1
|
Jurd C, Barr J. Leadership factors for cardiopulmonary resuscitation for clinicians in-hospital; behaviours, skills and strategies: A systematic review and synthesis without meta-analysis. J Clin Nurs 2024; 33:3844-3853. [PMID: 38757400 DOI: 10.1111/jocn.17215] [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: 12/07/2023] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
AIM To identify leadership factors for clinicians during in-hospital cardiopulmonary resuscitation. DESIGN Systematic review with synthesis without meta-analysis. METHODS The review was guided by SWiM, assessed for quality using CASP and reported with PRISMA. DATA SOURCES Cochrane, EMBASE, PubMed, Medline, Scopus and CINAHL (years of 2013-2023) and a manual reference list search of all included studies. RESULTS A total of 60 papers were identified with three major themes of useful resuscitation leadership; 'social skills', 'cognitive skills and behaviour' and 'leadership development skills' were identified. Main factors included delegating effectively, while being situationally aware of team members' ability and progress during resuscitation, and being empathetic and supportive, yet 'controlling the room' using a hands-off style. Shared decision-making to reduce cognitive load for one leader was shown to improve effective teamwork. Findings were limited by heterogeneity of studies and inconsistently applied tools to measure leadership. CONCLUSION Traditional authoritarian leadership styles are not wanted by team members with preference for shared leadership and collaboration. Balancing this with the need for team members to see leaders in 'control of the room' brings new challenges for leaders and trainers of resuscitation. IMPLICATIONS FOR NURSING PROFESSION All clinicians need effective leadership skills for cardiopulmonary resuscitation in-hospital. Nurses provide first response and ongoing leadership for cardiopulmonary resuscitation. Nurses typically display suitable skills that align with useful resuscitation leader factors. IMPACT What were the main findings? Collaboration rather than an authoritarian approach to leadership is preferred by team members. Nurses are suitable to 'control the room'. Restricting resuscitation team size will manage disruptive behaviour of team members. TRIAL REGISTRATION PROSPERO Registration: CRD42022385630. PATIENT OF PUBLIC CONTRIBUTION No patient of public contribution.
Collapse
Affiliation(s)
- Catherine Jurd
- Darling Downs Hospital and Health Service, Kingaroy Hospital, Kingaroy, Queensland, Australia
- Charles Darwin University, Casuarine, Brinkin, Northern Territory, Australia
| | - Jennieffer Barr
- Charles Darwin University, Casuarine, Brinkin, Northern Territory, Australia
| |
Collapse
|
2
|
Milatino Sgambati MA, d'Ercole A, Cascio M, Di Viesto G, Visicchio D, Boccardo C, Pozzetti I, Milocco M, Caporale M, Poggi AD. Assessment of Nontechnical Skills During Resuscitation: Validation in the Italian Version of the TEAM. Simul Healthc 2024:01266021-990000000-00133. [PMID: 39007692 DOI: 10.1097/sih.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
SUMMARY STATEMENT Nontechnical skills (hereinafter referred to as NTS), such as task management, leadership, situational awareness, communication, and decision making contribute to safe and efficient team performance. The importance during cardiopulmonary resuscitation is being increasingly emphasized. We carried out the intercultural adaptation of the TEAM score in Italian and to evaluate the reliability and validity of the resulting Italian version (i-TEAM). A forward-backward translation was made with the author called i-TEAM. Psychometric properties of the i-TEAM score were evaluated, including acceptability, construct validity, and interrater reliability. We divided the participants into 3 groups based on their experience, and we verified if there was a correlation between the final score NTS of i-TEAM and the groups. The Cronbach coefficient was 0.91 for the Total i-TEAM score. The descriptive statistics showed that there was no correlation between NTS score and experience (group). Our results show that i-TEAM has psychometric properties similar to the original score.
Collapse
Affiliation(s)
- Michele A Milatino Sgambati
- From the Azienda Regionale Emergenza Sanitaria ARES 118 (M.A.M.S), University of Rome "La Sapienza," Rome, Italy; Department of Emergency Medicine (A.D.E., M.C., C.B.), University of Rome La Sapienza, Roma, Lazio, Italy; Azienda Regionale Emergenza Sanitaria ARES 118 (G.D.V.), Rome, Italy; University of Rome "La Sapienza"-Rome (D.V.), Lazio, Italy; Analisi-statistiche.it-Rome (I.P.), Lazio, Italy; Azienda Regionale Emergenza Sanitaria ARES 118 (M.M.), Rome, Italy; Department of Anesthesiology and Intensive Care Medicine (M.G.C.), Catholic University of The Sacred Heart, Fondazione 'Policlinico Universitario A. Gemelli' IRCCS, Rome, Lazio, Italy; and Department of Surgical Sciences (A.D.P.), University of Rome-La Sapienza, Rome, Lazio, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Bourke SL, McKenna L, Cooper S, Lam L. Contextual determinants impacting final year nursing students' emergency team communication during deteriorating patient simulations: A grounded theory study. NURSE EDUCATION TODAY 2024; 138:106183. [PMID: 38554566 DOI: 10.1016/j.nedt.2024.106183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/07/2024] [Accepted: 03/21/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Ability to focus on development of students' team communication and non-technical skills may be reduced in content saturated nursing curricula. Even when communication and simulation-based education is provided, students' utilisation of non-technical skills remains challenging. Although simulation is a recognised means to learn communication skills, little is known about nursing students' team communication in simulated settings. OBJECTIVE To understand the process by which final year undergraduate nursing students communicate in simulated team emergencies. DESIGN Using constructivist grounded theory, data was collected using semi-structured interviews and student observations and analysed using constant comparative analysis. SETTING Simulation laboratories in one university nursing school in Australia. PARTICIPANTS 21 final year nursing students in seven teams. METHODS Data were gathered from interviews and video observations of final year nursing students during simulated team emergencies. RESULTS Interview data and observations of video-recordings revealed contextual determinants that influence communication within teams: the simulation context, the student context and the team context. Team member characteristics, such as cultural and linguistic background, life experiences, gender and age, the ability to shift from leadership to followership as well as environmental factors such as mask wearing and simulation fidelity, contributed to uncertainty in communicating that nursing team effectiveness. CONCLUSIONS Improvement of contextual conditions necessitates implementation of supportive strategies. These include development of educational initiatives, and further research in experiential learning as a modality for learners to experience team communication. Further, simulation context, student context and team context are important considerations. Meeting clinical communication learning needs of students allows better preparation to care for deteriorating patients as graduates.
Collapse
Affiliation(s)
- Sharon L Bourke
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Simon Cooper
- The Health Innovation and Transformation Centre (HITC), Institute of Health and Wellbeing, Federation University Australia, Berwick Campus, Clyde Road, Berwick, Victoria, Australia.
| | - Louisa Lam
- School of Nursing, Midwifery and Paramedicine (VIC), Faculty of Health Sciences, Australian Catholic University, Victoria Parade, Fitzroy, VIC 3065, Australia.
| |
Collapse
|
4
|
Karimi Z, Darban F, Karimi S, Safarzai E. The effectiveness of communication skills training on professional performance and quality of work life of pre-hospital emergency medical staff: An experimental study in Iran. Int Emerg Nurs 2024; 74:101426. [PMID: 38484686 DOI: 10.1016/j.ienj.2024.101426] [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: 08/10/2023] [Revised: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 05/28/2024]
Abstract
AIM Communication skills are one of the components that influence the performance of pre-hospital emergency staff who provide services to patients. This study aimed to determine the effectiveness of communication skills training on the professional performance and quality of work life of pre-hospital emergency staff. METHODS This experimental study with pretest-posttest design was conducted on 150 pre-hospital emergency staff in Iran from March 2022 to May 2023. The participants were randomly assigned into two control (n = 75) and experimental (n = 75) groups. The intervention included 4 sessions (3 h each) of communication skills training, weekly. The data gathering scales were Stamm's quality of work life questionnaire and Patterson's job performance questionnaire, which were used at start point, 4 and 8 weeks after that. RESULTS The mean score professional performance in experimental group increased significantly to 42.4 ± 0.70 in the second stage and to 44.5 ± 0.55 in the third stage (P < 0.05). The mean score of the quality of work life was also 96.9 ± 0.9 and 99.8 ± 0.9 in the 4th and 8th weeks after the intervention, which was significantly more than control group (P < 0.05). CONCLUSIONS The results showed the communication skills training improves professional performance and increases the quality of work life of pre-hospital emergency staff.
