Date of Award

Spring 5-2019

Document Type


Degree Name

Doctor of Philosophy (PhD)


Nursing and Allied Health Professions

First Advisor

Lora Hromadik

Second Advisor

Riah Hoffman

Third Advisor

Jan Wachter


Experts in the study of ergonomics and human performance factors have described the ‘collective mindfulness’ of nurses as a critical element to the attainment of highly reliable safety within patient care delivery. Little research exists related to the construct of mindfulness and its impact on safe nursing practice and situation awareness by the nurse.

A mixed method, descriptive correlational study of 102 senior-level nursing students at two baccalaureate nursing programs was used to examine the relationship between dispositional mindfulness, situation awareness (SA) and the clinical competence of senior-level nursing students engaged in a simulated patient care experience. Results of this study indicate that human cognitive factors negatively impacted the participants’ ability to focus attention, switch attention, and achieve SA necessary for quality and safe nursing care.

Quantitative analysis of study data revealed that self-reported dispositional levels of mindfulness did not correlate to the latent variable of clinical competence (r =0.099, n = 102, p = .320, 2-tailed) or SA (r = 0.091, n = 102, p = 0.363, 2-tailed); however, a weak correlation between the mindfulness facet of observing and the clinical competency of communication (r = .0.193, p = 0.053) was identified. Analysis of the relationship between SA and clinical competency revealed that overall higher levels of assessed SA were found to have a moderately strong, positive relationship with overall clinical competency scores (n =102, r = .301, p = .002, 2-tailed). The level of overall situation awareness demonstrated a positive correlation to three of the four competency related sub-scales: assessment (r = 0.212, p = 0.032), communication (r = 0.340, p = 0.000), and clinical judgment (r = 0.388, p = 0.000). The qualitative findings identified two areas in which nursing students described lacking mindfulness in their clinical practice: focused attention (acting with awareness, observing) and effective communication skills (describing).

These findings provide implications to nurse educators regarding the impact of mindfulness and situation awareness on the clinical outcomes of students. The findings further suggest the inclusion of teaching/learning strategies within the curriculum to develop both mindfulness and situation awareness as non-technical skills needed for safe practice.