Mixed simulation course increases participants' positive stress coping abilities

All clinical stressors are not created equal: Differential task stress in a simulated clinical environment

BACKGROUND

A variety of stressors are encountered while working in the emergency department and are often recreated in simulation-based medical education. We seek to examine the physiologic and stress state response of participants in a simulated clinical environment to commonly encountered stressors.

METHODS

Emergency medicine (EM) residents participated in a randomized, controlled trial of six simulated patient encounters with one of three stressors, medical difficulty, interpersonal challenge, and technology/equipment failure, randomized into each scenario. Participants wore smart shirts to measure heart rate variability (HRV) at rest and just after the introduced stressor and completed the Short Stress State Questionnaire (SSSQ) before and after each scenario.

RESULTS

Twenty-seven EM residents participated in the study. Interpersonal challenge resulted in increased distress as measured by SSSQ compared to the other two stressors (one way ANOVA, F[2,144] = 9.95, p < 0.001). There was no difference in worry or task engagement across stressors. HRV decreased significantly from rest for all stressors (p = 0.0003, p = 0.0112, p = 0.0027 for medical difficulty, interpersonal challenge, and equipment failure, respectively), but there was no statistically significant difference between mean change in HRV across stressors (one way ANOVA, F[2,120] = 0.17, p = 0.8452).

CONCLUSIONS

Interpersonal challenge stressor was significantly associated with an increase in distress in EM residents during the simulated encounters as compared to the other stressors. While heart rate variability decreased from rest for each stressor as expected following stressor introduction, differing stressors did not produce a differential change.

Role of Personality and Positive and Negative Affects in Coping Strategies of Nurses: A Cross-Sectional Study

Nurses are exposed to many highly stressful events. Individual variables, such as personality and affective state, have been related to vulnerability to maladaptive coping. Therefore, the objectives of this study were to analyze the relationships between the personality, positive and negative affects, and coping strategies of nurses and to establish the mediating role of affective state in the relationship between personality and coping. The sample was made up of 1,268 Spanish nurses aged 22-63 years who completed the Coping Strategies Inventory, the Positive and Negative Affect Schedule, and the 10-item Big Five Inventory. Descriptive analyses, correlations, and mediation models were estimated. The results showed relationships between the Big Five personality factors, positive and negative affects, and coping strategies. Negative affect was confirmed as a mediator between personality and less adaptive strategies and positive affect was confirmed on positive strategies. This study emphasizes the need to develop actions directed at teaching nurses adequate problem-solving strategies and training them in the ability to assign a different emotional value to complex situations.

DAA-based IIT simulation model enhances the interprofessional collaboration and team efficiency competency of health professionals

One of the ten recommendations of the commission on education of health professionals for the twenty-first century is the "promotion of interprofessional education that breaks down professional silos while enhancing collaborative relationships in effective teams." Continuously, the increasing prevalence of patients with complex chronic health issues challenges the staff's training strategy of healthcare institution. To ensure patient safety, the collaborative involvement of a team of health professional is necessary to delivery care to patients with complex health conditions and social disadvantage. Integrated interprofessional collaboration and team efficiency (IIT) is a competency that can optimize the multiple professional skills to provide well-coordinated, high-quality, and patient-centered care. IIT-based training is a way to improve team-based care through positive shared learning activities in a nonthreatening environment to respond to patient's needs. The describe, analysis, application (DAA) diamond is a debriefing method that provides different health professionals with valuable learning experiences through communication. Using advocacy-inquiry approach, DAA-based IIT simulation offers an effective platform for training IIT. Including all disciplines in the DAA-based IIT simulation process reinforces the unique role/contribution of each team member and provides a mechanism for the team to talk together for system improvements. Actually, good clinical care requires practitioner's ability to effectively resolve stress and conflict, improve job satisfaction/wellbeing, and enhance quality and safety of patient care. In our institution, regular DAA-based IIT simulation courses were held at various divisions and had been proved to improve the safety and quality of healthcare.