1
|
Dijkstra FS, de la Croix A, van Schuppen H, Meeter M, Renden PG. When routine becomes stressful: A qualitative study into resuscitation team members' perception of stress and performance. J Interprof Care 2024; 38:191-199. [PMID: 38129181 DOI: 10.1080/13561820.2023.2289507] [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: 11/10/2022] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Interprofessional teamwork is of high importance during stressful situations such as CPR. Stress can potentially influence team performance. This study explores the perception of stress and its stressors during performance under pressure, to be able to further adjust or develop training. Healthcare professionals, who are part of the resuscitation team in a large Dutch university medical center, discussed their experiences in homogeneous focus groups. Nine focus groups and one individual interview were conducted and analyzed thematically, in order to deepen our understanding of their experiences. Thematic analysis resulted in two scenarios, routine and stress and an analysis of accompanying team processes. Routine refers to a setting perceived as straightforward. Stress develops in the presence of a combination of stressors such as a lack of clarity in roles and a lack of knowledge on fellow team members. Participants reported that stress affects the team, specifically through an altering of communication, a decrease in situational awareness, and formation of subgroups. This may lead to a further increase in stress, and potentially result in a vicious cycle. Team processes in a stressful situation like CPR can be disrupted by different stressors, and might affect the team and their performance. Improved knowledge about the stressors and their effects might be used to design a training environment representative for the performance setting healthcare professionals work in. Further research on the impact of representative training with team-level stressors and the development of a "team brain" might be worthwhile.
Collapse
Affiliation(s)
- F S Dijkstra
- Academy of Health Sciences, Saxion University of Applied Sciences, Deventer, The Netherlands
- Educational and Family Studies, Faculty of Behavioural and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A de la Croix
- Amsterdam UMC location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands
- LEARN! Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H van Schuppen
- Department of Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - M Meeter
- Educational and Family Studies, Faculty of Behavioural and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P G Renden
- Department of Nursing, Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague, the Netherlands
- Research Group Relational Care, Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, the Netherlands
| |
Collapse
|
2
|
Tanabe R, Hongo T, Obara T, Nojima T, Nakao A, Elmer J, Naito H, Yumoto T. Treatment patterns and clinician stress related to care of out-of-hospital cardiac arrest patients with a do not attempt resuscitation order. Resusc Plus 2023; 16:100507. [PMID: 38026140 PMCID: PMC10665952 DOI: 10.1016/j.resplu.2023.100507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This research investigated treatment patterns for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders in Japanese emergency departments and the associated clinician stress. Methods A cross-sectional survey was conducted at 9 hospitals in Okayama, Japan, targeting emergency department nurses and physicians. The questionnaire inquired about the last treated out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation. We assessed emotional stress on a 0-10 scale and moral distress on a 1-5 scale among clinicians. Results Of 208 participants, 107 (51%) had treated an out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation order in the past 6 months. Of these, 65 (61%) clinicians used a "slow code" due to perceived futility in resuscitation (42/65 [65%]), unwillingness to terminate resuscitation upon arrival (38/65 [59%]), and absence of family at the time of patient's arrival (35/65 [54%]). Female clinicians had higher emotional stress (5 vs. 3; P = 0.007) and moral distress (3 vs. 2; P = 0.002) than males. Nurses faced more moral distress than physicians (3 vs. 2; P < 0.001). Adjusted logistic regression revealed that having performed a "slow code" (adjusted odds ratio, 5.09 [95% CI, 1.68-17.87]) and having greater ethical concerns about "slow code" (adjusted odds ratio, 0.35 [95% CI, 0.19-0.58]) were associated with high stress levels. Conclusions The prevalent use of "slow code" for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders underscores the challenges in managing these patients in clinical practice.
Collapse
Affiliation(s)
- Ryo Tanabe
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| |
Collapse
|