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Bradford JY, Camarda A, Gilmore L, Horigan AE, Kaiser J, MacPherson-Dias R, Perry A, Slifko A, Slivinski A, Van Dusen K, Bishop-Royse J, Delao AM. ENA Clinical Practice Guideline Synopsis: Family Presence During Resuscitation and Invasive Procedures. J Emerg Nurs 2024; 50:463-468. [PMID: 38705706 DOI: 10.1016/j.jen.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 05/07/2024]
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2
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Douglas CA, Smith MR. Family presence during resuscitation: Perceptions and confidence of intensive care nurses in an Australian metropolitan hospital. Aust Crit Care 2024; 37:295-300. [PMID: 37652791 DOI: 10.1016/j.aucc.2023.07.007] [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: 10/16/2022] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND While literature supporting family presence during resuscitation (FPDR) was first published over three decades ago, the practice remains controversial. Benefits have been confirmed, and barriers to practice identified through international research. The extent that FPDR is practised in Australian intensive care units (ICUs) is currently unknown. OBJECTIVES To examine ICU nurses' previous exposure and experiences with FPDR To establish their perceptions of the risks and benefits of the practice, as well as their confidence participating. METHODS A descriptive, cross-sectional study design, using validated FPDR risk-benefits and confidence scales, was distributed electronically to registered nurses working within a single adult ICU in Australia. RESULTS Fifty-six percent (n = 45) of respondents had never witnessed FPDR. Respondents were divided on whether families had the right to be present or should be given the option. ICU nurses perceived benefits for families but not for the patients involved or for the nurses participating. Nurses indicated they felt conflicted between the needs of the family, preserving the quality of the care delivered to a deteriorating patient, and protecting the safety of all stakeholders. Support for FPDR was often dependent on the availability of resources such as a family-support person. CONCLUSION This research establishes that ICU nurses lacked exposure to FPDR but were confident in their ability to perform, be observed, and support families during a resuscitation event. Therefore, confidence is likely not a factor in a decision to reject the practice. Further education is indicated as there remained a reluctance to adopt FPDR practice, despite many of the barriers reported having already been largely disproven by the available literature. Institutions have a role in policy development, ensuring adequate resources, and education.
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Affiliation(s)
- Candice Ann Douglas
- Adelaide Nursing School, The University of Adelaide, Corner of North Tce and George St, Adelaide SA, 5000, Australia.
| | - Morgan Roberta Smith
- Adelaide Nursing School, The University of Adelaide, Corner of North Tce and George St, Adelaide SA, 5000, Australia.
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3
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Caloca-Amber S, Mauriz E, Vázquez-Casares AM. Exploring eye-tracking data as an indicator of situational awareness in nursing students during a cardiorespiratory arrest simulation. Nurse Educ Pract 2024; 76:103911. [PMID: 38359685 DOI: 10.1016/j.nepr.2024.103911] [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: 10/14/2023] [Revised: 12/30/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
AIM To examine the components of visual attention that maintain situational awareness during simulation training in undergraduate nursing students with different instruction levels. BACKGROUND Eye-tracking can provide deep insight into the nurses' attention during simulated practice. Knowing which gaze patterns promote situational awareness can significantly improve nurse instruction. DESIGN A comparative observational study investigated the role of visual attention on the performance quality, psychophysiological parameters (vital signs, anxiety and stress) and socioemotional competencies (cognitive workload, motivation and self-efficacy) of nursing students with various experience levels. METHODS Thirty nursing students divided into two groups according to their academic level: first cycle (n=14) and second-cycle (n=16) faced a clinical simulation scenario to resolve a cardiorespiratory arrest event. Eye tracking-based analysis required the selection of six areas of interest. The monitorization of vital signs included measuring blood pressure, heart rate, respiratory rate and oxygen saturation before and after the simulation practice. Participants completed the socioemotional questionnaire (NASA-TLX). They answered the state subscale of the State-Trait Anxiety Inventory (STAI), the Visual Analogue Scale (VAS) of stress, the Situational Motivation Scale (SIMS) and the Baessler and Schwarzer General Self-Efficacy Scale. RESULTS The first-cycle group displayed higher vital sign scores than the second cycle, apart from the post-simulation respiratory rate. All physiological parameters increased in mean value after the clinical simulation, except oxygen saturation. Anxiety was the only parameter in the socioemotional domain to present a statistically significant difference between the groups. First-year nursing students showed greater anxiety, stress, mental workload, identified regulation and intrinsic motivation, while second-year students showed higher levels of amotivation, external regulation and perceived self-efficacy. Eye-tracking data (revisits, gaze and duration of fixations) exhibited statistically significant differences depending on the area of interest in both groups (p =. 05). The performance outcomes showed a negative and moderate association with gaze the total number of gazes in the second-cycle group (rho = -0.640, p = 0.010). CONCLUSION Eye-tracking-based analysis can help to predict performance quality while maintaining situational awareness during nursing instruction.
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Affiliation(s)
- Sandra Caloca-Amber
- Department of Nursing and Physiotherapy, Universidad de León, Campus de Vegazana, s/n, León 24071, Spain
| | - Elba Mauriz
- Department of Nursing and Physiotherapy, Universidad de León, Campus de Vegazana, s/n, León 24071, Spain.
| | - Ana M Vázquez-Casares
- Department of Nursing and Physiotherapy, Universidad de León, Campus de Vegazana, s/n, León 24071, Spain
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Rubin MA, Meulengracht SES, Frederiksen KAP, Thomsen T, Møller AM. The healthcare professionals' perspectives and experiences with family presence during resuscitation: A qualitative evidence synthesis. Acta Anaesthesiol Scand 2024; 68:101-121. [PMID: 37669907 DOI: 10.1111/aas.14323] [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: 03/11/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Family presence during resuscitation (FPDR) is a growing hospital praxis despite lack of high-quality evidence. The aim of this qualitative evidence synthesis review was to synthesize current evidence regarding healthcare professionals (HCP) perspectives on barriers and facilitating factors of FPDR and the potential impact of FPDR on HCP performance. METHODS We conducted a systematic literature search May 17, 2023 including primary studies with qualitative study designs. We applied NVivo for data analysis. Data was coded with line-by-line coding and organized into themes and categories following the method for thematic synthesis described by Thomas and Harden to analyse data. The studies underwent quality appraisal by Critical Appraisal Skills Program. We used GRADE CERQual to assess the confidence in the evidence. RESULTS We identified 8241 articles suitable for screening, 141 articles were full text screened, and nine studies included from Australia, UK and USA. In total, 134 HCP participated, between 2005 and 2019. Most studies lacked sufficiently rigorous data analysis and findings were appraised to have moderate GRADE CERQual confidence. We identified three analytical themes ("Facilitating factors for FPDR", "Barriers for FPDR" and "How staff are affected by FPDR") with eight descriptive subthemes. One finding was of high GRADE CERQual confidence: a belief that FPDR is "the right thing to do" which was a "Facilitating factor of FPDR." CONCLUSION The evidence on HCP perspectives is of low to moderate confidence. The interviewed consent that FPDR is the "right thing to do", and an ethical principle of beneficence is dominant, especially regarding children.
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Affiliation(s)
- Monika Afzali Rubin
- Department of Anaesthesiology and Herlev ACES, Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | | | - Katja Anna Poulsen Frederiksen
- Department of Anaesthesiology and Herlev ACES, Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | - Thordis Thomsen
- Department of Anaesthesiology and Herlev ACES, Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | - Ann Merete Møller
- Department of Anaesthesiology and Herlev ACES, Herlev Anaesthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Denmark
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Truchot J, Michelet D, Philippon AL, Drummond D, Freund Y, Plaisance P. Effect of a specific training intervention with task interruptions on the quality of simulated advance life support: A randomized multi centered controlled simulation study. Australas Emerg Care 2023; 26:153-157. [PMID: 36241582 DOI: 10.1016/j.auec.2022.10.001] [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: 09/21/2022] [Revised: 09/28/2022] [Accepted: 10/01/2022] [Indexed: 06/06/2023]
Abstract
PURPOSE Task interruptions (TI) are frequent disturbances for emergency professionals performing advanced life support (ALS). The aim of our study was to evaluate a specific training intervention with TI on the quality of simulated ALS. METHODS During this multi centered randomized controlled trial, each team included one resident, one nurse and one emergency physician. The teams were randomized for the nature of their training session: control (without interruption) or intervention (with TI). The primary outcome was non-technical skills assessed with the TEAM score. We also measured the no flow time, the Cardiff score and chest compression depth and rate. RESULTS On a total of 21 included teams, 11 were randomized to a control training session and 10 to the specific TI training. During training, teams' characteristics and skills were similar between the two groups. During the evaluation session, the TEAM score was not different between groups: median score for control group 33,5 vs 31,5 for intervention group. We also report similar no flow time and Cardiff score. CONCLUSION In this simulated ALS study, a specific training intervention with TI did not improve technical and non-technical skills. Further research is required to limit the impact of TI in emergency settings.
