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Riley K, Middleton R, Molloy L, Wilson V. Exploring rural Nurses' preparedness and post-resuscitation experiences. An ethnographic study. J Adv Nurs 2024. [PMID: 38923061 DOI: 10.1111/jan.16295] [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: 02/12/2024] [Revised: 05/29/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
AIM The focus of this paper is to provide a detailed ethnographic exploration of rural nurses' experiences of their resuscitation preparedness and the subsequent post-resuscitation period. DESIGN An ethnographic study across two small rural hospital sites in New South Wales, Australia. METHODS Fieldwork was undertaken between December 2020 and March 2022 and included over 240 h of nonparticipant observation, journalling and interviews. Data were analysed using reflexive thematic analysis. RESULTS The first key theme-'Sense of Preparedness'-included three subthemes: 'Gaining experience', 'Issues with training and education' and 'Lack of warning'. The second key theme 'Aftermath' comprised two subthemes: 'Getting on with it' and 'Making sense of the resus'. CONCLUSION This study has highlighted the intricate relationship between resuscitative preparedness and the post-resuscitation period in shaping rural nurse's experiences and their well-being. Rural nurses are asking for an authentic and contextually relevant training experience that mirrors the unique rural challenges they experience. In the absence of frequent resuscitation presentations, the post-resuscitation period should be viewed as a crucible moment that can be leveraged as a valuable learning opportunity enhancing rural nurses' sense of preparedness and the provision of quality resuscitation care. IMPACT Having a greater level of insight into the challenges that rural nurses experience in the pre- and post-resuscitation period is critical. This insight opens the door for fortifying policies and work processes that will better support rural nurses in the resuscitation environment. REPORTING METHOD Reporting complied with COREQ criteria for qualitative research. NO PATIENT OR PUBLIC CONTRIBUTION This study explored the experiences of rural nurses. No patient data were collected.
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Affiliation(s)
- Katherine Riley
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Rebekkah Middleton
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Val Wilson
- Prince of Wales Hospital, South Eastern Sydney Local Health District & Ingham Institute, Sydney, New South Wales, Australia
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Rixon A, Elder E, Bull C, Crilly Oam J, Østervan C, Frieslich H, Robertson S, Pink E, Wilson S. Leadership conceptions of nurses and physicians in emergency care: A scoping review. Int Emerg Nurs 2024; 74:101454. [PMID: 38677058 DOI: 10.1016/j.ienj.2024.101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The Emergency Department (ED) is a setting where teamwork and leadership is imperative, however, the literature to date is mostly discipline (nursing or medical) specific. This scoping review aimed to map what is known about nurses' and physicians' conceptions of leadership in the ED to understand similarities, differences, and opportunities for leadership development and research. METHOD Guided by the Joanna Briggs Institute approach, and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines, a systematic search of three electronic databases was performed. The Mixed Methods Assessment Tool was used for quality appraisal of included articles. RESULTS In total, 37 articles were included. Four key findings emerged: 1) leadership was rarely explicitly defined; 2) nurse leaders tended to be characterised as agents of continuity whilst physician leaders tended to be characterised as agents of change and continuity; 3) the clarification of expectations from nurse leaders was more evident than expectations from physician leaders; and 4) leadership discourse tended to be traditional rather than contemporary. CONCLUSION Despite the proliferation of studies into ED nurse, physician and interprofessional leadership, opportunities exist to integrate learnings from other sectors to strengthen the development of current and next generation of ED leaders.
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Affiliation(s)
- Andrew Rixon
- Department of Business Strategy and Innovation - Griffith Business School, Griffith University, Gold Coast, Queensland, Australia; Centre for Work, Organisation and Wellbeing, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Elizabeth Elder
- Centre for Work, Organisation and Wellbeing, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Claudia Bull
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Julia Crilly Oam
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Christina Østervan
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Hayley Frieslich
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Shaun Robertson
- Department of Emergency Medicine, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Ed Pink
- QEII Hospital, Brisbane, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Samuel Wilson
- Department of Management and Marketing, Swinburne Business School, Swinburne University of Technology, Melbourne, Australia
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Jurd C, Barr J. Leadership factors for cardiopulmonary resuscitation for clinicians in-hospital; behaviours, skills and strategies: A systematic review and synthesis without meta-analysis. J Clin Nurs 2024. [PMID: 38757400 DOI: 10.1111/jocn.17215] [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: 12/07/2023] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
AIM To identify leadership factors for clinicians during in-hospital cardiopulmonary resuscitation. DESIGN Systematic review with synthesis without meta-analysis. METHODS The review was guided by SWiM, assessed for quality using CASP and reported with PRISMA. DATA SOURCES Cochrane, EMBASE, PubMed, Medline, Scopus and CINAHL (years of 2013-2023) and a manual reference list search of all included studies. RESULTS A total of 60 papers were identified with three major themes of useful resuscitation leadership; 'social skills', 'cognitive skills and behaviour' and 'leadership development skills' were identified. Main factors included delegating effectively, while being situationally aware of team members' ability and progress during resuscitation, and being empathetic and supportive, yet 'controlling the room' using a hands-off style. Shared decision-making to reduce cognitive load for one leader was shown to improve effective teamwork. Findings were limited by heterogeneity of studies and inconsistently applied tools to measure leadership. CONCLUSION Traditional authoritarian leadership styles are not wanted by team members with preference for shared leadership and collaboration. Balancing this with the need for team members to see leaders in 'control of the room' brings new challenges for leaders and trainers of resuscitation. IMPLICATIONS FOR NURSING PROFESSION All clinicians need effective leadership skills for cardiopulmonary resuscitation in-hospital. Nurses provide first response and ongoing leadership for cardiopulmonary resuscitation. Nurses typically display suitable skills that align with useful resuscitation leader factors. IMPACT What were the main findings? Collaboration rather than an authoritarian approach to leadership is preferred by team members. Nurses are suitable to 'control the room'. Restricting resuscitation team size will manage disruptive behaviour of team members. TRIAL REGISTRATION PROSPERO Registration: CRD42022385630. PATIENT OF PUBLIC CONTRIBUTION No patient of public contribution.
