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Clinically, nurses must rapidly identify deteriorating patients and escalate patient care to adverse events. Novices, however, can easily succumb to cognitive overload. Augmented-reality (AR) devices, such as the Microsoft HoloLens 2, may help nurses attend to task-relevant information more effectively. The aim of this pilot study was to assess experienced nurses’ perceptions on the usability of AR. Practicing nurses were recruited for this study. Following a brief tutorial, demonstration and hands-on use of the HoloLens, nurses completed the system-usability scale (SUS) to rate usability. Additionally, interviews were conducted after the simulated use session. Experienced nurses (n=11) rated the usability of AR as 62.5±7.8. Themes that emerged from our open-ended interviews included the need for AR in nursing education and the potential benefit of a patient care checklist. Use of AR to support nurse decision making may reduce cognitive workload and focus attention on critical areas to recognize patient deterioration. 

Background Nurse identification of patient deterioration is critical, particularly during the COVID-19 pandemic, as patients can deteriorate quickly. While the literature has shown that nurses rely on intuition to make decisions, there is limited information on what sources of data experienced nurses utilize to inform their intuition. The objectives of this study were to identify sources of data that inform nurse decision-making related to recognition of deteriorating patients, and explore how COVID-19 has impacted nurse decision-making. Methods In this qualitative study, experienced nurses voluntarily participated in focused interviews. During focused interviews, expert nurses were asked to share descriptions of memorable patient encounters, and questions were posed to facilitate reflections on thoughts and actions that hindered or helped their decision-making. They were also asked to consider the impact of COVID-19 on nursing and decision-making. Interviews were transcribed verbatim, study team members reviewed transcripts and coded responses, and organized key findings into themes. Results Several themes related to decision-making were identified by the research team, including: identifying patient care needs, workload management, and reflecting on missed care opportunities to inform learning. Participants (n = 10) also indicated that COVID-19 presented a number of unique barriers to nurse decision-making. Conclusions Findings from this study indicate that experienced nurses utilize several sources of information to inform their intuition. It is apparent that the demands on nurses in response to pandemics are heightened. Decision-making themes drawn from participants’ experiences can to assist nurse educators for training nursing students on decision-making for deteriorating patients and how to manage the potential barriers (e.g., resource constraints, lack of family) associated with caring for patients during these challenging times prior to encountering these issues in the clinical environment. Nurse practice can utilize these findings to increase awareness among experienced nurses on recognizing how pandemic situations can impact to their decision-making capability.