1
|
Do Thi N, Thi GH, Lee Y, Minh KP, Thanh HN, Shin JS, Luong Xuan T. First-aid training for primary Healthcare providers on a remote Island: a mixed-methods study. BMC MEDICAL EDUCATION 2024; 24:790. [PMID: 39044192 DOI: 10.1186/s12909-024-05768-6] [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: 09/11/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Ensuring ongoing first-aid training for primary healthcare providers (PHPs) is one of the critical strategies for providing quality health services and contributing to achieving universal health coverage. However, PHPs have received insufficient attention in terms of training and capacity building, especially in the remote areas of low-to-middle-income countries. This study evaluated the effectiveness of a first-aid training program for PHPs on a Vietnamese island and explored their perspectives and experiences regarding first-aid implementation. METHODS A mixed-methods study was conducted among 39 PHPs working in community healthcare centers. The quantitative method utilized a quasi-experimental design to evaluate participants' first-aid knowledge at three time points: pre-training, immediately post-training, and three months post-training. Sixteen of the PHPs participated in subsequent semi-structured focus group interviews using the qualitative method. Quantitative data were analyzed using repeated measures analysis of variance (ANOVA), while qualitative data were subjected to thematic analysis. RESULTS The quantitative results showed a significant improvement in both the overall mean first-aid knowledge scores and the subdimensions of the first-aid knowledge scores among healthcare providers post-training. There was a statistically significant difference between the baseline and immediate posttest and follow-up knowledge scores (p < 0.001). However, the difference in knowledge scores between the immediate posttest and three-month follow-up was not significant (p > 0.05). Three main themes emerged from the focus group discussions: perception of first-aid in remote areas, facilitators and barriers. Participants identified barriers, including infrastructure limitations, shortage of the primary healthcare workforce, inadequate competencies, and insufficient resources. Conversely, receiving considerable support from colleagues and the benefits of communication technologies in implementing first aid were mentioned as facilitators. The training bolstered the participants' confidence in their first-aid responses, and there was a desire for continued education. CONCLUSIONS Implementing periodic first-aid refresher training for PHPs in a nationwide resource-limited setting can contribute significantly to achieving universal health coverage goals. This approach potentially enhances the preparedness of healthcare providers in these areas to deliver timely and effective first aid during emergencies, which may lead to more consistent primary healthcare services despite various challenges.
Collapse
Affiliation(s)
- Ninh Do Thi
- College of Nursing, Ewha Womans University, Seoul, Korea.
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam.
| | - Giang Hoang Thi
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Yoonjung Lee
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Khue Pham Minh
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Hai Nguyen Thanh
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Jwa-Seop Shin
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Tuyen Luong Xuan
- Vietnam National Institute of Maritime Medicine, Hai Phong, Vietnam
| |
Collapse
|
2
|
Regev S, Mitchnik IY. Mastering multicasualty trauma care with the Trauma Non-technical Skills Scale. J Trauma Acute Care Surg 2024:01586154-990000000-00768. [PMID: 38996423 DOI: 10.1097/ta.0000000000004417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
BACKGROUND Multicasualty events present complex medical challenges. This is the first study to investigate the role of nontechnical skills in prehospital multicasualty trauma care. We assessed the feasibility of using the Trauma Nontechnical Skills Scale (T-NOTECHS) instrument, which has not yet been investigated to evaluate these scenarios. METHODS We conducted an observational study involving military medical teams with Israel Defense Forces Military Trauma Life Support training to assess the T-NOTECHS' utility in predicting prehospital medical team performance during multicasualty event simulations. These teams were selected from a pool of qualified military Advanced Life Support providers. Simulations were conducted in a dedicated facility resembling a field setting, with video recordings to ensure data accuracy. Teams faced a single multicasualty scenario, assessed by two instructors, and were evaluated using a 37-item checklist. The T-NOTECHS scores were analyzed using regression models to predict simulation performance. RESULTS We included 27 teams for analysis, led by 28% physicians and 72% paramedics. Interrater reliability for simulation performance and T-NOTECHS scores showed good agreement. Overall T-NOTECHS scores were positively correlated with simulation performance scores (R = 0.546, p < 0.001). Each T-NOTECHS domain correlated with simulation performance. The Communication and Interaction domain explained a unique part of the variance (β = 0.406, p = 0.047). Assessment and Decision Making had the highest correlation (R = 0.535, p < 0.001). These domains significantly predicted specific items on the simulation performance checklist. Cooperation and Resource Management showed the least correlation with checklist items. CONCLUSION This study confirms the T-NOTECHS' reliability in predicting prehospital trauma team performance during multicasualty scenarios. Key nontechnical skills, especially Communication and Interaction, and Assessment and Decision Making, play vital roles. These findings underscore the importance of training in these skills to enhance trauma care in such scenarios, offering valuable insights for medical team preparation. LEVEL OF EVIDENCE Diagnostic Tests or Criteria; Level II.
Collapse
Affiliation(s)
- Stav Regev
- From the Faculty of Medicine (S.R., I.Y.M.), Tel Aviv University, Tel Aviv; Military Medical Academy (I.Y.M.), Israel Defense Force, Ha'Negev; and Department of Orthopaedic Surgery (I.Y.M.), Shamir Medical Center, Zrifin, Israel
| | | |
Collapse
|
3
|
Gualtieri M, Scivoletto G, Pitino F, Pisapia F, Valentini V. Sports-related Mandibular Fractures in the Center of Italy: A Retrospective Study. J Craniofac Surg 2024:00001665-990000000-01743. [PMID: 38953584 DOI: 10.1097/scs.0000000000010442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/31/2024] [Indexed: 07/04/2024] Open
Abstract
The main causes of injuries to the lower and middle third of the facial skeleton are traffic accidents, accidental falls, assaults, and sport. Regarding sports-related maxillofacial trauma, an 8-year retrospective study was conducted at the Department of Oral and Maxillofacial Surgery of the Policlinico Umberto I in Rome, Italy. In all, 329 patients were included, of which we analyzed 35 patients with sports-related mandibular fractures. Specifically, we assessed the type of mandibular fracture reported, age, gender, number of fracture lines, association with other maxillofacial fractures, and treatment options. The causes of sports-related injuries are often multifactorial. Therefore, the aim of our study was to understand the correlation between the type of sport practiced and the most frequently reported pattern of mandibular fracture, highlighting how, depending on the sport, the mechanism of action is different and may correlate with a specific type of mandibular fracture.
Collapse
Affiliation(s)
- Matteo Gualtieri
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome
- Unit of Maxillofacial Surgery and Otolaryngology, Floraspe Renzetti Hospital, Lanciano, Italy
| | - Giulia Scivoletto
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome
| | - Francesca Pitino
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome
| | - Francesco Pisapia
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome
| | - Valentino Valentini
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome
| |
Collapse
|
4
|
Fornander L, Laukkanen K, Molin I, Nilsson L, Berggren P. Team communication patterns during real and simulated trauma resuscitation-a social network analysis. ERGONOMICS 2024; 67:225-239. [PMID: 37273191 DOI: 10.1080/00140139.2023.2221000] [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: 12/18/2022] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
In trauma teams, coordination can be established through a centralised leader. The team can also use a decentralised strategy. In this descriptive study of video-recorded trauma resuscitations, using quantification of qualitative data, Social Network analysis of all real-time communications of eight in-real-life (IRL) and simulated trauma teams explained team social structure. The communication network structures in the simulated scenarios were more centralised using individually directed speech and had a high proportion of communication to update all team members. Such a structure might be the result of work performed in a complexity-stripped simulation environment where simplified task-executions required less interactions, or from work revolving around a deteriorating patient, imposing high demands on rapid decision-making and taskwork. Communication IRL was mostly decentralised, with more variability between cases, possibly due to unpredictability of the IRL case. The flexibility to act in a decentralised manner potentiates adaptability and seems beneficial in rapidly changing situations.Practitioner summary: Efficient collaboration in trauma teams is essential. Communication in in-real-life and simulated trauma teams was analysed using social network analysis. The simulation teams were overall more centralised compared to the IRL teams. The flexibility to act decentralised seems beneficial for emergency teams as it enables adaptability in unpredictable situations.
