Situation awareness in virtual and hybrid care: A systematic mapping and synthesis review
Date
2025
Authors
Myronuk, Lonn
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Abstract
The rapid expansion of virtual care (VC) during the COVID-19 pandemic has fundamentally transformed healthcare delivery, introducing new complexities for individuals and teams responsible for maintaining situation awareness (SA) across physical and virtual boundaries. This systematic mapping and synthesis review charts the landscape of existing literature at the intersection of SA and virtual/hybrid care (VC/HC) in clinical practice. Guided by the Population, Concept, Context (PCC) framework, systematic searches were conducted in MEDLINE, CINAHL, Embase, APA PsycINFO, Scopus, and Web of Science bibliographic databases and grey literature searches in Google Scholar and ProQuest Dissertations & Theses, seeking studies on SA in real-world clinical implementations of VC and HC. Searches were performed in September 2025. Additional references were identified by searches of reference lists. Searches identified 2,410 results. After review, 31 articles were included for analysis and synthesis.
The review reveals that while SA is widely recognized as critical for safe and effective decision-making in dynamic healthcare environments, its conceptualization, measurement, and operationalization in VC/HC contexts remain poorly defined and underexplored. Most studies rely on intuitive understandings of SA, without explicit definition or theoretical grounding, and predominantly employ descriptive, atheoretical approaches. Endsley’s three-level SA framework of perception, comprehension, and projection is the dominant theoretical model cited, though distributed and system-level perspectives are increasingly acknowledged.
Thematic analysis identified 28 factors influencing SA in VC and HC, clustering into eight overarching concepts: available information, technology capabilities/performance, individual cognitive/sensory factors, teamwork, workflow, user interface, education/training, and policy. Outcomes attributable to SA are reported in a minority of studies, with positive effects of VC on SA often asserted, particularly in hybrid distributed teams, without robust empirical support. The absence of controlled vocabulary terms for SA and HC in bibliographic databases further complicates systematic identification and synthesis of relevant literature.
This review identifies that priorities for future research in this area should include extension of literature scoping to encompass studies of SA in clinical simulations and field exercises involving VC/HC; emphasis on using explicit definition and operationalization for SA in VC/HC research; articulation of consensus definitions and descriptions for hybrid models of care; and continued transdisciplinary practices of incorporating insights from scholarship in human factors, sociotechnical systems, and teamwork theory.
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Keywords
situation awareness, virtual care, hybrid care, telemedicine, review