1
|
Phillips EC, Smith SE, Tallentire V, Blair S. Systematic review of clinical debriefing tools: attributes and evidence for use. BMJ Qual Saf 2024; 33:187-198. [PMID: 36977575 DOI: 10.1136/bmjqs-2022-015464] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Clinical debriefing (CD) following a clinical event has been found to confer benefits for staff and has potential to improve patient outcomes. Use of a structured tool to facilitate CD may provide a more standardised approach and help overcome barriers to CD; however, we presently know little about the tools available. This systematic review aimed to identify tools for CD in order to explore their attributes and evidence for use. METHODS A systematic review was conducted in line with PRISMA standards. Five databases were searched. Data were extracted using an electronic form and analysed using critical qualitative synthesis. This was guided by two frameworks: the '5 Es' (defining attributes of CD: educated/experienced facilitator, environment, education, evaluation and emotions) and the modified Kirkpatrick's levels. Tool utility was determined by a scoring system based on these frameworks. RESULTS Twenty-one studies were included in the systematic review. All the tools were designed for use in an acute care setting. Criteria for debriefing were related to major or adverse clinical events or on staff request. Most tools contained guidance on facilitator role, physical environment and made suggestions relating to psychological safety. All tools addressed points for education and evaluation, although few described a process for implementing change. Staff emotions were variably addressed. Many tools reported evidence for use; however, this was generally low-level, with only one tool demonstrating improved patient outcomes. CONCLUSION Recommendations for practice based on the findings are made. Future research should aim to further examine outcomes evidence of these tools in order to optimise the potential of CD tools for individuals, teams, healthcare systems and patients.
Collapse
Affiliation(s)
- Emma Claire Phillips
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, UK
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Samantha Eve Smith
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, UK
| | - Victoria Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, Forth Valley Royal Hospital, Larbert, UK
| | - Sheena Blair
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
Muysewinkel E, Vesentini L, Van Deynse H, Vanclooster S, Bilsen J, Van Overmeire R. A day in the life: psychological impact on emergency responders during the 22 March 2016 terrorist attacks. Front Psychiatry 2024; 15:1353130. [PMID: 38410678 PMCID: PMC10894950 DOI: 10.3389/fpsyt.2024.1353130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Terrorist attacks can cause severe long-term mental health issues that need treatment. However, in the case of emergency responders, research is often vague on the type of stressors that emergency responders encounter. For example, in addition to the threat that they work under, studies have shown that ill-preparation adds to the stress experienced by emergency responders. However, few studies have looked into the experience of emergency responders. In this study, we looked at the experience of emergency responders during the 22 March 2016 terrorist attacks in Belgium. Methods We used a qualitative design, in which we interviewed different types of emergency responders. Police officers, nurses, soldiers, firefighters, and Red Cross volunteers were included. Interviews were coded by two researchers and analyzed using a thematic approach. Results Four large themes were developed: constant threat and chaos, frustrations with lack of preparedness and training, ethical decisions, and debriefings. In addition, although emergency responders encountered constant threat, they often felt that they were ill-prepared for such attacks. One specific example was their lack of training in tourniquet usage. Furthermore, in a disaster setting, the emergency responders had to make life-and-death decisions for which they were not always prepared. Finally, debriefings were conducted in the aftermath of the attacks. Whereas most were perceived as positive, the debriefings among police officers were viewed as insufficient. Conclusions Emergency responding to terrorist attacks has many different dimensions of events that can cause stress. Our study revealed that preparation is key, not only in terms of material but also in terms of ethics and debriefings.
Collapse
Affiliation(s)
- Emilie Muysewinkel
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lara Vesentini
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Helena Van Deynse
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| | - Stephanie Vanclooster
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| |
Collapse
|
3
|
Gasteratos K, Michalopoulos J, Nona M, Morsi-Yeroyiannis A, Goverman J, Rakhorst H, van der Hulst RRWJ. Instructional Video of a Standardized Interprofessional Postsimulation Facilitator-guided Debriefing of a Fatality in Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5583. [PMID: 38333029 PMCID: PMC10852376 DOI: 10.1097/gox.0000000000005583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/30/2023] [Indexed: 02/10/2024]
Abstract
Background Postsimulation facilitator-guided debriefing (PSFGD) is the process of intentional discussion of thoughts, actions, and events that took place during simulation amongst the facilitator(s) and trainees. Despite the significance of delivering high-quality debriefings, there is a lack of evidence-based guidelines. Our study aimed to provide an instructional video demonstration of a PSFGD of a fatality. Methods Fifty surgical interns participated in a burn simulation scenario in two groups. Group 1 (control, or "no exposure," n = 25) consisted of residents who received oral postsimulation debriefing from an independent faculty member who had no exposure to our instructional video on how to debrief effectively. Group 2 (intervention, or "exposure," n = 25) consisted of interns who were debriefed by the second faculty member who did watch our instructional video before the simulation and learned about "advocacy and inquiry" techniques. The outcome measures were the Debriefing Assessment for Simulation in Healthcare score and the postdebrief multiple-choice question (MCQ) quiz scores to assess debriefers' performance and interns' knowledge consolidation, respectively. Results The "exposure" group presented statistically significantly higher values for the Debriefing Assessment for Simulation in Healthcare score (P < 0.001) and MCQ score (P < 0.001) compared with the "no exposure" group. Conclusions Debriefers who followed the methodology as demonstrated in our instructional video were considered more competent, and the residents achieved higher MCQ scores. The quality of the debriefing ensures improved critical thinking and problem-solving skills. Safer practice and better patient outcomes are achieved by developing debriefing programs for educators.
Collapse
Affiliation(s)
| | | | | | | | - Jeremy Goverman
- Summer M. Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Hinne Rakhorst
- Department of Plastic Surgery, MST Enschede, ZGT Almelo, the Netherlands
| | | |
Collapse
|
4
|
Sexton JR, Truog AW, Kelly-Weeder S, Loftin C. The Effects of Moral Distress on Resilience in Pediatric Emergency Department Nurses. J Emerg Nurs 2024:S0099-1767(23)00279-9. [PMID: 38300203 DOI: 10.1016/j.jen.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Moral distress is widespread in health care, and nurses working in high-pressure environments, such as emergency departments, experience stress at high rates. Understanding how moral distress affects pediatric emergency nursing care is essential to moderate its negative impacts. Increased resilience has been promoted as a tool to mitigate moral distress. The purpose of this study, conducted prior to the pandemic, was to examine patterns of moral distress and the impact of moral distress on resilience among pediatric emergency nurses. METHODS A cross-sectional exploratory study of pediatric emergency nurses was performed. Moral Distress Scale-Revised (Pediatric) and Connor-Davidson Resilience Scale 25© scores were collected and calculated. Exploratory factor analysis with principal components was used to identify patterns of moral distress that impact resilience. RESULTS Four distinct patterns of moral distress that impact resilience were identified: (1) incompetent practice, (2) incongruent truth-telling, (3) potentially inappropriate care, and (4) discordant health care teams. DISCUSSION Our study was the first to identify 4 patterns of moral distress in pediatric emergency nurses. As a result, actions to promote resilience include: (1) supporting competent practice, (2) upholding appropriate truth-telling, (3) recognizing and addressing potentially inappropriate care, and (4) building concordant health care teams and systems. This pre-pandemic data provides a foundational understanding of the relationship between moral distress and resilience in pediatric emergency nurses. Identifying factors of moral distress that impact resilience has significant implications for pediatric emergency nursing, including the development of future initiatives, education, and research.
