Surgical Nurses' Non-technical Skills: A Human Factors Approach

Abstract

This research is the first to explore the social and cognitive non-technical skills (NTS) required of nurses practising in general surgical wards, the first to identify a taxonomy of NTS for general surgical nurses and the first to identify the differences in levels of performance of the NTS between experienced and less experienced nurses. There is increasing evidence that poor performance of these skills by health professionals at the ‗sharp end‘ of healthcare is a significant factor contributing to preventable adverse patient events. The study was conducted in four general surgical wards in a metropolitan hospital in a large city in New Zealand using a Human Factors (HF) approach. Part A, the first stage of the study, involved non-participant observations of fifteen nurses and used an inductive process to identify a taxonomy of seven NTS required of the nurses in their roles in surgical wards. These skills are communication, teamwork, situation awareness, decision-making, leadership and management, planning, and patient advocacy. Part B, the second stage of the study, used applied cognitive task analysis (ACTA) to determine the key cognitive skills that nurses use in challenging situations and to determine the differences between experienced and less experienced nurses‘ practice. This involved a series of semi-structured interviews with six registered nurses. In conclusion, this research has developed a taxonomy of general surgical nurses‘ NTS, both social and cognitive, identified the cognitive demands and cognitive processes of nurses pertaining to challenging events, and has provided an understanding of the differences in decision-making between experienced and less experienced nurses. The study has also identified gaps in nursing practice and nursing knowledge that can compromise the safety and effectiveness of the healthcare provided to patients. The findings from this research have significant implications for professional nursing practice and nursing education and point to a requirement for NTS training to be introduced into the nursing education curriculum and to be part of continuing professional development for nurses working in clinical settings.