Cognitive science has made tremendous strides in recent decades. Through its contributions, we have gained insights that have informed both clinicians and basic scientists. In addition, it has provided important contributions in the area of patient safety and the factors that may contribute to the occurrence of adverse events. The impact of these contributions can be viewed from patient, clinician, and care environment perspectives. Several examples will illustrate the types of insights that can be gained to improve patient safety. Patient behavior is one important area that would benefit from cognitive science. When medication errors occur, often the focus is on clinician behaviors and performance; the importance of patient characteristics and behaviors often is overlooked. A recent study examined the complexity of medication instructions and the factors associated with patients' understanding of prescription drug warning labels. Findings indicate that comprehension of warning labels by patients was associated with patient literacy levels. Patients with low literacy levels were three to four times less likely to interpret prescription medication warnings correctly. In addition, multistep instructions were difficult across all literacy levels (Davis et al., 2006). Given the fact that patients are increasingly managing multiple prescriptions and over-the-counter medications, this study has important implications from both cognition and safety perspectives. Although the study did not examine other aspects of cognitive function, it suggests that more research is needed to ensure that factors that influence patients' adherence with medication regimens is needed to ensure safe patient self-management. Clinical simulations can be used for a variety of purposes. The effectiveness of simulations in research around sleep deprivation and implications for decision-making in patient care situations have been described (Howard et al., 2003). Researchers used an experimental design to measure the performance of anesthesiology residents under normal and sleep-deprived conditions. Psychomotor performance and mood in the sleep-deprived residents were impaired. Although simulations may not be identical to real patient care situations, the results support the thesis that cognitive processes are impaired in clinical decision-making situations when clinicians are sleep deprived. This certainly provides a safe, controlled environment in which actual mistakes will not jeopardize patients. One only has to imagine a staff nurse working a second consecutive shift under a mandatory overtime requirement due to the nursing shortage to envision the effects of sleep deprivation among nurses. Cioffi (2001) describes how simulation can be used for research and education to assess learning and performance in skill areas that would be directly transferable to real clinical situations. Methods are available to measure both validity and reliability. Use of simulations would provide an opportunity for research without compromising either scientific rigor or provider and patient safety. Croskerry (2003) approaches patient safety from a cognitive science perspective, describing various cognitive dispositions to respond to decision-making situations as demonstrated by physicians. Diagnostic errors by clinicians can occur through a variety of cognitive dispositions, including cognitive errors, failed perceptions, biases, and failed heuristics. Potential for reducing cognitive diagnostic errors has been demonstrated using metacognition, a reflective approach that involves stepping back from an immediate decision-making situation to examine and reflect on the thinking processes. This approach would appear to have direct implications and research potential for decision-making by nurses and other clinicians as well. …