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Affiliation(s)
- Catherine Jurd
- Darling Downs Hospital and Health Service, Kingaroy Hospital, Kingaroy, Queensland, Australia
- Charles Darwin University, Casuarine, Brinkin, Northern Territory, Australia
| | - Jennieffer Barr
- Charles Darwin University, Casuarine, Brinkin, Northern Territory, Australia
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Wolf L, Delao A, Kolbuk ME, Simon C. Elements of an Advanced Trauma Education Program for Emergency Nurses: A Modified Delphi Approach. J Trauma Nurs 2024; 31:149-157. [PMID: 38742723 DOI: 10.1097/jtn.0000000000000788] [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: 05/16/2024]
Abstract
BACKGROUND Basic trauma education for emergency department (ED) staff is available, but there are currently no advanced trauma nursing practice standards for ED nurses. OBJECTIVE The purpose of this study was to identify consensus-based elements of an advanced trauma nursing program for ED nurses. METHODS We used a modified Delphi process with three rounds of online survey data collection to ensure a large group of geographically diverse experts. Data were collected from February 2023 to May 2023. The sample for Round 1 was recruited from members of the Emergency Nurses Association reporting job titles, including trauma coordinator, trauma nursing core course instructor, and vice president of trauma services (n = 829). Participants in subsequent rounds were drawn from respondents to the initial invitation to participate (n = 131). Members of an emergency nursing research council with clinical and research expertise reviewed the results and provided expert input. RESULTS An initial sample of 131 experts identified 17 elements that were assigned a median score equivalent to "agree/strongly agree" (i.e., median 4/5 or 5/5) in Round 2 (n = 69). These elements were presented in Round 3 (n = 43) to determine a rank order. Critical thinking/clinical judgment was the overall priority, followed by assessment/reassessment and early recognition of trauma. CONCLUSIONS Emergency department trauma care experts identified priority content for advanced trauma education. Heterogeneity in the final ranking of components for this advanced trauma course, specifically differences by facility, regional, or demographic characteristics, suggests that training and education may not conform to a one-size-fits-all model.
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Affiliation(s)
- Lisa Wolf
- Author Affiliations: Emergency Nursing Research (Dr Wolf, Ms Delao, and Dr Simon), Education Program Development (Ms Kolbuk), Emergency Nurses Association, Schaumburg, IL; and Elaine Marieb College of Nursing, University of Massachusetts, Amherst, MA (Dr Wolf)
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Riley K, Wilson V, Middleton R, Molloy L. Examining the roles of rural nurses in resuscitation care: An ethnographic study. Int Emerg Nurs 2024; 73:101404. [PMID: 38325062 DOI: 10.1016/j.ienj.2023.101404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Rural nurses play a vital role in the provision of resuscitation care, as first responders and often the sole healthcare professionals delivering timely interventions with greater role autonomy and extended scope of practice. Whilst there is a developing body of literature describing the 'generalist' roles of rural nurses when providing care in acute care settings, little is known about the roles rural nurses assume during a resuscitation. AIM The aim of this study was to explore the role/s that rural nurses enact when delivering resuscitative care to their rural community. DESIGN/METHODS An ethnographic methodology was used across two rural hospital sites in Australia, involving non-participant observation and interviews. RESULTS Reflexive thematic analysis led to three themes that described the resuscitative roles of rural nurses: Senior and junior nurse, formal and informal leadership roles, multiple roles. CONCLUSION This study has placed a spotlight on rural nurse's capacity to be adaptive in a dynamic and highly variable resuscitative environment. Building leadership capacity should be a rural nursing workforce strategy, aimed at supporting the unique roles that rural nurses undertake when working with various external teams during resuscitations.
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Affiliation(s)
| | - Val Wilson
- Prince of Wales Hospital, South Eastern Sydney Local Health District & Ingham Institute, Australia.
| | | | - Luke Molloy
- University of Wollongong, School of Nursing, Australia.
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Wang L, Zhang X, Zhang P, Zhou Q, Wang Q, Cheng J. Development and psychometric evaluation of the trauma nurse core competency scale. Front Public Health 2022; 10:959176. [PMID: 36523571 PMCID: PMC9745320 DOI: 10.3389/fpubh.2022.959176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Trauma, especially severe trauma, has become a significant public health problem worldwide. This postulates higher requirements on the core competence of trauma nurses. However, limited scales exist to assess it validly and reliably. This study aims to develop and evaluate the psychometric properties of the Trauma Nurse Core Competency Scale (TNCCS). Methods This study included three stages. First, scale development was based on a broad literature review and two rounds of Delphi expert consultation. Then, a pre-investigation was conducted with 106 trauma nurses, and a formal scale was formed. Finally, scale evaluation of reliability and validity, based on a cross-sectional study, was tested with 1,107 trauma nurses. Content validity and structure validity were used to evaluate the validity of TNCCS. The Cronbach's α coefficient and the split-half reliability coefficient were used to evaluate the reliability of TNCCS. Results The final scale contained 46 items under three dimensions, which were Knowledge and skills (21 items), Comprehensive literacy (20 items), and Professionalism & physical and mental health (5 items). The Content Validity Index (CVI) of the total scale was 0.980. The goodness-of-fit indices (χ2/df = 3.547, RMSEA = 0.065, GFI = 0.929, CFI = 0.912, NFI = 0.904, IFI = 0.929) signified a good fit for this model. The Construct Reliability (CR) ranged from 0.89 to 0.98, and the Average Variance Extracted (AVE) ranged from 0.62 to 0.69. The Cronbach's α coefficient of the scale was 0.99, ranging from 0.90 to 0.98 for the subscales. The split-half reliability coefficient was 0.84. Conclusions The TNCCS demonstrated good validity and reliability, and it could be used to assess the core competency of trauma nurses. The present study has valuable implications for nursing managers to take corresponding measures to train and improve the core competence of trauma nurses.
