Meaningful Communication but not Superficial Anthropomorphism Facilitates Human-Automation Trust Calibration: The Human-Automation Trust Expectation Model (HATEM).

OBJECTIVE: The objective was to demonstrate anthropomorphism needs to communicate contextually useful information to increase user confidence and accurately calibrate human trust in automation. BACKGROUND: Anthropomorphism is believed to improve human-automation trust but supporting evidence remains equivocal. We test the Human-Automation Trust Expectation Model (HATEM) that predicts improvements to trust calibration and confidence in accepted advice arising from anthropomorphism will be weak unless it aids naturalistic communication of contextually useful information to facilitate prediction of automation failures. METHOD: Ninety-eight undergraduates used a submarine periscope simulator to classify ships, aided by the Ship Automated Modelling (SAM) system that was 50% reliable. A between-subjects 2 × 3 design compared SAM appearance (anthropomorphic avatar vs. camera eye) and voice inflection (monotone vs. meaningless vs. meaningful), with the meaningful inflections communicating contextually useful information about automated advice regarding certainty and uncertainty. RESULTS: Avatar SAM appearance was rated as more anthropomorphic than camera eye, and meaningless and meaningful inflections were both rated more anthropomorphic than monotone. However, for subjective trust, trust calibration, and confidence in accepting SAM advice, there was no evidence of anthropomorphic appearance having any impact, while there was decisive evidence that meaningful inflections yielded better outcomes on these trust measures than monotone and meaningless inflections. CONCLUSION: Anthropomorphism had negligible impact on human-automation trust unless its execution enhanced communication of relevant information that allowed participants to better calibrate expectations of automation performance. APPLICATION: Designers using anthropomorphism to calibrate trust need to consider what contextually useful information will be communicated via anthropomorphic features.

Differentiating Experience From Cue Utilization in Radiological Assessments.

OBJECTIVE: This research was designed to examine the contribution of self-reported experience and cue utilization to diagnostic accuracy in the context of radiology. BACKGROUND: Within radiology, it is unclear how task-related experience contributes to the acquisition of associations between features with events in memory, or cues, and how they contribute to diagnostic performance. METHOD: Data were collected from 18 trainees and 41 radiologists. The participants completed a radiology edition of the established cue utilization assessment tool EXPERTise 2.0, which provides a measure of cue utilization based on performance on a number of domain-specific tasks. The participants also completed a separate image interpretation task as an independent measure of diagnostic performance. RESULTS: Consistent with previous research, a k-means cluster analysis using the data from EXPERTise 2.0 delineated two groups, the pattern of centroids of which reflected higher and lower cue utilization. Controlling for years of experience, participants with higher cue utilization were more accurate on the image interpretation task compared to participants who demonstrated relatively lower cue utilization (p = .01). CONCLUSION: This study provides support for the role of cue utilization in assessments of radiology images among qualified radiologists. Importantly, it also demonstrates that cue utilization and self-reported years of experience as a radiologist make independent contributions to performance on the radiological diagnostic task. APPLICATION: Task-related experience, including training, needs to be structured to ensure that learners have the opportunity to acquire feature-event relationships and internalize these associations in the form of cues in memory.

Deriving the Practice-Primed Decision Model from a naturalistic decision-making perspective for acute care nursing research.

AIM: The purpose of this article is to present the derivation of the Practice Primed Decision Model from a naturalistic decision-making framework for use in guiding future nursing decision-making research. BACKGROUND: Acute care nurses make decisions in demanding environments under the influence of many factors. The influence of these factors on nurse decision-making is not well understood leading to gaps in understanding how to best support acute care nurse decision-making. METHODS: The strategy of theory derivation was used in the development of a new model for use in nursing research. This model incorporates important elements identified in naturalistic decision making, a Recognition Primed Decision Model and an integrative review of nurse decision-making literature. CONCLUSION: The new model, Practice Primed Decision Model, provides a new perspective to guide nurse decision-making research. This model includes factors influential to the nurse decision-making process that is more realistic in time limited, high stakes decision-making situations.