Collapse
Affiliation(s)
- Zahra Karimi
- Department of Psychiatric Nursing, Emergency Medical Services, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Fatemeh Darban
- Department of Nursing, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran.
| | - Samira Karimi
- Department of Clinical Psychology, Zahedan Branch, Islamic Azad University, Zahedan, Iran
| | - Enayatollah Safarzai
- Department of Nursing, Ali-Ebne-Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| |
Collapse
|
5
|
Armijo-Rivera S, Ferrada-Rivera S, Aliaga-Toledo M, Pérez LA. Application of the Team Emergency Assessment Measure Scale in undergraduate medical students and interprofessional clinical teams: validity evidence of a Spanish version applied in Chile. Front Med (Lausanne) 2023; 10:1256982. [PMID: 37771978 PMCID: PMC10525305 DOI: 10.3389/fmed.2023.1256982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023] Open
Abstract
Background Teamwork is one of the competencies necessary for physicians to work effectively in health systems and is a competency that can be developed with simulation in professionals and medicine students. The Team Emergency Assessment Measurement (TEAM) was created to evaluate the non-technical performance of team members during resuscitation events in real teams. The TEAM scale includes items to assess leadership, teamwork, situational awareness, and task management. An objective evaluation tool in Spanish is valuable for training health professionals at all undergraduate and continuing education levels. This study aimed to generate evidence of the validity of the Team Emergency Assessment Measure (TEAM) in Spanish to measure the performance of medical students and adult, pediatric, and obstetric emergency clinical teams in simulated emergencies as a self-assessment tool. Methods To develop the Spanish version of the instrument, a forward and backward translation process was followed by independent translators, native and fluent in English and Spanish, and a review by a panel of Chilean experts comprising three trained simulation instructors to verify semantics and cultural equivalence. High-fidelity simulations with debriefing were conducted with 5th-year medical students, in which students and instructors applied the Spanish version of the TEAM scale. In the second stage, adult, pediatric, and obstetric emergency management simulations were conducted using the TEAM scale for real clinical teams as a self-assessment tool. Findings By applying the overall TEAM scale to medicine students and clinical teams, Cronbach's alpha was 0.921. For medical students' self-assessment, we obtained Cronbach's alpha of 0.869. No significant differences were found between the overall scores and the scores by dimensions evaluated by instructors and students (p > 0.05). In the case of clinical team training, Cronbach's alpha was 0.755 for adult emergency teams, 0.797 for pediatric emergency teams, and 0.853 for obstetric emergency teams. Conclusion The validated instrument is adequate for evaluating teamwork in medical student simulations by instructors and peers and for self-assessment in adult, pediatric, and obstetric emergency clinical teams.
Collapse
Affiliation(s)
- Soledad Armijo-Rivera
- Escuela de Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Sandra Ferrada-Rivera
- Escuela de Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Unidad de Calidad y Seguridad del Paciente, Hospital Padre Hurtado, Santiago, Chile
| | | | - Leonardo A. Pérez
- Centro de Habilidades Clínicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Centro de Habilidades Clínicas y Disciplinares, Universidad de O'Higgins, Rancagua, Chile
| |
Collapse
|
6
|
Sanguanwit P, Kulrotwichit T, Tienpratarn W, Athinartrattanapong N, Trainarongsakul T, Angkoontassaneeyarat C. Effect of mini-course training in communication and teamwork on non-technical skills score in emergency residents: a prospective experimental study. BMC MEDICAL EDUCATION 2023; 23:529. [PMID: 37491254 PMCID: PMC10369795 DOI: 10.1186/s12909-023-04507-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Non-technical skill (NTS) teaching is a recent development in medical education that should be applied in medical education, especially in medical specialties that involve critically ill patients, resuscitation, and management, to promote patient safety and improve quality of care. Our study aimed to compare the effects of mini-course training in NTS versus usual practice among emergency residents. METHODS In this prospective (non-randomized) experimental study, emergency residents in the 2021-2022 academic year at Ramathibodi Hospital, a tertiary care university hospital, were included as participants. They were categorized into groups depending on whether they underwent a two-hour mini-course training on NTS (intervention group) or usual practice (control group). Each participant was assigned a mean NTS score obtained by averaging their scores on communication and teamwork skills given by two independent staff. The outcome was the NTS score before and after intervention at 2 weeks and 16 weeks. RESULTS A total of 41 emergency residents were enrolled, with 31 participants in the intervention group and 10 in the control group. The primary outcome, mean total NTS score after 2 weeks and 16 weeks, was shown to be significantly better in intervention groups than control groups (25.85 ± 2.06 vs. 22.30 ± 2.23; P < 0.01, 28.29 ± 2.20 vs. 23.85 ± 2.33; P < 0.01) although the mean total NTS score did not differ between the groups in pre-intervention period. In addition, each week the NTS score of each group increased 0.15 points (95% CI: 0.01-0.28, P = 0.03), although the intervention group showed greater increases than the control (0.24 points) after adjustment for time (95% CI: 0.08-0.39, P < 0.01). CONCLUSION Emergency residents who took an NTS mini-course showed improved mean NTS scores in communication and teamwork skills versus controls 2 weeks and 16 weeks after the training. Attention should be paid to implementing NTS in the curricula for training emergency residents. TRIAL REGISTRATION This trial was retrospectively registered in the Thai Clinical Trial Registry on 29/11/2022. The TCTR identification number is TCTR20221129006.
Collapse
Affiliation(s)
- Pitsucha Sanguanwit
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Thanet Kulrotwichit
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Welawat Tienpratarn
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand.
| | - Natsinee Athinartrattanapong
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Thavinee Trainarongsakul
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| | - Chuenruthai Angkoontassaneeyarat
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand
| |
Collapse
|
7
|
Cooper S, Connell C, Cant R. Review article: Use of the Team Emergency Assessment Measure in the rating of emergency teams' non-technical skills: A mapping review. Emerg Med Australas 2023; 35:375-383. [PMID: 36849717 DOI: 10.1111/1742-6723.14184] [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: 10/06/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 03/01/2023]
Abstract
The present study aims to explore the utility of the Team Emergency Assessment Measure (TEAM) in relation to the enhancement of emergency team non-technical skills based on research conducted over the last decade. In this mapping review, a citation mining process identified 22 primary studies for inclusion, published between 2012 and 2022. It provides outcome data on emergency teams' non-technical skills following team training and/or real-life patient emergencies. Emergency team studies related to resuscitation teams (adult, paediatric, newborn and obstetric cases) and medical emergency team (MET) management of patient deterioration. Team performance ratings varied, ranging from approximately 90% for experienced clinical teams down to 38% for students. Statistically significant improvements in performance were notable following training and/or repeated practice. Validity evidence, across 11 studies that provided change data described positive learning outcomes and moderate intervention effects. However, according to Kirkpatrick's model of educational evaluation the studies were limited to professional development phases of learning and immediate post-training assessments rather than care quality improvement. The review highlights a lack of studies evidencing quality improvement or clinical impact such as change of patient care practice or health service performance. There is a need to conduct well-designed studies that explore both technical and non-technical skills of resuscitation teams and METs. Currently, non-technical skills training and repeated performance evaluations using the TEAM contribute immensely to the proficiency of emergency teams.
Collapse
Affiliation(s)
- Simon Cooper
- Institute of Health and Wellbeing, Federation University Australia, Melbourne, Victoria, Australia
| | - Clifford Connell
- Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Robyn Cant
- Institute of Health and Wellbeing, Federation University Australia, Melbourne, Victoria, Australia
| |
Collapse
|
8
|
Parry AE, Richardson A, Kirk MD, Colquhoun SM, Durrheim DN, Housen T. Team effectiveness: epidemiologists' perception of collective performance during emergency response. BMC Health Serv Res 2023; 23:149. [PMID: 36782194 PMCID: PMC9925216 DOI: 10.1186/s12913-023-09126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND To describe epidemiologists' experience of team dynamics and leadership during emergency response, and explore the utility of the Team Emergency Assessment Measure (TEAM) tool during future public health emergency responses. The TEAM tool included categories for leadership, teamwork, and task management. METHODS We conducted a cross-sectional survey between October 2019 and February 2020 with the global applied field epidemiology workforce. To validate the TEAM tool for our context, we used exploratory and confirmatory factor analysis. RESULTS We analysed 166 completed surveys. Respondents included national and international emergency responders with representation of all WHO regions. We were unable to validate the TEAM tool for use with epidemiology teams involved in emergency response, however descriptive analysis provided insight into epidemiology emergency response team performance. We found female responders were less satisfied with response leadership than male counterparts, and national responders were more satisfied across all survey categories compared to international responders. CONCLUSION Functional teams are a core attribute of effective public health emergency response. Our findings have shown a need for a greater focus on team performance. We recommend development of a fit-for-purpose performance management tool for teams responding to public health emergencies. The importance of building and supporting the development of the national workforce is another important finding of this study.
