‘Situation awareness’ in midwifery practice: a scoping review

BACKGROUND: Failure of situational awareness (SA) has been identified as a common theme in potentially avoidable maternal and infant deaths, although the empirical basis for this attribution is unclear. Situation awareness is arguably a contentious issue which needs to be studied methodically to ascertain the theoretical and practical relevance to midwifery to better inform the application of this concept to the clinical context-rather than seemingly and uncritically import the construct from other healthcare areas and safety-critical sectors unrelated to midwifery practice. OBJECTIVES: To identify how situation awareness is defined, understood, measured and interpreted within the midwifery care safety context as a precursor to further research which may contribute to improvements in safety of maternity care. METHODS: A scoping review was conducted using a well-established methodological framework. A comprehensive literature search yielded 259 articles, of which 11 were included in the final review. Data from each article were extracted, charted and subjected to a thematic analysis. FINDINGS: All primary research papers applied Endsley's original definition of situation awareness, either explicitly or implicitly. Team SA was viewed as an aggregate of individual clinicians' SA. Only two of the studies attempted to measure SA; others made inferences about levels of SA based on observable features of teamwork. CONCLUSIONS: Endsley's model of SA has been applied to midwifery without full consideration of whether this theoretical construct is appropriate for this clinical context. Other extended SA models exist which could arguably provide a more informed systems-theoretic approach to maternity care safety, consistent with the current drive towards embedding systems thinking and creating a Just Culture in healthcare organisations.