Decision-making in nursing practice: An integrative literature review.

AIMS AND OBJECTIVES: To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). BACKGROUND: Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. DESIGN: PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. RESULTS: Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. CONCLUSIONS: Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. RELEVANCE TO CLINICAL PRACTICE: Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient outcomes.

Decision Making on the Labor and Delivery Unit: An Investigation of Influencing Factors.

Objective The aim of this study was to describe the relationship between negative affect (NA), decision-making style, time stress, and decision quality in health care. Background Health care providers must often make swift, high-stakes decisions. Influencing factors of the decision-making process in this context have been understudied. Method Within a sample of labor and delivery nurses, physicians, and allied personnel, we used self-report measures to examine the impact of trait factors, including NA, decision-making style, and perceived time stress, on decision quality in a situational judgment test (Study 1). In Study 2, we observed the influence of state NA, state decision-making style, state time stress, and their relationship with decision quality on real clinical decisions. Results In Study 1, we found that trait NA significantly predicted avoidant decision-making style. Furthermore, those who were higher on trait time stress and trait avoidant decision-making style exhibited poorer decisions. In Study 2, we observed associations between state NA with state avoidant and analytical decision-making styles. We also observed that these decision-making styles, when considered in tandem with time stress, were influential in predicting clinical decision quality. Conclusion NA predicts some decision-making styles, and decision-making style can affect decision quality under time stress. This is particularly true for state factors. Application Individual differences, such as affect and decision-making style, should be considered during selection. Training to reduce time stress perceptions should be provided.

The Role of Social Cue Utilization and Closing-the-Loop Communication in the Performance of Ad Hoc Dyads.

OBJECTIVE: To examine whether social cue utilization impacts the performance of ad hoc dyads through its relationship with closing the loop, a communication process whereby team members respond more frequently to initiating statements made by others. BACKGROUND: There lacks unequivocal experimental evidence for any single cognitive-based process that might predict the performance of ad hoc teams. METHOD: Using a quasi-experimental design, 80 participants were classified into 40 dyads based on their levels of social cue utilization and attempted a team problem-solving task. A serial mediation model revealed an indirect effect of social cue utilization on the performance of ad hoc dyads through closing the loop. RESULTS: Analyses indicated that social cue utilization impacts on the performance of ad hoc dyads independently of nonverbal reasoning ability and emotional intelligence. Further, the level of social cue utilization within dyads exhibits a positive indirect impact on the performance of ad hoc dyads through closing the loop. CONCLUSION: Ad hoc dyads with higher levels of social cue utilization engaged in a greater frequency of closing-the-loop statements and showed better subsequent performance on a problem-solving task in comparison to dyads with lower levels of social cue utilization. APPLICATION: Potential applications include the optimization of ad hoc team composition within high reliability environments like aviation and power control as well as improving training interventions with a specific mechanism for improving the performance of ad hoc teams.

'Gun! Gun! Gun!': An exploration of law enforcement officers' decision-making and coping under stress during actual events.

Research on decision-making under stress has mainly involved laboratory-based studies with few contextual descriptions of decision-making under stress in the natural ecology. We examined how police officers prepared for, coped with and made decisions under threat-of-death stress during real events. A delayed retrospective report method was used to elicit skilled police officers' thoughts and feelings during attempts to resolve such events. Reports were analysed to identify experiences of stress and coping, and thought processes underpinning decision-making during the event. Officers experienced a wide range of events, coped with stress predominantly via problem-focused strategies, and adapted their decision-making under stress based on the available context. Future officer training should involve a greater variety of training scenarios than is involved in current training, and expose trainees to the possible variants of each situation to foster better situational representation and, thus, a more reliable and adaptive mental model for use in decision-making. Practitioner Summary: This study concerns decision-making and coping strategies used by skilled police officers during real threat-of-death situations. Officers' decision-making strategies differed according to the complexity of the situation and they coped with the stress of these situations via attempts to resolve the situations (e.g. by planning responses) and, to a lesser extent, via attempts to deal with their emotions.

