الفهرس 
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Abstract
A patient safety incident is any unintended or unexpected incident, which could have harm or did lead to harm for one or more patients being cared for. Creating patient safety requires leadership, new knowledge, skills, and the willingness to recommit oneself every day to the difficult and time consuming work. Human beings frequently make errors and misjudgments in every sphere of error activity, those in medicine and health care, may have severe consequences, which bear a greater burden because errors can have greater consequences. Making an error not only has profound consequences for the patient and his family but also for the staff involved, particularly if they are seen, rightly or wrongly, as primarily responsible for the outcome ( Bonacumetal.,2004).
Overcoming these errors need a new technique as situation awareness that has been found to be applicable across a wide variety of domains. Situation awareness and patient safety have three distinct levels. The first level is perception, which involves noticing critical cues in the environment as the patient’s vital signs, symptoms, and monitor sounds. The second level is comprehension, which involves what the cues mean in relation to this patient as combining information from the patient and readings from monitors and charts to understand the status of a patient’s condition. The third is projection or anticipation, which involves prediction of what will happen on the current task in the near future as the nurse recognizes warning signs of patient deterioration in the next few minutes and proactively prevents it rather than reactively to both expected and unexpected events.(Wright&Fallacaro,2011).
Research aim
This study aimed to determine the effect of using the situation awareness technique on intensive care units nurses,practices of patient safety standards and assess nurses,satisfaction regarding the situation awareness technique in relation to patient safety practices.
Research hypotheses:
1-Nurses who were trained in situation awareness technique exhibit higher scores in patient safety practicesthan those who were not.
2- Nurses who were trainedin situation awareness technique exhibithigh satisfaction regarding situation awareness in relation to patient safety practices.
Materials
Research design:
A quasi experimental research design was used.
Setting:
The study was conducted at all intensive care units of six hospitals affiliated to Alexandria health affair directorate, in Alexandria city proper; AbuQuier hospital, AlMaamora chest hospital, Alexandria fever hospital, Al Gomhoria hospital , Gamal Hamada hospital, RasElteen hospital .
Subjects:
The subjects of this study comprised 118 nursing staff, who did not attend patient safety training before; they were selected to represent 167 intensive care unitnursing staff in the Ministry of Health and Population hospitals in Alexandria. The subjects were divided into two equal groups ”study and control” 59 nurses for each. They were selected according to EPI Info program estimation and the sample size was selected using the proportional stratified sampling technique from the six hospitals.
Tools:
The study was carried out using the following tools for data collection.
Tool I: Nurses’ practices of patient safety standards checklist.
It was developed by the researcher after extensive review of the Egyptian standards of patient safety .It was used to assess nurses’ practices of patient safety in ICU in relation to Egyptian Accreditation Standards of Patient Safety.
Tool II: Nurses’ satisfaction regarding the situation awareness technique in relation to patient safety practices questionnaire
It is developed by Ginsburg etal.(2012)and adapted by the researcher to measure nurses’ satisfaction regarding the situational awareness technique in relation to patient safety practices.
Method
• Written permission to conduct the study was obtained from the director of Alexandria Main Training Center and directors of the six hospitals affiliated to Alexandria health affair directorate to facilitate conducting the research.
• Written informed consent was obtained from the nursing staff after explanation of the study purpose and informed that observation of their practice will be carried out.
• Tools II, was translated into Arabic by the researcher.
• Tools content validity was tested by a jury of five experts in the related field and the necessary modifications were made
• Tools I, II were tested for their reliability and the tools were reliable.
• A pilot study was carried out on 10% of the sample size to ascertain the clarity and applicability of the tools. Results of this study revealed that all tools were clear and applicable and no modifications were made.
• The subjects were selected randomly according to systematic random sampling (every other one) and allocated randomly as:
• Study group (I): it comprised 59 nursing staff; they received the situation awareness technique training.
• Control group (II): it comprised 59 nursing staff; they received traditional lecturing during the same course.
• Tool I was used three times, one time before conducting as a pretest training and two times as a post test , the study group first evaluation was done before conducting training, the second evaluation was conducted immediately after practical training of each subgroup, the third evaluation was conducted after 21 days from ending the final day of each subgroup.
• Tool II was used once by the end of the training.
• The researcher developed a situational awareness technique training unit based on the SBAR technique which was carried out in 3 phases: preparation, implementation and evaluation phase.
A. The preparation phase
In this phase the researcher tried to find a real meaning to the new concept through adequate preparation for the researcher, content and educational environment
B. The Implementation phase:
In this phase the researcher implemented the situation awareness technique training unit based on the SBAR technique lesson plan.
C. The Evaluation phase:
In this phase the researcher assessed the subjects (the study group) two
times using tool I, the first evaluation was conducted immediately after practical training, the second evaluation conducted after 21 days from ending the final day of each subgroup. The control group evaluated as aposttestusing tool I.
Tool II was used to assess the study groups, satisfaction regarding situation awareness in relation to patient safety by the end of training.
The following are the main results yielded by the present study.
There was a statistically significant difference within the study group before and immediately after application of theSBAR technique in relation to all aspects of patient safety standards (≤ 0.05*). There were statistically significant differences between the study and control group after the application of the SBAR technique in relation to most aspects of patient safety standards.
The majority of study nurses got high satisfaction regarding handling of patient safety aspects using the situation awareness skill (98.3%).There was a statistical significant difference and relation only between study nurses gender and safety risk management regarding; accurate assessment of current situations and awareness of risk sources.
It can be concluded from the present study that
Situation awareness was presented to be successful in improving the study group practice in most aspects of patient safety standard and also verified its effectiveness as proved by the significant differences established between the study and control groups after the use of situation awareness as a teaching tool for training intensive care nurses in the patient safety practices . Moreover,the study group expressed high levels of satisfaction regarding using situation awareness in relation to patient safety practices. Consequently, Situation awareness is a valuable training toolfor maintaining upright practices of patient safety standards. Furthermore, situation awareness can be madeuse ofas an educational strategy in other aspects of health care for quality and performance improvement.
The following are the main recommendations of the study:
Regarding hospital administration team:
• Conduct workshops about situation awareness to all health care workers.
• Develop a situation awareness guide that includes the ideal technique of using SBAR.
• Change hospital patient handover policy to be SBAR technique unified hospital wide policy.
Regarding academic nursing institutions:
• Conduct situation awareness workshops for the nursing staff in the Faculty training center.
• Integrate situation awareness as one of the non-technical skill in the undergraduate nursing curricula.
Recommendation for further studies:
• Study to assess external factors influencing the application of situation awareness.
• Replicate the study on a large group of nurses in different departments.
• Study the effect of SBAR on nursing students’ critical thinking development.