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Affiliation(s)
- Lu Wang
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qianning Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Cheng
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Jing Cheng
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Restivo V, Minutolo G, Battaglini A, Carli A, Capraro M, Gaeta M, Odone A, Trucchi C, Favaretti C, Vitale F, Casuccio A. Leadership Effectiveness in Healthcare Settings: A Systematic Review and Meta-Analysis of Cross-Sectional and Before-After Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10995. [PMID: 36078706 PMCID: PMC9518077 DOI: 10.3390/ijerph191710995] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
To work efficiently in healthcare organizations and optimize resources, team members should agree with their leader's decisions critically. However, nowadays, little evidence is available in the literature. This systematic review and meta-analysis has assessed the effectiveness of leadership interventions in improving healthcare outcomes such as performance and guidelines adherence. Overall, the search strategies retrieved 3,155 records, and 21 of them were included in the meta-analysis. Two databases were used for manuscript research: PubMed and Scopus. On 16th December 2019 the researchers searched for articles published in the English language from 2015 to 2019. Considering the study designs, the pooled leadership effectiveness was 14.0% (95%CI 10.0-18.0%) in before-after studies, whereas the correlation coefficient between leadership interventions and healthcare outcomes was 0.22 (95%CI 0.15-0.28) in the cross-sectional studies. The multi-regression analysis in the cross-sectional studies showed a higher leadership effectiveness in South America (β = 0.56; 95%CI 0.13, 0.99), in private hospitals (β = 0.60; 95%CI 0.14, 1.06), and in medical specialty (β = 0.28; 95%CI 0.02, 0.54). These results encourage the improvement of leadership culture to increase performance and guideline adherence in healthcare settings. To reach this purpose, it would be useful to introduce a leadership curriculum following undergraduate medical courses.
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Affiliation(s)
- Vincenzo Restivo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Giuseppa Minutolo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Alberto Battaglini
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, Via Antonio Pastore 1, 16132 Genova, Italy
| | - Alberto Carli
- Santa Chiara Hospital, Largo Medaglie d’oro 9, 38122 Trento, Italy
| | - Michele Capraro
- School of Public Health, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Maddalena Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy
| | - Cecilia Trucchi
- Planning, Epidemiology and Prevention Unit, Liguria Health Authority (A.Li.Sa.), IRCCS San Martino Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Carlo Favaretti
- Centre on Leadership in Medicine, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy
| | - Francesco Vitale
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
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Du Z, Wang T. Effect of implementing quality control management in the treatment of severely injured patients: a retrospective cohort study in a level I trauma center in China. BMC Emerg Med 2022; 22:34. [PMID: 35247973 PMCID: PMC8897735 DOI: 10.1186/s12873-022-00595-8] [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: 12/09/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to review the impact of quality control management on the treatment of severely injured patients. Methods A retrospective analysis was conducted on patients with severe injury (injury severity score [ISS] ≥ 16) between January 1, 2018 and February 1, 2020. The selected patients were stratified as follows. The patients who were admitted prior to the implementation of quality control management—from January 1 to December 31, 2018—were assigned to the PRE group; the POST group included patients who were admitted after the implementation—from February 1, 2019 to February 1, 2020. Quality control management was implemented from January 1, 2019 to January 31, 2019. Parameters were compared to account for differences in terms of demographics, surgical procedures, results of process quality, and 72-h mortality. Results This study included 599 patients (PRE group: 212 males and 86 females; POST group: 228 males and 73 females; P = 0.20). The extent of document completion was 97.3 and 100% in the PRE and POST groups, respectively (P < 0.001). There was no delay in the arrival of the trauma surgeons or the multidisciplinary team after implementation. However, following implementation of quality control management, there was a significant reduction in the duration of basic diagnostics, time until receipt of laboratory data, time until first computed tomography scan, time until intubation, and time until an emergency operation (P < 0.05). The deaths were caused by severe head injury (PRE: 5.4%, POST: 4%), hemorrhagic shock (PRE: 2.4%, POST: 0.7%), multiple-organ failure (PRE: 1.0%, POST: 0.3%), or other causes (PRE: 0.7%, POST: 0.0%). The 72-h mortality decreased after the implementation of quality control management (PRE vs. POST groups: 9.4 vs. 5.0%, P = 0.04). Conclusions The implementation of quality control management resulted in decreased time to critical interventions, improved patient care efficiency, and reduced early mortality. We recommend that this approach be replicated at other trauma centers in China. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00595-8.
