awareness of ED physicians and nurses.

METHODS

This prospective, multi-method study combined standardized observations, self-reports of ED providers, and ED administrative data of staffing and patient load. Expert observers identified ED providers' workflow interruptions during 90min observation sessions. Afterwards, each provider reported perceived disruptiveness and situation awareness. Controlling for patient load, patient acuity and staffing, we conducted regression analyses to explore prospective associations between interruptions and provider outcomes.

RESULTS

During 74 observation sessions of overall 110h and 40min, we observed 1205 workflow interruptions (mean rate: 10.9 interruptions/hour). Provider situation awareness was fairly high (M = 7.10; scale 0-10) with no difference between ED physicians and nurses. After controlling for ED workload data, we observed that high rates of interruptions were associated with lower levels of situation awareness (β = -0.27). Further analyses revealed that particularly interruptions by telephone/beeper, technical malfunctions as well as interruptive communication related to completed cases were correlated to low SA.

DISCUSSION

This study in a naturalistic ED setting shows that ED physicians and nurses continuously cope with disruptions and interruptions. Our findings reveal that highly interruptive workflow environments impede providers' situation awareness. Moreover, it sheds light on specific sources and contents of interruptions that influence providers' SA in acute care.

CONCLUSION

Frequent workflow interruptions can degrade ED providers' situation awareness. A deeper understanding of how avoidable and unavoidable interruptions affect provider cognitions with particular focus on social and technology-related disruptions is required. Further emphasis should be placed on the effective application of work re-design in this context to foster safe and efficient patient care.

The effect of interactive analytical dashboard features on situation awareness and task performance

In recent years, new types of interactive analytical dashboard features have emerged for operational decision support systems (DSS). Analytical components of such features solve optimization problems hidden from the human eye, whereas interactive components involve the individual in the optimization process via graphical user interfaces (GUIs). Despite their expected value for organizations, little is known about the effectiveness of interactive analytical dashboards in operational DSS or their influences on human cognitive abilities. This paper contributes to the closing of this gap by exploring and empirically testing the effects of interactive analytical dashboard features on situation awareness (SA) and task performance in operational DSS. Using the theoretical lens of SA, we develop hypotheses about the effects of a what-if analysis as an interactive analytical dashboard feature on operational decision-makers' SA and task performance. The resulting research model is studied with a laboratory experiment, including eye-tracking data of 83 participants. Our findings show that although a what-if analysis leads to higher task performance, it may also reduce SA, nourishing a potential out-of-the-loop problem. Thus, designers and users of interactive analytical dashboards have to carefully mitigate these effects in the implementation and application of operational DSS. In this article, we translate our findings into implications for designing dashboards within operational DSS to help practitioners in their efforts to address the danger of the out-of-the-loop syndrome.

Cognitive skills of emergency medical services crew members: a literature review

Background

Situation awareness and decision making, listed in non-technical skills taxonomies, are critical for effective and safe performance in high-risk professions. These cognitive skills and their behavioral markers have been studied less in emergency medical services (EMS) crew members. This paper aims to review the existing literature and identify important aspects and behavioral markers of situation awareness and decision making in EMS crew members – those who work in the role of prehospital emergency care providers – and to synthesize findings as a basis for developing a rating and training tool.

Method

The search for relevant articles was conducted using electronic databases, reference lists of relevant reviews and included articles and personal collection of articles. The selection process based on the PRISMA statement yielded a total of 30 articles that met the eligibility criteria. Their findings were qualitatively synthesized using the structured approach, informed by the already known structure: situation awareness and its elements (gathering information, interpreting information, anticipating future states), decision making and its elements (generating and considering options, selecting and implementing an option, reviewing outcome/decision). Moreover, the element of maintaining standards also emerged as highly relevant for cognitive skills.

Results

This review found an increased research interest in the non-technical cognitive skills of EMS crew members. The majority of included articles’ research designs were qualitative, then mixed, Delphi, and quantitative. It revealed several specifics of cognitive skills, such as EMS crew members need to holistically assess a wide range of cues and information, to make various health- and safety-related decisions and take EMS standards into account. However, there was only a limited number of observable markers of cognitive skills, such as acts and verbalizations, that could be considered as examples of good behavior. In addition, findings indicate a lack of articles focused on mass-casualty incidents and the interconnection of cognitive skills with other non-technical and medical skills.

Conclusion

Further research is needed to get a more comprehensive view of behavioral markers of cognitive skills and to develop a rating and training tool to improve EMS crew members’ cognitive performance.