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Affiliation(s)
- Jennifer Truchot
- ILumens Platform of Medical Simulation Paris University, 45 rue des Saint Pères, 75006 Paris, France; ILumens Platform of Medical Simulation Paris University, 20 rue du département, 75010 Paris, France; Department of Emergency Medicine, Lariboisière University Hospital, APHP, Université de Paris, 2 rue Ambroise Paré, Paris, France; Emergency department - SAMU 75, Cochin University Hospital- University of Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France.
| | - Daphné Michelet
- ILumens Platform of Medical Simulation Paris University, 45 rue des Saint Pères, 75006 Paris, France; Department of Anesthesia and Intensive Care, American Memorial University Hospital, Reims, France
| | - Anne Laure Philippon
- Emergency Department, Pitié-Salpêtrière hospital, Sorbonne Université, APHP, Paris, France
| | - David Drummond
- ILumens Platform of Medical Simulation Paris University, 45 rue des Saint Pères, 75006 Paris, France; Pediatric Pulmonology, Necker-Enfants Malades University Hospital, APHP, France
| | - Yonathan Freund
- Emergency Department, Pitié-Salpêtrière hospital, Sorbonne Université, APHP, Paris, France
| | - Patrick Plaisance
- ILumens Platform of Medical Simulation Paris University, 45 rue des Saint Pères, 75006 Paris, France; ILumens Platform of Medical Simulation Paris University, 20 rue du département, 75010 Paris, France; Department of Emergency Medicine, Lariboisière University Hospital, APHP, Université de Paris, 2 rue Ambroise Paré, Paris, France
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6
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Varner-Perez SE, Mathis KA, Banks SK, Burke ES, Slaven JE, Morse GJ, Whitaker MK, Cottingham AH, Ahmed RA. A descriptive study of the multidisciplinary healthcare experiences of inpatient resuscitation events. Resusc Plus 2023; 13:100349. [PMID: 36654725 PMCID: PMC9841215 DOI: 10.1016/j.resplu.2022.100349] [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: 09/29/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
Background In-hospital resuscitation events have complex and enduring effects on clinicians, with implications for job satisfaction, performance, and burnout. Ethically ambiguous cases are associated with increased moral distress. We aim to quantitatively describe the multidisciplinary resuscitation experience. Methods Multidisciplinary in-hospital healthcare professionals at an adult academic health center in the Midwestern United States completed surveys one and six weeks after a resuscitation event. Surveys included demographic data, task load (NASA-TLX), overall and moral distress, anxiety, depression, and spiritual peace. Spearman's rank correlation was computed to assess task load and distress. Results During the 5-month study period, the study included 12 resuscitation events across six inpatient units. Of 82 in-hospital healthcare professionals eligible for recruitment, 44 (53.7%) completed the one-week post-resuscitation event survey. Of those, 37 (84.1%) completed the six-week survey. Highest median task load burden at one week was seen for temporal demand, effort, and mental demand. Median moral distress scores were low, while "at peace" median scores tended to be high. There were no significant non-zero changes in task load or distress scores from weeks 1-6. Mental demand (r = 0.545, p < 0.001), physical demand (r = 0.464, p = 0.005), performance (r = -0.539, p < 0.001), and frustration (r = 0.545, p < 0.001) significantly correlated with overall distress. Performance (r = -0.371, p = 0.028) and frustration (r = 0.480, p = 0.004) also significantly correlated with moral distress. Conclusions In-hospital healthcare professionals' experiences of resuscitation events are varied and complex. Aspects of task load burden including mental and physical demand, performance, and frustration contribute to overall and moral distress, deserving greater attention in clinical contexts.
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Affiliation(s)
- Shelley E. Varner-Perez
- Indiana University (IU) Health, Indianapolis, IN, USA,IU Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA,Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, IN, USA,Corresponding author at: Indiana University Health Methodist Hospital, Spiritual Care & Chaplaincy, 1812 N Capitol, Wile Hall W230, Indianapolis, IN 46202, USA.
| | | | | | - Emily S. Burke
- IU Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - James E. Slaven
- IU Department of Biostatistics and Health Data Science, IU School of Medicine, Indianapolis, IN, USA
| | | | | | - Ann H. Cottingham
- IU School of Medicine, Indianapolis, IN, USA,IU Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Rami A. Ahmed
- IU Department of Emergency Medicine, Division of Medical Simulation, IU School of Medicine, Indianapolis, IN, USA
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Sellmann T, Oendorf A, Wetzchewald D, Schwager H, Thal SC, Marsch S. The Impact of Withdrawn vs. Agitated Relatives during Resuscitation on Team Workload: A Single-Center Randomised Simulation-Based Study. J Clin Med 2022; 11:jcm11113163. [PMID: 35683550 PMCID: PMC9180995 DOI: 10.3390/jcm11113163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 01/25/2023] Open
Abstract
Background: Guidelines recommend that relatives be present during cardiopulmonary resuscitation (CPR). This randomised trial investigated the effects of two different behaviour patterns of relatives on rescuers’ perceived stress and quality of CPR. Material and methods: Teams of three to four physicians were randomised to perform CPR in the presence of no relatives (control group), a withdrawn relative, or an agitated relative, played by actors according to a scripted role, and to three different models of leadership (randomly determined by the team or tutor or left open). The scenarios were video-recorded. Hands-on time was primary, and the secondary outcomes comprised compliance to CPR algorithms, perceived workload, and the influence of leadership. Results: 1229 physicians randomised to 366 teams took part. The presence of a relative did not affect hands-on time (91% [87−93] vs. 92% [88−94] for “withdrawn” and 92 [88−93] for “agitated” relatives; p = 0.15). The teams interacted significantly less with a “withdrawn” than with an “agitated” relative (11 [7−16]% vs. 23 [15−30]% of the time spent for resuscitation, p < 0.01). The teams confronted with an “agitated” relative showed more unsafe defibrillations, higher ventilation rates, and a delay in starting CPR (all p < 0.05 vs. control). The presence of a relative increased frustration, effort, and perceived temporal demands (all <0.05 compared to control); in addition, an “agitated” relative increased mental demands and total task load (both p < 0.05 compared to “withdrawn” and control group). The type of leadership condition did not show any effects. Conclusions: Interaction with a relative accounted for up to 25% of resuscitation time. Whereas the presence of a relative per se increased the task load in different domains, only the presence of an “agitated” relative had a marginal detrimental effect on CPR quality (GERMAN study registers number DRKS00024761).
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Affiliation(s)
- Timur Sellmann
- Department of Anaesthesiology and Intensive Care Medicine, Bethesda Hospital, 47053 Duisburg, Germany;
- Department of Anaesthesiology 1, Witten/Herdecke University, 58455 Witten, Germany;
| | - Andrea Oendorf
- Institute of Emergency Medicine, 59755 Arnsberg, Germany; (A.O.); (D.W.); (H.S.)
- Department of Internal Medicine, Gertrudis Hospital, 45701 Herten, Germany
| | - Dietmar Wetzchewald
- Institute of Emergency Medicine, 59755 Arnsberg, Germany; (A.O.); (D.W.); (H.S.)
| | - Heidrun Schwager
- Institute of Emergency Medicine, 59755 Arnsberg, Germany; (A.O.); (D.W.); (H.S.)
| | - Serge Christian Thal
- Department of Anaesthesiology 1, Witten/Herdecke University, 58455 Witten, Germany;
- Department of Anaesthesiology, Helios University Hospital, 42283 Wuppertal, Germany
| | - Stephan Marsch
- Department of Intensive Care, University Hospital, 4031 Basel, Switzerland
- Correspondence: ; Fax: +41-612-655-300
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8
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Gröpel P, Wagner M, Bibl K, Schwarz H, Eibensteiner F, Berger A, Cardona FS. Provider Visual Attention Correlates With the Quality of Pediatric Resuscitation: An Observational Eye-Tracking Study. Front Pediatr 2022; 10:867304. [PMID: 35685920 PMCID: PMC9171025 DOI: 10.3389/fped.2022.867304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Eye-tracking devices are an innovative tool to understand providers' attention during stressful medical tasks. The knowledge about what gaze behaviors improve (or harm) the quality of clinical care can substantially improve medical training. The aim of this study is to identify gaze behaviors that are related to the quality of pediatric resuscitation. Methods Forty students and healthcare providers performed a simulated pediatric life support scenario, consisting of a chest compression task and a ventilation task, while wearing eye-tracking glasses. Skill Reporter software measured chest compression (CC) quality and Neo Training software measured ventilation quality. Main eye-tracking parameters were ratio [the number of participants who attended a certain area of interest (AOI)], dwell time (total amount of time a participant attended an AOI), the number of revisits (how often a participant returned his gaze to an AOI), and the number of transitions between AOIs. Results The most salient AOIs were infant chest and ventilation mask (ratio = 100%). During CC task, 41% of participants also focused on ventilation bag and 59% on study nurse. During ventilation task, the ratio was 61% for ventilation bag and 36% for study nurse. Percentage of correct CC rate was positively correlated with dwell time on infant chest (p = 0.044), while the overall CC quality was negatively correlated with dwelling outside of pre-defined task-relevant AOIs (p = 0.018). Furthermore, more dwell time on infant chest predicted lower leakage (p = 0.042). The number of transitions between AOIs was unrelated to CC parameters, but correlated negatively with mask leak during ventilations (p = 0.014). Participants with high leakage shifted their gaze more often between ventilation bag, ventilation mask, and task-irrelevant environment. Conclusion Infant chest and ventilation mask are the most salient AOIs in pediatric basic life support. Especially the infant chest AOI gives beneficial information for the resuscitation provider. In contrast, attention to task-irrelevant environment and frequent gaze shifts seem to harm the quality of care.
