workforce an interpretation situations could be made.
I certainly knew what was going on in the clinical area, and what seemed to resonate with some of the findings and case studies that Angela Jones was uncovering in the course of her study. For example, when registered nurses are dutifully documenting the observations of somebody whose condition was deteriorating. The nurse would be dutifully, perfectly documenting the blood pressure, perfectly documenting the pulse, perfectly documenting urine output, noting all these vital signs deteriorating, but not seeing what was unfolding before them; for example, that a patient was in hypovolemic shock after having surgery.
Another example involved a man who was homeless and was known to staff and the emergency department. He came in with severely infected feet. The staff were so focused on them that they didn’ t notice he had, in fact, suffered a myocardial infarction and had a serious heart condition from which he later died.
In the report, you and co-author Angela Jones analysed four case scenarios. One of these involved failure to see hypotensive shock caused by internal bleeding. What did you aim to describe through that scenario, and what were some of the common threads seen across all case scenarios? Again, it was this whole phenomena of the nurses being so focused on a task or whatever it was they were doing that they didn’ t see what was unfolding around them. In the paper, we also cite a study involving radiologists who were so focused on reading X-rays that a staggering 83 per cent failed to see [ the image of a gorilla inserted into the X-ray ], which was 48 times larger [ than the average lung nodules in the image from that case ]. They didn’ t see it was because they were so focused on what they were doing, but also because they didn’ t expect to see it. So there are two sides to this inattentional blindness, being so focused on something you don’ t see what else is going on around you and not seeing something because you don’ t expect to see it.
Getting back to that case of the man with the infected feet; probably, the staff didn’ t see his heart condition because they didn’ t expect it. It’ s a little bit more wobbly with the person in shock after having an internal bleed after surgery. You would wonder why they weren’ t expecting to see it. In that case, it was because they were so focused on the task.
What factors might be contributing to the prevalence of inattentional blindness? Several things. The way our brains are structured, for a start. The research is showing that as human beings, we’ re flawed. We can only focus on so many tasks at once. A good everyday example is the problem of people using their mobile phones while they’ re driving. They can be so focused on the task of speaking or texting that they become blind to what else is going on around them – including driving their cars – and, as we know, this can result in serious accidents.
Another thing can be the problem of many distractions. You’ re trying to navigate your way in the clinical environment and it can be rife with all sorts of distractions. For example, you might be navigating the corridors of the clinic and get caught up in focusing on one or two things and not noticing others.
So back to the YouTube video of the‘ invisible gorilla’ … Angela Jones was doing a presentation during her candidature, and we showed this video clip. Consistent with more formal inquiries into this idea of inattentional blindness, almost half the people in the audience did not notice the gorilla and one of those people was an astute professor who was quite aghast that she didn’ t see it and asked for the clip to be played again to prove to her the gorilla was there.
It was a humorous moment, but it illustrated very well how we as human beings can be so focused on a task that we miss something that is obvious.
If you go back over the video clip, you can see this person in a gorilla suit is in plain sight, and it might beggar belief how anybody missed it, but people do because they’ re so focused on the task that they’ ve been given to count the number of times the players touched the ball.
We applied that notion to the case studies we selected and discussed in the article, and we are speculating that this is one phenomena that could be explain what is going on in these situations where people missing what is obvious and before their eyes. In the cases we’ ve given, we’ re talking about deteriorating patients.
In what ways might it be addressed or mitigated? The person who devised the experiment believes it is possible to mitigate it through a program of education that cultivates and enables insight. He speaks of things like fostering people’ s capacity to have flashes of illumination and make connections where others do not. This is one of the things Jones found in her study – that what differentiated nurses who noticed things from those who didn’ t was that the ones who noticed made connections. They noted coincidences. They were curious. They sought to find out more about what was going on.
Finding a way of breaking free from being trapped by others’ assumptions can be difficult, but through education and practice, it is possible to develop these capacities, to enable clinical insights, and to try to overcome this problem of inattentional blindness.
You said further research is warranted to enable a better understanding of the nature and possible patient safety implications of inattentional blindness. What are some research priority areas? We are just speculating about this. This is a wonderful example of where interdisciplinary research could yield some interesting and beneficial results. I would encourage nurse researchers to collaborate with other researchers in psychology and neuropsychology, where they are doing this work on inattentional blindness, and see how research might be applied in a pragmatic way in the clinical context of examining how we might enhance patient safety through dealing with something that’ s a human factor.
This is, indeed, a human factor, not a systems factor. What was interesting about the cases that came out in Jones’ s study is they all occurred in the criticalcare environment, which has enormous mechanisms for monitoring, checking, tracking, and that sort of thing. So things shouldn’ t have been missed, but they were, and that speaks to the issue of human factors.
Jones made the observation that, ironically, all these mechanisms for monitoring and recording can, themselves, contribute to inattentional blindness. Nurses may become so reliant on these technologies that they fall into an assumptive routine that stops them looking at the bigger picture. Just as people can be distracted by technology, they can also be blinded by it and become over-reliant on it. This is an area we believe is just absolutely ripe for future inquiry and could be used to enhance nursing practice further in terms of ensuring safety success, rather than safety failure. ■ agedcareinsite. com. au 33