Nurses' Visual Attention During Initial Observation of Patients With Suspected Pneumonia: An Observational Pupillometry Study

AIM: Observation requires selective attention to visual information acquired through gaze. Measuring pupil diameter, an index of attention, we examined skilled and novice nurses during the initial assessment of a patient urgently admitted with suspected community-acquired pneumonia. METHODS: This observational study was conducted in a simulated environment. Participants comprised skilled nurses with advanced practice training and novice nurses. During a 120-s initial assessment of a mock patient with suspected community-acquired pneumonia, participants wore eye-tracking equipment. Pupil diameter and gaze transitions were recorded. Changes in pupil diameter were determined by subtracting the baseline value from the measured pupil diameter and compared while participants focused on specific regions such as the face. RESULTS: A total of 16 skilled nurses and 17 novice nurses participated. Novice nurses showed greater negative changes in pupil diameter than skilled nurses when focusing on the facial and chest areas. Mixed-effects modeling showed that, in the later phase of the task, novice nurses exhibited smaller changes in pupil diameter, whereas skilled nurses exhibited slightly larger changes. CONCLUSIONS: Compared with novice nurses, skilled nurses directed their attention more intensively to the face and chest during the initial assessment of a patient with suspected community-acquired pneumonia and impaired respiratory status. They also showed slightly larger changes in pupil diameter in the later phase of the task than novice nurses, suggesting the engagement of selective attention. These findings provide a basis for developing educational materials to train nurses to respond effectively to sudden changes in a patient's condition.