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Affiliation(s)
- Peter Gröpel
- Division of Sport Psychology, Department of Sport Sciences, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katharina Bibl
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Hannah Schwarz
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Felix Eibensteiner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Francesco S. Cardona
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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9
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Outcomes of Simulation-Based Experiences Related to Family Presence During Resuscitation: A Systematic Review. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Lacour M, Bloudeau L, Combescure C, Haddad K, Hugon F, Suppan L, Rodieux F, Lovis C, Gervaix A, Ehrler F, Manzano S, Siebert JN. Impact of a Mobile App on Paramedics' Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e31748. [PMID: 34617916 PMCID: PMC8532016 DOI: 10.2196/31748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrests (OHCAs) are stressful, high-stake events that are associated with low survival rates. Acute stress experienced in this situation is associated with lower cardiopulmonary resuscitation performance in calculating drug dosages by emergency medical services. Children are particularly vulnerable to such errors. To date, no app has been validated to specifically support emergency drug preparation by paramedics through reducing the stress level of this procedure and medication errors. OBJECTIVE This study aims to determine the effectiveness of an evidence-based mobile app compared with that of the conventional preparation methods in reducing acute stress in paramedics at the psychological and physiological levels while safely preparing emergency drugs during simulated pediatric OHCA scenarios. METHODS In a parent, multicenter, randomized controlled trial of 14 emergency medical services, perceived and physiologic stress of advanced paramedics with drug preparation autonomy was assessed during a 20-minute, standardized, fully video-recorded, and highly realistic pediatric OHCA scenario in an 18-month-old child. The primary outcome was participants' self-reported psychological stress perceived during sequential preparations of 4 intravenous emergency drugs (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate) with the support of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app designed to help pediatric drug preparation (intervention) or conventional methods (control). The State-Trait Anxiety Inventory and Visual Analog Scale questionnaires were used to measure perceived stress. The secondary outcome was physiologic stress, measured by a single continuous measurement of the participants' heart rate with optical photoplethysmography. RESULTS From September 3, 2019, to January 21, 2020, 150 advanced paramedics underwent randomization. A total of 74 participants were assigned to the mobile app (intervention group), and 76 did not use the app (control group). A total of 600 drug doses were prepared. Higher State-Trait Anxiety Inventory-perceived stress increase from baseline was observed during the scenario using the conventional methods (mean 35.4, SD 8.2 to mean 49.8, SD 13.2; a 41.3%, 35.0 increase) than when using the app (mean 36.1, SD 8.1 to mean 39.0, SD 8.4; a 12.3%, 29.0 increase). This revealed a 30.1% (95% CI 20.5%-39.8%; P<.001) lower relative change in stress response in participants who used the app. On the Visual Analog Scale questionnaire, participants in the control group reported a higher increase in stress at the peak of the scenario (mean 7.1, SD 1.8 vs mean 6.4, SD 1.9; difference: -0.8, 95% CI -1.3 to -0.2; P=.005). Increase in heart rate during the scenario and over the 4 drugs was not different between the 2 groups. CONCLUSIONS Compared with the conventional method, dedicated mobile apps can reduce acute perceived stress during the preparation of emergency drugs in the prehospital setting during critical situations. These findings can help advance the development and evaluation of mobile apps for OHCA management and should be encouraged. TRIAL REGISTRATION ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-019-3726-4.
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Affiliation(s)
- Matthieu Lacour
- University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | | | - Christophe Combescure
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Florence Hugon
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Suppan
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédérique Rodieux
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Lovis
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Alain Gervaix
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Ehrler
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Division of Medical Information Sciences, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Sergio Manzano
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Johan N Siebert
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.,Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
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- See Authors' Contributions,
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11
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Effect of Psychophysiological Stress and Socio-Emotional Competencies on the Clinical Performance of Nursing Students during a Simulation Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105448. [PMID: 34069709 PMCID: PMC8160605 DOI: 10.3390/ijerph18105448] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
Psychophysiological stress can affect the cognitive response and effective learning of students during medical simulation practices. This study aimed to explore the effect of psychophysiological stress and socio-emotional competencies on clinical performance during a simulation experience. A pre-test/post-test design was used to assess physiological (blood pressure, heart rate and blood oxygen saturation) and psychological parameters (stress and anxiety) as well as socio-emotional skills (cognitive load, self-efficacy and motivation) in nursing students (n = 40) before and after the simulation of a cardiopulmonary resuscitation practice. Physiological responses showed statistically significant differences between pre-test and post-test conditions for blood pressure and heart rate (p < 0.0001). Moderate and significant correlations were also observed when comparing self-efficacy with stress (r = −0.445, p = 0.004), anxiety (r = −0.467, p = 0.002) and motivation (r = −0.406, p = 0.009) measures. Similarly, cognitive-load dimensions were significantly associated with either physiological (r = −0.335, p = 0.034) or psychological (r = −0.448, p = 0.004) indicators. The analysis of multiple regression models revealed a relationship between the effectiveness of the simulated experience, post-test blood oxygen saturation, heart rate, workload and self-efficacy (R2 = 0.490; F (3, 39) = 8.305; p < 0.0001; d = 1.663). Therefore, the evaluation of psychophysiological parameters and socio-emotional skills seems to provide a promising framework for predicting the quality of simulated clinical practices.
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Torsy T, Deswarte W, Karlberg Traav M, Beeckman D. Effect of a dynamic mattress on chest compression quality during cardiopulmonary resuscitation. Nurs Crit Care 2021; 27:275-281. [PMID: 33884701 DOI: 10.1111/nicc.12631] [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: 10/19/2020] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In-hospital cardiac arrest is a medical emergency that occurs on a regular basis. As patients most at risk for an in-hospital cardiac arrest are usually positioned on a dynamic mattress, it is important to measure the effect of mattress compressibility on chest compression quality during cardiopulmonary resuscitation (CPR). High-quality CPR is essential for patient survival and good neurological outcome. AIMS AND OBJECTIVES To examine the effect of an inflated dynamic overlay mattress on chest compression quality during CPR and to explore the predictive effect of health care providers' anthropometric factors, hand positioning and mattress type on chest compression frequency and depth. DESIGN Manikin-based single-blinded randomised controlled trial. METHODS Nursing students (N = 70) were randomised to a control (viscoelastic foam mattress) or intervention group (inflated dynamic overlay mattress on top of a viscoelastic foam mattress) and had to perform chest compressions over a 2-minute period. Compression rate, depth and hand positioning were registered. The 2015 European Resuscitation Council (ERC) guidelines were used as a reference. RESULTS The mean difference in chest compression depth between control and intervention groups was 2.86 mm (P = .043). Both groups met the guidelines for adequate chest compression quality, as recommended by the ERC. A predictive effect of health care providers' body height and weight, mattress type and hand positioning on compression depth could be demonstrated (P = .004). CONCLUSIONS CPR in bedridden patients on a dynamic overlay mattress has a negative effect on the quality of chest compressions. Mean chest compression depth decreases significantly. However, clinical significance of the results may be debatable. Mattress type, body weight and hand positioning appear to be significant predictors for adequate chest compression depth. RELEVANCE TO CLINICAL PRACTICE A firm surface under the patient is needed during CPR. Special attention must be paid to correct hand positioning during CPR.
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Affiliation(s)
- Tim Torsy
- Department of Nursing, Odisee University College, Brussels, Belgium.,Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Wim Deswarte
- Department of Nursing, Odisee University College, Brussels, Belgium
| | - Malin Karlberg Traav
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.,Faculty of Medicine and Health Science, School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
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Aschieri D, Guerra F, Pelizzoni V, Paolini E, Stronati G, Moderato L, Losi G, Compagnucci P, Coccia M, Casella M, Dello Russo A, Bardy GH, Capucci A. Ventricular Fibrillation Recurrences in Successfully Shocked Out-of-Hospital Cardiac Arrests. ACTA ACUST UNITED AC 2021; 57:medicina57040358. [PMID: 33917184 PMCID: PMC8067796 DOI: 10.3390/medicina57040358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/19/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022]
Abstract
Background and Objectives: The prognostic impact of ventricular fibrillation (VF) recurrences after a successful shock in out-of-hospital cardiac arrest (OOHCA) is still poorly understood, and some evidence suggests a potential pro-arrhythmic effect of chest compressions in this setting. In the present analysis, we looked at the short-term and long-term prognosis of VF recurrences in OOHCA. And their potential association with chest compressions. Materials and Methods: The Progetto Vita, prospectively collecting data on all resuscitation efforts in the Piacenza province (Italy), was used for the present analysis. From the 461 OOHCAs found in a shockable rhythm, only those with optimal ECG tracings and good audio recordings (160) were assessed. Rhythms other than VF post-shock were analyzed five seconds after shock delivery and survival to hospital admission, hospital discharge, and long-term survival data over a 14-year follow-up were collected. Results: Population mean age was 64.4 ± 16.9 years, and 31.9% of all patients were female. Mean time to EMS arrival was 5.9 ± 4.5 min. Short- and long-term survival without neurological impairment were higher in patients without VF recurrence when compared to patients with VF recurrence, independently from the pre-induction rhythm (p < 0.001). After shock delivery, VF recurrence was higher when chest compressions were resumed early after discharge and more vigorously. Conclusions: VF recurrences after a shock could worsen short and long-term survival. The potential pro-arrhythmic effect of chest compressions should be factored in when considering the real risks and benefits of this procedure.
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Affiliation(s)
- Daniela Aschieri
- Cardiology Department, Civil Hospital, 29015 Castel San Giovanni, Italy; (D.A.); (G.L.); (M.C.)
| | - Federico Guerra
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; (G.S.); (P.C.); (A.D.R.); (A.C.)
- Correspondence:
| | - Valentina Pelizzoni
- Cardiology Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy; (V.P.); (L.M.)
| | - Enrico Paolini
- Cardiology Department, “Ospedali Riuniti Marche Nord”, 61121 Pesaro, Italy;
| | - Giulia Stronati
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; (G.S.); (P.C.); (A.D.R.); (A.C.)
| | - Luca Moderato
- Cardiology Department, “Guglielmo da Saliceto” Hospital, 29121 Piacenza, Italy; (V.P.); (L.M.)
| | - Giulia Losi
- Cardiology Department, Civil Hospital, 29015 Castel San Giovanni, Italy; (D.A.); (G.L.); (M.C.)
| | - Paolo Compagnucci
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; (G.S.); (P.C.); (A.D.R.); (A.C.)
| | - Michela Coccia
- Cardiology Department, Civil Hospital, 29015 Castel San Giovanni, Italy; (D.A.); (G.L.); (M.C.)
| | - Michela Casella
- Department of Clinical, Special and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy;
| | - Antonio Dello Russo
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; (G.S.); (P.C.); (A.D.R.); (A.C.)
| | - Gust H. Bardy
- Seattle Institute for Cardiac Research, Seattle, WA 98195, USA;
| | - Alessandro Capucci
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60020 Ancona, Italy; (G.S.); (P.C.); (A.D.R.); (A.C.)