Collapse
Affiliation(s)
- Amy Elizabeth Parry
- The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT, Australia.
| | - Alice Richardson
- grid.1001.00000 0001 2180 7477The Australian National University, Statistical Support Network, Acton, Australia
| | - Martyn D. Kirk
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia
| | - Samantha M. Colquhoun
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia
| | - David N. Durrheim
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, Newcastle, NSW Australia
| | - Tambri Housen
- grid.1001.00000 0001 2180 7477The Australian National University (ANU), National Centre for Epidemiology & Population Health (NCEPH), Building 62 Mills Road, Acton, ACT Australia ,grid.266842.c0000 0000 8831 109XUniversity of Newcastle, Newcastle, NSW Australia
| |
Collapse
|
9
|
The Concise Assessment of Leader Management Tool: Evaluation of Healthcare Provider Leadership During Real-Life Pediatric Emergencies. Simul Healthc 2023; 18:24-31. [PMID: 35533136 DOI: 10.1097/sih.0000000000000669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Resuscitation events in pediatric critical and emergency care are high risk, and strong leadership is an important component of an effective response. The Concise Assessment of Leadership Management (CALM) tool, designed to assess the strength of leadership skills during pediatric crises, has shown promising validity and reliability in simulated settings. The objective of this study was to generate further validity and reliability evidence for the CALM by applying it to real-life emergency events. METHODS A prospective, video-based study was conducted in an academic pediatric emergency department. Three reviewers independently applied the CALM tool to the assessment of pediatric emergency department physicians as they led both a cardiac arrest and a sepsis event. Time to critical event (epinephrine, fluid, and antibiotic administration) was collected via video review. Based on Kane's framework, we conducted fully crossed, person × event × rater generalizability (G) and decision (D) studies. Interrater reliability was calculated using Gwet AC 2 and intraclass correlation coefficients. Time to critical events was correlated with CALM scores using Spearman coefficient. RESULTS Nine team leaders were assessed in their leadership of 2 resuscitations each. The G coefficient was 0.68, with 26% subject variance, 20% rater variance, and no case variance. Thirty-three percent of the variance (33%) was attributed to third-order interactions and unknown factors. Gwet AC 2 was 0.3 and intraclass correlation was 0.58. The CALM score and time to epinephrine correlated at -0.79 ( P = 0.01). The CALM score and time to fluid administration correlated at -0.181 ( P = 0.64). CONCLUSIONS This study provides additional validity evidence for the CALM tool's use in this context if used with multiple raters, aligning with data from the previous simulation-based CALM validity study. Further development may improve reliability. It also serves as an exemplar of the rigors of conducting validity work within medical simulation.
Collapse
|
10
|
Morian H, Härgestam M, Hultin M, Jonsson H, Jonsson K, Nordahl Amorøe T, Creutzfeldt J. Reliability and validity testing of team emergency assessment measure in a distributed team context. Front Psychol 2023; 14:1110306. [PMID: 37151315 PMCID: PMC10157038 DOI: 10.3389/fpsyg.2023.1110306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for distributed teams and finding appropriate instruments to assess team performance is necessary. The Team Emergency Assessment Measure (TEAM), an instrument validated in traditional collocated acute-care settings, was tested for validity and reliability in this study when used for distributed teams. Three raters assessed video recordings of simulated team training scenarios (n = 18) among teams with varying levels of proficiency working with a remotely located physician via telemedicine. Inter-rater reliability, determined by intraclass correlation, was 0.74-0.92 on the TEAM instrument's three domains of leadership, teamwork, and task management. Internal consistency (Cronbach's alpha) ranged between 0.89-0.97 for the various domains. Predictive validity was established by comparing scores with proficiency levels. Finally, concurrent validity was established by high correlations, >0.92, between scores in the three TEAM domains and the teams' overall performance. Our results indicate that TEAM can be used in distributed acute-care team settings and consequently applied in future-directed learning and research on distributed healthcare teams.
Collapse
Affiliation(s)
- Hanna Morian
- Department of Nursing, Umeå University, Umeå, Sweden
- *Correspondence: Hanna Morian,
| | | | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anesthesia and Critical Care Medicine, Umeå University, Umeå, Sweden
| | - Håkan Jonsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Karin Jonsson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Torben Nordahl Amorøe
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Simulation Center West, Department of Research, Education, and Development, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
11
|
Sturesson LW, Persson K, Olmstead R, Bjurström MF. Influence of airway trolley organization on efficiency and team performance: A randomized, crossover simulation study. Acta Anaesthesiol Scand 2023; 67:44-56. [PMID: 36196685 PMCID: PMC10092151 DOI: 10.1111/aas.14155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Failed management of unanticipated difficult airway situations contributes to significant anesthesia-related morbidity and mortality. Optimization of design and layout of difficult airway trolleys (DATs) may influence outcomes during airway emergencies. The main objective of the current study was to evaluate whether a difficult airway algorithm-based DAT with integrated cognitive aids improves efficiency and team performance in difficult airway scenarios. METHODS In a crossover design, 16 teams (anesthetist, nurse anesthetist, assistant nurse) completed two high-fidelity simulated unanticipated difficult airway scenarios. Teams used both an algorithm-based DAT and a comparison, standard DAT, in the scenarios and were randomized to order of trolley type. Outcome measures included objective efficiency parameters, team performance assessment and subjective user-ratings. Linear mixed models ANOVA, including DAT type and order of condition as main factors, was utilized for the primary analyses of the team results. RESULTS Usage of the algorithm-based DAT was associated with fewer departures from the difficult airway algorithm (p = .010), and reduced number of unnecessary drawer openings (p = .002), but no significant differences in time to retrieval of airway devices or time to first effective ventilation, compared to the standard DAT. There were no significant differences in team performance, although participants expressed strong preference for the algorithm-based DAT (all user-rated measures p < .0001). Higher percentage of female members of the team improved adherence to the difficult airway algorithm (p = .043). CONCLUSIONS Algorithm-based DATs with integrated cognitive aids may improve efficiency in difficult airway situations, compared to traditional DATs. These findings have implications for improvement of anesthetic practice.
Collapse
Affiliation(s)
- Louise W Sturesson
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden
| | - Karolina Persson
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden
| | - Richard Olmstead
- Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Martin F Bjurström
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Anaesthesiology and Intensive Care, Lund, Sweden.,Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| |
Collapse
|
12
|
Calhoun AW, Scerbo MW. Preparing and Presenting Validation Studies: A Guide for the Perplexed. Simul Healthc 2022; 17:357-365. [PMID: 35470343 DOI: 10.1097/sih.0000000000000667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT Simulated environments are frequently used for learner assessment, and a wide array of assessment instruments have been created to assist with this process. It is important, therefore, that clear, compelling evidence for the validity of these assessments be established. Contemporary theory recognizes instrument validity as a unified construct that links a construct to be assessed with a population, an environment of assessment, and a decision to be made using the scores. In this article, we present a primer on 2 current frameworks (Messick and Kane), define the elements of each, present a rubric that can be used by potential authors to structure their work, and offer examples of published studies showing how each framework has been successfully used to make a validity argument. We offer this with the goal of improving the quality of validity-related publications, thereby advancing the quality of assessment in healthcare simulation.
Collapse
Affiliation(s)
- Aaron W Calhoun
- From the Division of Pediatric Critical Care (A.W.C.), Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY; and Department of Psychology (M.W.S.), Old Dominion University, Norfolk, VA
| | | |
Collapse
|
13
|
Kerins J, Keay R, Smith SE, Tallentire VR. Assessing team behaviours and time to defibrillation during simulated cardiac arrest: a pilot study of internal medicine trainees. Simul Healthc 2022. [DOI: 10.54531/cope7296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Understanding team behaviours leading to successful outcomes in resuscitation could help guide future training. Guidelines recommend defibrillation for shockable rhythm cardiac arrests within 2 minutes. This observational pilot study aimed to determine whether teamwork behaviours among medical trainees differed when time to defibrillation (TTD) was less than 2 minutes, versus 2 minutes or more.