Motivational cues predict the defensive system in team handball: A model based on regulatory focus theory.

This study was based on the naturalistic decision-making paradigm and regulatory focus theory. Its aim was to model coaches' decision-making processes for handball teams' defensive systems based on relevant cues of the reward structure, and to determine the weight of each of these cues. We collected raw data by video-recording 41 games that were selected using a simple random method. We considered the defensive strategy (DEF: aligned or staged) to be the dependent variable, and the three independent variables were (a) numerical difference between the teams; (b) score difference between the teams; and (c) game periods. We used a logistic regression design (logit model) and a multivariate logistic model to explain the link between DEF and the three category independent variables. Each factor was weighted differently during the decision-making process to select the defensive system, and combining these variables increased the impact on this process; for instance, a staged defense is 43 times more likely to be chosen during the final period in an unfavorable situation and in a man advantage. Finally, this shows that the coach's decision-making process could be based on a simple match or could require a diagnosis of the situation based on the relevant cues.

Naturalistic Decision Making in After-Action Review Meetings: The Implementation of and Learning from Post-Fall Huddles.

The purpose of this study was to add to our understanding of Naturalistic Decision Making (NDM) in healthcare, and how After Action Reviews (AARs) can be utilized as a learning tool to reduce errors. The study focused on the implementation of a specific form of AAR, a post-fall huddle, to learn from errors and reduce patient falls. Utilizing 17 hospitals that participated in this effort, information was collected on 226 falls over a period of 16 months. The findings suggested that the use of self-guided post-fall huddles increased over the time of the project, indicating adoption of the process. Additionally, the results indicate that the types of errors identified as contributing to the patient fall changed, with a reduction in task and coordination errors over time. Finally, the proportion of falls with less adverse effects (such as non-injurious falls) increased during the project time period. The results of this study fill a void in the NDM and AAR literature, evaluating the role of NDM in healthcare specifically related to learning from errors. Over time, self-guided AARs can be useful for some aspects of learning from errors.

Making sense out of uncertainty: cognitive strategies in the child custody decision-making process.

Child custody cases post-parental separation entail inherent complexities and uncertainties for legal experts and decision-makers, and are influenced by context factors. This study sheds light on how legal actors (i.e., judges, prosecutors, lawyers, psychologists, and social workers) navigate the uncertainties that arise in such context and, therefore, make their decisions. Based on a reflexive thematic analysis involving 73 participants from Brazil and England, this study reveals cognitive strategies employed by legal actors to comprehend uncertainty and operate in the decision-making context. These strategies encompass heuristics (i.e., selection, evaluation, degrees of freedom, and outsourcing decisions/ resolution) and metacognitive strategies (custodial arrangements, professional practices and 'best interests of the child' speech). These results provide a window into the decision-making processes in child custody cases; they offer a comprehensive understanding of the multifaceted sensemaking strategies employed by legal professionals. The results carry substantial implications for informing and improving legal practice in handling complex child custody situations. Furthermore, this study charts new paths for future research by highlighting potential avenues for refining and advancing the strategies employed by legal experts in these cases, especially considering the child's best interests.

Foresight for ethical AI.

There is growing expectation that artificial intelligence (AI) developers foresee and mitigate harms that might result from their creations; however, this is exceptionally difficult given the prevalence of emergent behaviors that occur when integrating AI into complex sociotechnical systems. We argue that Naturalistic Decision Making (NDM) principles, models, and tools are well-suited to tackling this challenge. Already applied in high-consequence domains, NDM tools such as the premortem, and others, have been shown to uncover a reasonable set of risks of underlying factors that would lead to ethical harms. Such NDM tools have already been used to develop AI that is more trustworthy and resilient, and can help avoid unintended consequences of AI built with noble intentions. We present predictive policing algorithms as a use case, highlighting various factors that led to ethical harms and how NDM tools could help foresee and mitigate such harms.

Patient decision making in recovering from surgery.

