Understanding Distributed Situational Awareness and Information Exchanges for Safe Patient Care by Hospital Ward...

With the growing complexity of hospital care, patient safety has become even more critical. This study explores the development and exchange of situation awareness of clinical hospital ward nurses engaged in interdisciplinary and distributed teamwork. A focused ethnographic study was conducted and involved shadowing 10 hospital ward nurses, semi-structured interviews, group reflections and patient record screenings. In-depth analysis of three representative clinical cases using state-space diagrams and a critical decision method was performed. The results show that development and exchange of situational awareness is often not reciprocal, timely or complete, with insufficient information available before decisions are made, which can compromise patient safety. Factors in communication, coordination and learning climate were identified as influential. We argue that the complexity of nurses' work in which sensitivity, alertness and control over key nodes in the healthcare network is required to achieve assimilation and accommodation in situational awareness among involved healthcare professionals. Although challenging, we see opportunities to improve situational awareness transactions through nurses' leadership behaviour. Analysing interdisciplinary and distributed collaboration from the perspective of an information network provides insight into improving situational awareness transactions, the key role nurses play in them, and further promoting patient safety.