Reaching the Core of Nursing Quality: Defining Situation Awareness in Nursing

Purpose:
Limited research in understanding how “attention” affects human factors. The greatest factor influencing attention is situation awareness (SA). The purpose of the research was to define and analyze the concept of situation awareness in acute care nursing.

Background/Significance:
Patient care error is the 8th leading cause of death in the United States. The current work environment in health care calls for a constant state of attention to the unexpected and right decision-making. Nursing work environments are high-hazard settings. The work is cognitively demanding and interdependent – requiring SA for effective prioritization and focused attention with little margin for human error. Unexplored is the phenomena of SA in nursing.

Methods:
The study design was a hybrid concept analysis. This method was chosen for its unique integration of theoretical analysis and field experience, incorporating the perspective of the nurse. The hybrid concept model is comprised of three phases: 1) theoretical, 2) fieldwork, and 3) analytics. Qualitative analysis of semi-structured interviews using purposive sampling technique ensured representation from expert, competent, and advanced beginner direct-care nurses serving inpatient nursing units representing three Magnet hospitals including a large community hospital, academic medical center, and a children's hospital

Results:
Themes and relationships in the transcripts were identified using content analysis. Nine defining themes emerged: perception, comprehension, projection, knowledge and expertise, cognitive overload, interruption management, task management, instantaneous learning, and cognitive stacking. Experience and interruption management contributed to cognitive overload. The resulting themes were more accurately illustrated in relationship with SA and encompassed five categories or main themes: SA and expertise, SA and cognitive overload, SA and interruption management, SA and task management, and SA and cognitive stacking. A definition for situation awareness in nursing is proposed.

Conclusions and Implications for Practice:
Additional research is necessary to quantify the empirical relationship between patient care outcomes and SA in nursing and to design and examine the effectiveness of methods aimed at accelerating the novice to expert trajectory impacting SA and cognitive stacking in nursing.