Patient work in surgery recovery is fraught with complex judgments and decisions. These decisions are not unlike ones that professionals make that we traditionally study with the Naturalistic Decision Making (NDM) theoretical lens and methods. Similarly, patients are making decisions in naturalistic settings and doing so with the objective of minimizing risk and maximizing safety. What is different is that patients are put in a position to perform complex, high level, high consequence work in the absence of any training, education, or decision support. Using a lived experience, I illustrate that the burden of judgement and decision making in surgery recovery work (e.g., caring for surgical sites, managing drains, managing medications, supporting activities of daily living) can be understood through a macrocognitive paradigm. Thus, the NDM theoretical lens and the associated methods is appropriate to study this problem space.

Understanding decision making in security operations centres: building the case for cyber deception technology.

Introduction: A Security Operations Centre (SOC) is a command centre where analysts monitor network activity, analyse alerts, investigate potential threats, and respond to incidents. By analysing data activities around the clock, SOC teams are crucial in ensuring the prompt detection and response to security incidents. SOC analysts work under considerable pressure to triage and respond to alerts in very short time frames. Cyber deception technology offers the promise of buying SOC analysts more time to respond by wasting the resources and time of attackers, yet such technology remains underutilised. Method: We carried out a series of interviews with experts to uncover the barriers which prevent the effective implementation of cyber deception in SOCs. Results: By using thematic analysis on the data, it was clear that while cyber deception technology is promising it is hindered by a lack of use cases, limited empirical research that demonstrates the efficacy of the technology, hesitancy to embrace a more active form of cyber defence, issues surrounding the over promising of results by off-the-shelf vendors, and an aversion to interrupting the decision-making processes of SOC analysts. Discussion: Taking this last point about the decision-making processes of SOC analysts we make the case that naturalistic decision making (NDM) would help us better understand how SOC analysts make decisions and how cyber deception technology could be used to best effect.

Decision-Making During High-Risk Events: A Systematic Literature Review.

Effective decision-making in crisis events is challenging due to time pressure, uncertainty, and dynamic decisional environments. We conducted a systematic literature review in PubMed and PsycINFO, identifying 32 empiric research papers that examine how trained professionals make naturalistic decisions under pressure. We used structured qualitative analysis methods to extract key themes. The studies explored different aspects of decision-making across multiple domains. The majority (19) focused on healthcare; military, fire and rescue, oil installation, and aviation domains were also represented. We found appreciable variability in research focus, methodology, and decision-making descriptions. We identified five main themes: (1) decision-making strategy, (2) time pressure, (3) stress, (4) uncertainty, and (5) errors. Recognition-primed decision-making (RPD) strategies were reported in all studies that analyzed this aspect. Analytical strategies were also prominent, appearing more frequently in contexts with less time pressure and explicit training to generate multiple explanations. Practitioner experience, time pressure, stress, and uncertainty were major influencing factors. Professionals must adapt to the time available, types of uncertainty, and individual skills when making decisions in high-risk situations. Improved understanding of these decisional factors can inform evidence-based enhancements to training, technology, and process design.

Nursing students' decision-making regarding postpartum hemorrhage: An exploration using the recognition-primed decision model.