Collapse
Affiliation(s)
- Liselott Fornander
- Department of Anaesthesiology and Intensive Care in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kati Laukkanen
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ida Molin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Emergency Medicine, Norrköping and Centre for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Peter Berggren
- Center for Disaster Medicine and Traumatology, Linköping University, Linköping, Sweden
- Department of Computer and Information Science, Linköping University, Linköping, Sweden
| |
Collapse
|
5
|
Kim HW, Roh YS. Perceived trauma nursing core competency, interprofessional collaborative competency, and associated barriers among regional trauma center nurses. Int Emerg Nurs 2024; 72:101388. [PMID: 38134844 DOI: 10.1016/j.ienj.2023.101388] [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: 07/29/2023] [Revised: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION As key members of interprofessional teams working in complex settings, nurses in trauma centers require trauma nursing core competency. PURPOSE This study sought to determine the levels and relationships of the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers among Korean regional trauma center nurses. METHODS This cross-sectional, descriptive, and correlational survey involved a convenience sample of 190 Korean trauma center nurses. Data were collected using a web-based self-reporting questionnaire about the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers. Data were analyzed using descriptive statistics, Pearson's correlation, and multiple regression (Enter method) analyses. RESULTS The perceived performance and importance of interprofessional collaborative competency, the perceived importance of trauma nursing core competency, and the perceived barriers to resources, training, competency, and interest significantly affected trauma nursing core competency performance, accounting for 64.5 % of the variance. CONCLUSIONS Training programs are needed to improve the core and interprofessional collaborative competencies of trauma nurses. Individual, team, and organizational approaches are essential to addressing the perceived barriers. The effects of training programs on the core competency of trauma nurses should be validated.
Collapse
Affiliation(s)
- Hyo-Won Kim
- Graduate School of Nursing & Health Sciences, Chung-Ang University, Seoul, Republic of Korea
| | - Young Sook Roh
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro Dongjak-gu, Seoul 06974, Republic of Korea.
| |
Collapse
|
6
|
Maiga AW, Vella MA, Appelbaum RD, Irlmeier R, Ye F, Holena DN, Dumas RP. Getting out of the bay faster: Assessing trauma team performance using trauma video review. J Trauma Acute Care Surg 2024; 96:76-84. [PMID: 37880840 DOI: 10.1097/ta.0000000000004168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Minutes matter for trauma patients in hemorrhagic shock. How trauma team function impacts time to the next phase of care has not been rigorously evaluated. We hypothesized better team performance scores to be associated with decreased time to the next phase of trauma care. METHODS This retrospective secondary analysis of a prospective multicenter observational study included hypotensive trauma patients at 19 centers. Using trauma video review, we analyzed team performance with the validated Non-Technical Skills for Trauma scale: leadership, cooperation and resource management, communication, assessment/decision making, and situational awareness. The primary outcome was minutes from patient arrival to next phase of care; deaths in the bay were excluded. Secondary outcomes included time to initiation and completion of first unit of blood and inpatient mortality. Associations between team dynamics and outcomes were assessed with a linear mixed-effects model adjusting for Injury Severity Score, mechanism, initial blood pressure and heart rate, number of team members, and trauma team lead training level and sex. RESULTS A total of 441 patients were included. The median Injury Severity Score was 22 (interquartile range, 10-34), and most (61%) sustained blunt trauma. The median time to next phase of care was 23.5 minutes (interquartile range, 17-35 minutes). Better leadership, communication, assessment/decision making, and situational awareness scores were associated with faster times to next phase of care (all p < 0.05). Each 1-point worsening in the Non-Technical Skills for Trauma scale score (scale, 5-15) was associated with 1.6 minutes more in the bay. The median resuscitation team size was 12 (interquartile range, 10-15), and larger teams were slower ( p < 0.05). Better situational awareness was associated with faster completion of first unit of blood by 4 to 5 minutes ( p < 0.05). CONCLUSION Better team performance is associated with faster transitions to next phase of care in hypotensive trauma patients, and larger teams are slower. Trauma team training should focus on optimizing team performance to facilitate faster hemorrhage control. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
Collapse
Affiliation(s)
- Amelia W Maiga
- From the Division of Acute Care Surgery, Department of Surgery (A.W.M., R.D.A.), Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Critical Illness, Brain dysfunction, and Survivorship Center (A.W.M.), Vanderbilt University Medical Center, Nashville, Tennessee; Division of Acute Care Surgery and Trauma (M.A.V.), University of Rochester Medical Center, Rochester, New York; Department of Biostatistics (R.I.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Medicine (F.Y.), Vanderbilt University Medical Center, Nashville, Tennessee; Division of Trauma and Acute Care Surgery (D.N.H.), Medical College of Wisconsin, Milwaukee, Wisconin; and Division of Burn Trauma Acute and Critical Care Surgery (R.P.D.), UT Southwestern Medical Center, Dallas, Texas
| | | | | | | | | | | | | |
Collapse
|
7
|
Essex R, Kennedy J, Miller D, Jameson J. A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations. Nurs Inq 2023; 30:e12571. [PMID: 37338510 DOI: 10.1111/nin.12571] [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: 02/16/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
Healthcare organisations are hierarchical; almost all are organised around the ranking of individuals by authority or status, whether this be based on profession, expertise, gender or ethnicity. Hierarchy is important for several reasons; it shapes the delivery of care, what is prioritised and who receives care. It also has an impact on healthcare workers and how they work and communicate together in organisations. The purpose of this scoping review is to explore the qualitative evidence related to hierarchy in healthcare organisations defined broadly, to address gaps in macro-level healthcare organisational research, specifically focusing on the (1) impact of hierarchy for healthcare workers and (2) how hierarchy is negotiated, sustained and challenged in healthcare organisations. After a search and screening, 32 papers were included in this review. The findings of this review detail the wide-reaching impacts that hierarchy has on healthcare delivery and health workers. The majority of studies spoke to hierarchy's impact on speaking up, that is, how it shaped communication between staff with differential status: not only what was said, but how it had an impact on what was acceptable to say, by whom and at what time. Hierarchy was also noted to have substantial personal costs, impacting on the well-being of those in less powerful positions. These findings also provide insight into the complex ways in which hierarchy was negotiated, challenged and reproduced. Studies not only detailed the way in which hierarchy was navigated day to day but also spoke to the reasons as to why hierarchy is often entrenched and difficult to shift. A number of studies spoke to the impact that hierarchy had in sustaining gender and ethnic inequalities, maintaining historically discriminatory practices. Importantly, hierarchy should not be reduced to differences between or within the professions in localised contexts but should be considered at a broad organisational level.
