Differing Visual Behavior Between Inexperienced and Experienced Critical Care Nurses While Using a Closed-Loop Ventilation System—A Prospective Observational Study

Abstract

Introduction: Closed-loop ventilation modes are increasingly being used in intensive care units to ensure more automaticity. Little is known about the visual behavior of health professionals using these ventilation modes. The aim of this study was to analyze gaze patterns of intensive care nurses while ventilating a patient in the closed-loop mode with Intellivent adaptive support ventilation® (I-ASV) and to compare inexperienced with experienced nurses.Materials and Methods: Intensive care nurses underwent eye-tracking during daily care of a patient ventilated in the closed-loop ventilation mode. Five specific areas of interest were predefined (ventilator settings, ventilation curves, numeric values, oxygenation Intellivent, ventilation Intellivent). The main independent variable and primary outcome was dwell time. Secondary outcomes were revisits, average fixation time, first fixation and fixation count on areas of interest in a targeted tracking-time of 60 min. Gaze patterns were compared between I-ASV inexperienced (n = 12) and experienced (n = 16) nurses.Results: In total, 28 participants were included. Overall, dwell time was longer for ventilator settings and numeric values compared to the other areas of interest. Similar results could be obtained for the secondary outcomes. Visual fixation of oxygenation Intellivent and ventilation Intellivent was low. However, dwell time, average fixation time and first fixation on oxygenation Intellivent were longer in experienced compared to inexperienced intensive care nurses.Discussion: Gaze patterns of intensive care nurses were mainly focused on numeric values and settings. Areas of interest related to traditional mechanical ventilation retain high significance for intensive care nurses, despite use of closed-loop mode. More visual attention to oxygenation Intellivent and ventilation Intellivent in experienced nurses implies more routine and familiarity with closed-loop modes in this group. The findings imply the need for constant training and education with new tools in critical care, especially for inexperienced professionals.

Application of eye‐tracking in nursing research: A scoping review

“…A total of 23 articles reported the use of eye trackers in the comparison of visual attention or stress/cognitive load between different levels of nursing experience groups, including a comparison between nursing students and registered nurses and between novice and expert or experienced nurses, whose results would be used as nurses or nursing students education. The experimental tasks included surgical counts (Koh et al., 2009 ), management of patient deterioration (Al‐Moteri et al., 2020 ; Shinnick, 2016 , 2021 , 2022 ), analysing electrocardiographs (Broadbent et al., 2014 ), using a closed‐loop ventilation system (Buehler et al., 2021 ), caring for a decompensated heart failure patient (Cabrera‐Mino et al., 2019 ), injection/infusion/blood collection/intravenous catheterization (Cai et al., 2022 ; Kataoka et al., 2011 ; Maekawa et al., 2016 ; Mihara et al., 2020 ; Parker et al., 2021 ; Sugimoto et al., 2022 ), observation of psychopathological symptoms (Chiba et al., 2021 ), seizure recognition (Fogarasi et al., 2010 ), medication administration (Badeaux, 2015 ), interpretation of simulated vital signs (Currie et al., 2018 ), performing sterile technique (Hayashi et al., 2018 ), experience within surgery (Koh, Park, et al., 2011 ), handling of needles (Sanchez et al., 2019 ), endotracheal suctioning (Takeuchi et al., 2019 ), and information gathering (Suetsugu et al., 2016 ).…”

“…Fifty‐one studies included nurses as participants, involving ICU nurses (Ahmadi et al., 2022 ; Buehler et al., 2021 ; Henneman, Gawlinski, et al., 2017 ; Hofmaenner et al., 2021 ), psychiatric nurses (Chiba et al., 2021 ), coronary care nurses (Currie et al., 2018 ; Lavoie et al., 2023 ), scrub nurses (Afkari & Bednarik, 2023 ; Koh et al., 2009 ; Koh, Park, et al., 2011 ; Koh, Tay, et al., 2011 ), neonatal nurses (Law et al., 2018 ; Law & Schmolzer, 2020 ; Wagner et al., 2022 ), nurse anaesthetist (Badeaux, 2015 ), emergency nurses (Henneman et al., 2012 ).…”

Novice nurses’ attention to task-relevant stimuli during practice

“…Similarly, Buehler et al compared experienced and novice nurses' gaze related to the ventilator in a critical care setting and found group differences in gaze time concerning aspects of oxygenation. [15] However, no attempt was made to correlate gaze characteristics with actual clinical performance.…”

“…One common finding within studies is the reliance of nurses on patient-related cues or stimuli to make these clinical decisions. [15][16][17] Healthcare scenarios are dynamic, which means that the scenario environment changes over time. Any detectable change in this environment is called a stimulus.…”

Gaze is more than just a point: Rethinking visual attention analysis using peripheral vision-based gaze mapping

“…The continuing technical advances in mobile eye tracking (MET) technology have enabled the in-depth study and understanding visual behavior, by providing valuable information on visual attention in fields such as aviation [15,16,26,29,30], medical diagnosis [3,6,10,11], surgery [1,25,40,43],or medical device product development [5,9,17,18,22,27]. While basic fixation and saccade-based eye-tracking measures are fairly easy to extract using commercial software and have been widely utilized for temporal visual attention analysis for decades [13], task-related behavior analysis benefits immensely from higher-level measures, such as the dwell times, as they allow the inference of object-specific attention [36].…”