Collapse
|
5
|
Sagalowsky ST, Woodward H, Agnant J, Bailey B, Duncan E, Grad J, Kessler DO. Structural Competency in Simulation-Based Health Professions Education: A Call to Action and Pragmatic Guide. Simul Healthc 2024:01266021-990000000-00097. [PMID: 38197665 DOI: 10.1097/sih.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
SUMMARY STATEMENT Simulation-based health professions educators can advance diversity, equity, and inclusion by cultivating structural competency, which is the trained ability to discern inequity not only at an individual level, but also at organizational, community, and societal levels. This commentary introduces Metzl and Hansen's Five-Step Model for structural competency and discusses its unique applicability to the metacognitive underpinnings of simulation-based health professions education. We offer a pragmatic guide for simulation-based health professions educators to collaboratively design learning objectives, simulation cases, character sketches, and debriefs in which structural competency is a simulation performance domain, alongside patient management, resource usage, leadership, situational awareness, teamwork, and/or communication. Our overall goal is to promote a paradigm shift in which educators are empowered to partner with patients, colleagues, and communities to recognize, learn about, and challenge the factors driving health inequities; a skill that may be applied to a broad range of health professions education within and outside of simulation.
Collapse
Affiliation(s)
- Selin T Sagalowsky
- From the New York University Grossman School of Medicine (S.T.S., J.A., E.D., J.G.), New York, NY; NewYork-Presbyterian Morgan Stanley Children's Hospital (H.W.), New York, NY; Family Advisory Council (B.B.), NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY; and Columbia University College of Physicians & Surgeons (D.O.K.), New York, NY
| | | | | | | | | | | | | |
Collapse
|
6
|
Neeley M, Crook TW, Gigante J. This Encounter Isn't Over Yet: The Importance of Debriefing. Pediatrics 2023; 152:e2023063198. [PMID: 37551525 DOI: 10.1542/peds.2023-063198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/09/2023] Open
Affiliation(s)
- Maya Neeley
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee; and Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Travis W Crook
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee; and Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Joseph Gigante
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee; and Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
7
|
Mossenson AI, Ocholi D, Gower S, Livingston PL. Skill Translation Following the Vital Anesthesia Simulation Training Facilitator Course: A Qualitative Study. Anesth Analg 2023; 137:551-558. [PMID: 37043403 DOI: 10.1213/ane.0000000000006468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND Simulation-based education (SBE) is common in resource-rich locations, but barriers exist to widespread implementation in low-resource settings (LRSs). Vital Anesthesia Simulation Training (VAST) was developed to offer low-cost, immersive simulation to teach core clinical practices and nontechnical skills to perioperative health care teams. To promote sustainability, courses in new locations are preceded by the VAST Facilitator Course (VAST FC) to train local faculty. The purpose of this study was to explore the experiences of VAST FC graduates in translating postcourse knowledge and skills into their workplaces. METHODS This qualitative study used focus group interviews with 24 VAST FC graduates (from 12 low- and middle-income and 12 high-income countries) to explore how they had applied new learning in the workplace. Focus groups were conducted by videoconferencing with data transcribed verbatim. Data were analyzed using inductive thematic analysis. RESULTS Enabler themes for knowledge and skill translation following facilitator training were (1) the structured debriefing framework, (2) the ability to create a supportive learning environment, and (3) being able to meaningfully discuss nontechnical skills. Two subthemes within the debriefing framework were (1.1) knowledge of conversational techniques and (1.2) having relevance to clinical debriefing. Barrier themes limiting skill application were (1) added time and effort required for comprehensive debriefing, (2) unsupportive workplaces, and (3) lack of opportunities for mentorship and practice postcourse. CONCLUSIONS Participants found parallels between SBE debriefing conversations, clinical event debriefing, and feedback conversations and were able to apply knowledge and skills in a variety of settings post course. This study supports the relevance of simulation facilitator training for SBE in LRSs.
Collapse
Affiliation(s)
- Adam I Mossenson
- From the SJOG Midland Public and Private Hospitals, Perth, Western AustraliaAustralia
- Curtin University, Perth, Western Australia, Australia
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Deborah Ocholi
- Faculty of Medicine, Dalhousie University, HalifaxNova Scotia, Canada
| | - Shelley Gower
- School of Nursing, Curtin University, Perth, Western Australia, Australia
| | - Patricia L Livingston
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
8
|
Stærk M, Lauridsen KG, Støtt CT, Riis DN, Løfgren B, Krogh K. Inhospital cardiac arrest - the crucial first 5 min: a simulation study. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:29. [PMID: 36085089 PMCID: PMC9462625 DOI: 10.1186/s41077-022-00225-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Early recognition and call for help, fast initiation of chest compressions, and early defibrillation are key elements to improve survival after cardiac arrest but are often not achieved. We aimed to investigate what occurs during the initial treatment of unannounced in situ simulated inhospital cardiac arrests and reasons for successful or inadequate initial resuscitation efforts. METHODS We conducted unannounced full-scale in situ simulated inhospital cardiac arrest followed by a debriefing. Simulations and debriefings were video recorded for subsequent analysis. We analyzed quantitative data on actions performed and time measurements to key actions from simulations and qualitative data from transcribed debriefings. RESULTS We conducted 36 simulations. Time to diagnosis of cardiac arrest was 37 (27; 55) s. Time to first chest compression from diagnosis of cardiac arrest was 37 (18; 74) s, time to calling the cardiac arrest team was 144 (71; 180) s, and time to first shock was 221 (181; 301) s. We observed participants perform several actions after diagnosing the cardiac arrest and before initiating chest compressions. Domains emerging from the debriefings were teaming and resources. Teaming included the themes communication, role allocation, leadership, and shared knowledge, which all included facilitators and barriers. Resources included the themes knowledge, technical issues, and organizational resources, of which all included barriers, and knowledge also included facilitators. CONCLUSION Using unannounced in situ simulated cardiac arrests, we found that key elements such as chest compressions, calling the cardiac arrest team, and defibrillation were delayed. Perceived barriers to resuscitation performance were leadership and teaming, whereas experience, clear leadership, and recent training were perceived as important facilitators for treatment progress.