Collapse
Affiliation(s)
- Ryan Essex
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Jack Kennedy
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Denise Miller
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Jill Jameson
- Institute for Lifecourse Development, University of Greenwich, London, UK
| |
Collapse
|
8
|
Xie L, Feng M, Cheng J, Huang S. Developing a core competency training curriculum system for emergency trauma nurses in China: a modified Delphi method study. BMJ Open 2023; 13:e066540. [PMID: 37130690 PMCID: PMC10163488 DOI: 10.1136/bmjopen-2022-066540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES To develop a core competency training curriculum system for emergency trauma nurses in China. DESIGN A modified Delphi study design. PARTICIPANTS The selection criteria for participants identified in practitioner roles were to be currently engaged in trauma care for over 5 years, to serve as the manager of emergency or trauma surgery department, and to have a bachelor's degree or higher. A total of 15 trauma experts from three grade A tertiary hospitals were invited to participate in this study by email or face to face in January 2022. The expert group comprised four trauma specialist doctors and 11 trauma specialist nurses. There were 11 women and 4 men. The age ranged from 32 to 50 (40.27±5.120) years. The number of years worked ranged from 6 to 32 (15.87±7.110). RESULTS Two rounds of questionnaires were issued to 15 experts in each round, and the effective recovery rate was 100.00%. In this study, expert judgement=0.947, expert familiarity with the content=0.807 and authority coefficient=0.877, and the results are highly reliable. The Kendall's W of the two rounds in this study ranged from 0.208 to 0.467, and the difference was statistically significant (p<0.05). In the two rounds of expert consultations, four items were deleted, five items were modified, two items were added and one item was merged. Ultimately, the curriculum system of core competency training for emergency trauma nurses includes training objectives (8 theoretical knowledge and 9 practical skills), training contents (6 first-level indicators, 13 second-level indicators and 70 third-level indicators), training methods (9), evaluation indicators (4) and evaluation methodologies (4). CONCLUSIONS This study proposed a core competency training curriculum system with systematic and standardised courses for emergency trauma nurses, which could be applied to assess trauma care performance, highlight areas for improvement for emergency trauma nurses and contribute to the accreditation of emergency trauma specialist nurses.
Collapse
Affiliation(s)
- La Xie
- Emergency Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mei Feng
- Emergency Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Cheng
- Emergency Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sufang Huang
- Emergency Department, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
9
|
Trauma Quality Improvement and Team Education: How Can We Better Optimize Our Training? CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
|
10
|
Ismail M, AbdulWahid J, Al-Zaidy MF, Al-Khafaji AO, Albairmani SS, Abdulsada AM, Salih HR, Hoz SS. Neurosurgery theater-based learning: Etiquette and preparation tips for medical students. Surg Neurol Int 2023; 14:153. [PMID: 37151439 PMCID: PMC10159286 DOI: 10.25259/sni_966_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/14/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Mustafa Ismail
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | - Mahmood F. Al-Zaidy
- Department of Neurosurgery, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Aktham O. Al-Khafaji
- Department of Neurosurgery, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Sama S. Albairmani
- Department of Neurosurgery, College of Medicine, University of Al-Iraqia, Baghdad, Iraq
| | | | - Hayder R. Salih
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
- Corresponding author: Samer S. Hoz, Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States.
| |
Collapse
|
11
|
Botelho F, Yanchar N, Abib S, Bank I, Harley JM, Poenaru D. A debriefing tool to acquire non-technical skills in trauma courses. Surg Open Sci 2022; 10:228-231. [PMID: 36389272 PMCID: PMC9661386 DOI: 10.1016/j.sopen.2022.10.012] [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: 07/21/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Objective The study reports the use of a nominal group technique (NGT) to evaluate the PEARLS Healthcare debriefing tool as a tool to foster non-technical skills in trauma simulation courses. Additionally, it introduces a debriefing card to be used in trauma courses. Design A nominal group technique was used to evaluate the main strategies for PEARLS. The experts had the opportunity to share their opinions in an online survey and online meeting. Results Seven participants participated in the nominal group. Based on the online survey results, the self-assessment debriefing strategy (from PEARLS) was rated 4.83/5 in relevance, the focused facilitation 5/5, and the provision of information 4.5/5. Participants felt that PEARLS was appropriate and useful for fostering non-technical skills: all the debriefing strategies contained in PEARLS were felt to be valid and worth using; and cue cards for the instructors were suggested to assist them in conducting structured formal debriefings. A specific debriefing tool for trauma scenarios was designed based on these suggestions, which is presented in this article. Conclusion A nominal group of experts in education, simulation, and trauma support PEARLS strategies for non-technical skills training in trauma courses. Surgical programs overlook non-technical skills, possibly due to uncertainty regarding their instruction. A structured debriefing tool can foster non-technical skills in trauma education. This study introduces a debriefing card for trauma scenarios generated by a group of experts.
Collapse
|
12
|
Schilling S, Armaou M, Morrison Z, Carding P, Bricknell M, Connelly V. Understanding teamwork in rapidly deployed interprofessional teams in intensive and acute care: A systematic review of reviews. PLoS One 2022; 17:e0272942. [PMID: 35980893 PMCID: PMC9387792 DOI: 10.1371/journal.pone.0272942] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/31/2022] [Indexed: 12/04/2022] Open
Abstract
The rapid increase of acute and intensive care capacities in hospitals needed during the response to COVID-19 created an urgent demand for skilled healthcare staff across the globe. To upscale capacity, many hospitals chose to increase their teams in these departments with rapidly re-deployed inter-professional healthcare personnel, many of whom had no prior experience of working in a high-risk environment and were neither prepared nor trained for work on such wards. This systematic review of reviews examines the current evidence base for successful teamwork in rapidly deployed interprofessional teams in intensive and acute care settings, by assessing systematic reviews of empirical studies to inform future deployments and support of rapidly formed clinical teams. This study identified 18 systematic reviews for further analysis. Utilising an integrative narrative synthesis process supported by thematic coding and graphical network analysis, 13 themes were found to dominate the literature on teams and teamwork in inter-professional and inter-disciplinary teams. This approach was chosen to make the selection process more transparent and enable the thematic clusters in the reviewed papers to be presented visually and codifying four factors that structure the literature on inter-professional teams (i.e., team-internal procedures and dynamics, communicative processes, organisational and team extrinsic influences on teams, and lastly patient and staff outcomes). Practically, the findings suggest that managers and team leaders in fluid and ad-hoc inter-professional healthcare teams in an intensive care environment need to pay attention to reducing pre-existing occupational identities and power-dynamics by emphasizing skill mix, establishing combined workspaces and break areas, clarifying roles and responsibilities, facilitating formal information exchange and developing informal opportunities for communication. The results may guide the further analysis of factors that affect the performance of inter-professional teams in emergency and crisis deployment.