AIM: To explore the knowledge content and structure of nursing students' decision-making in a high-stake clinical situation of postpartum hemorrhage using the Recognition-Primed Decision Model. BACKGROUND: According to research on clinical judgment, a nurse's expectations for a patient situation are central to the clinical decision-making process. However, little research has addressed the expectation concept and its relationship with the nurse's knowledge. Grounded in the naturalistic decision-making paradigm, the Recognition-Primed Decision Model provides a potential framework to describe the content and structure of nurses' knowledge and expectations as they unfold in high-stake clinical situations, such as postpartum hemorrhage. As it is typically used in studies of expert decision-making, it is crucial to test the adequacy of the Model with a student population and refine the research methods for using this framework. DESIGN: Descriptive design where qualitative data were analyzed using qualitative and quantitative methods. METHODS: A convenience sample of 53 students enrolled in a maternal and child health course in the Fall of 2021 was formed. As part of an online exercise to prepare for a simulation, they read a vignette presenting the story of a woman experiencing postpartum hemorrhage and recorded their answers to questions designed to probe their decision-making. Recordings were transcribed and subjected to content analysis based on the four components of recognition according to the Recognition-Primed Decision Model (i.e., cues, expectations, goals and actions). FINDINGS: All participants recognized the postpartum hemorrhage. Their knowledge was organized into clusters representing the potential causes (i.e., tone, trauma, tissue and thrombin) and consequences (i.e., hemodynamic instability) of postpartum hemorrhage, as well as other potential issues (e.g., pain and comfort, baby and partner, infection). Although students could identify relevant cues and actions, they had difficulties articulating their longer-term goals and expectations for the mother and care outcomes. CONCLUSIONS: This study showed the potential of the Recognition-Primed Decision Model to organize the content and structure of the knowledge that supported nursing students' decision-making in a high-stake situation. The findings suggest that their knowledge disproportionately focuses on the cause-and-effect relations between cues and actions. They invite further consideration of longer-term goals and expectations in nursing education to prepare students to anticipate events and assess patient responses appropriately.

Patient monitoring as a predictor of blood culture results in a tertiary neonatal intensive care unit.

We present a mesoergonomic approach to the early detection of neonatal sepsis, analyzing clinical data for 4999 patients from a neo-natal intensive care unit to predict positive culture results. The Apgar score at birth predicted positive results. For neonates with poor and intermediate Apgar scores, culture results for monitored infants were more likely to be positive than those for unmonitored infants. Thus, the medical staff tended to monitor infants who eventually had a greater chance for positive test results. A cost-effectiveness analysis indicated that for infants with high Apgar scores, the physician should decide whether to obtain a blood culture, based on the patient's characteristics. For infants with lower Apgar scores, it may be advisable to obtain a blood culture whenever one decides to monitor a neonate. The study demonstrates that staff decisions regarding a patient can serve as input for further clinical decision-making.

Neural Correlates of Decisions in Quasi-Realistic, Affective Social Interactions in Individuals With Violence-Related Socialization.

Appropriate social behavior in aggressive-provocative interactions is a prerequisite for a peaceful life. In previous research, the dysfunctions of the control of aggression were suggested to be modulated by enhanced bottom-up (sub-cortically driven) and reduced top-down (iso-cortical frontal) processing capability. In the present study, two groups of individuals with enhanced (EG) and normal (NG) experiences of violent acts during their socialization made binary behavioral decisions in quasi-realistic social interactions. These interactions were presented in short video clips taken from a first-person perspective. The video clips showed social interaction scenarios oriented on realistic everyday life situations. The behavioral data supported the distinct affective qualities of three categories of social interactions. These categories were labeled as aggressive-provocative, social-positive, and neutral-social interactions. Functional neuroimaging data showed extended activation patterns and higher signal intensity for the NG compared to the EG in the lateral inferior frontal brain regions for the aggressive provocative interactions. Furthermore, the peri-aqueductal gray (PAG) produced enhanced activations for the affective interaction scenarios (i.e., aggressive-provocative and social-positive) in both groups and as a trend with the medium effect size for the neutral interactions in the EG. As the individuals in the EG did not show open aggression during the functional MRIA (fMRI) investigation, we concluded that they applied individual self-control strategies to regulate their aggressive impulses immediately. These strategies appeared to be top-down regulated through the dorsal frontal brain areas. The predominant recruitment of the heteromodal cortices during the neural processing of complex social interactions pointed to the important role of the learning history of individuals and their socialization with differing levels of violent experiences as crucial modulators in convicts. Our data suggest that building or strengthening the association between prototypical social contexts (e.g., aggressive-provocative interactions) and appropriate behaviors as a response to it provides a promising approach to successfully re-socialize people with a delinquent history.

Do Personal Differences and Organizational Factors Influence Nurses' Decision Making? A Qualitative Study.

