'Situation awareness' in midwifery practice: a scoping review

Area of Science:

• Healthcare Safety
• Midwifery Practice
• Cognitive Systems Engineering

Background:

• Situational awareness (SA) is frequently implicated in preventable maternal and infant mortality, yet its empirical foundation in midwifery is not well-established.
• The construct of SA requires methodical investigation to determine its theoretical and practical relevance within midwifery, rather than uncritical adoption from unrelated fields.

Purpose of the Study:

• To systematically review the definition, understanding, measurement, and interpretation of SA within the context of midwifery care safety.
• To establish a foundation for future research aimed at enhancing the safety of maternity care through a clearer understanding of SA.

Main Methods:

• A scoping review was performed utilizing a recognized methodological framework.
• A comprehensive literature search identified 259 articles, with 11 ultimately included in the review.
• Data extraction, charting, and thematic analysis were conducted on the selected articles.

Main Results:

• Endsley's original definition of SA was consistently applied, either explicitly or implicitly, across all primary research papers.
• Team SA was conceptualized as the summation of individual clinicians' SA.
• Measurement of SA was attempted in only two studies; others inferred SA levels from observable teamwork indicators.

Conclusions:

• The application of Endsley's SA model in midwifery contexts has occurred without fully assessing its suitability for this specific clinical environment.
• Alternative, extended SA models may offer a more appropriate systems-theoretic perspective for maternity care safety.
• Adopting alternative models aligns with current healthcare trends emphasizing systems thinking and fostering a Just Culture.