Adaptation and Validation of the Situation Awareness Global Assessment Technique for Student Registered Nurse Anesthetists

ADAPTATION AND VALIDATION OF THE SITUATION AWARENESS GLOBAL ASSESSMENT TECHNIQUE FOR STUDENT REGISTERED NURSE ANESTHETISTS By Deniz Dishman, PhD, DNAP, MSN A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University, 2019 Major Director: Michael D. Fallacaro, DNS, FAAN Professor, Director of Special Projects Department of Nurse Anesthesia Anesthesia is a health care specialty fraught with high workload demands, including stressful work environments, increased production pressure, work areas with many distractions, an increasing use of advanced technology, and the constant need to prioritize work actions. Proper patient management requires skillful clinical judgment particularly in this dynamic environment during anesthetized conditions. Effective clinical judgment includes not only appropriate interventions but also recognition that condition changes are occurring. Additionally, proficient clinical judgment must incorporate the ability to project what may occur secondary to actual or potential condition changes. These key elements operationalize situation awareness (SA). Successful and safe anesthetic patient management requires high level SA to meet these workload needs. High level SA in student registered nurse anesthetists (SRNAs) is an important characteristic in the development of future, effective anesthesia providers. With Endsley’s “Theory of Situation Awareness” as the foundation, the goal of this study was to adapt and validate the “Situation Awareness Global Assessment Technique” (SAGAT), according to her recommendations, to quantify the SA of the nurse anesthesia graduate student (SRNA) subset of anesthesia trainees during the simulation of the induction of general anesthesia with the associated placement of an oral endotracheal tube. After attaining IRB exempt review status approval, this study used purposeful sampling to identify a sample of CRNA, nurse educator subjects. An exploratory sequential mixed methods design was utilized. Delphi methods during qualitative data collection and validation used a seven-member sample. Following content analysis of these results, items for the adapted SAGAT were created. Quantitative methods applied to these items utilized data collected from a 40-member sample to determine item content validity and scale content validity indices (SCVI/Ave. 0.92). Additionally, exploratory factor analysis was performed on these findings, providing further reliability with a Cronbach’s alpha of 0.937. This study’s findings revealed that a SAGAT specific to the anesthesia domain and the nurse anesthesia graduate student subgroup was amenable to adaptation and validation. The resultant adapted and validated items from this study are appropriate and applicable for use with SRNAs during specific simulated exercises. These results have positive implications in SRNA education and training, and can also be extended to other anesthesia trainees and practicing providers. Additionally, this study provides support of the further adaptation, validation, and use of this instrument in other anesthetic content areas, as well as other health care domains.