Collapse
Affiliation(s)
- Mathilde Stærk
- Department of Medicine, Randers Regional Hospital, Randers, Denmark.,Education and Research, Randers Regional Hospital, Randers, Denmark.,Department of Emergency Medicine, Gødstrup Hospital, Herning, Denmark
| | - Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Emergency Department, Randers Regional Hospital, Randers, Denmark.,Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | | | - Dung Nguyen Riis
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Løfgren
- Department of Medicine, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kristian Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark. .,Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
| |
Collapse
|
9
|
Barriers and facilitators for successful AED usage during in-situ simulated in-hospital cardiac arrest. Resusc Plus 2022; 10:100257. [PMID: 35677834 PMCID: PMC9168694 DOI: 10.1016/j.resplu.2022.100257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/18/2022] [Accepted: 05/22/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Methods Results Conclusion
Collapse
|
10
|
The impact of a clinical coaching education on faculty's coaching behavior. TEACHING AND LEARNING IN NURSING 2022. [DOI: 10.1016/j.teln.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
11
|
Coggins A, Zaklama R, Szabo RA, Diaz-Navarro C, Scalese RJ, Krogh K, Eppich W. Twelve tips for facilitating and implementing clinical debriefing programmes. MEDICAL TEACHER 2021; 43:509-517. [PMID: 33032476 DOI: 10.1080/0142159x.2020.1817349] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Contemporary clinical practice places a high demand on healthcare workforces due to complexity and rapid evolution of guidelines. We need embedded workplace practices such as clinical debriefing (CD) to support everyday learning and patient care. Debriefing, defined as a 'guided reflective learning conversation', is most often undertaken in small groups following simulation-based experiences. However, emerging evidence suggests that debriefing may also enhance learning in clinical environments where facilitators need to simultaneously balance psychological safety, learning goals and emotional well-being. This twelve tips article summarises international experience collated at the recent Association for Medical Education in Europe (AMEE) debriefing symposium. These tips encompass the benefits of CD, as well as suggested approach to facilitation. Successful CD programmes are frequently team focussed, interdisciplinary, implemented in stages and use a clear structure.
Collapse
Affiliation(s)
- Andrew Coggins
- Discipline of Emergency Medicine, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ramez Zaklama
- Discipline of Emergency Medicine, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca A Szabo
- Department of Obstetrics and Gynaecology and Department of Medical Education, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Cristina Diaz-Navarro
- Department of Perioperative Care, Cardiff and Vale University Health Board, Cardiff, UK
| | - Ross J Scalese
- Michael S. Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kristian Krogh
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
| | - Walter Eppich
- Departments of Pediatrics and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
12
|
Ratnitsky A, Havranek J, Mohr GL, Rüther-Wolf K, Schwendimann R. [Safety-II in daily clinical practice]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 162:10-15. [PMID: 33722522 DOI: 10.1016/j.zefq.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Providing patient safety is a central matter in health care requiring complex treatment processes containing many risks. In hospital care, adverse events and patient harm occur frequently. In this context, the safety sciences investigate causes and contributing factors of such events as well as improvement measures. With Safety-I and Safety-II, two complementary approaches come into play. While Safety-I aims to minimize adverse events, the Safety-II approach focuses on understanding the system as a whole whose normal operations can result in both desired and adverse events. With the implementation of the Critical Incident Report System (CIRS), the Safety-I approach (with a focus on errors and correction of negative consequences for patient safety) has become an integral part of the university hospital chosen for this study. The subject matter of this study is to determine if and how the Safety-II approach (focussing on normal operation and the understanding of positive effects for patient safety) is already in use and what measurements can support its integration in daily clinical practice. METHOD Through observation, the structures of daily feedback meetings (huddles) from six different hospital departments have been gathered to determine if they can be considered as potential starting points for the implementation of the Safety-II approach. The following expert interviews (n=7) discussed four potentials of the Safety-II approach using the Resilient Assessment Grid (RAG). Finally, a focus group discussed which measurements are central for the integration of the Safety-II approach in daily clinical practice. RESULTS The study shows that department teams partially follow the Safety-II approach. During team huddles, positive experiences are already exchanged. The expert interviews revealed that the RAG potentials respond, learn and anticipate have already been realized satisfactorily while the potential monitor fell behind. The focus groups regard the Safety-II approach more as a matter of corporate culture and less as a paradigm shift which is needed to be integrated into day-to-day business. DISCUSSION Successfully establishing the Safety-II approach requires a focus not just on unwanted occurrences. It is also necessary to focus on the often not directly apparent desired occurrences, which ensure patient safety, and to systematically reflect on them in order to contribute to the development of the organizational culture. Having a better understanding of how the system of daily clinical practice with all its subsystems works will make it possible to proactively counteract unwanted occurrences, for example through regular feedback sessions and debriefings, and to increase patient safety.
Collapse
Affiliation(s)
- Avital Ratnitsky
- Universitätsspital Basel, Abteilung Patientenzentriertes Management, Ärztliche Direktion, Basel, Schweiz
| | - Jennifer Havranek
- Hochschule für Angewandte Psychologie, Fachhochschule Nordwestschweiz (FHNW), Olten, Schweiz
| | - Giulia Lara Mohr
- Universitätsspital Basel, Abteilung für Patientensicherheit, Ärztliche Direktion, Basel, Schweiz
| | - Katharina Rüther-Wolf
- Universitätsspital Basel, Abteilung Patientenzentriertes Management, Ärztliche Direktion, Basel, Schweiz
| | - René Schwendimann
- Universitätsspital Basel, Abteilung für Patientensicherheit, Ärztliche Direktion, Basel, Schweiz.
| |
Collapse
|
13
|
Seelandt JC, Walker K, Kolbe M. "A debriefer must be neutral" and other debriefing myths: a systemic inquiry-based qualitative study of taken-for-granted beliefs about clinical post-event debriefing. Adv Simul (Lond) 2021; 6:7. [PMID: 33663598 PMCID: PMC7931165 DOI: 10.1186/s41077-021-00161-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this study was to identify taken-for-granted beliefs and assumptions about use, costs, and facilitation of post-event debriefing. These myths prevent the ubiquitous uptake of post-event debriefing in clinical units, and therefore the identification of process, teamwork, and latent safety threats that lead to medical error. By naming these false barriers and assumptions, the authors believe that clinical event debriefing can be implemented more broadly. METHODS We interviewed an international sample of 37 clinicians, educators, scholars, researchers, and healthcare administrators from hospitals, universities, and healthcare organizations in Western Europe and the USA, who had a broad range of debriefing experience. We adopted a systemic-constructivist approach that aimed at exploring in-depth assumptions about debriefing beyond obvious constraints such as time and logistics and focused on interpersonal relationships within organizations. Using circular questions, we intended to uncover new and tacit knowledge about barriers and facilitators of regular clinical debriefings. All interviews were transcribed and analyzed following a comprehensive process of inductive open coding. RESULTS In total, 1508.62 min of interviews (25 h, 9 min, and 2 s) were analyzed, and 1591 answers were categorized. Many implicit debriefing theories reflected current scientific evidence, particularly with respect to debriefing value and topics, the complexity and difficulty of facilitation, the importance of structuring the debriefing and engaging in reflective practice to advance debriefing skills. We also identified four debriefing myths which may prevent post-event debriefing from being implemented in clinical units. CONCLUSION The debriefing myths include (1) debriefing only when disaster strikes, (2) debriefing is a luxury, (3) senior clinicians should determine debriefing content, and (4) debriefers must be neutral and nonjudgmental. These myths offer valuable insights into why current debriefing practices are ad hoc and not embedded into daily unit practices. They may help ignite a renewed momentum into the implementation of post-event debriefing in clinical settings.
