Inattentional Blindness as Experienced by Hospital Nurses: A Focus Group Study

Jaewon Park; Mi Mi Park; Kyoung Ja Kim

doi:10.7475/kjan.2018.30.6.586

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Park, Park, and Kim: Inattentional Blindness as Experienced by Hospital Nurses: A Focus Group Study

Original Article

Korean J Adult Nurs 2018;30(6):586-598.

Published online: 21 December 2018

DOI: https://doi.org/10.7475/kjan.2018.30.6.586

Inattentional Blindness as Experienced by Hospital Nurses: A Focus Group Study

Jaewon Park¹, Mi Mi Park², Kyoung Ja Kim^1,

¹Assistant Professor, Department of Nursing, Hannam University, Daejeon, Korea

²Director of Nursing Department, Ajou University Hospital, Suwon, Korea

Corresponding author: Kim, Kyoung Ja https://orcid.org/0000-0001-9756-2103 Department of Nursing, Hannam University, 70 Hannamro, Daedeok-gu, Daejeon 34430, Korea. Tel: +82-42-629-8931, Fax: +82-42-629-8883, E-mail: asteria43@hnu.kr

Received 3 September 201830 October 2018 Accepted 21 November 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to explore Inattentional Blindness (IB) as experienced by hospital nurses.

Methods

Data were collected from August 3 to October 30, 2017 through focus group interviews with 24 nurses working in a university hospital in Seoul, Korea. Four focus group interviews were conducted and all interviews were recorded. Data were analyzed through qualitative content analysis.

Results

Three categories and seven subcategories were identified from 96 units of analysis, as follows: 1) occurrence of IB (preoccupation with specific factors, pressure from external factors, unexpected event); 2) triggers of IB (distraction, low expectation of error); and 3) influences due to exposure to IB (continuous self-surveillance, perceived need for thinking expansion).

Conclusion

The findings of this study show that nurses experienced IB directly and indirectly while performing their duties. IB occurred especially in common nursing situations, such as health assessment and medication administration. The results also suggest that it is necessary to develop strategies to prevent IB in the clinical setting, which can be useful not only to ensure patient safety but also to help patients regain their health.

Keywords: Attention, Hospitals, Nurse, Focus groups, Qualitative research

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Table 1.

Questions for Focus Group Interviews

Categories	Questions
Introductory question	• Please talk freely about the instances of inattentional blindness you have experienced.
Key questions	•Under what circumstances do you think inattentional blindness occurs? •What were the key clues you missed because of inattentional blindness? •What were your experiences when faced with the same situation, after having experienced that instance of inattentional blindness?
Concluding question	• Is there anything you would like to discuss further regarding inattentional blindness?

Table 2.

Demographic Characteristics of Participants (N=24)

Characteristics	Categories	n (%) or M± SD
Age (year)		25.95±1.63
	≤25	10 (41.7)
	26~30	14 (58.3)
Gender	Women	23 (95.8)
Gender	Men	1 (4.2)
Marital status	Unmarried	22 (91.7)
Marital status	Married	2 (8.3)
Education	3-year diploma	4 (16.7)
	Bachelor	19 (79.1)
	More than master	1 (4.2)
Clinical career (month)		42.43±16.40
	13~36	6 (25.0)
	37~60	14 (58.3)
	≥61	4 (16.7)
Position	Staff nurse	21 (87.5)
Position	Charge nurse	3 (12.5)
Working unit	General ward	13 (54.2)
Working unit	ICU/ER	11 (45.8)
Unit characteristic	Medical ward	8 (33.3)
Unit characteristic	Surgical ward	16 (66.7)

ICU=intensive care unit; ER=emergency room.

Table 3.

Inattentional Blindness as Experienced by Hospital Nurses

Categories	Subcategories	Examples
Occurrence of IB	Preoccupation with specific factors	“When determining whether the endotracheal tube has been inserted properly in the intubated patient's X-ray, the location of the tube needs to be considered. However, by overly focusing on the location, other aspects went unnoticed. In fact, during intubation, the patient's tooth had fallen into the esophagus and the tooth was obviously displayed in the X-ray. Even though there were five of us, we were all so focused on the location of the endotracheal tube that no one noticed the presence of the tooth.”
	Pressure from external factors	“Because of the pressure of having to complete the prescription within the given time frame and completing the nursing tasks in time…”
	Unexpected event	“One of the patients in the intensive care unit got up very quietly and walked barefoot to the front of the ward. The nurses did not notice even when the patient passed them by. Because the patient was very quiet, no one noticed even when the patient had passed them by and walked to the ward entrance all the way from the bed.”
Triggers of IB	Distraction	“When an unusual problem has occurred within the patient's body or when the patient raises a problem along with physical discomfort, the attention shifts to the other problem and the focus on the original problem is lost, even when the patient's original problem is one that would have been easily noticed under ordinary circumstances.”
	Low expectation of error	“Thinking that “no problem will occur, as the drug is being injected through a machine” or “this task is being accurately performed, as the prior duty was handled by experienced personnel,” when a drug is being injected through an infusion pump…“
Influences due to exposure to IB	Continuous self-surveillance	“In order to prevent making the same mistakes, I tend to think once more before each action. I think I tend to think twice or three times.”
	Perceived need for thinking expansion	“Because nurses work in shifts and tasks are carried over continuously across shifts, it is necessary to be aware of the patient's health status or the overall flow regarding the various nursing tasks.”

IB=inattentional blindness.

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