Integrating Spatial Awareness Into Nursing EHR Design: A Scoping Review of Usability and Cognitive Load.

Area of Science:

• Health Informatics
• Human-Computer Interaction
• Clinical Workflow Optimization

Background:

• Electronic health record (EHR) usability challenges contribute to documentation burden and cognitive overload, particularly in high-acuity clinical environments.
• Current EHR designs often do not align with real-world clinical settings, negatively impacting workflow and decision-making.
• Spatial awareness integration, linking physical equipment to digital representations, may reduce cognitive strain and enhance EHR usability.

Purpose of the Study:

• To conduct a scoping review on the usability of EHRs and cognitive load in relation to spatial awareness.
• To identify current approaches and limitations in integrating spatial awareness into EHR systems.

Main Methods:

• A scoping review adhering to PRISMA-ScR guidelines was performed.
• Searches were conducted across 7 databases for peer-reviewed articles on EHR usability, cognitive load, and spatial awareness.

Main Results:

• Thirty-five articles were included, predominantly from acute care settings (71.4%).
• Physicians (62.9%) and nurses (40.0%) were key end-user populations.
• Visual integration was common (88.6%), but few studies achieved full spatial mapping; conventional fixes improved speed but not fragmentation or spatial awareness (SA).

Conclusions:

• Few EHR systems effectively integrate spatial awareness into nursing workflows.
• Spatial awareness integration is a promising, yet largely untested, EHR design strategy.
• Systematic evaluation of spatial awareness integration, alongside simpler solutions, is warranted.