Collapse
Affiliation(s)
- Julia Carolin Seelandt
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Katie Walker
- New York City, Health + Hospitals Simulation Center, 1400 Pelham Parkway South, Building 4, 2nd Floor, Bronx, NY 10461 USA
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| |
Collapse
|
14
|
Heimberg E, Daub J, Schmutz JB, Eppich W, Hoffmann F. [Debriefing in pediatric emergency care]. Notf Rett Med 2021; 24:43-51. [PMID: 33551677 PMCID: PMC7853166 DOI: 10.1007/s10049-020-00833-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/28/2022]
Abstract
Kommunikationsfehler und systembedingte Probleme wirken sich negativ auf Teamarbeit und gemeinsame Entscheidungsfindung aus und können den Patienten Schaden zufügen. Regelmäßige Nachbesprechungen nach kritischen Ereignissen wiederum wirken sich positiv auf die Teamzusammenarbeit und das Patientenoutcome in der Kindernotfallversorgung aus. Das gemeinsame Reflektieren fördert das Lernen, hilft den Teams, sich zu verbessern, und verhindert, dass sich Fehler in Zukunft wiederholen. Dennoch werden Debriefings im präklinischen und klinischen Alltag noch immer qualitativ unzureichend durchgeführt. Gründe dafür sind mangelnde Zeit, Fehlen von erfahrenen Debriefern und fehlende Unterstützung durch Verantwortungsträger. Debriefings können je nach Bedarf zu verschiedenen Zeitpunkten mit unterschiedlicher Dauer stattfinden. Nachbesprechungen können auch rein virtuell oder als sogenannte Hybridveranstaltung durchgeführt werden. Nachbesprechungen sollten sich auf gemeinsames Lernen und das Erarbeiten zukunftsorientierter Verbesserungen konzentrieren. Nicht nur lebensbedrohliche Ereignisse können Nachbesprechungen auslösen, sondern auch potenziell kritische Situationen, wie routinemäßige Intubationen. Debriefing-Skripte fördern eine Strukturierung und ermöglichen selbst unerfahrenen Moderatoren, alle Aspekte zu bearbeiten. Neben der Diskussion schwieriger Abläufe sollten unbedingt positive Leistungen besprochen werden, um diese zu verstärken und das Lernen am Erfolg zu ermöglichen. Dabei sollten die Beweggründe eines Verhaltens erfragt und nicht nur die nach außen sichtbaren Leistungen bewertet werden. Diese Strategie fördert bedarfsgerechtes Lernen und konzentriert sich auf Lösungen. Hilfreich sind dabei spezielle Fragetechniken, echtes Interesse und eine positive Sicherheitskultur.
Collapse
Affiliation(s)
- E Heimberg
- Kinderintensivstation, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 1, 72076 Tübingen, Deutschland
| | - J Daub
- Kinderintensivstation, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 1, 72076 Tübingen, Deutschland
| | - J B Schmutz
- Department für Management, Technologie und Ökonomie, ETH Zürich, Zürich, Schweiz
| | - W Eppich
- RCSI Sim: Simulation Education and Research, Royal College of Surgeons of Ireland, Dublin, Irland
| | - F Hoffmann
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU München, München, Deutschland
| |
Collapse
|
15
|
Alexandrino H, Baptista S, Vale L, Júnior JHZ, Espada PC, Junior DS, Vane LA, Carvalho VH, Marcelo L, Madeira F, Duarte R, Ferreira L, Pereira J, Pinheiro LF, Fraga GP, Mesquita C. Improving Intraoperative Communication in Trauma: The Educational Effect of the Joint DSTC™-DATC™ Courses. World J Surg 2021; 44:1856-1862. [PMID: 32072223 DOI: 10.1007/s00268-020-05421-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC-DATC courses in candidates' self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario. METHODS Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC-DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most. RESULTS All participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course. CONCLUSIONS Joint training in the DSTC-DATC courses improved candidates' perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care.