Collapse
Affiliation(s)
- Stefan Schilling
- Department of Psychology, Health & Professional Development, Oxford Brookes University, Oxford, United Kingdom
- School of Security Studies, King’s College London, London, United Kingdom
- * E-mail:
| | - Maria Armaou
- Department of Psychology, Health & Professional Development, Oxford Brookes University, Oxford, United Kingdom
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Zoe Morrison
- Aberdeen Business School, Robert Gordon University, Aberdeen, United Kingdom
| | - Paul Carding
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom
| | - Martin Bricknell
- School of Security Studies, King’s College London, London, United Kingdom
| | - Vincent Connelly
- Department of Psychology, Health & Professional Development, Oxford Brookes University, Oxford, United Kingdom
| |
Collapse
|
13
|
Jepkosgei J, English M, Adam MB, Nzinga J. Understanding intra- and interprofessional team and teamwork processes by exploring facility-based neonatal care in kenyan hospitals. BMC Health Serv Res 2022; 22:636. [PMID: 35562721 PMCID: PMC9103056 DOI: 10.1186/s12913-022-08039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Within intensive care settings such as neonatal intensive care units, effective intra- and interprofessional teamwork has been linked to a significant reduction of errors and overall improvement in the quality of care. In Kenya, previous studies suggest that coordination of care among healthcare teams providing newborn care is poor. Initiatives aimed at improving intra- and interprofessional teamwork in healthcare settings largely draw on studies conducted in high-income countries, with those from resource-constrained low and middle countries, particularly in the context of newborn care lacking. In this study, we explored the nature of intra- and interprofessional teamwork among health care providers in newborn units (NBUs) of three hospitals in Kenya, and the professional and contextual dynamics that shaped their interactions. METHODS This exploratory qualitative study was conducted in three hospitals in Nairobi and Muranga Counties in Kenya. We adopted an ethnographic approach, utilizing both in-depth interviews (17) and non-participant observation of routine care provision in NBUs (250 observation hours). The study participants included: nurses, nursing students, doctors, and trainee doctors. All the data were thematically coded in NVIVO 12. RESULTS The nature of intra- and interprofessional teamwork among healthcare providers in the study newborn units is primarily shaped by broader contextual factors and varying institutional contexts. As a result, several team types emerged, loosely categorized as the 'core' team which involves providers physically present in the unit most times during the work shift; the emergency team and the temporary ad-hoc teams which involved the 'core' team, support staff students and mothers. The emergence of these team types influenced relationships among providers. Overall, institutionalized routines and rituals shaped team relations and overall functioning. CONCLUSIONS Poor coordination and the sub-optimal nature of intra-and interprofessional teamwork in NBUs are attributed to broader contextual challenges that include low staff to patient ratios and institutionalized routines and rituals that influenced team norming, relationships, and team leadership. Therefore, mechanisms to improve coordination and collaboration among healthcare teams in these settings need to consider contextual dynamics including institutional cultures while also targeting improvement of team-level processes including leadership development and widening spaces for more interaction and better communication.
Collapse
Affiliation(s)
- Joyline Jepkosgei
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, P. O. Box 43640 - 00100, 197 Lenana Place, Lenana Road, Nairobi, Kenya.
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, P. O. Box 43640 - 00100, 197 Lenana Place, Lenana Road, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mary B Adam
- AIC Kijabe Mission Hospital, Kijabe, Kenya
- Africa Consortium for Quality Improvement Research in Frontline Healthcare (ACQUIRE), Nairobi, Kenya
| | - Jacinta Nzinga
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, P. O. Box 43640 - 00100, 197 Lenana Place, Lenana Road, Nairobi, Kenya
| |
Collapse
|
14
|
Pavarini G, Smith LM, Shaughnessy N, Mankee-Williams A, Thirumalai JK, Russell N, Bhui K. Ethical issues in participatory arts methods for young people with adverse childhood experiences. Health Expect 2021; 24:1557-1569. [PMID: 34318573 PMCID: PMC8483199 DOI: 10.1111/hex.13314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/02/2021] [Accepted: 06/09/2021] [Indexed: 02/06/2023] Open
Abstract
Context Participatory arts‐based methods such as photovoice, drama and music have increasingly been used to engage young people who are exposed to psychosocial risks. These methods have the potential to empower youth and provide them with an accessible and welcoming environment to express and manage difficult feelings and experiences. These effects are, however, dependent on the way these methods are implemented and how potential ethical concerns are handled. Objective Using the current literature on arts‐based health research as a foundation, this paper examines ethical issues emerging from participatory arts methods with young people with traumatic experiences. Results We present a typology covering relevant issues such as power, accessibility, communication, trust and ownership, across the domains of partnership working, project entry, participation and dissemination. Drawing on our extensive clinical and research experiences, existing research and novel in‐practice examples, we offer guidance for ethical dilemmas that might arise at different phases of research. Conclusion Adequate anticipation and consideration of ethical issues, together with the involvement of young people, will help ensure that arts methods are implemented in research and practice with young people in a fair, meaningful and empowering way. Patient or Public Contribution The issues reviewed are largely based on the authors' experience conducting participatory research. Each of the projects referenced has its own systems for PPI including, variously, consultations with advisory groups, coproduction, youth ambassadors and mentor schemes. One of the coauthors, Josita Kavitha Thirumalai, is a young person trained in peer support and has provided extensive input across all stages.
Collapse
Affiliation(s)
- Gabriela Pavarini
- Department of Psychiatry, University of Oxford, Oxford, UK.,Wellcome Centre for Ethics and Humanities, Oxford Big Data Institute, University of Oxford, Oxford, UK
| | - Lindsay M Smith
- Department of Psychology, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | | | | | | | | | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,World Psychiatric Association UK Collaborating Centre, Oxford, UK.,Centre for Understanding Personality (CUSP), East London NHS Foundation, London, UK
| |
Collapse
|
15
|
Archambault P, Turcotte S, Smith PY, Said Abasse K, Paquet C, Côté A, Gomez D, Khechine H, Gagnon MP, Tremblay M, Elazhary N, Légaré F. Intention to Use Wiki-Based Knowledge Tools: Survey of Quebec Emergency Health Professionals. JMIR Med Inform 2021; 9:e24649. [PMID: 34142977 PMCID: PMC8277401 DOI: 10.2196/24649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/16/2021] [Accepted: 05/07/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical decision support systems are information technologies that assist clinicians in making better decisions. Their adoption has been limited because their content is difficult to adapt to local contexts and slow to adapt to emerging evidence. Collaborative writing applications such as wikis have the potential to increase access to existing and emerging evidence-based knowledge at the point of care, standardize emergency clinical decision making, and quickly adapt this knowledge to local contexts. However, little is known about the factors influencing health professionals' use of wiki-based knowledge tools. OBJECTIVE This study aims to measure emergency physicians' (EPs) and other acute care health professionals' (ACHPs) intentions to use wiki-based knowledge tools in trauma care and identify determinants of this intention that can be used in future theory-based interventions for promoting the use of wiki-based knowledge tools in trauma care. METHODS In total, 266 EPs and 907 ACHPs (nurses, respiratory therapists, and pharmacists) from 12 Quebec trauma centers were asked to answer a survey based on the theory of planned behavior (TPB). The TPB constructs were measured using a 7-point Likert scale. Descriptive statistics and Pearson correlations between the TPB constructs and intention were calculated. Multiple linear regression analysis was conducted to identify the salient beliefs. RESULTS Among the eligible participants, 57.1% (152/266) of EPs and 31.9% (290/907) of ACHPs completed the questionnaire. For EPs, we found that attitude, perceived behavioral control (PBC), and subjective norm (SN) were significant determinants of the intention to use wiki-based knowledge tools and explained 62% of its variance. None of the sociodemographic variables were related to EPs' intentions to use wiki-based knowledge tools. The regression model identified two normative beliefs ("approval by physicians" and "approval by patients") and two behavioral beliefs ("refreshes my memory" and "reduces errors"). For ACHPs, attitude, PBC, SN, and two sociodemographic variables (profession and the previous personal use of a wiki) were significantly related to the intention to use wiki-based knowledge tools and explained 60% of the variance in behavioral intention. The final regression model for ACHPs included two normative beliefs ("approval by the hospital trauma team" and "people less comfortable with information technology"), one control belief ("time constraints"), and one behavioral belief ("access to evidence"). CONCLUSIONS The intentions of EPs and ACHPs to use wiki-based knowledge tools to promote best practices in trauma care can be predicted in part by attitude, SN, and PBC. We also identified salient beliefs that future theory-based interventions should promote for the use of wiki-based knowledge tools in trauma care. These interventions will address the barriers to using wiki-based knowledge tools, find ways to ensure the quality of their content, foster contributions, and support the exploration of wiki-based knowledge tools as potential effective knowledge translation tools in trauma care.