Following ethical approval, groups of six internal medicine trainee (IMT) doctors in Scotland formed an
Twenty-three videos involving 138 trainees were scored using the TEAM tool. Scores ranged from 19–39.5/44 (mean 28.2). Mean TTD was 86.2 seconds (range 24–224), with 17/23 teams achieving defibrillation in under 2 minutes. Those achieving fast TTD achieved higher TEAM scores, and the result was statistically significant (30.1 ± 5.0 vs 22.9 ± 3.3,
This observational pilot study found that improved team performance, as measured by the TEAM tool, was associated with faster defibrillation by IMT doctors in simulated cardiac arrest. It highlighted the importance of adaptability as a team behaviour associated with successful performance, which is of interest to those involved in training high stakes emergency teams.
Collapse
Affiliation(s)
- Joanne Kerins
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Rona Keay
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Samantha E Smith
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| | - Victoria R Tallentire
- 1Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, Scotland
| |
Collapse
|
14
|
Nabecker S, Huwendiek S, Seidl C, Hana A, Theiler L, Greif R. Assessment of Human Factors After Advanced Life Support Courses Comparing Simulated Team and Real Team Assessment: A Randomized Controlled Cohort Trial. Front Cardiovasc Med 2022; 9:840114. [PMID: 35911508 PMCID: PMC9335945 DOI: 10.3389/fcvm.2022.840114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
AimHuman factors are essential for high-quality resuscitation team collaboration and are, therefore, taught in international advanced life support courses, but their assessment differs widely. In Europe, the summative life support course assessment tests mainly adhere to guidelines but few human factors. This randomized controlled simulation trial investigated instructors’ and course participants’ perceptions of human factors assessment after two different summative assessments.MethodsAll 5th/6th-year medical students who attended 19 advanced life support courses according to the 2015 European Resuscitation Council guidelines during one study year were invited to participate. Each course was randomized to either: (1) Simulated team assessment (one instructor simulates a team, and the assessed person leads this “team” through a cardiac-arrest scenario test); (2) Real team assessment (4 students form a team, one of them is assessed as the team leader; team members are not assessed and act only on team leader’s commands). After the summative assessments, instructors, and students rated the tests’ ability to assess human factors using a visual analog scale (VAS, 0 = no agreement, 10 = total agreement).ResultsA total of 227 students participated in the 1-day Immediate Life Support courses, 196 students in the 2-day Advanced Life Support courses, additionally 54 instructors were included. Instructors judged all human factors significantly better in real team assessments; students rated leadership and situational awareness comparable between both assessments. Assessment pass rates were comparable between groups.ConclusionSummative assessment in real teams was perceived significantly better to assess human factors. These results might influence current summative assessment practices in advanced life support courses.
Collapse
Affiliation(s)
- Sabine Nabecker
- Department of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, ON, Canada
- ERC Research NET, Niel, Belgium
- Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland
- *Correspondence: Sabine Nabecker,
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Christian Seidl
- EMS Rescue Service of the Canton Basel-Stadt, Basel, Switzerland
| | - Anisa Hana
- Department of Intensive Care Medicine, Laurentius Hospital, Roermond, Netherlands
| | - Lorenz Theiler
- Department of Anesthesia, Kantonsspital Aarau, Aarau, Switzerland
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- ERC Research NET, Niel, Belgium
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| |
Collapse
|
15
|
Jacob ER, Sundin D, Robertson S, Davies H. Extended immersive simulation to develop nontechnical skills: Content analysis of students' views. Collegian 2022. [DOI: 10.1016/j.colegn.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
16
|
Peran D, Sykora R, Vidunova J, Krsova I, Pekara J, Renza M, Brizgalova N, Cmorej PC. Non-technical skills in pre-hospital care in the Czech Republic: a prospective multicentric observational study (NTS study). BMC Emerg Med 2022; 22:83. [PMID: 35562664 PMCID: PMC9107236 DOI: 10.1186/s12873-022-00642-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/28/2022] [Indexed: 12/31/2022] Open
Abstract
Background Non-technical skills (NTS) are important for the proper functioning of emergency medical ambulance crews but have hardly been researched in the conditions of clinical pre-hospital care. The primary objective of this study, therefore, is to describe the use of NTS in practice. The secondary objective is to compare if the performance of NTS varies according to the type of case. Methods In this multicentric observational study the modified Team Emergency Assessment Measure (TEAM) score was used to assess the performed NTS of two or more crews on site. The evaluation consisted of leadership, teamwork and task management, rated by a field supervisor. The study observations took place in real clinical pre-hospital emergency medical cases when two or more crews were dispatched between October 2019 and August 2020. The sample size was determined by researchers prior to the study to at least 100 evaluated events per each of the three participating emergency medical services. The results are presented as median and interquartile range. The internal reliability, consistency and validity of test items and results were evaluated. The Kruskal–Wallis test and the post hoc Mann-Whitney U test with Bonferroni correction were used for multiple comparisons of three groups. Results A total of 359 events were evaluated. Surprisingly, the median value for all eight items was as high as 3.0 with a similar interquartile range of 1.0. There were no differences observed by case type (CPR vs. TRAUMA vs. MEDICAL) except from item 1. A post hoc analysis revealed that this difference is in favour of a higher rated performance of non-technical skills in CPR. Conclusions The overall result of the performance of non-technical skills can be regarded as very good and can serve for further evaluations. The crews achieved better parameters of NTS in leadership in resuscitation situations in comparison with general medical events. Trial Registration The study is registered at Clinical Trials under the ID: NCT04503369.
Collapse
Affiliation(s)
- David Peran
- Emergency Medical Services of the Karlovy Vary Region, Karlovy Vary, Czech Republic.,Prague Emergency Medical Services, Prague, Czech Republic.,Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Prague, Czech Republic.,Medical College, Prague, Czech Republic
| | - Roman Sykora
- Emergency Medical Services of the Karlovy Vary Region, Karlovy Vary, Czech Republic. .,Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Prague, Czech Republic. .,Medical College, Prague, Czech Republic.
| | - Jana Vidunova
- Emergency Medical Services of the Pilsen Region, Pilsen, Czech Republic
| | - Ivana Krsova
- Emergency Medical Services of the Pilsen Region, Pilsen, Czech Republic
| | - Jaroslav Pekara
- Prague Emergency Medical Services, Prague, Czech Republic.,Medical College, Prague, Czech Republic
| | - Metodej Renza
- Emergency Medical Services of the Karlovy Vary Region, Karlovy Vary, Czech Republic.,Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Prague, Czech Republic
| | - Nikola Brizgalova
- Emergency Medical Services of the Karlovy Vary Region, Karlovy Vary, Czech Republic
| | - Patrik Ch Cmorej
- Jan Evangelista Purkyne University, Faculty of Health Studies, Usti nad Labem, Czech Republic.,Emergency Medical Services of the Usti nad Labem Region, Usti nad Labem, Czech Republic
| |
Collapse
|
17
|
Perera A, Griffiths R, Myers JA. Integrative Review of Non-Technical Skills Frameworks to Apply for Air Medical Transfer of Pregnant Women. J Obstet Gynecol Neonatal Nurs 2022; 51:257-277. [PMID: 35278350 DOI: 10.1016/j.jogn.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To identify the most suitable non-technical skills framework to adapt and apply to the air medical transfer of pregnant women. DATA SOURCES Embase, PsycINFO, PubMed, MEDLINE, Web of Science, CINAHL, Science Direct, and Google Scholar. STUDY SELECTION We retrieved potentially relevant articles using a predefined combination of keywords extended with truncation and Boolean operators. Database and manual reference searches yielded 569 peer-reviewed articles. We included articles if they presented empirical data and described non-technical or cognitive competency skills frameworks for health care professionals. We discussed any ambiguities regarding inclusion, and they were resolved by consensus. We retained 71 full-text articles for final review. DATA EXTRACTION We coded extracted data under four criteria: non-technical skill categories, context of use, psychometric properties, and rating system. We generated descriptive summary tables of the characteristics of existing non-technical skills frameworks based on publication year, method of development, clinical setting, clinical specialty, routine/crisis-based performance, and team/individual performance. DATA SYNTHESIS We identified 42 non-technical skills frameworks from a variety of health care settings. We critically examined context of use and how use in various clinical settings may align with air transfers of pregnant women. Our findings illustrate the importance of team-based and routine performance rather than crisis-focused skills. Maintaining situational awareness throughout all stages of the transfer and communicating effectively with team members, the pregnant woman, and her partner are skills that are particularly important to ensure good outcomes. CONCLUSION We selected the Global Assessment of Obstetric Team Performance as the most suitable non-technical skills framework to adapt to the clinical setting of air medical transfer of pregnant women. We considered the clinical specialty, specific non-technical skills required in the setting, the framework's properties, and the requirement to focus on routine team performance.