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Stuby L, Jampen L, Sierro J, Paus E, Spichiger T, Suppan L, Thurre D. Effect on Chest Compression Fraction of Continuous Manual Compressions with Asynchronous Ventilations Using an i-gel ® versus 30:2 Approach during Simulated Out-of-Hospital Cardiac Arrest: Protocol for a Manikin Multicenter Randomized Controlled Trial. Healthcare (Basel) 2021; 9:354. [PMID: 33804664 PMCID: PMC8003743 DOI: 10.3390/healthcare9030354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/30/2022] Open
Abstract
The optimal airway management strategy during cardiopulmonary resuscitation is uncertain. In the case of out-of-hospital cardiac arrest, a high chest compression fraction is paramount to obtain the return of spontaneous circulation and improve survival and neurological outcomes. To improve this fraction, providing continuous chest compressions should be more effective than using the conventional 30:2 ratio. Airway management should, however, be adapted, since face-mask ventilation can hardly be carried out while continuous compressions are administered. The early insertion of a supraglottic device could therefore improve the chest compression fraction by allowing ventilation while maintaining compressions. This is a protocol for a multicenter, parallel, randomized simulation study. Depending on randomization, each team made up of paramedics and emergency medical technicians will manage the 10-min scenario according either to the standard approach (30 compressions with two face-mask ventilations) or to the experimental approach (continuous manual compressions with early insertion of an i-gel® supraglottic device to deliver asynchronous ventilations). The primary outcome will be the chest compression fraction during the first two minutes of cardiopulmonary resuscitation. Secondary outcomes will be chest compression fraction (per cycle and overall), compressions and ventilations quality, time to first shock and to first ventilation, user satisfaction, and providers' self-assessed cognitive load.
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Affiliation(s)
- Loric Stuby
- Genève TEAM Ambulances, Emergency Medical Services, CH-1201 Geneva, Switzerland;
| | - Laurent Jampen
- ESAMB—École Supérieure de Soins Ambulanciers, College of Higher Education in Ambulance Care, CH-1231 Conches, Switzerland;
| | - Julien Sierro
- Compagnie d’Ambulances de l’Hôpital du Valais, Emergency Medical Services, CH-1920 Martigny, Switzerland;
| | - Erik Paus
- SPSL—Service de Protection et Sauvetage Lausanne, Emergency Medical Services, CH-1005 Lausanne, Switzerland;
| | - Thierry Spichiger
- ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, CH-1052 Le Mont-sur-Lausanne, Switzerland;
- Ambulance Riviera, Association Sécurité Riviera, Emergency Medical Services, CH-1814 La Tour-de-Peilz, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, CH-1211 Geneva, Switzerland;
| | - David Thurre
- Genève TEAM Ambulances, Emergency Medical Services, CH-1201 Geneva, Switzerland;
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Umoren RA, Sawyer TL, Ades A, DeMeo S, Foglia EE, Glass K, Gray MM, Barry J, Johnston L, Jung P, Kim JH, Krick J, Moussa A, Mulvey C, Nadkarni V, Napolitano N, Quek BH, Singh N, Zenge JP, Shults J, Nishisaki A. Team Stress and Adverse Events during Neonatal Tracheal Intubations: A Report from NEAR4NEOS. Am J Perinatol 2020; 37:1417-1424. [PMID: 31365934 DOI: 10.1055/s-0039-1693698] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to examine the association between team stress level and adverse tracheal intubation (TI)-associated events during neonatal intubations. STUDY DESIGN TIs from 10 academic neonatal intensive care units were analyzed. Team stress level was rated immediately after TI using a 7-point Likert scale (1 = high stress). Associations among team stress, adverse TI-associated events, and TI characteristics were evaluated. RESULT In this study, 208 of 2,009 TIs (10%) had high stress levels (score < 4). Oxygenation failure, hemodynamic instability, and family presence were associated with high stress level. Video laryngoscopy and premedication were associated with lower stress levels. High stress level TIs were associated with adverse TI-associated event rates (31 vs. 16%, p < 0.001), which remained significant after adjusting for potential confounders including patient, provider, and practice factors associated with high stress (odds ratio: 1.90, 96% confidence interval: 1.36-2.67, p < 0.001). CONCLUSION High team stress levels during TI were more frequently reported among TIs with adverse events.
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Affiliation(s)
- Rachel A Umoren
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Taylor L Sawyer
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Anne Ades
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Stephen DeMeo
- Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, North Carolina
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kristen Glass
- Department of Pediatrics, Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Megan M Gray
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - James Barry
- Section of Neonatology, Department of Pediatrics, University of Colorado Hospital, University of Colorado School of Medicine, Aurora, Colorado
| | - Lindsay Johnston
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Philipp Jung
- Department of Pediatrics, University Hospital Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Jae H Kim
- Department of Pediatrics, Rady Children's Hospital-San Diego, University of California, San Diego, San Diego, California
| | - Jeanne Krick
- Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Ahmed Moussa
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Christine Mulvey
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Natalie Napolitano
- Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bin Huey Quek
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Neetu Singh
- Department of Pediatrics, Dartmouth Hitchcock Medical Center, West Lebanon, New Hampshire
| | - Jeanne P Zenge
- Section of Neonatology, Department of Pediatrics, University of Colorado Hospital, University of Colorado School of Medicine, Aurora, Colorado
| | - Justine Shults
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Vincent A, Semmer NK, Becker C, Beck K, Tschan F, Bobst C, Schuetz P, Marsch S, Hunziker S. Does stress influence the performance of cardiopulmonary resuscitation? A narrative review of the literature. J Crit Care 2020; 63:223-230. [PMID: 33046274 DOI: 10.1016/j.jcrc.2020.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
Cardiopulmonary resuscitation represents a major physical and psychological challenge for all involved health care workers because survival of the patients is closely related to the timely and accurate actions of rescuers. Consequently, rescuers may experience high levels of acute mental stress. Stress, in turn, may influence attentional resources and distractibility, which may affect the quality of resuscitation. This narrative review summarizes the current state of research concerning the influence of stress on resuscitation performance. Peer-reviewed studies retrieved in scientific databases were eligible. We found that rescuers experience high levels of stress and some associations of higher levels of stress with lower resuscitation performance. Finally, few interventional studies assessed whether interventions aiming at reducing levels of stress may have a beneficial effect on resuscitation performance, but results are variable. Although the mechanisms linking stress to performance of emergency teams are still not fully understood, factors such as individual experience and self-confidence of rescuers, gender composition and hierarchy within resuscitation teams may play an important role. This review provides a targeted overview of how stress can be defined and measured, how it may influence emergency situations such as a cardiopulmonary resuscitation, and which interventions have the potential to reduce overwhelming stress.
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Affiliation(s)
- Alessia Vincent
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Norbert K Semmer
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland; Department of Emergency Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Franziska Tschan
- Department of Psychology, University of Neuchâtel, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Cora Bobst
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Philipp Schuetz
- University Department of Medicine, Kantonsspital Aarau, Haus 7, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland.
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Effect of Facial Skin Temperature on the Perception of Anxiety: A Pilot Study. Healthcare (Basel) 2020; 8:healthcare8030206. [PMID: 32660004 PMCID: PMC7551020 DOI: 10.3390/healthcare8030206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
The extent of anxiety and psychological stress can impact upon the optimal performance of simulation-based practices. The current study investigates the association between differences in skin temperature and perceived anxiety by under- (n = 21) and post-graduate (n = 19) nursing students undertaking a cardiopulmonary resuscitation (CPR) training. Thermal facial gradients from selected facial regions were correlated with the scores assessed by the State-Trait Anxiety Inventory (STAI) and the chest compression quality parameters measured using mannequin-integrated accelerometer sensors. A specific temperature profile was obtained depending on thermal facial variations before and after the simulation event. Statistically significant correlations were found between STAI scale scores and the temperature facial recordings in the forehead (r = 0.579; p < 0.000), periorbital (r = 0.394; p < 0.006), maxillary (r = 0.328; p < 0.019) and neck areas (r = 0.284; p < 0.038). Significant associations were also observed by correlating CPR performance parameters with the facial temperature values in the forehead (r = 0.447; p < 0.002), periorbital (r = 0.446; p < 0.002) and maxillary areas (r = 0.422; p < 0.003). These preliminary findings suggest that higher anxiety levels result in poorer clinical performance and can be correlated to temperature variations in certain facial regions.
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18
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Acute provider stress in high stakes medical care: Implications for trauma surgeons. J Trauma Acute Care Surg 2019; 88:440-445. [DOI: 10.1097/ta.0000000000002565] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fukushima Y, Yamada A, Imoto N, Iba T. Does TeamSTEPPS affect psychological status? Int J Health Care Qual Assur 2019; 32:11-20. [DOI: 10.1108/ijhcqa-08-2017-0156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program is known to improve team and clinical performance, but the relationship to psychological stress has not been clarified. The purpose of this paper is to evaluate team performance, clinical performance and psychological stress simultaneously in a simulation-based training combined with or without the TeamSTEPPS program.
Design/methodology/approach
This randomized, controlled, prospective pilot study was performed to reveal TeamSTEPPS impact on psychological stress. The course included an emergency care training course, the TeamSTEPPS program, and a scenario simulation. Ten medical student teams were randomly allocated two groups: a TeamSTEPPS group and a non-TeamSTEPPS group. Team performance, clinical performance and psychological stress were evaluated simultaneously in the course; i.e., questionnaire evaluation and an observational evaluation for team performance; an assessor’s evaluation and a simulator’s evaluation for clinical performance. Autonomic nervous activity, represented by salivary amylase levels and heart rate variability, were measured as psychological stress indicators.
Findings
Team performance and clinical performance were significantly better in the TeamSTEPPS group, while psychological stress did not differ between the groups.
Originality/value
This is the first study to examine the relationship between TeamSTEPPS and psychological stress. Although only preliminary conclusions can be drawn from this small-scale study, results suggest that the TeamSTEPPS program improved team and clinical performance without increasing psychological stress.
