Acute care psychiatric nurses have a level of responsibility for every person residing on the unit, which contributes to the need to nurse the population on the unit as a whole. Therefore, psychiatric nurses have a dual role of providing care for individual clients and managing the demands of the unit. Hermeneutic phenomenology was utilized to gain insight into the lived experience of acute care psychiatric nurses. Six expert psychiatric nurses were recruited and interviewed to gain rich understanding of psychiatric nursing practices.
Analysis of the data revealed that psychiatric nurses use complex levels of awareness to provide person-centered care and maintain unit safety. The process of becoming aware took place in the present moment involving interplay of self-awareness, awareness of the client, and situational awareness. All aspects of awareness were required for the psychiatric nurse to understand the complex dynamics of an acute care unit, maintain safety, and deliver psychiatric nursing interventions. However, situational awareness has been generally unexplored in psychiatric nursing.
Situational Awareness Defined
Situational awareness involves noticing the elements of an environment, to form a holistic picture of the setting (Endsley, 1995). Situational awareness is used to predict future states of the environment, anticipate risks, and make decisions (Endsley, 1995). In acute care settings, the environment is often referred to as the unit milieu.
Situational Awareness in Acute Care Psychiatric Nursing
Kristy described situational awareness as, “(being) attuned to what's going on in the environment… around all of us. You're nursing the whole unit, even though you are only responsible for certain people.”
Dana reported, “Nurses are on top of all the clients and how one person could be impacting the rest of them… You need to pay attention to the dynamics to increase the safety of everyone on the ward.”
Amanda stated that situational awareness assists with time management. “You prioritize. There is never enough time to do everything you want - so you struggle to balance client demands and the demands of the unit. You need to pay attention or you run into problems.”
Psychiatric nurses require awareness of all persons residing on the unit along with the awareness of the milieu, or situational awareness. The practice of situational awareness has become ingrained into daily nursing care and practices.
The research team would like to take this opportunity to thank all psychiatric nurses for the exceptional work that they do and for their commitment to caring for the unit as a whole.
*Pseudonyms were used to protect the participant’s identities.
Endsley, M. R. (1995). Toward a theory of situational awareness in dynamic systems. The Journal of the Human Factors and Ergonomics Society, 37(1), 32-64.
Thomson, A. E., Racher, F., & Clements, K. (2019). Caring for the entire unit: Psychiatric nurses use of awareness. Journal of Psychosocial and Mental Health Services, 57(9), 17-23.
BIO: Andrea Thomson, Fran Racher, and Karen Clements are faculty members in the Department of Psychiatric Nursing at Brandon University.