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Evans JC, Evans MB, Slack M, Peddle M, Lingard L. Examining non-technical skills for ad hoc resuscitation teams: a scoping review and taxonomy of team-related concepts. Scand J Trauma Resusc Emerg Med 2021; 29:167. [PMID: 34863278 PMCID: PMC8642998 DOI: 10.1186/s13049-021-00980-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background Non-technical skills (NTS) concepts from high-risk industries such as aviation have been enthusiastically applied to medical teams for decades. Yet it remains unclear whether—and how—these concepts impact resuscitation team performance. In the context of ad hoc teams in prehospital, emergency department, and trauma domains, even less is known about their relevance and impact. Methods This scoping review, guided by PRISMA-ScR and Arksey & O’Malley’s framework, included a systematic search across five databases, followed by article selection and extracting and synthesizing data. Articles were eligible for inclusion if they pertained to NTS for resuscitation teams performing in prehospital, emergency department, or trauma settings. Articles were subjected to descriptive analysis, coherence analysis, and citation network analysis. Results Sixty-one articles were included. Descriptive analysis identified fourteen unique non-technical skills. Coherence analysis revealed inconsistencies in both definition and measurement of various NTS constructs, while citation network analysis suggests parallel, disconnected scholarly conversations that foster discordance in their operationalization across domains. To reconcile these inconsistencies, we offer a taxonomy of non-technical skills for ad hoc resuscitation teams. Conclusion This scoping review presents a vigorous investigation into the literature pertaining to how NTS influence optimal resuscitation performance for ad hoc prehospital, emergency department, and trauma teams. Our proposed taxonomy offers a coherent foundation and shared vocabulary for future research and education efforts. Finally, we identify important limitations regarding the traditional measurement of NTS, which constrain our understanding of how and why these concepts support optimal performance in team resuscitation. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00980-5.
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Affiliation(s)
- J Colin Evans
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - M Blair Evans
- Department of Psychology, Western University, London, ON, Canada
| | - Meagan Slack
- Middlesex-London Paramedic Service, London, ON, Canada
| | - Michael Peddle
- Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Janssens S, Simon R, Beckmann M, Marshall S. Shared Leadership in Healthcare Action Teams: A Systematic Review. J Patient Saf 2021; 17:e1441-e1451. [PMID: 29870514 DOI: 10.1097/pts.0000000000000503] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this review were to consolidate the reported literature describing shared leadership in healthcare action teams (HCATs) and to review the reported outcomes related to leadership sharing in healthcare emergencies. METHODS A systematic search of the English language literature before November 2017 was performed using PsycINFO, MEDLINE, PubMed, CINAHL, and EMBASE. Articles describing sharing of leadership functions in HCATs were included. Healthcare teams performing routine work were excluded. Studies were reviewed for type of leadership sharing and sharing-related outcomes. RESULTS Thirty-three articles met the inclusion criteria. A variety of shared leadership models were described across the following three categories: spontaneous collaboration, intuitive working relations, and institutionalized practices. While leadership sharing has the potential for both positive and negative influences on team performance, only six articles reported outcomes potentially attributable to shared leadership. CONCLUSIONS Despite strong evidence for a positive relationship between shared leadership and team performance in other domains, there is limited literature describing shared leadership models in HCATs. The association between shared leadership and team performance in HCATs is a rich area for further investigation.
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Inter Disciplinary Crisis Resource Management Simulation and Perioperative Nurses: A Qualitative Study. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gill HS, Nguyen PH, Fay KA, DelGaudio F, Roginski M, Atchinson PR, Marcolini E. Findings from a tandem clinician leadership intervention for emergency department cardiac arrest care during the COVID-19 pandemic. Am J Emerg Med 2021; 51:184-191. [PMID: 34763237 PMCID: PMC8541832 DOI: 10.1016/j.ajem.2021.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Cardiopulmonary arrest (CPA) care in the Emergency Department (ED) has had to be modified during the coronavirus disease (COVID-19) pandemic. Scarce literature exists on comfort of clinicians (defined as physicians, nurses & advanced practice providers-APP's) in these new roles and their perceived understanding of new algorithms. Methods Routine CPA care in our ED was modified during the COVID-19 pandemic. This involved clinicians in shared leadership roles alongside COVID-19 specific changes to CPA algorithms. The new protocol was operationalized through a two-step educational intervention involving didactic education and in-situ simulations. Univariate analyses using student's t-test assessed effectiveness of this educational intervention with clinician comfort as team leaders and perceived knowledge as primary outcomes on a scale of 1 (strongly disagree) to 5 (strongly agree). Subgroup analysis across physicians (attending & resident), nurses & APP's were also undertaken with an alpha of 0.05, and p values <0.05 were considered statistically significant. Secondary outcomes of task saturation, procedural safety and error prevention were also analyzed. Results Across 83 of 95 total participants, our primary outcome of clinician comfort in the team leader role improved from a mean value of 3.41 (SD: 1.23) pre-intervention to 4.11 (SD: 0.88) with a p-value <0.001 post intervention. Similar and statistically significant findings in clinician comfort were noted across all subgroups except attending physicians and APP's. Perceived knowledge increased from a mean value of 3.54 (SD: 1.06) pre-intervention to a mean value of 4.24 (SD: 0.67) with a p-value <0.001 post intervention. Similar and statistically significant findings in perceived knowledge were noted across all subgroups except APP's. Responses were registered in either the strongly agree or agree category with regards to task saturation (89%), procedural safety (93%) and error prevention (71%) across all clinicians post intervention. Conclusion Our pilot investigation of the effectiveness of an educational intervention of a novel CPA protocol in the ED during the COVID-19 pandemic reached statistical significance with regards to clinician comfort in shared leadership roles and perceived knowledge. These findings suggest that the protocol is rapidly teachable, usable and can be efficiently disseminated across ED clinicians of varying experience, especially in pandemic settings. Further work regarding effectiveness of this new protocol in real life cardiac arrest scenarios is warranted.