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Vanhoy MA, Horigan A, Stapleton SJ, Valdez AM, Bradford JY, Killian M, Reeve NE, Slivinski A, Zaleski ME, Proehl J, Wolf L, Delao A, Gates L. Clinical Practice Guideline: Family Presence. J Emerg Nurs 2019; 45:76.e1-76.e29. [DOI: 10.1016/j.jen.2018.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Comparative Analysis of Emergency Medical Service Provider Workload During Simulated Out-of-Hospital Cardiac Arrest Resuscitation Using Standard Versus Experimental Protocols and Equipment. Simul Healthc 2018; 13:376-386. [PMID: 30407958 DOI: 10.1097/sih.0000000000000339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Protocolized automation of critical, labor-intensive tasks for out-of-hospital cardiac arrest (OHCA) resuscitation may decrease Emergency Medical Services (EMS) provider workload. A simulation-based assessment method incorporating objective and self-reported metrics was developed and used to quantify workloads associated with standard and experimental approaches to OHCA resuscitation. METHODS Emergency Medical Services-Basic (EMT-B) and advanced life support (ALS) providers were randomized into two-provider mixed-level teams and fitted with heart rate (HR) monitors for continuous HR and energy expenditure (EE) monitoring. Subjects' resting salivary α-amylase (sAA) levels were measured along with Borg perceived exertion scores and multidimensional workload assessments (NASA-TLX). Each team engaged in the following three OHCA simulations: (1) baseline simulation in standard BLS/ALS roles; (2) repeat simulation in standard roles; and then (3) repeat simulation in reversed roles, ie, EMT-B provider performing ALS tasks. Control teams operated with standard state protocols and equipment; experimental teams used resuscitation-automating devices and accompanying goal-directed algorithmic protocol for simulations 2 and 3. Investigators video-recorded resuscitations and analyzed subjects' percent attained of maximal age-predicted HR (%mHR), EE, sAA, Borg, and NASA-TLX measurements. RESULTS Ten control and ten experimental teams completed the study (20 EMT-Basic; 1 EMT-Intermediate, 8 EMT-Cardiac, 11 EMT-Paramedic). Median %mHR, EE, sAA, Borg, and NASA-TLX scores did not differ between groups at rest. Overall multivariate analyses of variance did not detect significant differences; univariate analyses of variance for changes in %mHR, Borg, and NASA-TLX from resting state detected significant differences across simulations (workload reductions in experimental groups for simulations 2 and 3). CONCLUSIONS A simulation-based OHCA resuscitation performance and workload assessment method compared protocolized automation-assisted resuscitation with standard response. During exploratory application of the assessment method, subjects using the experimental approach appeared to experience reduced levels of physical exertion and perceived workload than control subjects.
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22
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Bensouda B, Mandel R, Mejri A, Lachapelle J, St-Hilaire M, Ali N. Effect of an audience on trainee stress and performance during simulated neonatal intubation: a randomized crossover trial. BMC MEDICAL EDUCATION 2018; 18:230. [PMID: 30285715 PMCID: PMC6171149 DOI: 10.1186/s12909-018-1338-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Neonatal intubation is a stressful procedure taught to trainees. This procedure can attract additional observers. The impact of observers on neonatal intubation performance by trainees has not been studied. Our objective was to evaluate if additional observers present during neonatal mannequin endotracheal intubation (NMEI) by junior trainees, affects their performance and their stress levels. METHODS A randomized cross over trial was conducted. First year residents with no experience in neonatal intubation were assigned to NMEI condition A or B randomly on day 1. Subjects were crossed over to the other condition on day 2. Condition A: Only one audience member was present Condition B: Presence of an audience of 5 health care providers. Differences in the time to successful NMEI was recorded and compared between conditions. A portable heart rate monitor was used to measure peak heart rate above baseline during NMEI under both conditions. RESULTS Forty nine residents were recruited. 72% were female with a median age of 25 years (IQR: 24-27). Time to successful intubation was comparable under both conditions with a mean difference of - 3.94 s (95% CI: -8.2,0.4). Peak heart rate was significantly lower under condition A (mean difference - 11.9 beats/min, 95% CI -15.98 to - 7.78). CONCLUSION Although the time required to NMEI did not increase, our results suggest that presence of observers significantly increases trainee stress. The addition of extraneous observers during simulation training may better equip residents to deal with such stressors. TRIAL REGISTRATION Date of registration: March 2016, NCT 02726724 .
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Affiliation(s)
- Brahim Bensouda
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
| | - Romain Mandel
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
| | - Abdelwaheb Mejri
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
| | - Jean Lachapelle
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
| | - Marie St-Hilaire
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
| | - Nabeel Ali
- Maisonneuve Rosemont Hospital, Pediatric Department, University of Montreal, 5415 Boulevard de l’Assomption, Montréal, QC H1T2M4 Canada
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Brinkrolf P, Lukas R, Harding U, Thies S, Gerss J, Van Aken H, Lemke H, Schniedermeier U, Bohn A. A better understanding of ambulance personnel's attitude towards real-time resuscitation feedback. Int J Qual Health Care 2018; 30:110-117. [PMID: 29340631 DOI: 10.1093/intqhc/mzx189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 12/18/2017] [Indexed: 01/26/2023] Open
Abstract
Objective High-quality chest compressions during cardiopulmonary resuscitation (CPR) play a significant role in surviving cardiac arrest. Chest-compression quality can be measured and corrected by real-time CPR feedback devices, which are not yet commonly used. This article looks at the acceptance of such systems in comparison of equipped and unequipped personnel. Design Two groups of emergency medical services' (EMS) personnel were interviewed using standardized questionnaires. Setting The survey was conducted in the German cities Dortmund and Münster. Participants Overall, 205 persons participated in the survey: 103 paramedics and emergency physicians from the Dortmund fire service and 102 personnel from the Münster service. Intervention The staff of the Dortmund service were not equipped with real-time feedback systems. The test group of equipped personnel of the ambulance service of Münster Fire brigade uses real-time feedback systems since 2007. Main outcome measure What is the acceptance level of real-time feedback systems? Are there differences between equipped and unequipped personnel? Results The total sample is receptive towards real-time feedback systems. More than 80% deem the system useful. However, this study revealed concerns and prejudices by unequipped personnel. Negative ratings are significantly lower at the Münster site that is experienced with the use of the real-time feedback system in contrast to the Dortmund site where no such experience exists-the system's use in daily routine results in better evaluation than the expectations of unequipped personnel. Conclusions Real-time feedback systems receive overall positive ratings. Prejudices and concerns seem to decrease with continued use of the system.
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Affiliation(s)
- Peter Brinkrolf
- Department of Anaesthesiology, University Hospital Greifswald, Ferdinand-Sauerbruch Straße, 17489 Greifswald, Germany
| | - Roman Lukas
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Münster University Hospital, Albert-Schweitzer-Campus 1, Geb. A1, 48149 Münster, Germany
| | - Ulf Harding
- Emergency Department, Klinikum Wolfsburg, Sauerbruchstr. 7, 38440 Wolfsburg, Germany
| | - Sebastian Thies
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Münster University Hospital, Albert-Schweitzer-Campus 1, Geb. A1, 48149 Münster, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, Faculty of Medicine, University of Münster, Schmeddingstraße 56, 48149 Münster, Germany
| | - Hugo Van Aken
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Münster University Hospital, Albert-Schweitzer-Campus 1, Geb. A1, 48149 Münster, Germany
| | - Hans Lemke
- City of Dortmund Fire Department, Emergency Medical Director, Steinstraße 25, 44122 Dortmund, Germany
| | - Udo Schniedermeier
- Klinikum Westfalen, Knappschaftskrankenhaus Dortmund, Emergency Medical Department, Wieckesweg 27, 44309 Dortmund, Germany
| | - Andreas Bohn
- City of Münster Fire Service, Yorkring 25, 48159 Münster, Germany
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Husebø SE, Silvennoinen M, Rosqvist E, Masiello I. Status of Nordic research on simulation-based learning in healthcare: an integrative review. Adv Simul (Lond) 2018; 3:12. [PMID: 30002918 PMCID: PMC6032768 DOI: 10.1186/s41077-018-0071-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/18/2018] [Indexed: 01/03/2023] Open
Abstract
Background Based on common geography, sociopolitics, epidemiology, and healthcare services, the Nordic countries could benefit from increased collaboration and uniformity in the development of simulation-based learning (SBL). To date, only a limited overview exists on the Nordic research literature on SBL and its progress in healthcare education. Therefore, the aim of this study is to fill that gap and suggest directions for future research. Methods An integrative review design was used. A search was conducted for relevant research published during the period spanning from 1966 to June 2016. Thirty-seven studies met the inclusion criteria. All included studies were appraised for quality and were analyzed using thematic analysis. Results The Nordic research literature on SBL in healthcare revealed that Finland has published the greatest number of qualitative studies, and only Sweden and Norway have published randomized control trials. The studies included interprofessional or uniprofessional teams of healthcare professionals and students. An assessment of the research design revealed that most studies used a qualitative or a descriptive design. The five themes that emerged from the thematic analysis comprised technical skills, non-technical skills, user experience, educational aspects, and patient safety. Conclusion This review has identified the research relating to the progress of SBL in the Nordic countries. Most Nordic research on SBL employs a qualitative or a descriptive design. Shortcomings in simulation research in the Nordic countries include a lack of well-designed randomized control trials or robust evidence that supports simulation as an effective educational method. In addition, there is also a shortage of studies focusing on patient safety, the primary care setting, or a combination of specialized and primary care settings. Suggested directions for future research include strengthening the design and methodology of SBL studies, incorporating a cross-country comparison of studies using simulation in the Nordic countries, and studies combining specialized and primary care settings. Electronic supplementary material The online version of this article (10.1186/s41077-018-0071-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sissel Eikeland Husebø
- 1Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,2Department of Surgery, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health and Social Sciences, University of Southeast Norway, Porsgrunn, Norway
| | - Minna Silvennoinen
- 4School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland.,5Department of Teacher Education, University of Jyväskylä, Jyväskylä, Finland
| | - Eerika Rosqvist
- 6Department of Education and Science, The Center of Medical Expertise, Central Finland Healthcare District, Jyväskylä, Finland
| | - Italo Masiello
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Lee K, Kim MJ, Park J, Park JM, Kim KH, Shin DW, Kim H, Jeon W, Kim H. The effect of distraction by dual work on a CPR practitioner's efficiency in chest compression: A randomized controlled simulation study. Medicine (Baltimore) 2017; 96:e8268. [PMID: 29068995 PMCID: PMC5671828 DOI: 10.1097/md.0000000000008268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the clinical setting, the dispersed practitioners' attention often leads to decreased competence in their performance. We aimed to investigate the effect of distracted practitioners on the quality of chest compression during cardiopulmonary resuscitation. METHODS A randomized controlled crossover simulation study was conducted. Participants were recruited from among doctors, nurses, and paramedics working in a university tertiary hospital. The paced auditory serial addition test (PASAT) was used as a tool for distracting participants. In the crossover design, each participant played 2 scenarios with a 20-minute time gap, by a random order; 2-minute continuous chest compressions with and without PASAT being conducted. The primary outcome was the percentage of compression with an adequate compression rate. Secondary outcomes were the percentage of compression with adequate depth, the percentage of compression with full chest wall recoil, mean compression rate (per minute), mean compression depth, and subjective difficulty of chest compression. RESULTS Forty-four participants were enrolled, and all of them completed the study. It was found that the percentage of compression with an adequate compression rate was lower when the PASAT was conducted. Although there was no difference in the percentage of compression with adequate depth (P = .88), the percentage of compression with complete chest recoil was lower when PASAT was conducted. In addition, while the mean compression rate was higher when PASAT was conducted, the mean compression depth was not significantly different (P = .65). The subjective difficulty was not different (P = .69). CONCLUSIONS Health care providers who are distracted have a negative effect on the quality of chest compression, in terms of its rate and chest wall recoil. TRIAL REGISTRATION www.ClinicalTrials.gov, NCT03124290.