Collapse
Affiliation(s)
- Patrick Archambault
- Département de médecine d'urgence, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
| | - Stéphane Turcotte
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Pascal Y Smith
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Kassim Said Abasse
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Catherine Paquet
- Département de marketing, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - André Côté
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Dario Gomez
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Hager Khechine
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Marie-Pierre Gagnon
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Faculté des sciences infirmières, Université Laval, Québec, QC, Canada
| | - Melissa Tremblay
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nicolas Elazhary
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
| |
Collapse
|
16
|
Vincent-Lambert C, Kotzé D. Doctors', nurses' and clinical associates' understanding of emergency care practitioners. Health SA 2021; 26:1523. [PMID: 33824727 PMCID: PMC8008012 DOI: 10.4102/hsag.v26i0.1523] [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: 07/24/2020] [Accepted: 01/20/2021] [Indexed: 11/05/2022] Open
Abstract
Background Healthcare professionals’ understanding of the knowledge, skills and training of their counterparts from other disciplines cultivates appreciation and respect within the workplace. This, in turn, results in better teamwork and improved patient care. Emergency departments are places where emergency care practitioners (ECPs) engage with doctors, nurses and clinical associates. Whilst the importance of inter-professional communication and teamwork between in-hospital professionals and pre-hospital emergency care providers is acknowledged, no literature could be found describing exactly how much these in-hospital professionals understand about the training and capabilities of their ECP colleagues. Aim The aim of this study was to assess the level of understanding that prospective doctors, nurses and clinical associates have regarding the training and capabilities of ECPs. Setting The research was conducted in Johannesburg, South Africa, at two universities. Methods Seventy-seven participants completed a purpose-designed questionnaire assessing their understanding regarding the education and clinical capabilities of ECPs. Results In total, 64% of participants demonstrated a poor understanding of the level of education and clinical capabilities of ECPs. The remaining 36% showed only moderate levels of understanding. Conclusion Medical, nursing and clinical associate graduates have a generally poor understanding of the education and clinical capabilities of their ECP colleagues who practise predominantly in the pre-hospital environment. This lack of understanding can become a barrier to effective communication between ECPs and in-hospital staff during patient handover in emergency departments. Contribution This research highlights a lack of understanding about the role and function of South African ECPs as pre-hospital emergency care providers and the need for more effective inter-professional education.
Collapse
Affiliation(s)
- Craig Vincent-Lambert
- Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Dirk Kotzé
- Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
17
|
Berger E, Samuel S. A qualitative analysis of the experiences, training, and support needs of school mental health workers regarding student trauma. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1111/ap.12452] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Emily Berger
- Faculty of Education, Monash University, Clayton, Victoria, Australia,
| | - Sarah Samuel
- Faculty of Education, Monash University, Clayton, Victoria, Australia,
| |
Collapse
|
18
|
Scott J, Kandala NB, Fearon P, Robinson L. Embedded rehabilitation in major trauma: Retrospective pre-post observational study of service and patient outcomes. Injury 2021; 52:160-166. [PMID: 33168202 DOI: 10.1016/j.injury.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/02/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Major trauma describes serious and often multiple injuries where there is a strong possibility of death or residual disability. There is little robust evidence on the effects of embedded rehabilitation within the trauma care pathway. Trauma rehabilitation services therefore remain fragmented and poorly integrated. This study aimed to determine changes in hospital length of stay (LoS), intensive care unit (ICU) LoS, 30-day mortality and Glasgow Outcome Scale following implementation of an embedded rehabilitation service into a Major Trauma Centre (MTC). METHODS Retrospective pre-post observational study of a rehabilitation service introduced into an MTC, consisting of a dedicated 10-bedded inpatient unit, co-ordinating rehabilitation hub, and specialist multi-disciplinary outpatient clinic. Overall hospital LoS, ICU LoS, 30-day mortality and GOS were selected as outcome measures. Patient characteristics (age, sex, injury mechanism, injury severity score, Glasgow Coma Scale, and most injured body region) were compared and controlled for when analysing outcomes. RESULTS The study cohort included 6,484 patients, of which 4,298 were pre-intervention and 2,186 post-intervention. Patients in the post-intervention cohort were older than those in the pre-intervention cohort (58.3 compared to 56.6, p<0.001) and had higher injury severity scores (48.7% >15 compared to 43.9% >15). Moderate but significant changes to the most injured body region were also observed (p<0.001), with fewer injuries affecting the limbs (25.8% to 24.9%), spine (15.3% to 12.1%), multiple locations (11.3% to 10.7%), abdomen (2.7% to 2.4%) and face/other (1.9% to 1.5%) and more injuries affecting the head (27.5% to 31.5%) and chest (15.6% to 16.9%). Controlling for changes to patient characteristics between the two time periods, there was a reduction in overall hospital LoS of 2.56 days (b=-2.56, p<0.001) and ICU LoS of 0.94 days (b=-0.96, p<0.001). There was a 31% reduced chance of 30-day mortality in post-intervention patients (OR=0.69, 95%CI=0.54 to 0.88), and almost two times higher relative chance of GOS Good Recovery (RR=1.94, CI=1.51 to 2.49). DISCUSSION Embedded rehabilitation is an important and necessary component of an effective trauma system that is associated with improved service and patient outcomes. Future research should examine prospectively how a dedicated rehabilitation service affects medium- and long-term patient-centred outcomes.
Collapse
Affiliation(s)
- Jason Scott
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
| | - Ngianga-Bakwin Kandala
- Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom; University of the Witwatersrand, Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa.
| | - Paul Fearon
- Royal Victoria Infirmary, Great North Trauma and Emergency Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Lisa Robinson
- Royal Victoria Infirmary, Great North Trauma and Emergency Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| |
Collapse
|
19
|
Sethuraman KN, Chang WTW, Zhou AL, Xia B, Gingold DB, McCunn M. Collaboration and Decision-Making on Trauma Teams: A Survey Assessment. West J Emerg Med 2021; 22:278-283. [PMID: 33856312 PMCID: PMC7972389 DOI: 10.5811/westjem.2020.10.48698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/04/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Leadership, communication, and collaboration are important in well-managed trauma resuscitations. We surveyed resuscitation team members (attendings, fellows, residents, and nurses) in a large urban trauma center regarding their impressions of collaboration among team members and their satisfaction with patient care decisions. Methods The Collaboration and Satisfaction About Care Decisions in Trauma (CSACD.T) survey was administered to members of ad hoc trauma teams immediately after resuscitations. Survey respondents self-reported their demographic characteristics; the CSACD.T scores were then compared by gender, occupation, self-identified leader role, and level of training. Results The study population consisted of 281 respondents from 52 teams; 111 (39.5%) were female, 207 (73.7%) were self-reported White, 78 (27.8%) were nurses, and 140 (49.8%) were physicians. Of the 140 physician respondents, 38 (27.1%) were female, representing 13.5% of the total surveyed population. Nine of the 52 teams had a female leader. Men, physicians (vs nurses), fellows (vs attendings), and self-identified leaders trended toward higher satisfaction across all questions of the CSACD.T. In addition to the comparison groups mentioned, women and general team members (vs non-leaders) gave lower scores. Conclusion Female residents, nurses, general team members, and attendings gave lower CSACD.T scores in this study. Identification of nuances and underlying causes of lower scores from female members of trauma teams is an important next step. Gender-specific training may be necessary to change negative team dynamics in ad hoc trauma teams.