Collapse
Affiliation(s)
- Henrique Alexandrino
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, 3000-548, Coimbra, Portugal. .,Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Sérgio Baptista
- Centro Hospitalar Médio Tejo, EPE, Av. Maria de Lurdes Melo e Castro, Ap. 118, 2304-909, Tomar, Portugal
| | - Luís Vale
- Hospital Nélio Mendonça and Regional Emergency Service (SRPC/IPRAM) - Serviço de Saúde da RAM, E.P.E, Avenida Luís de Camões, no 57, 9004-514, Funchal, Portugal
| | - José Hélio Zen Júnior
- Hospital e Maternidade Galileo, Valinhos, São Paulo, Brazil.,Faculdade de Ciências Médicas, Pós Graduação em Ciências Médicas, Universidade Estadual de Campinas/UNICAMP, Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-887, Brazil
| | - Paulo César Espada
- Departamento de Cirurgia Geral, Faculdade Medicina de São José do Rio Preto-FAMERP, São José de Rio Preto, Brazil
| | | | - Luiz Antonio Vane
- Faculdade de Ciências Médicas, Avenida Brigadeiro Faria Lima, 811, Putim, São José dos Campos, São Paulo, Brazil
| | - Vanessa Henriques Carvalho
- School of Medical Science - Unicamp - Campinas-Brazil School of Medical Sciences (SMS), University of Campinas (Unicamp), Rua Alexander Fleming, 181, Cidade Universitária "Prof. Zeferino Vaz", Campinas, SP, 13083-970, Brazil
| | - Lara Marcelo
- Centro Hospitalar Universitário do Porto, EPE, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Filipa Madeira
- Department of Anesthesiology, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | | | - Luís Ferreira
- Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | - Jorge Pereira
- Department of Surgery, Tondela-Viseu Hospital Center, Viseu, Portugal
| | | | - Gustavo Pereira Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences (SMS), University of Campinas (Unicamp), Rua Alexander Fleming, 181, Cidade Universitária "Prof. Zeferino Vaz", Campinas, SP, 13083-970, Brazil
| | - Carlos Mesquita
- Department of Surgery, Coimbra University Hospital Center, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| |
Collapse
|
16
|
Skryabina EA, Betts N, Amlôt R, Reedy G. Understanding the psychological impacts of responding to a terrorist incident. Eur J Psychotraumatol 2021; 12:1959116. [PMID: 34868476 PMCID: PMC8635676 DOI: 10.1080/20008198.2021.1959116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Responding to a mass casualty event can cause significant distress, even for highly trained medical and emergency services personnel. OBJECTIVE The purpose of the study was to understand more about first responders' perspectives about their participation in major incident responses, specifically how and which individual and system factors contributed to their preparedness or may have enabled or hindered their response. The aim of the work was to improve preparedness and response for future incidents. METHODS This study reports a detailed analysis of qualitative interview data from frontline staff who responded to a large mass casualty terrorist incident in the UK in 2017. Data highlighted the psychological distress caused by responding to terrorist events and thus became the focus of further, detailed analysis. RESULTS Participants (n = 21) articulated in their own words the psychological distress experienced by many of the first responders to the event. Participants reported that they were not prepared to deal with psychological impact associated with this mass casualty terrorist incident and their role in the response, and that follow-up support was inconsistent. Multiple factors were identified as potentially increasing psychological distress. Social support provided by peers and organizational debriefs were identified as two most common support mechanisms. Organizational support was identified as inconsistent. CONCLUSIONS This research contributes to the literature the voices of first responders to UK terrorist incidents, building on existing findings while further contributing unique contextual perspectives. This research reinforces the importance of psychosocial support for those who respond to these tragic incidents, and offers a number of recommendations for organizational preparedness for future events. ABBREVIATIONS A&E: Accident and Emergency; EPRR: Emergency Preparedness, Resilience and Response; ERD: Emergency Response Department; HEPE: Health Emergency Preparedness Exercise; PHE: Public Health England; PHE REGG: Public Health England Research Ethics and Governance Group; MCI: Mass Casualty Incident; NHS: National Health Service.
Collapse
Affiliation(s)
- Elena A Skryabina
- Behavioural Science Team, Emergency Response Department Science & Technology, Public Health England, Salisbury, UK
| | - Naomi Betts
- Behavioural Science Team, Emergency Response Department Science & Technology, Public Health England, Salisbury, UK
| | - Richard Amlôt
- Behavioural Science Team, Emergency Response Department Science & Technology, Public Health England, Salisbury, UK
| | - Gabriel Reedy
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
17
|
Robinson T, Santorino D, Dube M, Twine M, Najjuma JN, Cherop M, Kyakwera C, Brenner J, Singhal N, Bajunirwe F, Wishart I, Lin Y, Lorentzen H, Lutnæs DE, Cheng A. Sim for Life: Foundations-A Simulation Educator Training Course to Improve Debriefing Quality in a Low Resource Setting: A Pilot Study. Simul Healthc 2020; 15:326-334. [PMID: 33003188 DOI: 10.1097/sih.0000000000000445] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Despite the importance of debriefing, little is known about the effectiveness of training programs designed to teach debriefing skills. In this study, we evaluated the effectiveness of a faculty development program for new simulation educators at Mbarara University of Science and Technology in Uganda, Africa. METHODS Healthcare professionals were recruited to attend a 2-day simulation educator faculty development course (Sim for Life: Foundations), covering principles of scenario design, scenario execution, prebriefing, and debriefing. Debriefing strategies were contextualized to local culture and focused on debriefing structure, conversational strategies, and learner centeredness. A debriefing worksheet was used to support debriefing practice. Trained simulation educators taught simulation sessions for 12 months. Debriefings were videotaped before and after initial training and before and after 1-day refresher training at 12 months. The quality of debriefing was measured at each time point using the Objective Structured Assessment of Debriefing (OSAD) tool by trained, calibrated, and blinded raters. RESULTS A total of 13 participants were recruited to the study. The mean (95% confidence interval) OSAD scores pretraining, posttraining, and at 12 months before and after refresher were 18.2 (14.3-22.1), 26.7 (22.8-30.6), 25.5 (21.2-29.9), and 27.0 (22.4-31.6), respectively. There was a significant improvement from pretraining to posttraining (P < 0.001), with no significant decay from posttraining to 12 months (P = 0.54). There was no significant difference in OSAD scores pre- versus post-refresher training at 12 months (P = 0.49). CONCLUSIONS The Sim for Life Foundations program significantly improves debriefing skills with retention of debriefing skills at 12 months.
Collapse
Affiliation(s)
- Traci Robinson
- From the Department of Pediatrics (J.B., N.S., A.C.), Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada, Global Health Unit (T.R.), University of Calgary, Calgary, Alberta, Canada; Mbarara University of Science and Technology (D.S., M.T., J.N.N., M.C., C.K., F.B.), Mbarara, Uganda; eSIM Provincial Program (M.D.), Alberta Health Services; Department of Emergency Medicine (I.W.), University of Calgary; KidSIM Simulation Program (Y.L.), Alberta Children's Hospital, Calgary, Alberta, Canada; Operations Training, Oceaneering (H.L.), Sandnes; Formerly of: SAFER (D.E.L.); and The Norwegian Healthcare Investigation Board (D.E.L.), Stavanger, Norway
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Mannarino C, Bradley E, Puro A, Sung D, Wolfe K. Pathophysiology for the Pediatric Critical Care Fellow: Three Representative Simulation Cases. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10931. [PMID: 32733996 PMCID: PMC7384746 DOI: 10.15766/mep_2374-8265.10931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/15/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION During the course of fellowship training, pediatric critical care fellows are expected to develop a broad and in-depth understanding of the pathophysiology of multiple disease processes. The simulation-based pediatric critical care pathophysiology curriculum we present uses scenarios created by pediatric critical care fellows to teach complex pathophysiology. METHODS Each of the three representative cases presented covered a specific pathophysiologic process and required participants to acutely manage (1) an 18-year-old patient with altered mental status in the setting of hepatic encephalopathy; (2) an 8-year-old patient with sepsis, coagulopathy, and acute kidney injury; or (3) a 12-year-old patient with status epilepticus. Each case could be conducted in a simulation suite or an acute care unit bed. We assessed learners' knowledge and attitudes at the end of these simulations with a structured debriefing session and via completion of an evaluation form. The simulations were then followed by a 30-minute interactive didactic session on the topic. RESULTS Each scenario had six fellow participants who completed evaluations. After completing each of the three case scenarios presented, the majority of participating pediatric critical care fellows indicated that the content was relevant and sufficiently challenging. They also indicated that these simulation scenarios would improve their clinical practice. DISCUSSION This fellow-developed simulation curriculum is novel, highlighting the relevance for critical care fellows' understanding of realistic clinical scenarios while promoting advanced management skills with a pathophysiology focus.