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Affiliation(s)
- Kwangchun Lee
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junseok Park
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang
| | - Joon Min Park
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang
| | - Kyung Hwan Kim
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang
| | - Dong Wun Shin
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang
| | - Hoon Kim
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang
| | - Woochan Jeon
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang
| | - Hyunjong Kim
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang
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Pérez Alonso N, Pardo Rios M, Juguera Rodriguez L, Vera Catalan T, Segura Melgarejo F, Lopez Ayuso B, Martí Nez Riquelme C, Lasheras Velasco J. Randomised clinical simulation designed to evaluate the effect of telemedicine using Google Glass on cardiopulmonary resuscitation (CPR). Emerg Med J 2017; 34:734-738. [PMID: 28768700 DOI: 10.1136/emermed-2016-205998] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 04/20/2017] [Accepted: 06/11/2017] [Indexed: 01/13/2023]
Abstract
AIM Through a clinical simulation, this study aims to assess the effect of telematics support through Google Glass (GG) from an expert physician on performance of cardiopulmonary resuscitation (CPR) performed by a group of nurses, as compared with a control group of nurses receiving no assistance. METHODS This was a randomised study carried out at the Catholic University of Murcia (November 2014-February 2015). Nursing professionals from the Emergency Medical Services in Murcia (Spain) were asked to perform in a clinical simulation of cardiac arrest. Half of the nurses were randomly chosen to receive coaching from physicians through GG, while the other half did not receive any coaching (controls). The main outcome of the study expected was successful defibrillation, which restores sinus rhythm. RESULTS Thirty-six nurses were enrolled in each study group. Statistically significant differences were found in the percentages of successful defibrillation (100% GG vs 78% control; p=0005) and CPR completion times: 213.91 s for GG and 250.31 s for control (average difference=36.39 s (95% CI 12.03 to 60.75), p=0.004). CONCLUSIONS Telematics support by an expert through GG improves success rates and completion times while performing CPR in simulated clinical situations for nurses in simulated scenarios.
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Affiliation(s)
- Nuria Pérez Alonso
- Nursing Faculty, Catholic University of Murcia (UCAM), Nurse in the 061 Emergency Services (112) of Murcia, Murcia, Spain
| | - Manuel Pardo Rios
- Nursing Faculty, Catholic University of Murcia (UCAM), Nurse in the 061 Emergency Services (112) of Murcia, Murcia, Spain
| | - Laura Juguera Rodriguez
- Nursing Faculty, Catholic University of Murcia (UCAM), Nurse in the 061 Emergency Services (112) of Murcia, Murcia, Spain
| | - Tomas Vera Catalan
- Nursing Faculty, Master's degree in Cardiovascular Risk of the Catholic University of Murcia (UCAM), Murcia, Spain
| | | | - Belen Lopez Ayuso
- Computer Engineering Faculty, Catholic University of Murcia (UCAM), Murcia, Spain
| | | | - Joaquin Lasheras Velasco
- Computer Engineering Faculty, Catholic University of Murcia (UCAM), Murcia, Spain.,Center of Information Technologies and Communications (CENTIC) of Murcia, Murcia, Spain
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Klosiewicz T, Zalewski R, Dabrowska A, Maciejewski A. Chest compressions in infants. Am J Emerg Med 2017; 35:1773-1774. [PMID: 28526594 DOI: 10.1016/j.ajem.2017.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Tomasz Klosiewicz
- Department of Rescue and Disaster Medicine, Poznan University of Medical Sciences, Poland; Polish Society of Medical Simulation, Poland.
| | - Radoslaw Zalewski
- Department of Rescue and Disaster Medicine, Poznan University of Medical Sciences, Poland
| | - Agata Dabrowska
- Department of Rescue and Disaster Medicine, Poznan University of Medical Sciences, Poland; Polish Society of Medical Simulation, Poland
| | - Adrian Maciejewski
- Department of Rescue and Disaster Medicine, Poznan University of Medical Sciences, Poland; Polish Society of Medical Simulation, Poland
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28
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Kenny G, Bray I, Pontin D, Jefferies R, Albarran J. A randomised controlled trial of student nurse performance of cardiopulmonary resuscitation in a simulated family-witnessed resuscitation scenario. Nurse Educ Pract 2017; 24:21-26. [PMID: 28319727 DOI: 10.1016/j.nepr.2017.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 11/20/2016] [Accepted: 03/12/2017] [Indexed: 11/25/2022]
Abstract
This randomized controlled trial, conducted in a UK University nursing department, compared student nurses' performance during a simulated cardiac arrest. Eighteen teams of four students were randomly assigned to one of three scenarios: 1) no family witness; 2) a "quiet" family witness; and 3) a family witness displaying overt anxiety and distress. Each group was assessed by observers for a range of performance outcomes (e.g. calling for help, timing to starting cardiopulmonary resuscitation), and simulation manikin data on the depth and timing of three cycles of compressions. Groups without a distressed family member present performed better in the early part of the basic life support algorithm. Approximately a third of compressions assessed were of appropriate pressure. Groups with a distressed family member present were more likely to perform compressions with low pressure. Groups with no family member present were more likely to perform compressions with too much pressure. Timing of compressions was better when there was no family member present. Family presence appears to have an effect on subjectively and objectively measured performance. Further study is required to see how these findings translate into the registered nurse population, and how experience and education modify the impact of family member presence.
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Affiliation(s)
- Gerard Kenny
- Centre for Clinical and Health Services Research, Department of Nursing and Midwifery, University of the West of England, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, United Kingdom.
| | - Isabelle Bray
- Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, United Kingdom.
| | - David Pontin
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, United Kingdom.
| | - Rachel Jefferies
- Centre for Clinical and Health Services Research, Department of Nursing and Midwifery, University of the West of England, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, United Kingdom.
| | - John Albarran
- Centre for Clinical and Health Services Research, Department of Nursing and Midwifery, University of the West of England, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, United Kingdom.
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McNeer RR, Bennett CL, Dudaryk R. Intraoperative Noise Increases Perceived Task Load and Fatigue in Anesthesiology Residents: A Simulation-Based Study. Anesth Analg 2016; 122:512-25. [PMID: 26797555 DOI: 10.1213/ane.0000000000001067] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Operating rooms are identified as being one of the noisiest of clinical environments, and intraoperative noise is associated with adverse effects on staff and patient safety. Simulation-based experiments would offer controllable and safe venues for investigating this noise problem. However, realistic simulation of the clinical auditory environment is rare in current simulators. Therefore, we retrofitted our operating room simulator to be able to produce immersive auditory simulations with the use of typical sound sources encountered during surgeries. Then, we tested the hypothesis that anesthesia residents would perceive greater task load and fatigue while being given simulated lunch breaks in noisy environments rather than in quiet ones. As a secondary objective, we proposed and tested the plausibility of a novel psychometric instrument for the assessment of stress. METHODS In this simulation-based, randomized, repeated-measures, crossover study, 2 validated psychometric survey instruments, the NASA Task Load Index (NASA-TLX), composed of 6 items, and the Swedish Occupational Fatigue Inventory (SOFI), composed of 5 items, were used to assess perceived task load and fatigue, respectively, in first-year anesthesia residents. Residents completed the psychometric instruments after being given lunch breaks in quiet and noisy intraoperative environments (soundscapes). The effects of soundscape grouping on the psychometric instruments and their comprising items were analyzed with a split-plot analysis. A model for a new psychometric instrument for measuring stress that combines the NASA-TLX and SOFI instruments was proposed, and a factor analysis was performed on the collected data to determine the model's plausibility. RESULTS Twenty residents participated in this study. Multivariate analysis of variance showed an effect of soundscape grouping on the combined NASA-TLX and SOFI instrument items (P = 0.003) and the comparisons of univariate item reached significance for the NASA Temporal Demand item (P = 0.0004) and the SOFI Lack of Energy item (P = 0.001). Factor analysis extracted 4 factors, which were assigned the following construct names for model development: Psychological Task Load, Psychological Fatigue, Acute Physical Load, and Performance-Chronic Physical Load. Six of the 7 fit tests used in the partial confirmatory factor analysis were positive when we fitted the data to the proposed model, suggesting that further validation is warranted. CONCLUSIONS This study provides evidence that noise during surgery can increase feelings of stress, as measured by perceived task load and fatigue levels, in anesthesiologists and adds to the growing literature pointing to an overall adverse impact of clinical noise on caregivers and patient safety. The psychometric model proposed in this study for assessing perceived stress is plausible based on factor analysis and will be useful for characterizing the impact of the clinical environment on subject stress levels in future investigations.
