Nurses’ use of situation awareness in decision-making: an integrative review

Abstract

Aim. To critically review the literature related to situation awareness and clinical decision-making by nurses. Background. International recognition that situation awareness positively contributes to clinical decision-making has led to a growing body of healthcare literature. To date, research has predominately focused on anaesthetists and surgeons using measurement frameworks from the aviation industry. The evidence focussing directly on situation awareness in decision-making by nurses remains limited. Data sources. Databases: PROQUEST, Web of Science, CINAHL, and PUBMED. Review methods. An integrative review was undertaken following an extensive literature search with the date range January 1965 - March 2011. English language literature reviews, primary qualitative, quantitative and mixed method studies describing situation awareness in decision-making by or including nurses were included. Results. Five empirical studies of nurses' situation awareness were reviewed. Of these, three included decision-making and situation awareness by nurses in inter-professional teams; two related solely to situation awareness and decision-making by nurses. Findings from the five studies could be grouped under three themes: individual factors influencing situation awareness, interpersonal behaviours influencing situation awareness and situation awareness improving working relationships and patient care. Conclusion. Further investigation is needed to identify the situation awareness skills that are vital to decision-making by nurses. Elucidating essential skills sets associated with situation awareness may inform the development of education and training to enhance clinical decision-making by nurses.