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Affiliation(s)
- Harman S Gill
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | | | - Kayla A Fay
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Frank DelGaudio
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Matthew Roginski
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Evie Marcolini
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Bennett CE. Not Who, but Rather How: The Ideal Resuscitation Team Leader. Mayo Clin Proc Innov Qual Outcomes 2021; 5:817-819. [PMID: 34458679 PMCID: PMC8379376 DOI: 10.1016/j.mayocpiqo.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Fowler KR, Robbins LK, Lucero A. Nurse manager communication and outcomes for nursing: An integrative review. J Nurs Manag 2021; 29:1486-1495. [PMID: 33793022 DOI: 10.1111/jonm.13324] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
AIM To evaluate literature on the importance of good communication between managers and nurses, and its influence on nurses and patient care. BACKGROUND In the nursing scenario, concepts such as engagement and job satisfaction are tied to manager communication and influence the care provided (Kunie et al., 2017). It is crucial to recognize the importance of manager communication on the nurses and patient care. The evaluation was guided by this question: in the review of post-2014 quantitative studies, is there evidence that nurse managers with high communication competence have better patient/staff outcomes than those with lower competencies? EVALUATION We evaluated current research through an evidence review on the day-to-day influence of nurse manager communication. We conducted our search using common health databases. Since the American Organization for Nurse Leadership developed nurse manager competencies in 2014, we only included articles published after that year. Further inclusion criteria included primary, quantitative and peer-reviewed research. KEY ISSUES Thirty articles remained after the application of inclusion/exclusion criteria with five themes emerging: patient safety and quality, job satisfaction, leadership styles, innovative practice and general management skills. CONCLUSION Research associates positive patient and staff outcomes with a leader who exhibits communication competences. IMPLICATIONS FOR NURSING MANAGEMENT Assessment of current competence levels in communication in nurse managers is needed. Education for improving communication skills is also needed.
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Affiliation(s)
| | | | - Angela Lucero
- The University of Texas at El Paso, El Paso, TX, USA
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Sethuraman KN, Chang WTW, Zhou AL, Xia B, Gingold DB, McCunn M. Collaboration and Decision-Making on Trauma Teams: A Survey Assessment. West J Emerg Med 2021; 22:278-283. [PMID: 33856312 PMCID: PMC7972389 DOI: 10.5811/westjem.2020.10.48698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/04/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Leadership, communication, and collaboration are important in well-managed trauma resuscitations. We surveyed resuscitation team members (attendings, fellows, residents, and nurses) in a large urban trauma center regarding their impressions of collaboration among team members and their satisfaction with patient care decisions. Methods The Collaboration and Satisfaction About Care Decisions in Trauma (CSACD.T) survey was administered to members of ad hoc trauma teams immediately after resuscitations. Survey respondents self-reported their demographic characteristics; the CSACD.T scores were then compared by gender, occupation, self-identified leader role, and level of training. Results The study population consisted of 281 respondents from 52 teams; 111 (39.5%) were female, 207 (73.7%) were self-reported White, 78 (27.8%) were nurses, and 140 (49.8%) were physicians. Of the 140 physician respondents, 38 (27.1%) were female, representing 13.5% of the total surveyed population. Nine of the 52 teams had a female leader. Men, physicians (vs nurses), fellows (vs attendings), and self-identified leaders trended toward higher satisfaction across all questions of the CSACD.T. In addition to the comparison groups mentioned, women and general team members (vs non-leaders) gave lower scores. Conclusion Female residents, nurses, general team members, and attendings gave lower CSACD.T scores in this study. Identification of nuances and underlying causes of lower scores from female members of trauma teams is an important next step. Gender-specific training may be necessary to change negative team dynamics in ad hoc trauma teams.
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Affiliation(s)
- Kinjal N Sethuraman
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland
| | - Wan-Tsu W Chang
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland
| | - Amy L Zhou
- University of Maryland, College Park, Maryland
| | - Boyan Xia
- University of Maryland, College Park, Maryland
| | - Daniel B Gingold
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Maureen McCunn
- University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland.,University of Maryland School of Medicine, Department of Anesthesiology, Baltimore, Maryland
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Kim AY, Sim IO. Mediating Factors in Nursing Competency: A Structural Model Analysis for Nurses' Communication, Self-Leadership, Self-Efficacy, and Nursing Performance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186850. [PMID: 32961719 PMCID: PMC7558162 DOI: 10.3390/ijerph17186850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/12/2020] [Accepted: 09/17/2020] [Indexed: 05/26/2023]
Abstract
This study examined the structural relationship among clinical nurses' communication ability, self-leadership, self-efficacy, and nursing performance. A structural model analysis was applied to identify factors influencing nursing performance and analyze the effects of self-leadership and self-efficacy as mediators. A survey was conducted among clinical nurses working in general hospitals in Seoul, Gyeonggi, and Gangwon Province of the Republic of Korea. In the final analysis, data from 168 questionnaires were used. SPSS 24.0 and Amos 23.0 programs were used for frequency analysis, exploratory factor analysis, reliability analysis, correlation analysis, confirmatory factor analysis, structural equation model analysis, and mediating effect analysis through bootstrapping. The significance level was set at 5% for all analyses. First, the model's fitness figures met the criteria for the appropriate judgment presented in previous studies, so the model between nurses' communication ability, self-leadership, self-efficacy, and nursing performance was suitable for predicting a causal relationship. Second, the relationship between nurses' communication ability and self-leadership had a statistically significant effect. Also, the relationship between communication ability and self-efficacy had a statistically significant effect. Third, nurses' communication ability affected nursing performance through self-efficacy.
