Busby Steven, Witucki-Brown Janet
School of Nursing, Vanderbilt University,Nashville, TN, USA.
J Emerg Nurs. 2011 Sep;37(5):444-52. doi: 10.1016/j.jen.2010.07.023. Epub 2010 Sep 21.
Nurses and other field-level providers will be increasingly called on to respond to both natural and manmade situations that involve multiple casualties. Situational Awareness (SA) is necessary for managing these complicated incidents. The purpose of the study was to create new knowledge by discovering the process of SA in multi-casualty incidents (MCI) and develop substantive theory with regard to field-level SA for use by emergency response nurses and other providers.
A qualitative, grounded theory approach was used to develop the first substantive theory of SA for MCI. The sample included 15 emergency response providers from the Southeastern United States. One pilot interview was conducted to trial and refine the semi-structured interview questions. Following Institutional Review Board approval, data collection and analysis occurred from September 2008 through January 2009. The grounded theory methods of Corbin and Strauss (2008) and Charmaz (2006) informed this study. Transcribed participant interviews constituted the bulk of the data with additional data provided by field notes and extensive memos. Multiple levels of coding, theoretical sampling, and theoretical sensitivity were used to develop and relate concepts resulting in emerging theory. Multiple methods were used for maintaining the rigor of the study.
The process of SA in MCI involves emergency responders establishing and maintaining control of dynamic, contextually-based situations. Against the backdrop of experience and other preparatory interval actions, responders handle various types of information and manage resources, roles, relationships and human emotion. The goal is to provide an environment of relative safety in which patient care is provided. SA in MCI is an on-going and iterative process with each piece of information informing new actions. Analysis culminated in the development of the Busby Theory of Situational Awareness in Multi-casualty Incidents.
SA in MCI is a growing need at local, national and international levels. The newly developed theory provides a useful model for appreciating SA in the context of MCI thereby improving practice and providing a tool for education. The theory also provides a catalyst for further research refining and testing of the theory and for studying larger-scale incidents.
护士和其他现场工作人员将越来越多地被要求应对涉及多人伤亡的自然和人为情况。态势感知（SA）对于管理这些复杂事件至关重要。本研究的目的是通过发现多伤亡事件（MCI）中态势感知的过程来创造新知识，并开发关于现场态势感知的实质性理论，以供应急护士和其他工作人员使用。
采用定性的扎根理论方法来开发第一个关于MCI的态势感知实质性理论。样本包括来自美国东南部的15名应急工作人员。进行了一次试点访谈，以试验和完善半结构化访谈问题。在获得机构审查委员会批准后，数据收集和分析于2008年9月至2009年1月进行。Corbin和Strauss（2008年）以及Charmaz（2006年）的扎根理论方法为本研究提供了指导。转录的参与者访谈构成了数据的主体，此外还有现场记录和大量备忘录提供的额外数据。使用多层次编码、理论抽样和理论敏感性来开发和关联概念，从而形成新兴理论。采用多种方法来确保研究的严谨性。
MCI中的态势感知过程涉及应急人员建立并维持对动态的、基于情境的情况的控制。在经验和其他准备阶段行动的背景下，应急人员处理各类信息并管理资源、角色、关系和人类情感。目标是提供一个相对安全的环境，以便进行患者护理。MCI中的态势感知是一个持续且反复的过程，每条信息都会为新行动提供依据。分析最终形成了多伤亡事件态势感知的巴斯比理论。
MCI中的态势感知在地方、国家和国际层面的需求日益增长。新开发的理论为理解MCI背景下的态势感知提供了一个有用的模型，从而改善实践并提供教育工具。该理论还为进一步研究完善和检验该理论以及研究更大规模事件提供了催化剂。
