Table 3.

Barriers to team situational awareness

Topic	Participant	Quote
Perception barriers
Poor communication	YP11	I went to the emergency room and they did some tests and then I told them some stuff and they kind of just ignored it. I was like, I give up, you're the doctors, I can't argue with you. And [they said] “you're fine, you can go home” and I was like “no, I'm not. I need to be put in,” and here I am.
	AP13	Like when I first went in with the migraines, they gave me Fentanyl and I told them it wasn't working, and so the lady says, “Oh, we'll just give you more this time.” And [they] gave me more. That wasn’t what I said, I said it wasn't working, can we try something different? I was trying to make it very plain, I was not just there chasing pain meds. And that was like communication stopped there. They had an idea what I was about, and that was pretty much it. Like the last time I was in the ER over there, they basically told me not to come back because I was wasting their time.
Fear	YP12	I just feel like if stuff gets worse, I don’t like to know about it. If it’s really dangerous to me I tend to not want to know about it
	AP11	They didn’t really give me a book, they just really told me everything, which I wish they wouldn’t have. I feel like half the stuff they told me that was probably going to happen that I was so terrified about didn’t happen, wasn’t going to happen, probably.
Protect patients	YC11	I mean, it's just hard—he knows things because he reads and he researches. But I guess you don't want them to know the reality of the true—it's a grim reality in many ways, so you try to shield them from that and keep them as healthy as you can. So he doesn't feel like—it's just that, not that I don't want him to know, but as he gets older he's going to learn these things and be there to talk with him about it, but I don't want him to say “hey, I just got my lung transplant. What do you mean I don't need a lung transplant?” So as he gets older, he's understanding more about it and he can learn, but not just to bombard him when he's little.
Comprehension barriers
Cognitive challenges	AP09	Yeah, I'm still on morphine, but it was stronger in the beginning, so I mean the doctors need to give it to you I guess as often as you can, I just think everybody needs to be cognizant of the fact that I probably will need that information again when I'm more clear-headed, when the patient's more clear-headed, because it's especially—like to me kind of palpable that I have asked the same questions a few times.
Different interpretations	YC01	Her temp usually runs in the 97 range and her temp got up to 99 and I told the evening nurse, “I think that’s a fever.” The nurse said “no, that’s not a fever, we don’t think a fever is until she gets to 100.” Well, the next morning it had spiked up to 103 degrees and she ended up having an infection on her port. If the nurse had listened to me the night before, could we have potentially caught it earlier? I think we could have. But she didn’t listen. So I think it’s very important that they listen to me as well as I listen to them
Blind trust	AP02	He's a professional, it's not important I understand what he's saying because I understand he's saying it from facts and looking at my condition and stuff, so I don't need to know his reasoning and all that. I'm not a psychologist!
Projection barriers
Unrealistic expectations	YC03	Last year it was actually her first time being admitted and I had no idea what to expect. Nobody had told us. In the 12 years that we've been dealing with cystic fibrosis, I honestly wasn't aware how long the CF clean-out was. So when she was admitted, I thought we were going to be here three nights maybe 2-3 nights, and when I came in and asked how long do we stay, and they told me two weeks, my heart just dropped.
	AP03	I'm supposed to go on dialysis a long time ago this year, and I refused to go, so then this happened.