Collapse
|
18
|
Keay R, Kerins J, Tallentire V. 84 Using the Team Tool in High-Fidelity Immersive Simulation for Internal Medicine Trainees: Assessing Leadership of Cardiac Arrest Scenarios. Simul Healthc 2021. [DOI: 10.54531/zsjx2498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Non-technical skills (NTS) play a crucial role in cardiac arrest resuscitation performance, both in simulated and clinical environments This observational pilot study aimed to explore the leadership and team-working behaviours of IMT1 doctors in a simulated cardiac arrest scenario, to identify strengths and areas for improvement to focus future training.The Scottish national IMT1 boot camp involves a variety of high-fidelity immersive simulation scenarios across the 3-day course. Trainees are in groups of six with one IMT taking a lead role in each scenario. This study assessed a scenario of shockable rhythm cardiac arrest. All group participants are involved as the cardiac arrest team, with the original ‘hot seat’ participant expected to take the role of team leader, unless otherwise agreed by the team. The scenario is followed by a facilitated debrief around leadership in cardiac arrest.Following ethical approval from NHS Education for Scotland and written participant consent, videos of the cardiac arrest scenario were observed by the research team. Leadership and team behaviours were scored using the validated Team Emergency Assessment Measure (TEAM) Seventeen videos involving 102 trainees were reviewed and scored using the TEAM tool. The average overall TEAM score was 6.19/10. Scores for each of the 11 NTS domains ranged from 2.13/4 to 3.25/4. IMT1s scored highly on adapting to changing situations and monitoring and reassessing, but poorly on team leader displaying direction and command and leader maintaining a global perspective. When leadership scores were high, overall team performance was also high. General observations from field notes found the team often did not allocate a leader until cardiac arrest occurred. The leader often struggled to remain hands-off with a lack of assertiveness and poor communication between the leader and team. One hundred and fourteen IMT1s completed a pre- and post-course questionnaire. Average pre-course confidence in cardiac arrest team leadership was 3.8/7, and among the lowest of all situations rated. This improved to 5.35/7 post-course, but compared with other situations, remained low.This pilot study found leadership to be a key component in managing cardiac arrest for IMT1s, influencing overall team performance. Particular areas for improvement include hands-off leadership, leader assertiveness and whole team communication, which could be the focus of future educational interventions. Scenario participation and facilitated debrief improved overall confidence, but further focussed leadership and team training is required as IMT1s transition into the leadership role.
Collapse
|
19
|
Dewolf P, Vanneste M, Desruelles D, Wauters L. Measuring non-technical skills during prehospital advanced cardiac life support: A pilot study. Resusc Plus 2021; 8:100171. [PMID: 34693380 PMCID: PMC8517196 DOI: 10.1016/j.resplu.2021.100171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 11/05/2022] Open
Abstract
Aim To analyse non-technical skills of mobile medical teams during out-of-hospital cardiac arrests (OHCA) using the validated Team Emergency Assessment Measure (TEAM) tool. To research the correlation between non-technical skills and patient outcome. Methods Adult patients who experienced an out-of-hospital cardiac arrest between July 2016, and June 2018, and were treated by a mobile medical team from the University Hospital Leuven, were eligible for the study. Resuscitations were video recorded from the team leader’s perspective. Video recordings were reviewed and scored by emergency physicians, using the TEAM evaluation form. Results In total 114 OHCAs were analysed. The mean TEAM score was 34.4/44 (SD = 5.5). The mean item score was 3.1/4 (SD = 0.8). On average, ‘effective team communication’ had the lowest score (2.4), while ‘acting with composure and control’ and ‘following of approved standards/guidelines’ scored the highest (3.4). The average non-technical skills theme scores were 2.9 (SD = 0.9) for ‘Leadership’, 3.1 (SD = 0.8) for ‘Teamwork’ and 3.3 (SD = 0.7) for ‘Task management’. ‘Leadership’ was rated significantly lower than ‘Teamwork’ (p = 0.004) and ‘Task management’ (p < 0.001). No significant correlation was found between TEAM and return of spontaneous circulation (p = 0.574) or one month survival (p = 0.225). Conclusion The mean overall TEAM score was categorized as good. Task management scored high, while leadership and team communication received lower scores. Future training programs should thus focus on improving leadership and communication. In this pilot study no correlation was found between non-technical skills and survival.
Collapse
Affiliation(s)
- Philippe Dewolf
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.,KULeuven, University, Faculty of Medicine, Belgium
| | - Maïté Vanneste
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Didier Desruelles
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Lina Wauters
- Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| |
Collapse
|
20
|
Riley K, Middleton R, Wilson V, Molloy L. Voices from the 'resus room': An integrative review of the resuscitation experiences of nurses. J Clin Nurs 2021; 31:1164-1173. [PMID: 34542206 DOI: 10.1111/jocn.16048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nurses are often the first responders to resuscitations. Understanding their experiences of resuscitation will highlight the resuscitative context nurses work within and identify the conditions that support or hamper their delivery of safe and effective resuscitative care. AIM The aim of this integrative review is to develop an understanding of nurses' experience of resuscitation, to gain knowledge of their challenges and identify gaps in evidence. DESIGN Integrative review. METHODS The electronic databases CINAHL, MEDLINE, Scopus and Web of Science were systematically searched from 2000-2021. Methodological quality of the papers was evaluated using the Mixed Methods Appraisal Tool (MMAT). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist was used to guide and report the integrative review. RESULTS Eleven articles met criteria for review. Four themes arose from the literature that addressed nurses experiences of resuscitation: Chaos (external/internal), ethical dilemmas, clinical confidence and need for support. CONCLUSION Nurses' experiences of resuscitation are multifaceted. Addressing the challenges that nurses experience during resuscitation will help ensure that nurses' are supported in their professional growth and personal well-being. Relevance to clinical practice and research: Building nursing leadership capacity within resuscitations is an area of clinical practice/research that is gaining traction as a valid solution to address the challenges nurses experience during resuscitations. Whilst the barriers to debriefing requires a greater level of consideration within the workplace.
Collapse
Affiliation(s)
- Katherine Riley
- School of Nursing, University of Wollongong, New South Wales, Australia
| | | | - Val Wilson
- School of Nursing, University of Wollongong, New South Wales, Australia
| | - Luke Molloy
- School of Nursing, University of Wollongong, New South Wales, Australia
| |
Collapse
|
21
|
Azimirad M, Magnusson C, Wiseman A, Selander T, Parviainen I, Turunen H. Identifying teamwork-related needs of the medical emergency team: Nurses' perspectives. Nurs Crit Care 2021; 27:804-814. [PMID: 34216412 DOI: 10.1111/nicc.12676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/26/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of medical emergency team (MET) in managing deteriorating patients and enhancing patient safety is greatly affected by teamwork. AIMS To identify teamwork-related needs of the MET from MET nurses' perspectives. To assess the associations between MET nurses' perceptions of teamwork and their work experience and education. STUDY DESIGN A quantitative, descriptive correlational design. METHODS Registered intensive care unit (ICU) nurses (n = 50) who were members of the MET in an acute tertiary care hospital answered a modified version of the team assessment questionnaire in 2017. Data were analysed using descriptive statistics, the Kruskal-Wallis test, and the univariate analysis of variance method. The reporting of this study adheres to the strengthening the reporting of observational studies (STROBE) guidelines. RESULTS Participants showed least agreement with the items presenting leadership skills (mean = 2.6, SD = 0.68). Approximately 50% nurses disagreed that the MET had adequate resources, training, and skills. The majority of nurses (80%) felt that their responsibilities as a MET member interfered with taking care of their own ICU patients. Many nurses (64%) felt that they did not have a voice in MET's decision-making process. Approximately 50% nurses felt that they were not recognized for their individual contribution, and they were uncertain regarding MET's policies for dealing with conflicts. The amounts of MET nurses' work experience and education were associated with MET skills and function, respectively. CONCLUSION Key teamwork elements of the MET that need improvements include decision-making and conflict resolution skills, valuing team members, and team leadership. Practicing shared mental models, implementing the TeamSTEPPS curricula at hospitals for training ICU nurses, and simulation-based team-training programmes may be beneficial in improving teamwork of MET members. RELEVANCE TO CLINICAL PRACTICE This study revealed key teamwork elements of the MET that need improvements. Our findings may contribute to improve teamwork, thereby optimizing MET function, and enhancing patient outcomes.
