8/6/2009 1 Steven Busby, PhD, FNP-BC NANPA Clinical Symposium, September, 2009 University of Alabama in Huntsville To identify the terms situational awareness and multi- casualty incidents and situate them within the realm of nursing and nurse practitioner practice. To analyze the newly developed theory within nursing, the Busby Theory of Situational Awareness in Multi-Casualty Incidents. To analyze and synthesize the implications of this new theory with respect to Benner’s Novice to Expert theory, and to discuss the implications for nursing practice education and research. FNP PhD in Nursing with Homeland Security Nursing Specialty (1 of 6 in the U.S.) Local Involvement National Involvement Federal DMAT Nursing Needs to be Involved! Conceptually Aviation, Battlefield Direction, Business (1-6) Human Factors Research (8-10) Healthcare Applications Limited Admin – CDC (Biosense) (11) Hospital - Anesthesia, Perioperative (12-13) Field – Triage, Patient Disposition, Scene Safety (14-16) Dissertation Focus – Add to current state of the knowledge and situate the research within nursing Methodology Define MCI – None appropriate, This study 2-25 pts. (14,17) Qualitative Grounded Theory (18-19) Data Collection and Analysis 15 Responder Interviews Resulted in over 900 codes Open, Focused and Axial Coding Theoretical Sensitivity Resulted in 11 categories which were then related to one another Theoretically Sampled for Experience, Profession and Context Pseudonym Age Gender Ethnicity Full years of service Type of Professional Volunteer/ Paid Currently working in emergency response Mark 42 M W 22 EMT/FF P Y Ed 27 M W 3 EMT/FF V Y John 43 M W 25 Paramedic P Y Jane 43 F W 13 Paramedic P Y Frank 52 M W 34 FF/previous EMT P Y Mike 49 M W 34 EMT/FF P Y Kyle 36 M W 17 Nurse/Paramedic /FF P/V Y Jason 28 M W 2 EMT/FF V Y Dawn 36 F W 7 Nurse/Paramedic NA N Seth 38 M W 18 Nurse/Paramedic P Y Diane 30 F W 4 Nurse/Paramedic/ VFF P/V Y Jack 33 M W 12 EMT/FF P Y Dan 34 M W 14 Paramedic P Y Stan 22 M W 3 EMT/VFF P/V Y Bill 44 M W 24 Physician V Y Table 1 Participant Demographics N=15 Note. M= male; F = female; W = white; FF = firefighter; V= volunteer; P = paid; Y = yes; N =no
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8/6/2009
1
Steven Busby, PhD, FNP-BC
NANPA Clinical Symposium, September, 2009
University of Alabama in Huntsville
� To identify the terms situational awareness and multi-casualty incidents and situate them within the realm of nursing and nurse practitioner practice.
� To analyze the newly developed theory within nursing, the Busby Theory of Situational Awareness in Multi-Casualty Incidents.
� To analyze and synthesize the implications of this new theory with respect to Benner’s Novice to Expert theory, and to discuss the implications for nursing practice education and research.
� FNP
� PhD in Nursing with Homeland Security Nursing Specialty (1 of 6 in the U.S.)
� Local Involvement
� National Involvement
Federal DMAT
Nursing Needs
to be Involved!
� Conceptually� Aviation, Battlefield Direction, Business (1-6)
8. Endsley, M.R. (1995a). Toward a theory of situation awareness in dynamic systems.
Human Factors 37, 32-64.
9. Bedny, G., & Meister, D. (1999). Theory of activity and situation awareness.
International Journal of Cognitive Ergonomics, 3, 63-72.
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10. Smith, K., & Hancock, P.A. (1995). Situation awareness is adaptive, externally directed consciousness. Human Factors 37, 137-148.
11. Bradley, C.A., Rolka, H., Walker D., & Loonsk, J. (2005). BioSense: implementation of a national early event detection and situational awareness system. Morbidity and Mortality, Weekly Report, 54, 11-19.
12. Gaba, D.M., Howard, S.K., & Small, S.D. (1995). Situation awareness in anesthesiology. Human Factors, 37, 20-31.
13. Levine, W.C., Meyer, M., Brzezinski, P., Robbins, J., & Sandberg, W.S. (2005). Computer automated total perioperative situational awareness and safety systems. International Congress Series, 1281, 856-861.
14. Johnson, G.A., & Calkins, A. (1999). Prehospital triage and communication performance in small mass casualty incidents: a gauge for disaster preparedness. American Journal of Emergency Medicine, 17, 148-150.
15. Zoraster, R.M., Chidester, C., & Koenig, W. (2007). Field triage and patient maldistribution in a mass-casualty incident. Prehospital and Disaster Medicine, 22, 224-229.
16. Limmer, D., Mistovich, J.J., & Krost, W.S. (2006). Beyond the basics: scene safety. Emergency Medical Services 35, 70-74.
17. Simplified START/JumpSTART algorithms suitable for pocket card. Retrieved from http://www.jumpstarttriage.com/uploads/START_JumpSTART_card.doc on April 5, 2008.
18. Corbin, J., & Strauss, A. (2008). Basics of qualitative research (3rd ed.). Thousand Oaks, CA: Sage Publications, Inc.
19. Charmaz, K. (2006). Constructing grounded theory, a practical guide through qualitative analysis. Thousand Oaks, CA: Sage Publications, Inc.
20. Larence, E.R. (2007). Guidance from operations directorate will enhance collaboration
among departmental operations centers. (GAO-07-683T). Washington, DC:
Government Accountability Office.
21. Jenkins, W. (2007). Observations on DHS and FEMA efforts to prepare for and respond
to major and catastrophic disasters and address related recommendations and
legislation. (GAO-07-1142T). Washington, DC: Government Accountability
Office.
22. Rogers, B. & Lawhorn, E. (2007). Disaster preparedness: Occupational and environmental health professionals’ response to hurricanes Katrina and Rita. AAOHN Journal, 55(5); 197-207.
23. Benner, P. (1982). From novice to expert. American Journal of Nursing, 82, 402-40722.
24. Benner, P. (2001). From novice to expert. Excellence and power in clinical nursing
practice (Commemorative Edition). New Jersey: Prentice Hall Health.