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Affiliation(s)
- Richard R McNeer
- From the *Department of Anesthesiology, University of Miami-Miller School of Medicine, Miami, Florida; and †Music Engineering Technology, Frost School of Music, University of Miami, Miami, Florida
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30
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The effect of a standardised source of divided attention in airway management. Eur J Anaesthesiol 2016; 33:195-203. [DOI: 10.1097/eja.0000000000000315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bourgeon L, Bensalah M, Vacher A, Ardouin JC, Debien B. Role of emotional competence in residents' simulated emergency care performance: a mixed-methods study. BMJ Qual Saf 2015; 25:364-71. [PMID: 26438884 DOI: 10.1136/bmjqs-2015-004032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Emergency situations can generate negative affect in medical personnel, which can negatively impact on the quality of care. Several studies have demonstrated a positive influence of emotional competence (EC) on negative affect. The goal of this study was to test the effect of EC level on simulated emergency care situation in medical residents. METHODS The sample included 21 medical residents caring for a simulated seriously wounded person whose condition suddenly deteriorated. Medical performance was scored by expert medical doctors (MDs). EC level and affective states were evaluated with self-assessment questionnaires. Finally, the origin of the negative affect experienced by the residents was identified through individual interviews. RESULTS Higher EC levels were found to be associated with better medical performance and a lower intensity of negative affect. The latter two variables were found to correlate negatively. The main source of negative affect for residents was the inability to establish a diagnosis, regardless of their EC level and their medical performance. CONCLUSIONS The results suggest that residents who have a high EC level are better able to manage negative affect, so that they are better able to put their medical knowledge to work and explore alternative diagnoses. Emotional-management training for residents who, as new MDs, have limited experience may be beneficial to complement simulation exercises. Additional studies should be considered to better define the links between the affect experienced by MDs and their thought processes during establishment of a diagnosis.
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Affiliation(s)
- Leonore Bourgeon
- Department of ACSO, Institut de Recherche Biomedicale des Armées, Brétigny-sur-Orge, France
| | | | - Anthony Vacher
- Department of ACSO, Institut de Recherche Biomedicale des Armées, Brétigny-sur-Orge, France
| | - Jean-Claude Ardouin
- Department of ACSO, Institut de Recherche Biomedicale des Armées, Brétigny-sur-Orge, France
| | - Bruno Debien
- Department of CESIMO, Ecole du Val-de-Grace, Paris, France EmergenSim, Paris, France
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Cardiopulmonary resuscitation guidance improves medical students' adherence to guidelines in simulated cardiac arrest: a randomised cross-over study. Eur J Anaesthesiol 2014; 30:752-7. [PMID: 23702601 DOI: 10.1097/eja.0b013e328362147f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The 2010 Resuscitation Guidelines require high-quality chest compression and rapid defibrillation for patients with ventricular fibrillation with rhythm analysis and defibrillation repeated every 2 min. A lack of adherence to the guidelines by medical students was observed during simulated resuscitation training. OBJECTIVES To assess whether real-time cardiopulmonary resuscitation guidance, including an audiovisual countdown timer, a metronome, a display of the chest compression quality and voice prompts, might improve adherence to the guidelines by medical students. DESIGN Randomised cross-over simulation study. SETTING Studienhospital Münster, Faculty of Medicine University Münster, Germany PARTICIPANTS One hundred and forty-one medical students (fifth year) in 47 teams. INTERVENTION Simulated resuscitation with and without real-time cardiopulmonary resuscitation guidance. MAIN OUTCOME MEASURES The preshock pause, postshock pause, fraction of time without chest compression and defibrillation intervals. Observed quality parameters were chest compression depth and chest compression rate. RESULTS With real-time cardiopulmonary resuscitation guidance, there were improved mean (SD) chest compression rates (105 ± 8 vs. 121 ± 12 bpm; P < 0.005), fewer inappropriate shock intervals [median (interquartile range) 0 (1 to 5) vs. 4 (1 to 7); P < 0.005], a smaller fraction of time without chest compression (18.9 ± 4.4 vs. 22.5 ± 7.0%; P < 0.005) and shorter postshock pauses (2.3 ± 0.9 vs. 3.4 ± 1.2 s; P < 0.005). CONCLUSION Real-time cardiopulmonary resuscitation guidance significantly increased adherence to the guidelines by medical students treating simulated out-of-hospital cardiac arrest. Using a simple tool such as a countdown timer makes it possible to reduce the number of inappropriate shock intervals and time without chest compression.
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Krage R, Tjon Soei Len L, Schober P, Kolenbrander M, van Groeningen D, Loer SA, Wagner C, Zwaan L. Does individual experience affect performance during cardiopulmonary resuscitation with additional external distractors? Anaesthesia 2014; 69:983-9. [DOI: 10.1111/anae.12747] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 01/20/2023]
Affiliation(s)
- R. Krage
- Department of Anaesthesia; VU University Medical Centre; Amsterdam The Netherlands
| | - L. Tjon Soei Len
- Department of Anaesthesia; VU University Medical Centre; Amsterdam The Netherlands
| | - P. Schober
- Department of Anaesthesia; VU University Medical Centre; Amsterdam The Netherlands
| | - M. Kolenbrander
- Department of Anaesthesia; VU University Medical Centre; Amsterdam The Netherlands
| | - D. van Groeningen
- Department of Anaesthesia; VU University Medical Centre; Amsterdam The Netherlands
| | - S. A. Loer
- Department of Anaesthesia; VU University Medical Centre; Amsterdam The Netherlands
| | - C. Wagner
- Department of Public and Occupational Health; EMGO Institute for Health and Care Research; Amsterdam The Netherlands
| | - L. Zwaan
- Department of Public and Occupational Health; EMGO Institute for Health and Care Research; Amsterdam The Netherlands
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de Man FR, Erwteman M, van Groeningen D, Ziedses des Plantes PV, Boer C, Loer SA, Krage R. The effect of audible alarms on anaesthesiologists' response times to adverse events in a simulated anaesthesia environment: a randomised trial. Anaesthesia 2014; 69:598-603. [DOI: 10.1111/anae.12640] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 12/01/2022]
Affiliation(s)
- F. R. de Man
- Department of Anaesthesiology; Institute for Cardiovascular Research; VU University Medical Centre; Amsterdam The Netherlands
| | - M. Erwteman
- Department of Anaesthesiology; Institute for Cardiovascular Research; VU University Medical Centre; Amsterdam The Netherlands
| | - D. van Groeningen
- Department of Anaesthesiology; Institute for Cardiovascular Research; VU University Medical Centre; Amsterdam The Netherlands
| | - P. V. Ziedses des Plantes
- Department of Anaesthesiology; Institute for Cardiovascular Research; VU University Medical Centre; Amsterdam The Netherlands
| | - C. Boer
- Department of Anaesthesiology; Institute for Cardiovascular Research; VU University Medical Centre; Amsterdam The Netherlands
| | - S. A. Loer
- Department of Anaesthesiology; Institute for Cardiovascular Research; VU University Medical Centre; Amsterdam The Netherlands
| | - R. Krage
- Department of Anaesthesiology; Institute for Cardiovascular Research; VU University Medical Centre; Amsterdam The Netherlands
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Piquette D, Tarshis J, Sinuff T, Fowler RA, Pinto R, Leblanc VR. Impact of acute stress on resident performance during simulated resuscitation episodes: a prospective randomized cross-over study. TEACHING AND LEARNING IN MEDICINE 2014; 26:9-16. [PMID: 24405341 DOI: 10.1080/10401334.2014.859932] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Medical trainees have identified stress as an important contributor to their medical errors in acute care environments. PURPOSES The objective of this study was to determine if the addition of acute stressors to simulated resuscitation scenarios would impact on residents' simulated clinical performance. METHODS Fifty-four residents completed a control and a high-stress simulated scenario on separate visits. Stress measures were collected before and after scenarios. Two assessors independently evaluated residents' videotaped performance. RESULTS Both control and high-stress scenarios triggered significant stress responses among participants; however, stress responses were not significantly different between control and high-stress conditions. No difference in performance was found between control and high-stress conditions (F value = 2.84, p = .098). CONCLUSIONS Residents exposed to simulated resuscitation scenarios experienced significant stress responses irrespective of the presence of acute stressors during these scenarios. This anticipatory stressful response could impact on resident learning and performance and should be further explored.
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Affiliation(s)
- Dominique Piquette
- a Department of Critical Care Medicine , University of Toronto , Toronto , Ontario , Canada
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Hunziker S, Pagani S, Fasler K, Tschan F, Semmer NK, Marsch S. Impact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: a randomized controlled trial. BMC Emerg Med 2013; 13:8. [PMID: 23607331 PMCID: PMC3640892 DOI: 10.1186/1471-227x-13-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 04/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) causes significant stress for the rescuers which may cause deficiencies in attention and increase distractibility. This may lead to misjudgements of priorities and delays in CPR performance, which may further increase mental stress (vicious cycle). This study assessed the impact of a task-focusing strategy on perceived stress levels and performance during a simulated CPR scenario. METHODS This prospective, randomized-controlled trial was conducted at the simulator-center of the University Hospital Basel, Switzerland. A total of 124 volunteer medical students were randomized to receive a 10 minute instruction to cope with stress by loudly posing two task-focusing questions ("what is the patient's condition?", "what immediate action is needed?") when feeling overwhelmed by stress (intervention group) or a control group. The primary outcome was the perceived levels of stress and feeling overwhelmed (stress/overload); secondary outcomes were hands-on time, time to start CPR and number of leadership statements. RESULTS Participants in the intervention group reported significantly less stress/overload levels compared to the control group (mean difference: -0.6 (95% CI -1.3, -0.1), p=0.04). Higher stress/overload was associated with less hands-on time. Leadership statements did not differ between groups, but the number of leadership statements did relate to performance. Hands-on time was longer in the intervention- group, but the difference was not statistically significant (difference 5.5 (95% CI -3.1, 14.2), p=0.2); there were no differences in time to start CPR (difference -1.4 (95% CI -8.4, 5.7), p=0.71). CONCLUSIONS A brief stress-coping strategy moderately decreased perceived stress without significantly affecting performance in a simulated CPR. Further studies should investigate more intense interventions for reducing stress. TRIAL REGISTRATION NCT01645566.