Collapse
Affiliation(s)
- Candace Mannarino
- Fellow, Pediatric Cardiac Critical Care Medicine, Northwestern University Feinberg School of Medicine; Fellow, Pediatric Cardiac Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Erin Bradley
- Clinical Instructor, Pediatric Critical Care Medicine, Neonatology Associates of Atlanta PC; Clinical Instructor, Pediatric Critical Care Medicine, Children's Healthcare of Atlanta
| | - Amanda Puro
- Instructor, Pediatric Critical Care Medicine, Dell Children's Medical Center of Central Texas
| | - Deborah Sung
- Fellow, Pediatric Critical Care Medicine, Northwestern University Feinberg School of Medicine; Fellow, Pediatric Cardiac Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Katie Wolfe
- Instructor, Pediatric Critical Care Medicine, Northwestern University Feinberg School of Medicine; Instructor, Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
| |
Collapse
|
19
|
Cold Debriefings after In-hospital Cardiac Arrest in an International Pediatric Resuscitation Quality Improvement Collaborative. Pediatr Qual Saf 2020; 5:e319. [PMID: 32766493 PMCID: PMC7351457 DOI: 10.1097/pq9.0000000000000319] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/05/2020] [Indexed: 12/19/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Clinical event debriefing functions to identify optimal and suboptimal performance to improve future performance. “Cold” debriefing (CD), or debriefing performed more than 1 day after an event, was reported to improve patient survival in a single institution. We sought to describe the frequency and content of CD across multiple pediatric centers. Methods: Mixed-methods, a retrospective review of prospectively collected in-hospital cardiac arrest (IHCA) data, and a supplemental survey of 18 international institutions in the Pediatric Resuscitation Quality (pediRES-Q) collaborative. Data from 283 IHCA events reported between February 2016 and April 2018 were analyzed. We used a Plus/Delta framework to collect debriefing content and performed a qualitative analysis utilizing a modified Team Emergency Assessment Measurement Framework. Univariate and regression models were applied, accounting for clustering by site. Results: CD occurred in 33% (93/283) of IHCA events. Median time to debriefing was 26 days [IQR 11, 41] with a median duration of 60 minutes [20, 60]. Attendance was variable across sites (profession, number per debriefing): physicians 12 [IQR 4, 20], nurses 1 [1, 6], respiratory therapists 0 [0, 1], and administrators 1 [0, 1]. “Plus” comments reported per event were most commonly clinical standards 47% (44/93), cooperation 29% (27/93), and communication 17% (16/93). “Delta” comments were in similar categories: clinical standards 44% (41/93), cooperation 26% (24/93), and communication 14% (13/93). Conclusions: CDs were performed after 33% of cardiac arrests in this multicenter pediatric IHCA collaborative. The majority of plus and delta comments could be categorized as clinical standards, cooperation and communication.
Collapse
|
20
|
Tavares W, Eppich W, Cheng A, Miller S, Teunissen PW, Watling CJ, Sargeant J. Learning Conversations: An Analysis of the Theoretical Roots and Their Manifestations of Feedback and Debriefing in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1020-1025. [PMID: 31365391 DOI: 10.1097/acm.0000000000002932] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Feedback and debriefing are experience-informed dialogues upon which experiential models of learning often depend. Efforts to understand each have largely been independent of each other, thus splitting them into potentially problematic and less productive factions. Given their shared purpose of improving future performance, the authors asked whether efforts to understand these dialogues are, for theoretical and pragmatic reasons, best advanced by keeping these concepts unique or whether some unifying conceptual framework could better support educational contributions and advancements in medical education.The authors identified seminal works and foundational concepts to formulate a purposeful review and analysis exploring these dialogues' theoretical roots and their manifestations. They considered conceptual and theoretical details within and across feedback and debriefing literatures and traced developmental paths to discover underlying and foundational conceptual approaches and theoretical similarities and differences.Findings suggest that each of these strategies was derived from distinct theoretical roots, leading to variations in how they have been studied, advanced, and enacted; both now draw on multiple (often similar) educational theories, also positioning themselves as ways of operationalizing similar educational frameworks. Considerable commonality now exists; those studying and advancing feedback and debriefing are leveraging similar cognitive and social theories to refine and structure their approaches. As such, there may be room to merge these educational strategies as learning conversations because of their conceptual and theoretical consistency. Future scholarly work should further delineate the theoretical, educational, and practical relevance of integrating feedback and debriefing.
Collapse
Affiliation(s)
- Walter Tavares
- W. Tavares is assistant professor and scientist at both The Wilson Centre and the Post-MD Education Office, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, and scientist, Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket, Ontario, Canada; ORCID: http://orcid.org/0000-0001-8267-9448. W. Eppich is associate professor of pediatrics-emergency medicine and medical education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. A. Cheng is associate professor of pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. S. Miller is associate professor of emergency medicine and medical education, Department of Emergency Medicine, and assistant dean, undergraduate medical education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. P.W. Teunissen is professor, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands, and maternal fetal medicine specialist, VU University Medical Center, Amsterdam, the Netherlands. C.J. Watling is professor, Departments of Clinical Neurological Sciences and Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada. J. Sargeant is professor, Continuing Professional Development Program and Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | | |
Collapse
|
21
|
Gougoulis A, Trawber R, Hird K, Sweetman G. 'Take 10 to talk about it': Use of a scripted, post-event debriefing tool in a neonatal intensive care unit. J Paediatr Child Health 2020; 56:1134-1139. [PMID: 32196132 DOI: 10.1111/jpc.14856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/18/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022]
Abstract
AIM This study assessed the impact of a scripted, post-event debriefing tool in identifying logistical, procedural, personnel and performance obstacles and successes in a clinical setting. It was predicted that the debriefing tool would highlight the importance of routine debriefing following challenging clinical events. METHODS The study was conducted in a 22-bed neonatal intensive care unit at a tertiary hospital and involved all staff members in the perinatal service. The debriefing tool, a two-page form providing a structured, scripted approach, was used at the earliest opportunity after acute clinical deteriorations, emergency caesarean sections and any other critical events as decided by the neonatal team. Sessions were facilitated by either a nursing or medical member of the neonatal team. Following a 2-month trial, impact was measured via the comparison of before and after survey questions as well as review of a database of issues raised, subsequent actions and outcomes. RESULTS Significant, positive changes were observed for survey questions specific to the frequency of debriefing, team communication, provision of learning opportunities and identification of logistical, equipment and procedural issues. In addition, the database highlighted the significant positive impact in day-to-day practice as a result of changes initiated by the debriefing tool. All participants requested the unit to continue using the tool. CONCLUSION Scripted, post-event debriefing is achievable and valuable in the clinical setting. It encourages a supportive workplace culture and empowers team members to initiate practical change in their organisations.