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Affiliation(s)
| | - In Ok Sim
- Correspondence: ; Tel.: +82-10-3372-5920
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Communication Skills, Problem-Solving Ability, Understanding of Patients' Conditions, and Nurse's Perception of Professionalism among Clinical Nurses: A Structural Equation Model Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134896. [PMID: 32645992 PMCID: PMC7369768 DOI: 10.3390/ijerph17134896] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 02/06/2023]
Abstract
This study was intended to confirm the structural relationship between clinical nurse communication skills, problem-solving ability, understanding of patients’ conditions, and nurse’s perception of professionalism. Due to changes in the healthcare environment, it is becoming difficult to meet the needs of patients, and it is becoming very important to improve the ability to perform professional nursing jobs to meet expectations. In this study method, structural model analysis was applied to identify factors influencing the perception of professionalism in nurses. The subjects of this study were 171 nurses working at general hospitals in city of Se, Ga, and Geu. Data analysis included frequency analysis, identification factor analysis, reliability analysis, measurement model analysis, model fit, and intervention effects. In the results of the study, nurse’s perception of professionalism was influenced by factors of communication skills and understanding of the patient’s condition, but not by their ability to solve problems. Understanding of patient’s condition had a mediating effect on communication skills and nursing awareness. Communication skills and understanding of the patient’s condition greatly influenced the nurse’s perception of professionalism. To improve the professionalism of clinical nurses, nursing managers need to emphasize communication skills and understanding of the patient’s condition. The purpose of this study was to provide a rationale for developing a program to improve job skills by strengthening the awareness of professional positions of clinical nurses to develop nursing quality of community.
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Shade L, Reeves K, Rees J, Hendrickson L, Halladay J, Dolor RJ, Bray P, Tapp H. Research nurses as practice facilitators to disseminate an asthma shared decision making intervention. BMC Nurs 2020; 19:40. [PMID: 32477003 PMCID: PMC7236364 DOI: 10.1186/s12912-020-00414-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 03/20/2020] [Indexed: 12/01/2022] Open
Abstract
Background Practice facilitation is a method of introducing and sustaining organizational change. It involves the use of skilled healthcare professionals called practice facilitators (PFs) to help address the challenges associated with implementing evidence-based guidelines and complex interventions into practice. PFs provide a framework for translating research into practice by building relationships, improving communication, fostering change, and sharing resources. Nurses are well positioned to serve as PFs for the implementation of complex interventions, however, there is little evidence currently available to describe nurses in this role. Additionally, the best strategies to implement complex interventions into practices are still not fully understood. Combining practice facilitation with the train-the-trainer model has the potential to spread knowledge and skills. Shared decision making (SDM), which involves patients and providers jointly engaging in decisions around treatment options, has been shown to improve outcomes for patients with asthma. The goal of this manuscript is to describe and evaluate the practice facilitation process from the ADAPT-NC Study which successfully utilized research nurses to implement a complex asthma SDM toolkit intervention into primary care practices. Methods As part of a larger study, 10 primary care practices were recruited for a facilitator-led dissemination intervention involving a 12-week rollout of an asthma SDM toolkit (trial registration: 1.28.2014, #NCT02047929). An experienced lead PF trained research nurses as PFs from each of the 4 participating practice-based research networks (PBRNs) in a train-the-trainer model utilizing a one-day training event and subsequent remote meetings. Evaluation of PF engagement was measured through process improvement surveys. Results Overall, the asthma SDM intervention was successfully implemented within the 4 PBRNs. All 10 facilitator-led practices remained engaged with their PFs, with 8 out of the 10 practices able to incorporate and sustain SDM visits or clinics. Responses from the surveys for process improvement yielded improved PF communication and team dynamics over time. Conclusions This study demonstrated effective use of research nurses as practice facilitators during the dissemination of an asthma SDM intervention into primary care practices, adding to the knowledge of best practices by describing a model of large-scale implementation of a complex intervention through practice facilitation with nurses. Trial registration “Comparing Traditional and Participatory Dissemination of a Shared Decision Making Intervention” was retrospectively registered at https://clinicaltrials.gov/ on January 28th, 2014 (NCT02047929).
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Affiliation(s)
- Lindsay Shade
- 1Atrium Health, Department of Family Medicine Research, 2001 Vail Avenue, Suite 400B Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Kelly Reeves
- 1Atrium Health, Department of Family Medicine Research, 2001 Vail Avenue, Suite 400B Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Jennifer Rees
- 2University of North Carolina at Chapel Hill, 160 N. Medical Drive, CB 7064, Chapel Hill, NC 27599 USA
| | - Lori Hendrickson
- 3Duke University Medical Center, 2608 Erwin Road, Suite 210, Durham, NC 27705 USA
| | - Jacqueline Halladay
- 4Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, CB 7595, Chapel Hill, NC 27599-7595 USA
| | - Rowena J Dolor
- 5Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, 200 Morris Street, 3rd Floor, Durham, NC 27701 USA
| | - Paul Bray
- Vidant Medical Group, 2000 Venture Tower Drive, Greenville, NC 27834 USA
| | - Hazel Tapp
- 1Atrium Health, Department of Family Medicine Research, 2001 Vail Avenue, Suite 400B Mercy Medical Plaza, Charlotte, NC 28207 USA
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Factors Affecting Interprofessional Teamwork in Emergency Department Care of Polytrauma Patients: Results of an Exploratory Study. J Trauma Nurs 2020; 26:312-322. [PMID: 31714492 DOI: 10.1097/jtn.0000000000000469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Considering that traumatic injuries are the leading cause of death among young adults across the globe, emergency department care of polytrauma patients is a crucial aspect of optimized care and premature death prevention. Unfortunately, many studies have highlighted important gaps in collaboration among different trauma team professionals, posing a major quality-of-care challenge. Using the conceptual framework for interprofessional teamwork (IPT) of , the aim of this qualitative descriptive exploratory study was to better understand IPT from the perspective of health professionals in emergency department care of polytrauma patients, specifically by identifying factors that facilitate and impede IPT. Data were collected from a sample of 7 health professionals involved in the care of polytrauma patients through individual interviews and a focus group. In the second phase, 2 structured observations of polytrauma patient care were conducted. Following a thematic analysis, results revealed multiple factors affecting IPT, which can be divided into 5 broad categories: individual, relational, processual, organizational, and contextual. Individual factors, a category that is not part of the conceptual framework of , also emerged as playing a major part in IPT.
