Human Factors Theory Part Two

In Human Factors, Patient Safety on September 1, 2010 at 11:12 am

Human factors research has also highlighted the importance of situational awareness which is: the perception of elements in the environment, an assessment of their meaning, and a projection as to how the situation might progress (Salmon, et al., 2008). This concept involves attention to the patient in terms of what is happening, what is the meaning of the symptoms or events and predicting how might the situation turn out so interventions can be made to intervene or maintain the current state (St. Pierre, et al., 2008). Features in the environment are mapped to mental models which are developed through training and experience (Salmon, et al., 2008) and thus situational awareness is an interaction between the person and the environment…. Unexpected events trigger modifications of these mental models (Salmon, et al., 2008). One of the ways to facilitate accurate situational awareness is through the use of teams to validate a shared understanding of the situation (Salmon, et al., 2008). A key component of team situational awareness is communication and awareness of roles of team members (Salmon, et al., 2008).
A final human factors element involves perception. Perception begins with the sensory organs which need environmental stimuli of a particular threshold to be detected (St. Pierre, et al, 2008). Stimuli below that threshold may be barely detectable while stimuli above that threshold may be described as “sensory overload” (St. Pierre, et al., 2008; Maddox, 2008). Perception of these stimuli involves the integration of information from the senses with information previously learned (St. Pierre, et al., 2008). Perception by humans is not truth based but more dependent on expectations (St. Pierre, et al., 2008). Expectations can replace the data gained from the actual scanning of the environment. Change is more readily perceived than a static environment (Maddox, 2008). Habituation explains the decreased perception when something is constantly present (Maddox, 2008). A relevant issue in nursing today is monitor fatigue in which there is decreased response by nurses to warning alarms in environments when these alarms are often triggered by events other than the major one they are intended to signify.
Another perception factor involves problems with pattern recognition. Confirmation bias occurs because of the tendency to defend a hypothesis once it is formed in spite of evidence that disproves it (Lovallo & Sibony, 2010). In this human factor, the nurse may look for only information that supports an initial hypothesis. In clinical practice, this type of bias has been shown to contribute to medication errors. According to the Institute for Safe Medication Practices [ISMP] (1996) this type of human factor can cause one to read a medication order as something they are familiar with even if the medication is a different one. Many hospital staff and licensing agencies mistakenly believe that medication safety is achieved as long as nurses practice the 5 rights of medication administration: right patient, right drug, right dose, right time and right route (ISMP, 2004). A nurse can follow this paradigm yet still make an error because of this theory of confirmation bias. One example is a nurse looking for a common medication that is in similar packaging to another medication and reading the vial as the common medication when it is not. One use of technology to decrease this human perception limitation is the implementation of bar code medication technology.

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