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Learning from the aviation industry
The Importance of Situational Awareness: A Qualitative Study of Family Members’ and Nurses’ Perspectives on Teaching During Family-Centered Rounds.  Beck J et al.   Academic Medicine 2015;90:1401-07.

Reviewed by Fatima Aly

What was the study question?

What do family members and nurses consider effective teaching behaviors of attending physicians during family-centered rounds?

How was the study done?

Study participants consisted of bedside nurses and .family members of patients hospitalized during the study period or recruited from families who serve on a Parent Family Advisory Council. Two focus groups with nurses (15 participants) and three focus groups with family members (13 participants) were conducted by 2 facilitators, audio recorded and transcribed. Four physician investigators with experience in qualitative analysis analyzed the data.

What were the results?

The unifying concept that emerged from the focus groups was the importance of the attending physician maintaining situational awareness defined as “a person’s comprehension or understanding of both his or her dynamic environment and his or her need to make decisions that ultimately lead to correct actions.” Learning is most successful if the attending physician manages four categories of situational awareness:

  • Cognitive factors:  all stake holders should share knowledge using language and content that is appropriate for all
  • Logistics and time management: appropriate patient care is balanced with educational needs and concerns of all.
  • Physical environment: the actual location of the family centered rounds (bedside, outside); what is being discussed (sensitive topics, relevance to family members).
  • Emotional state: sensitivity to the emotional needs of all so all feel empowered without fear of loss of autonomy, credibility or privacy. 

What are the implications of these findings?

Faculty development efforts around family-centered rounds should  improve their educational value for all participants including the family and the nurses.

Editor’s note: Lacking or inadequate situation awareness has been identified as one of the primary factors in accidents attributed to human error.  Situational awareness was originally recognized as a critical element for successful decision making in aviation and is now viewed as a critical foundation for successful decision-making across a broad range of complex and dynamic systems including aviation, air traffic control, ship navigation, health care, emergency response, military command and control operations, and offshore oil and nuclear power plant management. To this list we can add Family Centered Rounds (RR).

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