This study investigated the effect of nursing experience on attention allocation and task performance during surgery. The prevention of cases of retained foreign bodies after surgery typically depends on scrub nurses, who are responsible for performing multiple tasks that impose heavy demands on the nurses' cognitive resources. However, the relationship between the level of experiences and attention allocation strategies has not been extensively studied. Eye movement data were collected from 10 novice and 10 experienced scrub nurses in the operating theater for caesarean section surgeries. Visual scanning data, analyzed by dividing the workstation into four main areas and the surgery into four stages, were compared to the optimum expected value estimated by SEEV (Salience, Effort, Expectancy, and Value) model. Both experienced and novice nurses showed significant correlations to the optimal percentage dwell time values, and significant differences were found in attention allocation optimality between experienced and novice nurses, with experienced nurses adhering significantly more to the optimal in the stages of high workload. Experienced nurses spent less time on the final count and encountered fewer interruptions during the count than novices indicating better performance in task management, whereas novice nurses switched attention between areas of interest more than experienced nurses. The results provide empirical evidence of a relationship between the application of optimal visual attention management strategies and performance, opening up possibilities to the development of visual attention and interruption training for better performance.

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Cases of retained foreign objects after surgery have been a problem since the beginning of modern surgery. However, the preventive measure to this problem has remained rather primitive – through manual surgical count by scrub nurses. The process of counting is subject to errors under stressful environment, such as time pressure, distractions, and high cognitive workload. The objective of this study is to measure the differences in the performance and attention patterns according to the expertise of the scrub nurses within an operating theatre, finally drawing a conclusion on the means through which the performance of scrub nurses can be optimized to reduce chances of errors. Qualitative observations on three different types of surgery and two eye movement data collected in the operation theatre have shown both qualitative and quantitative differences in performance and behavioral patterns between expert and novice scrub nurses, suggesting that task switching, task prioritization and situation awareness are latent factors affecting their task performances.

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Interruptions during surgical counts are critical gateways for adverse events to happen. It is important to understand the cognitive strategies nurses employ during interruptions of counts and to reduce the likelihood of adverse events. 45 counts of interruptions out of 141 surgical counts throughout 20 surgeries were recorded using an eye tracking system on 20 scrub nurses. It was observed that 62 % of the interruptions occurred during the closure count -one of the most important counts during a surgical procedure. An evaluation of the nature of the interruptions highlighted 5 main categories of interruptions, with 40% involving failure in working memory, and 53 % involving active task prioritization that led to the break in task. The categories of interruptions were grouped under three key cognitive factors influencing effective interruption management and discussed. The three cognitive factors include 'working memory', 'active task prioritization' and 'prospective memory'. Future work includes secondary analysis on the surgical count videos, and post experimental interviews with the scrub nurses.