1. Newland, Jamesetta PhD, RN, FNP-BC, FAANP, FNAP

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I was recently sitting in an airport with a 3-hour wait until my flight departed. I thought about the many hours I spend in a typical week during my daily commute waiting for the subway and train. A portion of that time is spent watching people and forming impressions based on physical appearance such as dress, hairstyle, and body habitus; their companions; and their behaviors. My likely inaccurate assessments are never validated because I don't have subsequent or ongoing interactions with any of the people I'm watching. Sometimes, though, the intent in watching people is different; the interest is in trying to figure out some aspect of human nature through observation and comparison to known information. I imagine that others conduct similar unscientific observations of people as well. In the aftermath of all the threats to our nation's safety, government officials have encouraged everyone to maintain a higher level of alertness. The New York City metro system bombards commuters with the message, "If you see something, say something." This message is plastered on billboards and repeatedly announced over the public address system. Discerning observational skills are not just for professionals anymore.

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The power of perception

In my nursing training, I first realized the importance of paying attention to the details of everyone in my environment during an undergraduate clinical in the hospital. The instructor asked if any of us could describe the man who had walked past the nursing station about 5 minutes earlier. All 10 of us looked at each other, a little puzzled, and asked, "What man?" The instructor proceeded to give a detailed description of his physical features, clothes, gait, and a few specific mannerisms. How was she able to notice so much about this man in a window of only a few minutes when none of us had seen him at all? At first, we thought she had invented this man; we held the perception that instructors must have supernatural powers to know and do all they did as nurses. Then a gentleman approached the desk area, as oblivious of us as we were of him earlier. He fit the exact description the instructor had given. We then learned that the scenario had not been staged; the instructor had simply taken advantage of a teachable moment. She framed her comments within the context of a nurse's responsibility to be aware of everyone who entered the patients' environment to identify potential risks to patient safety. As a student, I initially considered only people who had direct contact with my patient as relevant to their care and safety.


Using observation to promote safety

Nurses work within healthcare systems and have a responsibility to help reduce circumstances that compromise patient safety. The Quality and Safety Education for Nurses (QSEN) initiative notes that safety, "minimizes risk of harm to patients and providers through both system effectiveness and individual performance."1 The QSEN project includes tools to prepare nurses with the knowledge, skills, and attitudes needed to deliver care that improves quality and promotes patient safety. Competencies for pre-licensure nurses and separate competencies for graduate nurses have been developed and are available on the website. As nurses, we observe through a different lens than when we are people-watching in public. But the definition of observation in Merriam-Webster's Learner's Dictionary applies either way: "the act of careful watching and listening; the activity of paying close attention to someone or something in order to get information."2 It is how we act upon that information that makes the difference.


Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP

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1. Quality and Safety Education for Nurses. Safety. [Context Link]


2. Merriam-Webster. Learner's Dictionary. Observation. [Context Link]