Abstract
Failure to rescue continues to be a significant contributor to in-hospital deaths despite efforts to the contrary. Failure to rescue is the failure to prevent death or permanent disability resulting from a complication of an underlying illness or medical care and is associated with a mortality rate of 122.1 deaths per 1,000 hospital discharges (Agency for Healthcare Research and Quality [AHRQ], 2014, n.d.). Failing to detect early patient deterioration is a key contributor to failure to rescue and a manifestation of inadequate situation awareness. Situation awareness is an essential patient safety skill. As nurses spend more time at the patient’s bedside than other health care disciplines, they are the best positioned to detect early clinical deterioration. Potential inadequate nurse situation awareness presents a significant patient safety issue that requires ongoing research to provide health care organizations with tools with which to address the issue.
Situation awareness is not consistently defined in health care, as illustrated by Orique’s and Despins’ literature review in this issue. The most commonly used definition is that of Mica Endsley. In this definition, situation awareness is presented as three sequential levels: perception of elements within the environment, comprehension of the meaning of those elements related to the current situation, and projection of what those elements will do in the future. From this perspective, the definition of situation awareness is related to the goals and objectives of a specific job or function (Endsley & Jones, 2012). Although situation awareness has been studied in both simulated environments and clinical settings to enhance participant learning and identify challenges that nurses face at each level, we know little about situation awareness errors made by nurses.
Some health care organizations have analyzed adverse event reports through the lens of situation awareness, deliberately categorizing specific adverse patient outcomes as failure of situation awareness events (e.g. Brady et al., 2013). Such organizations have used the results of these analyses to focus quality improvement initiatives on improving specific levels of situation awareness. A similar approach can be used in nursing research to add to existing knowledge and develop a taxonomy of situation awareness error types. For example, specific patient outcomes, such as unexpected patient transfer to the intensive care unit, can be defined as situation awareness failures. Operationalized error definitions at each of Endsley’s three levels of situation awareness can be used to examine nursing care related to these events, for example, failure to recognize a decreased level of consciousness could be defined as a perception error. Identifying the goals and objectives for each level of situation awareness in relation to the event can help differentiate nursing from nonnursing responsibilities in developing these operational definitions. Research that produces knowledge regarding nursing situation awareness errors can be translated into practice through the creation of tools or guidelines for tool development that individual organizations can adapt for use within their institutions. These tools can be used to assess nurses’ situation awareness and identify improvement opportunities at the individual and system levels, thereby supporting the ongoing development of this key patient safety skill.