Decision-making processes (DMPs) can be altered by several factors that might impact patient outcomes. However, nurses' views and experiences regarding the multitude of personal and organizational factors that may facilitate or inhibit their decision-making abilities have rarely been studied. PURPOSE: To explore the personal and organizational factors that influence nurse DMPs in clinical settings at Ministry of Health hospitals (MOH). METHOD: A qualitative research design was conducted. A purposive sample of 52 nurses was recruited from general and critical wards in two major Ministry of Health hospitals in Hail, Saudi Arabia. A total of eight focus groups (semi-structured interviews) were conducted to elicit participant responses. RESULTS: In this study, the personal differences covered nurses' experience, physical and psychological status, autonomy, communication skills, values, and cultural awareness. Organizational factors included the availability of resources, organizational support, workload, the availability of educational programs, the availability of monitoring programs, and the consistency and unity of policies, rules, and regulation applications. CONCLUSIONS: The major contribution of this study is the comprehensive illustration of influential factors at both the personal level and the organizational level that impact DMPs to achieve desired outcomes for patients and health organizations. This study utilizes a framework that could explain the nature of nurse DMPs.

The role of analytical reasoning and source credibility on the evaluation of real and fake full-length news articles.

AIM: Previous research has focused on accuracy associated with real and fake news presented in the form of news headlines only, which does not capture the rich context news is frequently encountered in real life. Additionally, while previous studies on evaluation of real and fake news have mostly focused on characteristics of the evaluator (i.e., analytical reasoning), characteristics of the news stimuli (i.e., news source credibility) and the interplay between the two have been largely ignored. To address these research gaps, this project examined the role of analytical reasoning and news source credibility on evaluation of real and fake full-length news story articles. The project considered both accuracy and perceived credibility ratings as outcome variables, thus qualifying previous work focused solely on news detection accuracy. METHOD: We conducted two independent but parallel studies, with Study 2 as a direct replication of Study 1, employing the same design but in a larger sample (Study 1: N = 292 vs. Study 2: N = 357). In both studies, participants viewed 12 full-length news articles (6 real, 6 fake), followed by prompts to evaluate each article's veracity and credibility. Participants were randomly assigned to view articles with a credible or non-credible source and completed the Cognitive Reflection Test as well as short demographic questions. FINDINGS: Consistent across both studies, higher analytical reasoning was associated with greater fake news accuracy, while analytical reasoning was not associated with real news accuracy. In addition, in both studies, higher analytical reasoning was associated with lower perceived credibility for fake news, while analytical reasoning was not associated with perceived credibility for real news. Furthermore, lower analytical reasoning was associated with greater accuracy for real (but not fake) news from credible compared to non-credible sources, with this effect only detected in Study 2. CONCLUSIONS: The novel results generated in this research are discussed in light of classical vs. naturalistic accounts of decision-making as well as cognitive processes underlying news articles evaluation. The results extend previous findings that analytical reasoning contributes to fake news detection to full-length news articles. Furthermore, news-related cues such as the credibility of the news source systematically affected discrimination ability between real and fake news.

Patient decision-making personas: An application of a patient-centered cognitive task analysis (P-CTA).

Personas can be used to understand patterns of variation in patients' performance of cognitive work, particularly self-care decision making. In this study, we used a patient-centered cognitive task analysis (P-CTA) to develop self-care decision-making personas. We collected data from 24 older adults with chronic heart failure and 14 support persons, using critical incident and fictitious scenario interviews. Qualitative analyses produced three personas but revealed that individuals exemplify different personas across situations. The Rule-Following persona seeks clear rules, exercises caution under uncertainty, and grounds actions in confidence in clinician experts. The Researching persona seeks information to gain better understanding, invents strategies, and conducts experiments independently or with clinicians. The Disengaging persona does not actively seek rules or information and does not attempt to reduce uncertainty or conduct experiments. We discuss the situational nature of personas, their use in design, and the benefits of P-CTA for studying patient decision making.