First Advisor

Roehrs, Carol Joy

Document Type


Date Created



Graduate nurses encounter complex and rapidly changing patient care situations that require attentiveness, careful surveillance, and the recognition of subtle changes and patterns that will lead to appropriate decisions. Many researchers concur that new graduates are ill-equipped to meet these challenges, resulting in significant risk to patient safety. Situation Awareness (SA) is a skill that has been taught in the field of aviation to facilitate decision-making in complex, dynamic situations; however, there is little known about how nursing students develop SA. This mixed methods explorative study contrasted sophomore and senior nursing students’ (n=33) measured levels of SA during simulations of deteriorating patients, and gathered information from the students regarding how they came to be aware of changes. The results indicate students do not have complete SA (avg. score 69%). There is also evidence of significant differences between sophomore and senior nursing students’ scores on the comprehensive scale (F(1,31) = 10.394, p = .002) with senior scores significantly higher than sophomore scores. Students described how they became aware of the situation through developing expectations, determining salience and processing the information to create a meaningful whole. These themes support the proposed definition of situation awareness specific to nursing. This study found that nursing students develop Situation Awareness during the course of their nursing program indicating the necessity for deliberate development of this important skill. These study results can be also used to improve nursing education by teaching students specific skills including recognition of changes in respiratory rate and habits of frequent reassessment for patients whose condition is changing. Together these skills will help address the lack of SA which impairs clinical judgment and contributes to unsafe nursing care. Recommendations include further study and measurement of nursing student SA as well as teaching strategies aimed at developing SA.

Abstract Format



Clinical judgment; Situational awareness; Simulated patients; Nursing -- Study and teaching (Higher); Nursing students


153 pages

Local Identifiers


Rights Statement

Copyright is held by author.