Investigating the relationship between eye movements and situation awareness in weather forecasting

Physiological indicators, including eye tracking measures, may provide insight into human decision making and cognition in many domains, including weather forecasting. Situation awareness (SA), a critical component of forecast decision making, is commonly conceptualized as the degree to which information is perceived, understood, and projected into a future context. Drawing upon recent applications of eye tracking in the study of forecaster decision making, we investigate the relationship among eye movement measures, automation, and SA assessed through a freeze probe assessment method. In addition, we explore the relationship between an automated forecasting decision aid use and information seeking behavior. In this study, a sample of professional weather forecasters completed a series of tasks, informed by a set of forecasting decision aids, and with variable access to an experimental automated tool, while an eye tracking system captured data related to eye movements and information usage. At the end of each forecasting task, participants responded to a set of questions related to the environmental situation in the framework of a survey-based assessment technique in order to assess their level of situation awareness. Regression analysis revealed a moderate relationship between the SA measure and eye tracking metrics, supporting the hypothesis that eye tracking may have utility in assessing SA. The results support the use of eye tracking in the assessment of specific and measurable attributes of the decision-making process in weather forecasting. The findings are discussed in light of potential benefits that eye tracking could bring to human performance assessment as well as decision-making research in the forecasting domain.

Practice makes better? Testing a model for training program evaluators in situation awareness

Evaluation approaches should be appropriate for their contexts. Scholars and practitioners alike have widely acknowledged this view for at least four decades, and the ability to respond to context is clearly established as a core evaluator competency. Outside of evaluation, this knowledge of context, known as situation awareness, is seen as a critical feature of good decision making and as a factor that distinguishes experts from novices across a wide range of domains. Yet there are few opportunities for evaluators to explicitly build their skills in situation awareness. This study addressed that gap by examining the potential for one online training program, informed by research on deliberate practice, to accelerate evaluators' progress towards expertise in situation awareness. Built to align with evidence on developing situation awareness skills, the EvalPractice portal combined (1) an extensive 'case bank' of real-world evaluation scenarios, (2) repetitive practice that allowed novice evaluators to practice interpreting these evaluation scenarios, and (3) immediate feedback on the accuracy of these efforts based on events from the real-life version of the scenario. Findings from a small EvalPractice pilot suggest that it may be possible to improve foundational situation awareness skills using deliberate practice, but that further research is required to understand strategies for building higher-level situation awareness skills in evaluation.

Situation awareness method using spectral analysis of random matrix for integrated energy system

Situation awareness is essential to ensure operation of integrated energy systems consisting of the electricity, gas and heat systems. However, the multi-energy flow characteristics of system result in strong coupling relationships among different subsystems including different detection variables, which bring new challenges to situation awareness. To address this issue, a data driven detection method based on spectral analysis of random matrix is proposed in this paper. Firstly, a detection matrix model, which combines different types of variables, is established to fully reflect the interdependencies among subsystems, both internal and external. Furthermore, a novel detection method, which analyzes the degree of the spectral deviation of presented model, is presented to accomplish situation awareness. The proposed method can effectively handle the problem of power-gas-heat coupling, multi-variable modeling and rapid situation judging without requiring complicated numerical model. With this effort, not only the changed time but also the position of changed node could be obtained simultaneously through only spectral computation. Finally, simulation results are presented to illustrate the effectiveness of the proposed detection method.

VR-Based investigation of forklift operator situation awareness for preventing collision accidents

Forklifts are among the machines involved with the highest levels of occupational fatalities. As many accidents involved with a forklift can be attributed to the low situation awareness (SA) of the operator, it is essential to understand the factors influencing a forklift operator's SA for reducing forklift accidents, especially of collision type. Against this background, this research aims to investigate how a forklift operator's SA about other people around can be influenced by the type of subtasks they are carrying out. In this research, a virtual reality (VR) environment is used as the experiment environment, in which subjects perform a series of subtasks, such as driving, turning, reversing, loading and unloading, with a VR forklift simulation model. A SAGAT-an established SA measurement technique based on a series of queries targeting Level 1, 2, and 3 SA-is used as the main method to collect data about subjects' SA in the experiment. The analysis of the data reveals that a forklift operator is likely to have a reduced SA about the workers around when he/she is performing a loading or unloading task due to attention narrowing, which occurs when a person concentrates on a cognitively demanding task. The findings provide insights into how forklift operator SA could be improved through an SA-oriented safety training program and also how sensing technologies might assist forklift operators with maintaining a good SA.

Avatar-based versus conventional vital sign display in a central monitor for monitoring multiple patients: a multicenter computer-based laboratory study

BACKGROUND

Maintaining adequate situation awareness is crucial for patient safety. Previous studies found that the use of avatar-based monitoring (Visual Patient Technology) improved the perception of vital signs compared to conventional monitoring showing numerical and waveform data; and was further associated with a reduction of perceived workload. In this study, we aimed to evaluate the effectiveness of Visual Patient Technology on perceptive performance and perceived workload when monitoring multiple patients at the same time, such as in central station monitors in intensive care units or operating rooms.