Collapse
Affiliation(s)
- Anastasi Gougoulis
- Medical Education Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Rory Trawber
- Medical Education Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Kathryn Hird
- School of Medicine, Notre Dame University, Fremantle, Western Australia, Australia
| | - Greg Sweetman
- Medical Education Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| |
Collapse
|
22
|
Lehn A, Navaratnam D, Broughton M, Cheah V, Fenton A, Harm K, Owen D, Pun P. Functional neurological disorders: effective teaching for health professionals. BMJ Neurol Open 2020; 2:e000065. [PMID: 33681789 PMCID: PMC7903179 DOI: 10.1136/bmjno-2020-000065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/23/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives To provide an outline for the delivery of an educational course or lecture about functional neurological disorders (FND) that is directed towards health professionals with varying clinical knowledge and to highlight the educational efficacy that can be derived from a well-designed educational platform. Method Through multidisciplinary collaboration, a course designed to develop the skills for diagnosis and management of FND was created. Elements essential to the delivery of education are: (A) knowledge creation; (B) facilitating multidisciplinary cross-pollination; (C) listening to patients’ experiences; (D) communication skills practice; (E) case studies; (F) discipline specific mentoring; (G) establishing and addressing participant learning goals and (H) developing collegial and referral networks. Changes in participants’ knowledge and clinical practice were assessed via anonymous questionnaires before and after the course. Results Dramatically improved knowledge and confidence in assessment and management of people with FND has been found both immediately following the course as well as on 6-month follow-up. Conclusion It is possible to make real change in the understanding and management of medical and allied health clinicians working with people with FND with a low-cost intervention. Also, the development of educational networks and multidisciplinary collaboration can lead to the creation of therapeutic platforms for the diagnosis, management and advocacy of this patient group.
Collapse
Affiliation(s)
- Alexander Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,The University of Queensland Princess Alexandra Hospital Clinical School, Woolloongabba, Queensland, Australia
| | | | - Megan Broughton
- Brisbane Clinical Neuroscience Centre, Brisbane, Queensland, Australia
| | - Vince Cheah
- Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Alison Fenton
- Active Rehabilitation, Brisbane, Queensland, Australia
| | - Karl Harm
- Active Rehabilitation, Brisbane, Queensland, Australia
| | - Diana Owen
- Mater Education Centre, Brisbane, Queensland, Australia
| | - Paul Pun
- Emotional Health Unit, Mater Misericordiae Health Services Brisbane Ltd, Brisbane, Queensland, Australia
| |
Collapse
|
23
|
Debriefing in der Kindernotfallversorgung. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-019-00831-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
24
|
Harder N, Lemoine J, Harwood R. Psychological outcomes of debriefing healthcare providers who experience expected and unexpected patient death in clinical or simulation experiences: A scoping review. J Clin Nurs 2019; 29:330-346. [DOI: 10.1111/jocn.15085] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/22/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Nicole Harder
- Rady Faculty of Health Sciences College of Nursing University of Manitoba Winnipeg MB Canada
| | | | - Rae Harwood
- College of Nursing University of Manitoba Winnipeg MB Canada
| |
Collapse
|
25
|
Arnold J, Cashin M, Olutoye OO. Simulation-Based Clinical Rehearsals as a Method for Improving Patient Safety. JAMA Surg 2019; 153:1143-1144. [PMID: 30347045 DOI: 10.1001/jamasurg.2018.3526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jennifer Arnold
- Division of Neonatology, Johns Hopkins Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Melissa Cashin
- Simulation Education, Texas Children's Hospital, Houston
| | - Oluyinka O Olutoye
- Surgery, Pediatrics and Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
26
|
Cheng A, Nadkarni VM, Mancini MB, Hunt EA, Sinz EH, Merchant RM, Donoghue A, Duff JP, Eppich W, Auerbach M, Bigham BL, Blewer AL, Chan PS, Bhanji F. Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2019; 138:e82-e122. [PMID: 29930020 DOI: 10.1161/cir.0000000000000583] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.
Collapse
|
27
|
Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open 2019; 9:e028280. [PMID: 31515415 PMCID: PMC6747874 DOI: 10.1136/bmjopen-2018-028280] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To investigate the relationship between teamwork and clinical performance and potential moderating variables of this relationship. DESIGN Systematic review and meta-analysis. DATA SOURCE PubMed was searched in June 2018 without a limit on the date of publication. Additional literature was selected through a manual backward search of relevant reviews, manual backward and forward search of studies included in the meta-analysis and contacting of selected authors via email. ELIGIBILITY CRITERIA Studies were included if they reported a relationship between a teamwork process (eg, coordination, non-technical skills) and a performance measure (eg, checklist based expert rating, errors) in an acute care setting. DATA EXTRACTION AND SYNTHESIS Moderator variables (ie, professional composition, team familiarity, average team size, task type, patient realism and type of performance measure) were coded and random-effect models were estimated. Two investigators independently extracted information on study characteristics in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS The review identified 2002 articles of which 31 were included in the meta-analysis comprising 1390 teams. The sample-sized weighted mean correlation was r=0.28 (corresponding to an OR of 2.8), indicating that teamwork is positively related to performance. The test of moderators was not significant, suggesting that the examined factors did not influence the average effect of teamwork on performance. CONCLUSION Teamwork has a medium-sized effect on performance. The analysis of moderators illustrated that teamwork relates to performance regardless of characteristics of the team or task. Therefore, healthcare organisations should recognise the value of teamwork and emphasise approaches that maintain and improve teamwork for the benefit of their patients.
Collapse
Affiliation(s)
- Jan B Schmutz
- Department of Communication Studies, Northwestern University, Evanston, Illinois, USA
| | - Laurenz L Meier
- Department of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| |
Collapse
|
28
|
Kolbe M, Boos M. Laborious but Elaborate: The Benefits of Really Studying Team Dynamics. Front Psychol 2019; 10:1478. [PMID: 31316435 PMCID: PMC6611000 DOI: 10.3389/fpsyg.2019.01478] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
In this manuscript we discuss the consequences of methodological choices when studying team processes "in the wild." We chose teams in healthcare as the application because teamwork cannot only save lives but the processes constituting effective teamwork in healthcare are prototypical for teamwork as they range from decision-making (e.g., in multidisciplinary decision-making boards in cancer care) to leadership and coordination (e.g., in fast-paced, acute-care settings in trauma, surgery and anesthesia) to reflection and learning (e.g., in post-event clinical debriefings). We draw upon recently emphasized critique that much empirical team research has focused on describing team states rather than investigating how team processes dynamically unfurl over time and how these dynamics predict team outcomes. This focus on statics instead of dynamics limits the gain of applicable knowledge on team functioning in organizations. We first describe three examples from healthcare that reflect the importance, scope, and challenges of teamwork: multidisciplinary decision-making boards, fast-paced, acute care settings, and post-event clinical team debriefings. Second, we put the methodological approaches of how teamwork in these representative examples has mostly been studied centerstage (i.e., using mainly surveys, database reviews, and rating tools) and highlight how the resulting findings provide only limited insights into the actual team processes and the quality thereof, leaving little room for identifying and targeting success factors. Third, we discuss how methodical approaches that take dynamics into account (i.e., event- and time-based behavior observation and micro-level coding, social sensor-based measurement) would contribute to the science of teams by providing actionable knowledge about interaction processes of successful teamwork.