Collapse
Affiliation(s)
- Mina Azimirad
- Department of Nursing Science, University of Eastern Finland (UEF), Kuopio, Finland
| | - Carin Magnusson
- Duke of Kent Building, School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Surrey, UK
| | - Allison Wiseman
- College of Health & Life Sciences, Brunel University London, Uxbridge, UK
| | | | | | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland (UEF), Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
22
|
Freytag J, Stroben F, Hautz WE, Penders D, Kämmer JE. Effects of using a cognitive aid on content and feasibility of debriefings of simulated emergencies. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc95. [PMID: 34286075 PMCID: PMC8256120 DOI: 10.3205/zma001491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/04/2021] [Accepted: 02/25/2021] [Indexed: 06/13/2023]
Abstract
Background: Adverse events in patient care are often caused by failures in teamwork. Simulation training and its debriefing can contribute to improving teamwork and thus patient care. When conducting debriefings, there are several design factors that can potentially influence learning outcomes. This study examines the use of a cognitive aid to help structure the content of debriefings and compares it with debriefings that are merely roughly structured. In addition, the feasibility of the debriefing, the satisfaction of the participants and their teamwork during the training are investigated. Methods: In a simulated night shift, seven teams of four to five medical students (n=32) took part in six cases that simulated common situations in an emergency medicine environment and received a debriefing on their teamwork after each case, either in the intervention condition with the help of the TeamTAG tool - a cognitive aid focusing on selected teamwork principles from Crisis Resource Management (CRM) - or in the control condition without it. The facilitators noted the topics of the debriefings and rated their experience of conducting them; the participants indicated their satisfaction with the debriefings, as well as their assessment of the importance of CRM principles. In addition, the quality of teamwork was assessed using the Team Emergency Assessment Measure (TEAM). Results: The analysis showed no difference in the number of teamwork principles discussed between the control and intervention conditions, but topics were repeated more frequently in the control group. The TeamTAG guideline was focused on and implemented by the tutors, who discussed the CRM principles included in the TeamTAG more consistently than in the control condition. The tutors in both conditions were satisfied with the implementation, and the use of TeamTAG facilitated time management. There were no differences in participants' satisfaction, their assessment of the importance of the teamwork principles, or the quality of teamwork between conditions. Conclusion: The use of a cognitive aid can help to direct the focus on certain topics or learning objectives and facilitate time management through pre-structuring; however, a difference in learning outcomes (in terms of the quality of teamwork) could not be identified. Besides the influence of a certain structure or script, a strong influence from the individual guiding the debriefing is likely.
Collapse
Affiliation(s)
- Julia Freytag
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Simulated Patient Programme, Berlin, Germany
| | - Fabian Stroben
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CBF), Berlin, Germany
| | - Wolf E. Hautz
- Inselspital University Hospital Bern, Department of Emergency Medicine, Bern, Switzerland
| | - Dorothea Penders
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Lernzentrum, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Juliane E. Kämmer
- Inselspital University Hospital Bern, Department of Emergency Medicine, Bern, Switzerland
| |
Collapse
|
23
|
Wilson S, Rixon A, Hartanto S, White P, Judkins S. Review article: Systematic literature review of leadership in emergency departments. Emerg Med Australas 2020; 32:935-952. [PMID: 33089650 DOI: 10.1111/1742-6723.13658] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 01/04/2023]
Abstract
Emergency medicine (EM) is a discipline with complex leadership demands. However, studies of EM physician leadership and ED leadership are in their infancy. As such, there is a lack of clarity about the forms, antecedents, enablers, barriers and consequences of EM physician leadership. A systematic review of the scientific literature was conducted to reveal the different conceptualisations of EM physician leadership, the activities involved in the practice of leadership, and the knowledge and skills of effective ED leaders. Seven databases were systematically searched for peer-reviewed empirical studies on the topic of EM physicians carrying out a manager or leadership role in an ED setting. Finally, 26 articles were included, and their findings were synthesised and analysed narratively. Two conceptualisations of EM physician leadership were found, reflecting clinical leadership and medical leadership, respectively. Clinical leadership is performed by all EM physicians, often informally, within their daily clinical practice, whereas medical leadership is performed by EM physicians who work at the management level within a hospital, in addition to or instead of their clinical practice. The focus of EM physician leadership and ED leadership research is team leadership, with much less attention given to wider organisation leadership. Consistent with the focus on team leadership, clinical knowledge and skill in orchestrating teams, especially trauma and resuscitation teams, emerged as the most important factors underpinning leadership effectiveness. Future research and training should make better use of existing leadership theory and research designs to illuminate the forms, dynamics, antecedents, moderators and consequences of EM physician leadership.
Collapse
Affiliation(s)
- Samuel Wilson
- Department of Management and Marketing, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Andrew Rixon
- Department of Business Technology and Entrepreneurship, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Stephanie Hartanto
- Department of Business Technology and Entrepreneurship, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Peter White
- Australasian College for Emergency Medicine, Melbourne, Victoria, Australia
| | - Simon Judkins
- Australasian College for Emergency Medicine, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
Saunders R, Wood E, Coleman A, Gullick K, Graham R, Seaman K. Emergencies within hospital wards: An observational study of the non-technical skills of medical emergency teams. Australas Emerg Care 2020; 24:89-95. [PMID: 32747297 DOI: 10.1016/j.auec.2020.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/28/2020] [Accepted: 07/10/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medical emergency teams are essential in responding to acute deterioration of patients in hospitals, requiring both clinical and non-technical skills. This study aims to assess the non-technical skills of medical emergency teams during hospital ward emergencies and explore team members perceptions and experiences of the use non-technical skills during medical emergencies. METHODS A multi-methods study was conducted in two phases. During phase one observation and assessment of non-technical skills used in medical emergencies using the Team Emergency Assessment Measure (TEAM™) was conducted; and in the phase two in-depth interviews were undertaken with medical emergency team members. RESULTS Based on 20 observations, mean TEAM™ ratings for non-technical skill domains were: 'leadership' 5.0 out of 8 (±2.0); 'teamwork' 21.6 out of 28 (±3.6); and 'task management' 6.5 out of 8 (±1.4). The mean 'global' score was 7.5 out of 10 (±1.5). The qualitative findings identified three areas, 'individual', 'team' and 'other' contributing factors, which impacted upon the non-technical skills of medical emergency teams. CONCLUSION Non-technical skills of hospital medical emergency teams differ, and the impact of the skill mix on resuscitation outcomes was recognised by team members. These findings emphasize the importance non-technical skills in resuscitation training and well-developed processes for medical emergency teams.
Collapse
Affiliation(s)
- Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
| | - Emma Wood
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Adam Coleman
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Karen Gullick
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Renée Graham
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
| | - Karla Seaman
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
| |
Collapse
|
25
|
Nontechnical Competency Framework for Health Professionals in All-Hazard Emergency Environment: A Systematic Review. Disaster Med Public Health Prep 2020; 15:255-265. [PMID: 32029017 DOI: 10.1017/dmp.2019.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To summarize characteristics and commonalities of non-technical competency frameworks for health professionals in emergency and disaster. METHODS An electronic literature search was conducted in PubMed, MEDLINE, ERIC, Scopus, Cochrane database, and Google Scholar to identify original English-language articles related to development, evaluation or application of the nontechnical competency frameworks. Reviewers assessed identified articles for exclusion/inclusion criteria and abstracted data on study design, framework characteristics, and reliability/validity evidence. RESULTS Of the 9627 abstracts screened, 65 frameworks were identified from 94 studies that were eligible for result extraction. Sixty (63.8%) studies concentrated on clinical settings. Common scenarios of the studies were acute critical events in hospitals (44;46.8%) and nonspecified disasters (39;41.5%). Most of the participants (76; 80.9%) were clinical practitioners, and participants in 36 (38.3%) studies were multispecialty. Thirty-three (50.8%) and 42 (64.6%) frameworks had not reported evidence on reliability and validity, respectively. Fourteen of the most commonly involved domains were identified from the frameworks. CONCLUSIONS Nontechnical competency frameworks applied to multidisciplinary emergency health professionals are heterogeneous in construct and application. A fundamental framework with standardized terminology for the articulation of competency should be developed and validated so as to be accepted and adapted universally by health professionals in all-hazard emergency environment.