METHODS

A prospective, within-subject, computer-based laboratory study was performed in two tertiary care hospitals in Switzerland in 2018. Thirty-eight physician and nurse anesthetists volunteered for the study. The participants were shown four different central monitor scenarios in sequence, where each scenario displayed two critical and four healthy patients simultaneously for 10 or 30 s. After each scenario, participants had to recall the vital signs of the critical patients. Perceived workload was assessed with the National Aeronautics and Space Administration Task-Load-Index (NASA TLX) questionnaire.

RESULTS

In the 10-s scenarios, the median number of remembered vital signs significantly improved from 7 to 11 using avatar-based versus conventional monitoring with a mean of differences of 4 vital signs, 95% confidence interval (CI) 2 to 6, p < 0.001. At the same time, the median NASA TLX scores were significantly lower for avatar-based monitoring (67 vs. 77) with a mean of differences of 6 points, 95% CI 0.5 to 11, p = 0.034. In the 30-s scenarios, vital sign perception and workload did not differ significantly.

CONCLUSIONS

In central monitor multiple patient monitoring, we found a significant improvement of vital sign perception and reduction of perceived workload using Visual Patient Technology, compared to conventional monitoring. The technology enabled improved assessment of patient status and may, thereby, help to increase situation awareness and enhance patient safety.

Exploring individual and work organizational peculiarities of working in emergency medical communication centers in Norway- a qualitative study

Background

Emergency Medical call-takers working in Emergency Medical Communication Centers (EMCCs) are addressing complex and potentially life threatening problems. The call-takers have to make fast decisions, responding to problems described in phone calls. Recent studies focus mainly on individual aspects of call-takers’ work. The objectives of this study were to explore 1) What characterizes individual work performance of call takers in EMCCs? and 2) What characterizes work organizational factors call takers see as most relevant to the performance of their work?

Methods

The research is based upon in-depth interviews with call takers at three EMCCs in Norway (n = 19). Interviews were performed during the period May 2013 to September 2014. Data was analyzed using thematic analysis.

Results

Two main themes that related to individual work performance and to work organizational factors in EMCCs were identified, namely: 1) “Core technologies” and 2) “Environmental issues” . The theme “Core technologies” included the subthemes a) multiple tasks, b) critical incidents, and c) unpredictability. The theme “Environmental issues” included the subthemes a) lack of support, b) lack of resources, c) exposure to complaints, and d) an invisible service.

Conclusion

At the individual level, multiple tasks, how to cope with critical incidents, and the unpredictability of daily work when calls are received, make the work of call takers both stressful and challenging. The individual call taker’s ability to interprete the situation by intuition and experience when calls are received, is the main factor behind the peculiarities working in the centers at the individual level. At the organizational level, the lack of resources and managerial support seems to provoke concerns about the quality of services rendered by the centers. These aspects should be taken into account in the managing of these services, making them a more integrated part of the health service system.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4370-0) contains supplementary material, which is available to authorized users.

Individual differences in higher-level cognitive abilities do not predict overconfidence in complex task performance

Even when people perform tasks poorly, they often report unrealistically positive estimates of their own abilities in these situations. To better understand the origins of such overconfidence, we investigated whether it could be predicted by individual differences in working memory, attentional control, and self-reported trait impulsivity. Overconfidence was estimated by contrasting objective and subjective measures of situation awareness (the ability to perceive and understand task-relevant information in the environment), acquired during a challenging air traffic control simulation. We found no significant relationships between overconfidence and either working memory or attentional control. However, increased impulsivity significantly predicted greater overconfidence. In addition, overall levels of overconfidence were lower in our complex task than in previous studies that used less-complex lab-based tasks. Our results suggest that overconfidence may not be linked to high-level cognitive abilities, but that dynamic tasks with frequent opportunities for performance feedback may reduce misconceptions about personal performance.

[An introduction to human factors: From aeronautic to obstetrics]

The theme of human factors is becoming more and more prominent in the healthcare field. Indeed, despite their expertise, healthcare providers display the same limits, those of any human being working in a team, in a system that requires high-reliability. Error is inherent in all human activity. Therefore, the study of human factors makes a perfect sense. The aim of our article is to provide to readers general and recent information on the concept of human factors, and to introduce other related notions such as "error", "fault", non-punishment of error, leadership, crew resource management, situation awareness. Indeed, in some teams, a lack of situation awareness, a poor communication, or an inadequate leadership may lead to a deteriorated clinical situation, leading to a significant and unbearable risk to our pregnant patients. We have a lot to learn from other professional systems that require high-reliability such as aeronautic, military and nuclear field for example. Thus, understanding a teamwork running and the genesis of the errors, developing some notions as illustrated by non-punishment of the error occurrence, debriefings, maintenance of regular staffs, high-fidelity simulation may allow the teams to evolve in a safer system for our pregnant patients.