Exploring the Association Between Spatial Awareness and Situation Awareness Among Nurses in Intensive Care Units

Objective: This study examines the relationship between spatial awareness and situation awareness (SA) among ICU nurses, focusing on how physical environmental factors influence their ability to perceive, comprehend, and anticipate critical situations in high-pressure settings. Background: SA is a well-established concept in high-risk fields, including healthcare, where it has been widely studied in relation to clinical decision-making and patient safety. However, the role of spatial awareness in shaping SA, particularly in ICU settings, remains underexplored. Nurses rely on spatial awareness to navigate complex environments, manage patient care, and respond to emergencies. However, the extent to which specific environmental factors affect SA has not been fully examined. Method: A qualitative research approach was used to explore ICU nurses’ memory of using information gained from their spatial awareness and SA. Semi-structured interviews were conducted with ICU nurses from various specialized units. Thematic analysis was applied using NVivo software to categorize environmental influences and examine how nurses process spatial information to maintain SA. Results: Findings reveal that spatial awareness is integral to SA, with room size, room layout, and equipment accessibility emerging as the most critical factors influencing nurses' ability to navigate and manage ICU workflows. Nurses described how restricted pathways, cluttered workspaces, excessive noise, and crowding increase cognitive burden and impair SA, while clear sightlines, standardization of the physical environment, controlled lighting and temperature, and reduced environmental distractions enhance their ability to anticipate patient needs. Additionally, the study identified emerging themes beyond existing SA models, highlighting cognitive overload, team coordination, and environmental adaptability as essential components of SA in ICU settings. Conclusions: This study underscores the interdependence of spatial awareness and SA, emphasizing how environmental conditions shape nurses’ cognitive processes and decision-making. Recognizing the role of spatial awareness in clinical performance provides a foundation for further research on improving ICU environments to enhance SA and reduce cognitive load. Future studies should expand on these findings by exploring how environmental modifications, technological advancements, and interdisciplinary design approaches can better support spatial awareness in critical care settings.