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Situation Awareness and the Decision-making Processes of Final Year Nursing Students.

AIMS AND OBJECTIVES
To investigate final year nursing students' use of situation awareness (SA) when making clinical decisions about patients' progress post-surgery.


BACKGROUND
Making clinical decisions about patient care is a generic nursing competence, developed in pre-registration nursing programs and critical to providing safe patient care. SA is an important precursor to making decisions and is linked to improved clinical outcomes. However there is evidence to suggest that nursing students feel inadequately prepared to make clinical decisions.


DESIGN
Endsley's (2000) 3-level situation awareness framework was used to guide the study. Level 1 SA is perception of information required to make a decision. Level 2 relates to comprehending the information. Level 3 SA is projecting how this information will inform the future. Twelve final year nursing students were recruited to participate. Think aloud research method was used to capture students' decision-making, followed by semi-structured interviews. Data was analysed using an adapted protocol analysis and was encoded inductively. The COREQ checklist has been used in reporting the study.


RESULTS
Students demonstrated levels 1, 2 and 3 SA when making clinical decisions. However, it was not demonstrated consistently and at times subsequent decision-making was inappropriate. Three themes emerged: 'systems approach to assessment of post-operative patients'; 'policy drives practice'; and 'deferring decisions to registered nurses'. Within the themes students demonstrated differing levels of SA.


CONCLUSION
Making safe clinical decisions is a paramount skill for nurses however student nurses are ill equipped to undertake this skill. SA is important in informing safe decision-making but students' use of SA is variable. Cognitive apprenticeship, applied to supporting development of SA, affords the opportunity to develop students' decision-making.


RELEVANCE TO CLINICAL PRACTICE
Clinical decision-making is a generic competence for all registered nurses and imperative for safe practice. However, student nurses are unprepared to undertake this skill once registered. This article is protected by copyright. All rights reserved.