Background

Accurate situation awareness has been identified as a critical component of effective deteriorating patient response systems and an essential patient safety skill for nursing practice. However, situation awareness has been defined and theorised from multiple perspectives to explain how individuals, teams and systems maintain awareness in dynamic task environments.

Aim

Our aim was to critically analyse the different approaches taken to the study of situation awareness in healthcare and explore the implications for nursing practice and research as it relates to clinical deterioration in ward contexts.

Methods

We undertook a meta-narrative review of the healthcare literature to capture how situation awareness has been defined, theorised and studied in healthcare. Following an initial scoping review, we conducted an extensive search of ten electronic databases and included any theoretical, empirical or critical papers with a primary focus on situation awareness in an inpatient hospital setting. Included papers were collaboratively categorised in accordance with their theoretical framing, research tradition and paradigm with a narrative review presented.

Results

A total of 120 papers were included in this review. Three overarching narratives reflecting philosophical, patient safety and solution focussed framings of situation awareness and seven meta-narratives were identified as follows: individual, team and systems perspectives of situation awareness (meta-narratives 1–3), situation awareness and patient safety (meta-narrative 4), communication tools, technologies and education to support situation awareness (meta-narratives 5–7). We identified a concentration of literature from anaesthesia and operating rooms and a body of research largely located within a cognitive engineering tradition and a positivist research paradigm. Endsley's situation awareness model was applied in over 80% of the papers reviewed. A minority of papers drew on alternative situation awareness theories including constructivist, collaborative and distributed perspectives.

Conclusions

Nurses have a critical role in identifying and escalating the care of deteriorating patients. There is a need to build on prior studies and reflect on the reality of nurse's work and the constraints imposed on situation awareness by the demands of busy inpatient wards. We suggest that this will require an analysis that complements but goes beyond the dominant cognitive engineering tradition to reflect the complex socio-cultural reality of ward-based teams and to explore how situation awareness emerges in increasingly complex, technologically enabled distributed healthcare systems.

中文翻译：

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情境意识和减轻与患者恶化相关的风险：对理论和模型及其与护理实践相关性的元叙述回顾

背景

准确的情境意识已被确定为有效恶化患者反应系统的关键组成部分，也是护理实践中必不可少的患者安全技能。然而，情境意识已经从多个角度定义和理论化，以解释个人、团队和系统如何在动态任务环境中保持意识。

目的

我们的目的是批判性地分析在医疗保健中研究情境意识的不同方法，并探索与病房环境中的临床恶化相关的护理实践和研究的意义。

方法

我们对医疗保健文献进行了元叙事审查，以了解如何在医疗保健中定义、理论化和研究情境意识。在初步范围审查之后，我们对十个电子数据库进行了广泛搜索，包括任何理论、实证或批判性论文，主要关注住院医院环境中的情境意识。纳入的论文根据其理论框架、研究传统和范式进行了协作分类，并提供了叙述性评论。

结果

本次综述共收录 120 篇论文。三个总体叙述反映了情境意识的哲学、患者安全和以解决方案为重点的框架，并确定了以下七个元叙述：情境意识的个人、团队和系统视角（元叙述 1-3）、情境意识和患者安全（元叙述） - 叙述 4)、支持情境意识的通信工具、技术和教育（元叙述 5-7）。我们确定了来自麻醉和手术室的大量文献，以及主要位于认知工程传统和实证研究范式中的研究主体。Endsley 的态势感知模型被应用在 80% 以上的论文中。少数论文借鉴了替代情境意识理论，包括建构主义、

结论

护士在识别和升级病情恶化患者的护理方面发挥着关键作用。有必要在先前的研究的基础上反思护士工作的现实以及由于繁忙的住院病房的需求而对情境意识施加的限制。我们建议，这将需要一种补充但超越占主导地位的认知工程传统的分析，以反映基于病房的团队复杂的社会文化现实，并探索情境意识如何在日益复杂的、技术支持的分布式医疗保健系统中出现。