Collapse
Affiliation(s)
- Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Margarete Boos
- Institute for Psychology, University of Göttingen, Göttingen, Germany
| |
Collapse
|
29
|
Influence of Cardiopulmonary Resuscitation Coaching and Provider Role on Perception of Cardiopulmonary Resuscitation Quality During Simulated Pediatric Cardiac Arrest. Pediatr Crit Care Med 2019; 20:e191-e198. [PMID: 30951004 DOI: 10.1097/pcc.0000000000001871] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to describe the impact of a cardiopulmonary resuscitation coach on healthcare provider perception of cardiopulmonary resuscitation quality during simulated pediatric cardiac arrest. DESIGN Prospective, observational study. SETTING We conducted secondary analysis of data collected from a multicenter, randomized trial of providers who participated in a simulated pediatric cardiac arrest. SUBJECTS Two-hundred pediatric acute care providers. INTERVENTIONS Participants were randomized to having a cardiopulmonary resuscitation coach versus no cardiopulmonary resuscitation coach. Cardiopulmonary resuscitation coaches provided feedback on cardiopulmonary resuscitation performance and helped to coordinate key tasks. All teams used cardiopulmonary resuscitation feedback technology. MEASUREMENTS AND MAIN RESULTS Cardiopulmonary resuscitation quality was collected by the defibrillator, and perceived cardiopulmonary resuscitation quality was collected by surveying participants after the scenario. We calculated the difference between perceived and measured quality of cardiopulmonary resuscitation and defined accurate perception as no more than 10% deviation from measured quality of cardiopulmonary resuscitation. Teams with a cardiopulmonary resuscitation coach were more likely to accurately estimate chest compressions depth in comparison to teams without a cardiopulmonary resuscitation coach (odds ratio, 2.97; 95% CI, 1.61-5.46; p < 0.001). There was no significant difference detected in accurate perception of chest compressions rate between groups (odds ratio, 1.33; 95% CI, 0.77-2.32; p = 0.32). Among teams with a cardiopulmonary resuscitation coach, the cardiopulmonary resuscitation coach had the best chest compressions depth perception (80%) compared with the rest of the team (team leader 40%, airway 55%, cardiopulmonary resuscitation provider 30%) (p = 0.003). No differences were found in perception of chest compressions rate between roles (p = 0.86). CONCLUSIONS Healthcare providers improved their perception of cardiopulmonary resuscitation depth with a cardiopulmonary resuscitation coach present. The cardiopulmonary resuscitation coach had the best perception of chest compressions depth.
Collapse
|
30
|
Schmutz JB, Kolbe M, Eppich WJ. Twelve tips for integrating team reflexivity into your simulation-based team training. MEDICAL TEACHER 2018; 40:721-727. [PMID: 29703126 DOI: 10.1080/0142159x.2018.1464135] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Due to increasing complexity in healthcare, clinicians must often make decisions under uncertain conditions in which teams must be flexible and process emerging information "on the fly" in order to adapt to changing circumstances. A crucial strategy that helps teams to adapt, learn, and develop is team reflexivity (TR) - a team's ability to collectively reflect on group objectives, strategies, processes, and outcomes of past and current performance and to adapt accordingly. We provide 12 evidence-based tips on incorporating TR into simulation-based team training (SBTT). The first three points elaborate on basic principles of TR, when TR can take place and why it matters. The following nine tips are then organized according to three phases in which teams are able to engage in TR: pre-action, in-action, and post-action. SBTT represents an ideal venue to train various TR behaviors that foster team learning and improve patient care.
Collapse
Affiliation(s)
- Jan B Schmutz
- a Department of Management , Technology and Economics, ETH Zurich , Zurich , Switzerland
| | - Michaela Kolbe
- b Simulation Centre , University Hospital Zurich , Zurich , Switzerland
| | - Walter J Eppich
- c Departments of Pediatrics and Medical Education , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| |
Collapse
|
31
|
Coaching the Debriefer: Peer Coaching to Improve Debriefing Quality in Simulation Programs. Simul Healthc 2018; 12:319-325. [PMID: 28538446 DOI: 10.1097/sih.0000000000000232] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
STATEMENT Formal faculty development programs for simulation educators are costly and time-consuming. Peer coaching integrated into the teaching flow can enhance an educator's debriefing skills. We provide a practical guide for the who, what, when, where, why, and how of peer coaching for debriefing in simulation-based education. Peer coaching offers advantages such as psychological safety and team building, and it can benefit both the educator who is receiving feedback and the coach who is providing it. A feedback form for effective peer coaching includes the following: (1) psychological safety, (2) framework, (3) method/strategy, (4) content, (5) learner centeredness, (6) co-facilitation, (7) time management, (8) difficult situations, (9) debriefing adjuncts, and (10) individual style and experience. Institutional backing of peer coaching programs can facilitate implementation and sustainability. Program leaders should communicate the need and benefits, establish program goals, and provide assessment tools, training, structure, and evaluation to optimize chances of success.
Collapse
|
32
|
Abstract
The National League for Nursing and International Nursing Association for Clinical Simulation and Learning stress that debriefing fosters critical reflection and is essential to all educational settings. The call to action for nurse educators is to incorporate theory-based debriefing throughout the curriculum. This article reports on how one school of nursing implemented the theory-based model, Debriefing for Meaningful Learning©, into the prelicensure baccalaureate curriculum.
Collapse
|
33
|
Führen optimierte Teamarbeit und Führungsverhalten zu besseren Reanimationsergebnissen? Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
34
|
SYNSEG – Eine Methode zur syntaxgeleiteten Segmentierung von Kodiereinheiten für die Analyse von Gruppenprozessen. GIO-GRUPPE-INTERAKTION-ORGANISATION-ZEITSCHRIFT FUER ANGEWANDTE ORGANISATIONSPSYCHOLOGIE 2016. [DOI: 10.1007/s11612-016-0345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
35
|
„Speaking Up“ statt tödlichem Schweigen im Krankenhaus. GIO-GRUPPE-INTERAKTION-ORGANISATION-ZEITSCHRIFT FUER ANGEWANDTE ORGANISATIONSPSYCHOLOGIE 2016. [DOI: 10.1007/s11612-016-0343-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|