Collapse
Affiliation(s)
- Kinjal N Sethuraman
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland
| | - Wan-Tsu W Chang
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.,University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland
| | - Amy L Zhou
- University of Maryland, College Park, Maryland
| | - Boyan Xia
- University of Maryland, College Park, Maryland
| | - Daniel B Gingold
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Maureen McCunn
- University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland.,University of Maryland School of Medicine, Department of Anesthesiology, Baltimore, Maryland
| |
Collapse
|
20
|
Curtis K, Elphick TL, Eyles M, Ruperto K. Identifying facilitators and barriers to develop implementation strategy for an ED to Ward handover tool using behaviour change theory (EDWHAT). Implement Sci Commun 2020. [DOI: 10.1186/s43058-020-00045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Effective clinical handover is fundamental to clinical practice and recognised as a global quality and safety priority. Problems with clinical handover from the emergency department (ED) to inpatient ward across four hospitals in the Illawarra Shoalhaven Local Health District (ISLHD) were identified in a number of reportable clinical incidents. To address this, an ED to inpatient ward electronic clinical handover tool was developed and implemented. However, site uptake of the tool varied from 45 to 90%.
Aim
To determine the facilitators and barriers of the ED to Ward Handover Tool (EDWHAT) implementation and design strategy to improve local compliance and inform wider implementation.
Methods
An exploratory convergent mixed-method approach was used. Data were collected via a 13-item electronic survey informed by the Theoretical Domains Framework (TDF) distributed to eligible nurses across the health district. Descriptive statistics for quantitative data and thematic analysis for qualitative data were conducted. The data were then integrated and mapped to the TDF and the Behaviour Change Wheel to identify specific behaviour change techniques to support implementation.
Results
There were 300 respondents. The majority of nurses knew where to locate the tool (91.26%), but 45.79% felt that it was not adequate to ensure safe handover. The most frequently reported factors that hindered nurses from using the tool were inability to access a phone near a computer (44.32%) (environmental domain), being told to transfer the patient before being able to complete the form (39.93%) (reinforcement) and the other nurse receiving (or giving) the handover not using the form (38.83%) (social influence). An implementation checklist to identify barriers and solutions to future uptake was developed.
Conclusion
To improve uptake, the functionality, content, and flow of the handover tool must be revised, alongside environmental restructuring. Nurses would benefit from an awareness of each speciality’s needs to develop a shared mental model and monitoring, and enforcement of tool use should become part of a routine audit.
Collapse
|
21
|
Gäble A, AlMatter M, Armbruster M, Berndt M, Kuršumovic A, Mühlmann M, Kimmig H, Kumle B, Ritz R, Russo S, Schmid F, Wanner G, Wirth S. [Resuscitation room diagnostics]. Radiologe 2020; 60:642-651. [PMID: 32507969 DOI: 10.1007/s00117-020-00704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CLINICAL PROBLEM The indication for resuscitation room care is an acute (potentially) life-threatening patient condition. Typical causes for this are polytrauma, acute neurological symptoms, acute chest and abdominal pain or the cause remains unclear at first. The care is always provided in a suitably composed interdisciplinary team. This requires cause-specific standards tailored to the care facility and requires a mutual understanding of the partners involved with regard to specialist interests and care processes. STANDARD RADIOLOGICAL METHODS Whole-body CT is established for polytrauma imaging and usually each institution has already defined an institutional standard. For the other causes, first imaging with CT is just as common, but the protocols and procedures to be used are often not as clear as in the case of polytrauma. METHODICAL INNOVATION AND EVALUATION For polytrauma service, ATLS and procedures according to ABCDE already serve as a largely standardized framework in the resuscitation room. For every other group of causes, comparable concepts should be developed and institutionally strive for objectification of continuous improvement. This refers not only to the resuscitation room stay but also to the interfaces before and after resuscitation room service. PRACTICAL RECOMMENDATIONS After the patient has arrived, it has to be determined whether the assessment of a vital risk is retained. If so, institutionally defined care standards must be followed for the various causes. This concerns the interface logistics, the definition of a team leader including associated tasks, the supply processes including the CT examination protocols as well as the close communication.
Collapse
Affiliation(s)
- Alexander Gäble
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland.
| | - Muhammad AlMatter
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland
| | - Marco Armbruster
- Klinik und Poliklinik für Radiologie, Klinikum der LMU, München, Deutschland
| | - Maria Berndt
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Adisa Kuršumovic
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland.,Klinik für Neurochirurgie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Marc Mühlmann
- Klinik und Poliklinik für Radiologie, Klinikum der LMU, München, Deutschland
| | - Hubert Kimmig
- Klinik für Neurologie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Bernhard Kumle
- Zentrale Notaufnahme und Aufnahmestation, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Rainer Ritz
- Klinik für Neurochirurgie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Sebastian Russo
- Klinik für Anästhesiologie, Intensiv‑, Notfall- und Schmerzmedizin, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Frank Schmid
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland
| | - Guido Wanner
- Klinik für Unfallchirurgie und Orthopädie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Stefan Wirth
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland.,Klinik und Poliklinik für Radiologie, Klinikum der LMU, München, Deutschland.,European Society of Emergency Radiology, Wien, Österreich
| |
Collapse
|
22
|
Hawkins R, Evans M, Hammond S, Hartopp R, Evans E. Placenta accreta spectrum disorders - Peri-operative management: The role of the anaesthetist. Best Pract Res Clin Obstet Gynaecol 2020; 72:38-51. [PMID: 32888811 DOI: 10.1016/j.bpobgyn.2020.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022]
Abstract
The incidence of placenta accreta spectrum (PAS) is increasing and will become more commonly encountered by obstetric anaesthetists in the elective and emergency settings. Significant maternal and neonatal morbidity is associated with these disorders, and hence it is important for anaesthetists to have early involvement in perioperative planning. Major haemorrhage should be anticipated and requires robust perioperative preparation including Patient Blood Management (PBM) and use of intraoperative strategies for haemorrhage management wherever possible. Several institutions have demonstrated good outcomes with regional anaesthesia alone, but the choice of anaesthetic technique requires individualised planning considering patient, anaesthetic and surgical factors. Optimisation of postoperative analgesia needs additional consideration; it is key to good recovery, minimising the impact on quality of life and reducing the risk of persistent post-surgical pain. Further research is required to ascertain the optimal multi-modal analgesic regime including the role of peripheral nerve blockade.
Collapse
Affiliation(s)
- Richard Hawkins
- Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, United Kingdom.
| | - Matthew Evans
- Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, United Kingdom
| | - Sarah Hammond
- Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, United Kingdom
| | - Richard Hartopp
- Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, United Kingdom
| | - Emma Evans
- Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, United Kingdom
| |
Collapse
|
23
|
Dekker-van Doorn C, Wauben L, van Wijngaarden J, Lange J, Huijsman R. Adaptive design: adaptation and adoption of patient safety practices in daily routines, a multi-site study. BMC Health Serv Res 2020; 20:426. [PMID: 32410618 PMCID: PMC7227082 DOI: 10.1186/s12913-020-05306-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background Most interventions to improve patient safety (Patient Safety Practices (PSPs)), are introduced without engaging front-line professionals. Administrative staff, managers and sometimes a few professionals, representing only one or two disciplines, decide what to change and how. Consequently, PSPs are not fully adapted to the professionals’ needs or to the local context and as a result, adoption is low. To support adoption, two theoretical concepts, Participatory Design and Experiential Learning were combined in a new model: Adaptive Design. The aim was to explore whether Adaptive Design supports adaptation and adoption of PSPs by engaging all professionals and creating time to (re) design, reflect and learn as a team. The Time Out Procedure (TOP) and Debriefing (plus) for improving patient safety in the operating theatre (OT) was used as PSP. Methods Qualitative exploratory multi-site study using participatory action research as a research design. The implementation process consisted of four phases: 1) start-up: providing information by presentations and team meetings, 2) pilot: testing the prototype with 100 surgical procedures, 3) small scale implementation: with one or two surgical disciplines, 4) implementation hospital-wide: including all surgical disciplines. In iterations, teams (re) designed, tested, evaluated, and if necessary adapted TOPplus. Gradually all professionals were included. Adaptations in content, process and layout of TOPplus were measured following each iteration. Adoption was monitored until final implementation in every hospital’s OT. Results 10 Dutch hospitals participated. Adaptations varied per hospital, but all hospitals adapted both procedures. Adaptations concerned the content, process and layout of TOPplus. Both procedures were adopted in all OTs, but user participation and time to include all users varied between hospitals. Ultimately all users were actively involved and TOPplus was implemented in all OTs. Conclusions Engaging all professionals in a structured bottom-up implementation approach with a focus on learning, improves adaptation and adoption of a PSP. As a result, all 10 participating hospitals implemented TOPplus with all surgical disciplines in all OTs. Adaptive Design gives professionals the opportunity to adapt the PSP to their own needs and their specific local context. All hospitals adapted TOPplus, but without compromising the essential features for its effectiveness.
