Visual attention during post-handover bedside observation of critically ill patients: an eye-tracking comparison across emergency and critical care nursing experience groups.

چکیده اصلی

BACKGROUND: Post-handover bedside observation is routine in critical care, but experience-related differences in gaze behavior during this observation remain unclear. This study compared gaze behavior according to emergency and critical care nursing experience. METHODS: This cross-sectional observational study was conducted in a Japanese emergency and critical care center between September 2022 and February 2024. Sixty-six nurses were classified into four experience groups: <1 year, 1-<4 years, 4-<9 years, and ≥ 9 years. Eighteen mechanically ventilated patients contributed 66 observation sessions. Mobile eye tracking measured fixation duration, fixation count, and visit count across 13 areas of interest. Fixation duration was expressed as a percentage of observation time, while count outcomes were analyzed using negative binomial generalized estimating equations with observation duration as an offset and patient-level clustering. The Benjamini-Hochberg procedure controlled the false discovery rate across 42 tests. RESULTS: After false discovery rate correction, significant differences among experience groups remained for five fixation-duration, four fixation-rate, and six visit-rate measures. Pairwise differences in fixation duration and fixation rate varied in direction across areas of interest. In contrast, all significant visit-rate comparisons involving the < 1-year group showed lower rates, including for the lower limbs, insertion sites, physiological measurement devices, infusion lines and pumps, and urinary catheter. Total visit rate was also lower in the < 1-year group than in the 4-<9-year group. This categorical association remained significant after covariate adjustment and in a generalized linear mixed-model sensitivity analysis. When experience was modeled numerically with covariate adjustment, the association was attenuated (p = 0.055). CONCLUSIONS: Experience-related differences were observed across gaze measures, with visit rate demonstrating the most directionally consistent pattern. Nurses with < 1 year of experience showed fewer gaze entries per unit time into several patient-, device-, and treatment-related areas than nurses in a more-experienced group. The findings suggest that experience-related differences may involve not only the amount of visual attention directed to individual areas but also the frequency with which nurses direct gaze toward multiple potential sources of patient information. Gaze behavior should not be interpreted as a direct measure of clinical competence, observation quality, or clinical judgment.

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