Collapse
|
26
|
Etherington N, Larrigan S, Liu H, Wu M, Sullivan KJ, Jung J, Boet S. Measuring the teamwork performance of operating room teams: a systematic review of assessment tools and their measurement properties. J Interprof Care 2019; 35:37-45. [PMID: 31865827 DOI: 10.1080/13561820.2019.1702931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Teamwork is fundamental to surgical patient safety but is inconsistently measured. While many tools have been developed for elective intraoperative situations, it is unclear which is the most robust. This systematic review aimed to identify tools to measure the teamwork of operating room teams. Studies were included if they examined the measurement properties of these tools. PsycINFO, Embase (via OVID), CINAHL, ERIC, Medline and Medline in Process (via OVID) were searched through to May 3, 2019, as were reference lists of included studies and previously published relevant reviews. Retrieved articles were screened and data extracted in duplicate by two independent reviewers. Quality was assessed using the COSMIN checklist. Of the 2121 references identified, 14 studies of six assessment tools were included. Tools were validated across various specialties, mostly in clinical rather than simulated settings. The Observational Teamwork Assessment for Surgery (OTAS) and Operating Theater Team Non-Technical Skills Assessment Tool (NOTECHS) were the most frequently investigated tools. Though acceptable for assessing teamwork, both NOTECHS and OTAS rely on the questionable assumption that the teamwork of a team is equivalent to the sum of individual performances. Future studies may investigate other assessment tools that assess the whole team as the unit of analysis along with the potential of these tools to provide healthcare providers with meaningful feedback in clinical practice.
Collapse
Affiliation(s)
| | - Sarah Larrigan
- Faculty of Medicine, University of Ottawa , Ottawa, Canada
| | - Henry Liu
- Faculty of Medicine, University of Ottawa , Ottawa, Canada
| | - Michael Wu
- Faculty of Medicine, University of Ottawa , Ottawa, Canada
| | | | - James Jung
- La Ki Shing Knowledge Institute, St. Michael' Hospital , Toronto, Ontario
| | - Sylvain Boet
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute.,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital , Ottawa, Ontario
| |
Collapse
|
27
|
Doymaz S, Rizvi M, Orsi M, Giambruno C. How Prepared Are Pediatric Residents for Pediatric Emergencies: Is Pediatric Advanced Life Support Certification Every 2 Years Adequate? Glob Pediatr Health 2019; 6:2333794X19876809. [PMID: 31555721 PMCID: PMC6747847 DOI: 10.1177/2333794x19876809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/11/2019] [Accepted: 08/21/2019] [Indexed: 12/02/2022] Open
Abstract
Objectives. We assessed pediatric residents’ retention of knowledge and clinical skills according to the time since their last American Heart Association Pediatric Advanced Life Support (AHA PALS) certification. Methods. Sixty-four pediatric residents were recruited and divided into 3 groups based on the time since their last PALS certification, as follows: group 1, 0 to 8 months; group 2, 9 to 16 months, and group 3, 17 to 24 months. Residents’ knowledge was tested using 10 multiple-choice AHA PALS pretest questions and their clinical skills performance was assessed with simulation mock code scenarios using 2 different AHA PALS checklists, and mean scores were calculated for the 3 groups. Differences in the test scores and overall clinical skill performances among the 3 groups were analyzed using analyses of variance, χ2 tests, and Jonckheere-Terpstra tests. Statistical significance was set at P < .05. Results. The pediatric residents’ mean overall clinical skills performance scores declined within the first 8 months after their last AHA PALS certification date and continued to decrease over time (87%, 82.6%, and 77.4% for groups 1, 2, and 3, respectively; P = .048). Residents’ multiple-choice test scores declined in all 3 groups, but the scores were not significantly different. Conclusions. Residents’ clinical skills performance declined within the first 8 months after PALS certification and continued to decline as the time from the last certification increased. Using mock code simulations and reinforcing AHA PALS guidelines during pediatric residency deserve further evaluation.
Collapse
Affiliation(s)
- Sule Doymaz
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Munaza Rizvi
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | | |
Collapse
|
28
|
Cheng A, Nadkarni VM, Mancini MB, Hunt EA, Sinz EH, Merchant RM, Donoghue A, Duff JP, Eppich W, Auerbach M, Bigham BL, Blewer AL, Chan PS, Bhanji F. Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2019; 138:e82-e122. [PMID: 29930020 DOI: 10.1161/cir.0000000000000583] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.
Collapse
|
29
|
Bakhsh A, Martin GFJ, Bicknell CD, Pettengell C, Riga C. An Evaluation of the Impact of High-Fidelity Endovascular Simulation on Surgeon Stress and Technical Performance. JOURNAL OF SURGICAL EDUCATION 2019; 76:864-871. [PMID: 30527702 DOI: 10.1016/j.jsurg.2018.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/29/2018] [Accepted: 10/28/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To measure the physiological stress response associated with high-fidelity endovascular team simulation. DESIGN This is a prospective cohort study. SETTING This study was performed at St Mary's Hospital (Imperial College London, London, UK), in a tertiary setting. PARTICIPANTS Thirty-five participants (10 vascular surgical residents, 4 surgical interns, 12 theatre nurses, 2 attending vascular surgeons, 6 medical students and 1 technician) were recruited from the Imperial Vascular Unit at St Mary's Hospital, Imperial College London by direct approach. All participants finished the study. RESULTS Junior surgeons experienced significantly increased sympathetic tone (Low frequency/high frequency (LF/HF) ratio) during team simulation compared to individual simulation (6.01 ± 1.68 vs. 8.32 ± 2.84, p < 0.001). Within team simulation junior surgeons experienced significantly higher heart rate (beats per minute) than their senior counterparts (82 ± 5.83 vs. 76 ± 6.02, p = 0.033). Subjective workload scores (NASA Task Load Index [NASA-TLX]) correlated moderately and significantly with sympathetic tone in surgeons across all stages of simulation. (r = 0.39, p = 0.01). CONCLUSIONS A discrete, measurable increase in stress is experienced by surgeons during high-fidelity endovascular simulation and differentially effects junior surgeons. High-fidelity team simulation may have a role to play in improving nontechnical skill, reducing intra-operative stress, and reducing error.
Collapse
Affiliation(s)
- Ali Bakhsh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Guy F J Martin
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Colin D Bicknell
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Chris Pettengell
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Celia Riga
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| |
Collapse
|
30
|
Freytag J, Stroben F, Hautz WE, Schauber SK, Kämmer JE. Rating the quality of teamwork-a comparison of novice and expert ratings using the Team Emergency Assessment Measure (TEAM) in simulated emergencies. Scand J Trauma Resusc Emerg Med 2019; 27:12. [PMID: 30736821 PMCID: PMC6368771 DOI: 10.1186/s13049-019-0591-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023] Open
Abstract
Background Training in teamwork behaviour improves technical resuscitation performance. However, its effect on patient outcome is less clear, partly because teamwork behaviour is difficult to measure. Furthermore, it is unknown who should evaluate it. In clinical practice, experts are obliged to participate in resuscitation efforts and are thus unavailable to assess teamwork quality. Consequently, we sought to determine if raters with little clinical experience and experts provide comparable evaluations of teamwork behaviour. Methods Novice and expert raters judged teamwork behaviour during 6 emergency medicine simulations using the Teamwork Emergency Assessment Measure (TEAM). Ratings of both groups were analysed descriptively and compared with U and t tests. We used a mixed effects model to identify the proportion of variance in TEAM scores attributable to rater status and other sources. Results Twelve raters evaluated 7 teams rotating through 6 cases, for a total of 84 observations. We found no significant difference between expert and novice ratings for 7 of the 11 items of the TEAM or in the sums of all item scores. Novices rated teamwork behaviour higher on 4 items and overall. Rater status accounted for 11.1% of the total variance in scores. Conclusions Experts’ and novices’ ratings were similarly distributed, implying that raters with limited experience can provide reliable data on teamwork behaviour. Novices show a consistent, but slightly more lenient rating behaviour. Clinical studies and real-life teams may thus employ novices using a structured observational tool such as TEAM to inform their performance review and improvement. Electronic supplementary material The online version of this article (10.1186/s13049-019-0591-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Julia Freytag
- Simulated Patients Program, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Fabian Stroben
- Lernzentrum, Office of the Vice Dean for Teaching and Learning, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,AG Progress Test Medizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.,Centre for Health Sciences Education, University of Oslo, Gaustadalléen 30, 0373, Oslo, Norway
| | - Stefan K Schauber
- Centre for Health Sciences Education, University of Oslo, Gaustadalléen 30, 0373, Oslo, Norway
| | - Juliane E Kämmer
- AG Progress Test Medizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Center for Adaptive Rationality, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany.