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Trauma Response Nurse: Bringing Critical Care Experience and Continuity to Early Trauma Care. J Trauma Nurs 2020; 26:215-220. [PMID: 31283751 DOI: 10.1097/jtn.0000000000000454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Multitrauma patients can benefit significantly from specialized care. Prior to mid-2016, this hospital's trauma team did not include a surgical intensive care unit (SICU) nurse. As the value of bringing this expertise to the patient upon arrival was realized, the role of the trauma response nurse (TRN) was developed. The TRN role was designed to provide a dedicated SICU nurse to care for trauma patients from emergency department (ED) arrival through disposition. The integration of the TRN role into the trauma team sought to improve quality and safety, as well as communication and collaboration, and enhance continuity of care. The primary responsibilities of the TRN were to assist with clinical interventions, transport patients fromthe ED to tests and procedures, and assume care through disposition. Additional TRN duties included education, community outreach, and performance improvement. TRNs now respond to all trauma activations that occur on weekday day shift. This role has improved collaboration between nursing disciplines, improved the overall function of the trauma team, and enhanced the safety of trauma patients during transport. TRNs make valuable contributions to the education and outreach missions of the trauma program and ensure that patients are receiving the highest level of trauma care.
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Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
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Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
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Ryan A, Rizwan R, Williams B, Benscoter A, Cooper DS, Iliopoulos I. Simulation Training Improves Resuscitation Team Leadership Skills of Nurse Practitioners. J Pediatr Health Care 2019; 33:280-287. [PMID: 30497891 DOI: 10.1016/j.pedhc.2018.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In the current era of limited physician trainee work hours, limited nurse practitioner orientation times, and highly specialized care settings, frontline providers have limited opportunities for mentored resuscitation training in emergency situations. We aimed to evaluate the effectiveness of a pilot program to improve resuscitation team leadership skills of nurse practitioners using simulation-based training. METHODS Seven nurse practitioners underwent a 4-hour simulation course in pediatric cardiac emergencies. Pre- and post-course surveys were conducted to evaluate previous emergency leadership experience and self-reported comfort in the team lead role. The time to verbalization of a shared mental model to the team was tracked during the simulations. RESULTS The increases in self-reported comfort level in team leading, sharing a mental model, and differential diagnosis were statistically significant. Average time to shared mental model significantly decreased between simulations. DISCUSSION Simulation can improve code leadership skills of nurse practitioners. These preliminary findings require confirmation in larger studies.
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Harvey EM, Freeman D, Wright A, Bath J, Peters VK, Meadows G, Hamill ME, Flinchum M, Shaver KH, Collier BR. Impact of Advanced Nurse Teamwork Training on Trauma Team Performance. Clin Simul Nurs 2019. [DOI: 10.1016/j.ecns.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Maliziola C, Frigerio S, Lanzarone S, Barale A, Berardino M, Clari M. Sensitivity and specificity of trauma team activation protocol criteria in an Italian trauma center: A retrospective observational study. Int Emerg Nurs 2019; 44:20-24. [PMID: 30824337 DOI: 10.1016/j.ienj.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 01/20/2019] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The trauma team (TT) model could reduce mortality, morbidity, and duration of hospital stay, costs, and complications. To avoid over- or undertriage for trauma team activation, robust criteria have to be chosen. OBJECTIVE This study aimed to evaluate the sensitivity and specificity of a TT activation protocol for major trauma patients to predict the need for emergency treatment. METHODS A retrospective observational study was carried out in the Emergency Department (ED) of a major Italian trauma center. Patients with trauma or burns who accessed the ED in 2015 with a triage red or yellow priority treatment code were included, while pediatric patients were excluded. Sensitivity, specificity and positive predictive values were calculated for each TT activation criteria and the aggregated criteria. RESULTS Data from 240 patients were collected: 40.42% of patients had a congruent triage while 50% were overtriaged and 9.58% undertriaged. A correct triage led to a lower hospital stay (p < 0.01), while undertriage was not associated with patients' death (p = 0.16). All criteria had a specificity higher than 95%, a total sensitivity of 80.83% and a total positive predictive value of 43.49%. CONCLUSION This study highlighted that the TT activation criteria had high specificity and sensitivity, while the positive predictive value of the criteria was lower. Mechanisms of injury criteria were less specific and sensitive in detecting the TT activation correctly. As nurses play a pivotal role in the triage of traumatized patients and the TT, reduction of under- and overtriage is essential to improve the patients' health outcome.
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Affiliation(s)
| | - Simona Frigerio
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
| | - Salvatore Lanzarone
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
| | - Alessandra Barale
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
| | - Maurizio Berardino
- Città della Salute e della Scienza di Torino University Hospital, Turin, Italy.