Collapse
Affiliation(s)
- Connie Dekker-van Doorn
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands. .,Erasmus University Medical Center, Department of Surgery, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Linda Wauben
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands.,Delft University of Technology, Department of BioMechanical Engineering, Faculty of Mechanical Engineering, Mekelweg 2, 2628, CD, Delft, The Netherlands
| | - Jeroen van Wijngaarden
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, P.O. Box 738, 3000, DR, Rotterdam, The Netherlands
| | - Johan Lange
- Erasmus University Medical Center, Department of Surgery, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Robbert Huijsman
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, P.O. Box 738, 3000, DR, Rotterdam, The Netherlands
| |
Collapse
|
24
|
Factors Affecting Interprofessional Teamwork in Emergency Department Care of Polytrauma Patients: Results of an Exploratory Study. J Trauma Nurs 2020; 26:312-322. [PMID: 31714492 DOI: 10.1097/jtn.0000000000000469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Considering that traumatic injuries are the leading cause of death among young adults across the globe, emergency department care of polytrauma patients is a crucial aspect of optimized care and premature death prevention. Unfortunately, many studies have highlighted important gaps in collaboration among different trauma team professionals, posing a major quality-of-care challenge. Using the conceptual framework for interprofessional teamwork (IPT) of , the aim of this qualitative descriptive exploratory study was to better understand IPT from the perspective of health professionals in emergency department care of polytrauma patients, specifically by identifying factors that facilitate and impede IPT. Data were collected from a sample of 7 health professionals involved in the care of polytrauma patients through individual interviews and a focus group. In the second phase, 2 structured observations of polytrauma patient care were conducted. Following a thematic analysis, results revealed multiple factors affecting IPT, which can be divided into 5 broad categories: individual, relational, processual, organizational, and contextual. Individual factors, a category that is not part of the conceptual framework of , also emerged as playing a major part in IPT.
Collapse
|
25
|
Pomare C, Long JC, Churruca K, Ellis LA, Braithwaite J. Interprofessional collaboration in hospitals: a critical, broad-based review of the literature. J Interprof Care 2020; 34:509-519. [PMID: 31928245 DOI: 10.1080/13561820.2019.1702515] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Interprofessional collaboration (IPC) is a common term applied in the healthcare literature, with suggestions it contributes to improved quality and safety of patient care across the globe. Despite worldwide implementation of models of IPC, past systematic or meta-reviews on this topic have concluded that the evidence is mixed. However, these reviews are yet to adequately consider the qualitative and mixed-methods literature on this topic. In this critical review, we synthesize the outcomes and key findings of IPC in hospitals, taking a broader approach by including diverse study designs. A total of 4,776 abstracts were screened from three major databases (Medline, CINAHL, Embase). Thirty-four studies fulfilled inclusion criteria. Although outcomes and key findings (e.g., staff turnover, error rates) were mostly positive, there were inconsistencies in the results. The included studies reflected a variety of study designs and different methodological approaches. Overall, our review revealed moderate evidence that IPC can positively influence patient, staff and organizational factors in hospitals, and that inconsistent findings may be due to variation in context (e.g., the cohort of patients). Recommendations from the review are to incorporate qualitative- and mixed-methods approaches to studying IPC in healthcare and tailor evaluations of IPC outcomes specific to the context.
Collapse
Affiliation(s)
- Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| |
Collapse
|
26
|
Ndibu Muntu Keba Kebe N, Chiocchio F, Bamvita JM, Fleury MJ. Variables associated with interprofessional collaboration: a comparison between primary healthcare and specialized mental health teams. BMC FAMILY PRACTICE 2020; 21:4. [PMID: 31914942 PMCID: PMC6950896 DOI: 10.1186/s12875-019-1076-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 12/30/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study has two aims: first, to identify variables associated with interprofessional collaboration (IPC) among a total of 315 Quebec mental health (MH) professionals working in MH primary care teams (PCTs, N = 101) or in specialized service teams (SSTs, N = 214); and second, to compare IPC associated variables in MH-PCTs vs MH-SSTs. METHODS A large number of variables acknowledged as strongly related to IPC in the literature were tested. Multivariate regression models were performed on MH-PCTs and MH-SSTs respectively. RESULTS Results showed that knowledge integration, team climate and multifocal identification were independently and positively associated with IPC in both MH-PCTs and MH-SSTs. By contrast, knowledge sharing was positively associated with IPC in MH-PCTs only, and organizational support positively associated with IPC in MH-SSTs. Finally, one variable (age) was significantly and negatively associated with IPC in SSTs. CONCLUSIONS Improving IPC and making MH teams more successful require the development and implementation of differentiated professional skills in MH-PCTs and MH-SSTs by care managers depending upon the level of care required (primary or specialized). Training is also needed for the promotion of interdisciplinary values and improvement of interprofessional knowledge regarding IPC.
Collapse
Affiliation(s)
- Nicolas Ndibu Muntu Keba Kebe
- Department of Management, Evaluation and Health Policy, Université de Montréal, School of Public Health, 7101 Parc Avenue, Montreal, Quebec, H3N 1X9, Canada
| | - François Chiocchio
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada
| | - Jean-Marie Bamvita
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montreal, Quebec, H4H 1R3, Canada
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University; Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montreal, Quebec, H4H 1R3, Canada.
| |
Collapse
|
27
|
Dumas RP, Vella MA, Chreiman KC, Smith BP, Subramanian M, Maher Z, Seamon MJ, Holena DN. Team Assessment and Decision Making Is Associated With Outcomes: A Trauma Video Review Analysis. J Surg Res 2019; 246:544-549. [PMID: 31635832 DOI: 10.1016/j.jss.2019.09.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/24/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Teamwork is a critical element of trauma resuscitation. Assessment tools such as T-NOTECHS (Trauma NOn-TECHnical Skills) exist, but correlation with patient outcomes is unclear. Using emergency department thoracotomy (EDT), we sought to describe T-NOTECHS scores during resuscitations. We hypothesized that patients undergoing EDT whose resuscitations had better scores would be more likely to have return of spontaneous circulation (ROSC). METHODS Continuously recording video was used to review all captured EDTs over a 24-mo period. We used a modification of the validated T-NOTECHS instrument to measure five domains on a 3-point scale (1 = best, 2 = average, 3 = worst). A total T-NOTECHS score was calculated by one of three reviewers. The primary outcome was ROSC. ROSC was defined as an organized rhythm no longer requiring internal cardiac compressions. Associations between variables and ROSC were examined using univariate regression. RESULTS Sixty-one EDTs were captured. Nineteen patients had ROSC (31%) and 42 (69%) did not. The median T-NOTECHS score for all resuscitations was 8 [IQR 6-10]. As demographic and injury data (age, gender, mechanism, signs of life) were not associated with ROSC in univariate analysis, they were not considered for inclusion in a multivariable regression model. The association between overall T-NOTECHS score and ROSC did not reach statistical significance, but examination of the individual components of the T-NOTECHS score demonstrated that, compared to resuscitations that had "average" (2) or "worst" (3) scores on "Assessment and Decision Making," resuscitations with a "best" score were 5 times more likely to lead to ROSC. CONCLUSIONS Although the association between overall T-NOTECHS scores and ROSC did not reach statistical significance, better scores in the domain of assessment and decision making are associated with improved rates of ROSC in patients arriving in cardiac arrest who undergo EDT. LEVEL OF EVIDENCE Level IV Therapeutic/Care Management.