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Affiliation(s)
- Sabina Hunziker
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland.
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Long-term intended and unintended experiences after Advanced Life Support training. Resuscitation 2013; 84:373-7. [DOI: 10.1016/j.resuscitation.2012.07.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 07/13/2012] [Accepted: 07/20/2012] [Indexed: 11/24/2022]
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BJØRSHOL CONRADARNFINN. Optimising basic skills in adult cardiopulmonary resuscitation. Acta Anaesthesiol Scand 2012. [DOI: 10.1111/aas.12046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Training and practice in medicine are inherently stressful. The effects of stress on performance in clinical situations are poorly understood. The purpose of this study was to examine the stress responses and clinical performance of residents during low and high stress (HS) simulated trauma resuscitations. METHODS Thirteen emergency medicine and general surgery residents were evaluated in HS and low stress (LS) trauma resuscitation simulations. Subjective and physiologic (heart rate, salivary cortisol) responses were measured at baseline and in response to the scenarios. Performance was assessed with global rating and checklist scores of technical performance, time to record critical information, and the Anesthesia Non-Technical Skills tool. Post-scenario recall was assessed with the completion of a standardized trauma history form. RESULTS Post-scenario subjective stress and cortisol levels were higher in the HS scenario compared with the LS scenario (p < 0.05). Checklist performance scores and post-scenario recall were significantly lower in the HS compared with the LS condition (p < 0.05). CONCLUSION In trainees, some aspects of performance and immediate recall appear to be impaired in complex clinical scenarios in which they exhibit elevated subjective and physiologic stress responses. The findings of this study highlight a potential threat to patient safety and demand further investigation. Future studies should strive to further elucidate the effects of stress on specific components of performance and investigate ways to reduce its negative impact.
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NESET A, BIRKENES TS, FURUNES T, MYKLEBUST HE, MYKLETUN RJ, ODEGAARD S, OLASVEENGEN TM, KRAMER-JOHANSEN J. A randomized trial on elderly laypersons' CPR performance in a realistic cardiac arrest simulation. Acta Anaesthesiol Scand 2012; 56:124-31. [PMID: 22092097 DOI: 10.1111/j.1399-6576.2011.02566.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bystander cardiopulmonary resuscitation (CPR) is important for survival after cardiac arrest. We hypothesized that elderly laypersons would perform CPR poorer in a realistic cardiac arrest simulation, compared to a traditional test. METHODS Sixty-four lay rescuers aged 50-75 were randomized to realistic or traditional test, both with ten minutes of telephone assisted CPR. Realistic simulation started suddenly without warning, leaving the test subject alone in a confined and noisy apartment. Traditional test was conducted in a spacious and calm classroom with a researcher present. CPR performance was recorded with a manikin with human like chest properties. Heart rate and self-reported exhaustion were registered. RESULTS CPR quality was not different in the two groups: compression depth, 43 mm ± 7 versus 43 ± 4, P = 0.72; compressions rate, 97 min(-1) ± 11 versus 93 ± 15, P = 0.26; ventilation rate, 2.4 min(-1) ± 1.7 versus 2.8 ± 1.1, P = 0.35; and hands-off time 273 s ± 50 versus 270 ± 66, P = 0.82; in realistic (n = 31) and traditional (n = 33) groups, respectively. No fatigue was evident in the repeated measures analysis of variance. Work load was not different between the groups; attained percentage of age predicted maximum heart rate, 73% ± 9 and 76 ± 11, P = 0.37, reported exhaustion 43 ± 21 (scale: 0 to 100) and 37 ± 19, P = 0.24. CONCLUSIONS Elderly lay people are capable of performing chest compressions with acceptable quality for ten minutes in a realistic cardiac arrest simulation. Ventilation quality and hands-off time were not adequate in either group.
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Affiliation(s)
| | | | - T. FURUNES
- Faculty of Social Sciences; University of Stavanger; Stavanger; Norway
| | | | - R. J. MYKLETUN
- Faculty of Social Sciences; University of Stavanger; Stavanger; Norway
| | - S. ODEGAARD
- Institute for Experimental Medical Research; Oslo University Hospital HF; Oslo; Norway
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Abstract
The quality of chest compression is a determinant of survival after cardiac arrest. Therefore, the European Resuscitation Council (ERC) 2010 guidelines on resuscitation strongly focus on compression quality. Despite its impact on survival, observational studies have shown that chest compression quality is not reached by professional rescue teams. Real-time feedback devices for resuscitation are able to measure chest compression during an ongoing resuscitation attempt through a sternal sensor equipped with a motion and pressure detection system. In addition to the electrocardiograph (ECG) ventilation can be detected by transthoracic impedance monitoring. In cases of quality deviation, such as shallow chest compression depth or hyperventilation, feedback systems produce visual or acoustic alarms. Rescuers can thereby be supported and guided to the requested quality in chest compression and ventilation. Feedback technology is currently available both as a so-called stand-alone device and as an integrated feature in a monitor/defibrillator unit. Multiple studies have demonstrated sustainable enhancement in the education of resuscitation due to the use of real-time feedback technology. There is evidence that real-time feedback for resuscitation combined with training and debriefing strategies can improve both resuscitation quality and patient survival. Chest compression quality is an independent predictor for survival in resuscitation and should therefore be measured and documented in further clinical multicenter trials.
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Dynamics and association of different acute stress markers with performance during a simulated resuscitation. Resuscitation 2011; 83:572-8. [PMID: 22115935 DOI: 10.1016/j.resuscitation.2011.11.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 09/18/2011] [Accepted: 11/02/2011] [Indexed: 11/21/2022]
Abstract
AIM Whether mental stress negatively impacts team performance during cardio-pulmonary resuscitation (CPR) remains controversial; this may partly be explained by differences in stress measures used in previous studies. Our aim was to compare self-reported, biochemical and physiological stress measures in regard to CPR performance. METHODS This prospective, observational study was conducted at the simulator center of the University Hospital Basel, Switzerland. Self-reported (feeling stressed and overwhelmed [stress/overload]), biochemical (plasma cortisol) and physiological (heart rate, heart rate variability) stress measures were assessed in 28 residents (teams of 2) before, during and after resuscitation. Team performance was defined as time to start CPR and hands-on time during the first 180 s. RESULTS At baseline, significant negative correlations of heart rate variability with stress/overload and heart rate, as well as positive correlations of heart rate and cortisol were found. During resuscitation, self-reported, biochemical and physiological stress measures did not correlate significantly. There was no association of baseline stress measures with performance. During CPR, stress/overload was significantly associated with time to start CPR (regression coefficient 12.01 (95% CI 0.65, 23.36), p=0.04), while heart rate was negatively associated with time to start CPR (regression coefficient -0.78 (95% CI -1.44, -0.11), p=0.027) and positively with hands-on time (regression coefficient 2.22 (95% CI 0.53, 3.92), p=0.015). CONCLUSIONS Self-reported stress (stress/overload) was the only predictor for low CPR performance. Biochemical measures showed no association, and physiological measures (heart rate) showed an inverse association, which may be due to physical activity, limiting its value as a mental stress marker in this acute setting.
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Bjørshol CA, Sunde K, Myklebust H, Assmus J, Søreide E. Decay in chest compression quality due to fatigue is rare during prolonged advanced life support in a manikin model. Scand J Trauma Resusc Emerg Med 2011; 19:46. [PMID: 21827652 PMCID: PMC3169466 DOI: 10.1186/1757-7241-19-46] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 08/09/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to measure chest compression decay during simulated advanced life support (ALS) in a cardiac arrest manikin model. METHODS 19 paramedic teams, each consisting of three paramedics, performed ALS for 12 minutes with the same paramedic providing all chest compressions. The patient was a resuscitation manikin found in ventricular fibrillation (VF). The first shock terminated the VF and the patient remained in pulseless electrical activity (PEA) throughout the scenario. Average chest compression depth and rate was measured each minute for 12 minutes and divided into three groups based on chest compression quality; good (compression depth ≥ 40 mm, compression rate 100-120/minute for each minute of CPR), bad (initial compression depth < 40 mm, initial compression rate < 100 or > 120/minute) or decay (change from good to bad during the 12 minutes). Changes in no-flow ratio (NFR, defined as the time without chest compressions divided by the total time of the ALS scenario) over time was also measured. RESULTS Based on compression depth, 5 (26%), 9 (47%) and 5 (26%) were good, bad and with decay, respectively. Only one paramedic experienced decay within the first two minutes. Based on compression rate, 6 (32%), 6 (32%) and 7 (37%) were good, bad and with decay, respectively. NFR was 22% in both the 1-3 and 4-6 minute periods, respectively, but decreased to 14% in the 7-9 minute period (P = 0.002) and to 10% in the 10-12 minute period (P < 0.001). CONCLUSIONS In this simulated cardiac arrest manikin study, only half of the providers achieved guideline recommended compression depth during prolonged ALS. Large inter-individual differences in chest compression quality were already present from the initiation of CPR. Chest compression decay and thereby fatigue within the first two minutes was rare.
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Affiliation(s)
- Conrad A Bjørshol
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.
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