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A Tiered Approach to Trauma Education in the Emergency Department. J Trauma Nurs 2018; 25:318-322. [PMID: 30216263 DOI: 10.1097/jtn.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although trauma centers are required to provide trauma education to nurses caring for trauma patients, there are no clearly defined standards for this education. In an effort to improve emergency department (ED) trauma nursing care, a tiered approach to ED trauma education (basic, intermediate, and advanced) was developed to provide specialized trauma education to a larger number of ED nurses at a Level II trauma center in Georgia. This tiered approach to ED trauma nurse education has resulted in the ability to quickly activate multiple trauma teams that work together competently and efficiently, leading to improved patient care and development of competent ED trauma nurses.
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Abstract
Trauma leads to 5.7 million annual deaths globally, accounting for 25%-33% of global unintentional deaths and 90% of the global trauma burden in low- and middle-income countries. The Lancet Commission on Global Surgery and the World Health Organization assert that emergent and essential surgical capacity building and trauma system improvement are essential to address the global burden of trauma. In response, the Rutgers Global Surgery program, the School of Nursing and Medicine, and the Robert Wood Johnson University Hospital faculty collaborated in the first Interprofessional Models in Global Injury Care and Education Symposium in June 2016. This 2-week symposium combined lectures, high-fidelity simulation, small group workshops, site visits to Level I trauma centers, and a 1-day training course from the Panamerican Trauma Society. The aim was to introduce global trauma nurses to trauma leadership and trauma system development. After completing the symposium, 10 nurses from China, Colombia, Kenya, Puerto Rico, and Uruguay were surveyed. Overall, 88.8% of participants reported high levels of satisfaction with the program and 100% stated being very satisfied with trauma lectures. Symposia, such as that developed and offered by Rutgers University, prepare nurses to address trauma within system-based care and facilitate trauma nursing leadership in their respective countries.
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Barleycorn D, Lee GA. How effective is trauma simulation as an educational process for healthcare providers within the trauma networks? A systematic review. Int Emerg Nurs 2018; 40:37-45. [PMID: 29703590 DOI: 10.1016/j.ienj.2018.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/07/2018] [Accepted: 03/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Major trauma is a significant public health problem and a leading cause of death for several age groups. To address this issue, Major Trauma Networks were introduced in the UK from 2010, consisting of Major Trauma Centres (MTCs) and a network of linked Trauma Units (TUs). OBJECTIVE The aim is to undertake a systematic review to examine how effective is trauma simulation as an educational process for healthcare providers within trauma networks. METHODS The databases searched included Medline, Embase and Cinahl from 2010 to 2016. This time frame was chosen to reflect more contemporaneous research into simulation training since the advent of trauma networks in 2010 and the publication of national trauma guidelines (NICE). Seven observational studies were selected for narrative review. The screening and selection process followed the PRISMA guidance. The method used to assess the selected studies is based on the Scottish Intercollegiate Guidelines Network (SIGN) handbook. RESULTS Overall, the studies showed benefits of simulation in trauma training, with some statistical evidence that non-technical skills and overall trauma team performance improved after simulation training, which appears to be effective. Although no studies found any specific correlation of simulation- based learning in trauma to wider effects such as patient outcomes, length of stay or morbidity. Some studies have found that time to diagnosis and treatment arising from improved non-technical trauma team skills from simulation, are a valid surrogate indicator of improved patient outcomes. CONCLUSION Overall, it is evident from this review that trauma simulation is an effective educational tool, which can aid trauma learning, develop team's non-technical skills and increase task completion, having a positive impact on the trauma network. Trauma units should therefore benefit from increased trauma simulation training and accessibility to repeated simulation based courses or workshops.
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Affiliation(s)
- Donna Barleycorn
- Kingston University and St Georges, University of London, London, UK.
| | - Geraldine A Lee
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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What is the impact of multidisciplinary team simulation training on team performance and efficiency of patient care? An integrative review. ACTA ACUST UNITED AC 2015; 19:44-53. [PMID: 26614537 DOI: 10.1016/j.aenj.2015.10.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 10/07/2015] [Accepted: 10/14/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND In hospital emergencies require a structured team approach to facilitate simultaneous input into immediate resuscitation, stabilisation and prioritisation of care. Efforts to improve teamwork in the health care context include multidisciplinary simulation-based resuscitation team training, yet there is limited evidence demonstrating the value of these programmes.(1) We aimed to determine the current state of knowledge about the key components and impacts of multidisciplinary simulation-based resuscitation team training by conducting an integrative review of the literature. METHODS A systematic search using electronic (three databases) and hand searching methods for primary research published between 1980 and 2014 was undertaken; followed by a rigorous screening and quality appraisal process. The included articles were assessed for similarities and differences; the content was grouped and synthesised to form three main categories of findings. RESULTS Eleven primary research articles representing a variety of simulation-based resuscitation team training were included. Five studies involved trauma teams; two described resuscitation teams in the context of intensive care and operating theatres and one focused on the anaesthetic team. Simulation is an effective method to train resuscitation teams in the management of crisis scenarios and has the potential to improve team performance in the areas of communication, teamwork and leadership. CONCLUSION Team training improves the performance of the resuscitation team in simulated emergency scenarios. However, the transferability of educational outcomes to the clinical setting needs to be more clearly demonstrated.
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Curtis K, Crouch R. Trauma care--a system fit for the 21st century? Int Emerg Nurs 2014; 23:1-2. [PMID: 25488409 DOI: 10.1016/j.ienj.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kate Curtis
- Guest Editors Major Trauma Special Issue, International Emergency Nursing.
| | - Robert Crouch
- Guest Editors Major Trauma Special Issue, International Emergency Nursing.
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