| |
Collapse
|
31
|
Effectiveness of Education in Improving the Performance of Medical Emergency Team Nurses. Clin Simul Nurs 2019. [DOI: 10.1016/j.ecns.2017.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
32
|
Boet S, Etherington N, Larrigan S, Yin L, Khan H, Sullivan K, Jung JJ, Grantcharov TP. Measuring the teamwork performance of teams in crisis situations: a systematic review of assessment tools and their measurement properties. BMJ Qual Saf 2018; 28:327-337. [PMID: 30309910 DOI: 10.1136/bmjqs-2018-008260] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Educational interventions to improve teamwork in crisis situations have proliferated in recent years with substantial variation in teamwork measurement. This systematic review aimed to synthesise available tools and their measurement properties in order to identify the most robust tool for measuring the teamwork performance of teams in crisis situations. METHODS Searches were conducted in Embase (via OVID), PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Medline and Medline In-Process (via OVID) (through 12 January 2017). Studies evaluating the measurement properties of teamwork assessment tools for teams in clinical or simulated crisis situations were included. Two independent reviewers screened studies based on predetermined criteria and completed data extraction. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS The search yielded 1822 references. Twenty studies were included, representing 13 assessment tools. Tools were primarily assessed in simulated resuscitation scenarios for emergency department teams. The Team Emergency Assessment Measure (TEAM) had the most validation studies (n=5), which demonstrated three sources of validity (content, construct and concurrent) and three sources of reliability (internal consistency, inter-rater reliability and test-retest reliability). Most studies of TEAM's measurement properties were at no risk of bias. CONCLUSIONS A number of tools are available for assessing teamwork performance of teams in crisis situations. Although selection will ultimately depend on the user's context, TEAM may be the most promising tool given its measurement evidence. Currently, there is a lack of tools to assess teamwork performance during intraoperative crisis situations. Additional research is needed in this regard.
Collapse
Affiliation(s)
- Sylvain Boet
- Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Nicole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sarah Larrigan
- University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Li Yin
- University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Hira Khan
- Department of Health Sciences, Faculty of Science , Carleton University, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - James J Jung
- Division of General Surgery, St. Michael's Hospital, Toronto, Canada
| | | |
Collapse
|
33
|
The Influence of Culture on Teamwork and Communication in a Simulation-Based Resuscitation Training at a Community Hospital in Honduras. ACTA ACUST UNITED AC 2018; 13:363-370. [DOI: 10.1097/sih.0000000000000323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Peddle M, Bearman M, Radomski N, Mckenna L, Nestel D. What non-technical skills competencies are addressed by Australian standards documents for health professionals who work in secondary and tertiary clinical settings? A qualitative comparative analysis. BMJ Open 2018; 8:e020799. [PMID: 30082346 PMCID: PMC6078249 DOI: 10.1136/bmjopen-2017-020799] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES At minimum, safe patient outcomes are recognised as resulting from a combination of technical and non-technical skills. Flin and colleagues provide a practical framework of non-technical skills, cognitive, social and interpersonal, that complement technical skills, with categories identified as situational awareness, communication, team working, decision-making, leadership, coping with stress and managing fatigue. The aim of this research was to explore the alignment of categories and elements of non-technical skills with those in the published standards documents of several health professions in Australia. DESIGN A qualitative comparative analysis using document analysis and deductive coding examined, extracted and interpreted data from competency standards documents focusing on non-technical skills categories and elements. PARTICIPANTS A purposive sample of 11 health professions competency standards documents required for registration in Australia. FINDINGS The 11 competency standards documents contained 1616 statements. Although standards documents addressed all non-technical skills categories, there was limited reporting of managing stress and coping with fatigue. Of the 31 elements included in the non-technical skills framework, 22 were not common to all health professions and 3 elements were missing from the standards documents. Additionally, the documents were composed differently with no common taxonomy and multifaceted statements. CONCLUSION While commonalities identified in the standards documents related to non-technical skills categories are likely to support patient safety, gaps in associated elements may undermine their effectiveness. The notable lack of reference to stress and fatigue requires further attention for health professional well-being in Australia. A shared taxonomy with clear statements may offer the best support for collaborative practice and positive patient outcomes. Competency standards need to be flexible to respond to the emerging demands of current healthcare practice along with consumer and health service needs.
Collapse
Affiliation(s)
- Monica Peddle
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Melbourne, Victoria, Australia
| | - Natalie Radomski
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lisa Mckenna
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Debra Nestel
- Faculty of Medicine, Nursing and Health Sciences, Monash Institute for Health and Clinical Education, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
35
|
Porter JE, Cant RP, Cooper SJ. Rating teams’ non-technical skills in the emergency department: A qualitative study of nurses’ experience. Int Emerg Nurs 2018; 38:15-20. [DOI: 10.1016/j.ienj.2017.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/11/2017] [Accepted: 12/25/2017] [Indexed: 12/23/2022]
|
36
|
Freytag J, Stroben F, Hautz WE, Eisenmann D, Kämmer JE. Improving patient safety through better teamwork: how effective are different methods of simulation debriefing? Protocol for a pragmatic, prospective and randomised study. BMJ Open 2017; 7:e015977. [PMID: 28667224 PMCID: PMC5726131 DOI: 10.1136/bmjopen-2017-015977] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Medical errors have an incidence of 9% and may lead to worse patient outcome. Teamwork training has the capacity to significantly reduce medical errors and therefore improve patient outcome. One common framework for teamwork training is crisis resource management, adapted from aviation and usually trained in simulation settings. Debriefing after simulation is thought to be crucial to learning teamwork-related concepts and behaviours but it remains unclear how best to debrief these aspects. Furthermore, teamwork-training sessions and studies examining education effects on undergraduates are rare. The study aims to evaluate the effects of two teamwork-focused debriefings on team performance after an extensive medical student teamwork training. METHODS AND ANALYSES A prospective experimental study has been designed to compare a well-established three-phase debriefing method (gather-analyse-summarise; the GAS method) to a newly developed and more structured debriefing approach that extends the GAS method with TeamTAG (teamwork techniques analysis grid). TeamTAG is a cognitive aid listing preselected teamwork principles and descriptions of behavioural anchors that serve as observable patterns of teamwork and is supposed to help structure teamwork-focused debriefing. Both debriefing methods will be tested during an emergency room teamwork-training simulation comprising six emergency medicine cases faced by 35 final-year medical students in teams of five. Teams will be randomised into the two debriefing conditions. Team performance during simulation and the number of principles discussed during debriefing will be evaluated. Learning opportunities, helpfulness and feasibility will be rated by participants and instructors. Analyses will include descriptive, inferential and explorative statistics. ETHICS AND DISSEMINATION The study protocol was approved by the institutional office for data protection and the ethics committee of Charité Medical School Berlin and registered under EA2/172/16. All students will participate voluntarily and will sign an informed consent after receiving written and oral information about the study. Results will be published.
Collapse
Affiliation(s)
- Julia Freytag
- Simulated Patients Program, Charité Medical School Berlin, Berlin, Germany
| | - Fabian Stroben
- Lernzentrum (Skills Lab), Charité Medical School Berlin, Berlin, Germany
- Department of Emergency Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Dorothea Eisenmann
- Lernzentrum (Skills Lab), Charité Medical School Berlin, Berlin, Germany
- Department of Anesthesiology and Operative Intensive Care Medicine CCM & CVK, Charité Medical School Berlin, Berlin, Germany
| | - Juliane E Kämmer
- Progress Test Medizin, Charité Medical School Berlin, Berlin, Germany
- Max Planck Institute for Human Development, Center for Adaptive Rationality, Berlin, Germany
| |
Collapse
|