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

Usability challenges in electronic health records drive documentation burden and cognitive overload, especially in high-acuity settings. Current electronic health record design often fails to accurately reflect real-world clinical environments, disrupting workflow and decision-making processes. Integrating spatial awareness, which aligns physical clinical equipment with its digital representation, may enhance usability by reducing cognitive strain and fostering intuitive interaction.

This scoping review followed PRISMA-ScR guidelines. We searched 7 databases for peer-reviewed articles concerning the usability of electronic health records and cognitive load in relation to spatial awareness.

Thirty-five articles met the inclusion criteria. Many were in acute care (71.4%). End-user populations: physicians (n=22, 62.9%), nurses (n=14, 40.0%), and other roles (n=8, 22.9%). Key findings included visual integration (88.6%), kinesthetic interaction (34.3%), and auditory cues (5.7%). Conventional fixes commonly improved entry speed but rarely reduced fragmentation or enhanced SA; no study implemented full room- or device-aligned spatial mapping. Most evaluations used prototype or custom systems (n=20, 57.1%).

Despite advancements in interface technology, few systems achieve spatial integration within nursing workflows. Integrating spatial awareness represents a promising but untested design approach that warrants systematic evaluation alongside optimized, simpler solutions.