Collapse
Affiliation(s)
- Ryan P Dumas
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Michael A Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen C Chreiman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P Smith
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madhu Subramanian
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zoe Maher
- Division of Trauma and Surgical Critical Care, Temple University, Philadelphia, Pennsylvania
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel N Holena
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
28
|
Implementation of a Trauma Quality Improvement Program Communications Package Decreases Time-to-Operation for Facial Trauma. Ann Plast Surg 2019; 82:S380-S385. [DOI: 10.1097/sap.0000000000001818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Brazil V, Purdy E, Alexander C, Matulich J. Improving the relational aspects of trauma care through translational simulation. Adv Simul (Lond) 2019; 4:10. [PMID: 31139436 PMCID: PMC6528296 DOI: 10.1186/s41077-019-0100-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022] Open
Abstract
Background Major trauma care is complex and requires individuals and teams to perform together in time critical, high-stakes situations. Scenario-based simulation is well established as a strategy for trauma teamwork improvement, but its role in the relational and cultural aspects of trauma care is less well understood. Relational coordination theory offers a framework through which we aimed to understand the impact of an established trauma simulation programme. Methods We studied simulation activities using a narrative survey of trauma providers from anaesthesia, emergency medicine, medical imaging, surgery, trauma service, intensive care, and pre-hospital providers at Gold Coast University Hospital, in conjunction with data from an ethnography. Data analysis was performed using a recursive approach—a simultaneous deductive approach using the relational coordination framework and an inductive analysis. Results Ninety-five of 480 (19.8%) staff completed free-text survey questions on simulation. Deductive analysis of data from these narrative survey results using the RC framework domains identified examples of shared goals, shared knowledge, communication and mutual respect. Two major themes from the inductive analysis—“Behaviour, process and system change” and “Culture and relationships”—aligned closely with findings from the RC analysis, with additional themes of “Personal and team learning” and the “Impact of the simulation experience” identified. Conclusions Our findings suggest that an established trauma simulation programme can have a profound impact on the relational aspects of care and the development of a collaborative culture, with perceived tangible impacts on teamwork behaviours and institutional systems and processes. The RC framework—shared knowledge, shared goals and mutual respect in the context of communication that is timely, accurate, frequent and problem-solving based—can provide a common language for simulation educators to design and debrief simulation exercises that aim to have a translational impact.
Collapse
Affiliation(s)
- Victoria Brazil
- 1Faculty of Health Science and Medicine, Bond University, Robina, QLD Australia.,2Gold Coast Hospital and Health Service, Southport, QLD Australia
| | - Eve Purdy
- 2Gold Coast Hospital and Health Service, Southport, QLD Australia.,3Queen's University, Kingston, ON Canada
| | - Charlotte Alexander
- 4Emergency Department, Gold Coast Hospital and Health Service, Southport, QLD Australia
| | - Jack Matulich
- 5Simulation Service, Gold Coast Hospital and Health Service, Southport, QLD Australia
| |
Collapse
|
30
|
Harvey EM, Freeman D, Wright A, Bath J, Peters VK, Meadows G, Hamill ME, Flinchum M, Shaver KH, Collier BR. Impact of Advanced Nurse Teamwork Training on Trauma Team Performance. Clin Simul Nurs 2019. [DOI: 10.1016/j.ecns.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
31
|
Ndibu Muntu Keba Kebe N, Chiocchio F, Bamvita JM, Fleury MJ. Profiling mental health professionals in relation to perceived interprofessional collaboration on teams. SAGE Open Med 2019; 7:2050312119841467. [PMID: 30956791 PMCID: PMC6444404 DOI: 10.1177/2050312119841467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/12/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES This study aims at identifying profiles of mental health professionals based on individual, interactional, structural and professional role characteristics related to interprofessional collaboration. METHODS Mental health professionals (N = 315) working in primary health care and specialized mental health teams in four Quebec local service networks completed a self-administered questionnaire eliciting information on individual, interactional, structural and professional role characteristics. RESULTS Cluster analysis identified four profiles of mental health professionals. Those with the highest interprofessional collaboration scores comprised two profiles labeled "highly collaborative female professionals with fewer conflicts and more knowledge sharing and integration" and "highly collaborative male professionals with fewer conflicts, more participation in decision-making and mutual trust." By contrast, the profile labeled "slightly collaborative professionals with high seniority, many conflicts and less knowledge integration and mutual trust" had the lowest interprofessional collaboration score. Another profile positioned between these groups was identified as "moderately collaborative female psychosocial professionals with less participation in decision-making." DISCUSSION AND CONCLUSION Organizational support, participation in decision-making, knowledge sharing, knowledge integration, mutual trust, affective commitment toward the team, professional diversity and belief in the benefits of interdisciplinary collaboration were features associated with profiles where perceived interprofessional collaboration was higher. These team qualities should be strongly encouraged by mental health managers for improving interprofessional collaboration. Training is also needed to promote improvement in interprofessional collaboration competencies.
Collapse
Affiliation(s)
- Nicolas Ndibu Muntu Keba Kebe
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | | | - Jean-Marie Bamvita
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, QC, Canada
| |
Collapse
|
32
|
Batista REA, Peduzzi M. Interprofessional Practice in the Emergency Service: specific and shared assignments of nurses. Rev Bras Enferm 2019; 72:213-220. [DOI: 10.1590/0034-7167-2017-0797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/23/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To map and categorize, according to the Nursing Interventions Classification (NIC), the specific assignments of the nurses and to identify the assignments shared with doctors and physiotherapists in the Emergency Service. Method: Descriptive exploratory study, carried out in two phases: first, the analysis of dissertations /theses from the database of the Center for Studies and Research of the Brazilian Nursing Association; Second, the use of the Delphi Technique to reach the consensus about which assignments were specific to the nurse and which were shared with physiotherapists and doctors. Results: The results were 45.7% for specific to the nurses, 14.2% for shared with physiotherapists and/or doctors, and in 40% (n=42) there was no consensus about the sharing of assignments. Conclusion: The sharing of actions among professionals shows an increase in the scope of the practice of professions and the constitution of a common sphere of work, but the high number of assignments with no consensus among specialists can be a potential factor in conflicts due to the lack of definition of these assignments.
Collapse
|
33
|
The impact of simulated multidisciplinary Trauma Team Training on team performance: A qualitative study. Australas Emerg Care 2018; 22:1-7. [PMID: 30998866 DOI: 10.1016/j.auec.2018.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/16/2018] [Accepted: 11/20/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Effective teamwork is imperative in the emergency trauma setting as trauma teams work in the uncertain and complex context of resuscitating critically injured patients. Poorly performing teams have the potential to contribute to adverse events. Efforts to improve teamwork in trauma include simulation-based multidisciplinary team training with a non-technical skills (NTS) focus. However, there is a lack of evidence linking teamwork training programs with the uptake of NTS in real life trauma resuscitations. The aim of this study was to understand trauma team members' perspectives and experiences of teamwork in real world trauma resuscitations at a Level 1 Trauma Hospital, following completion of a simulated multidisciplinary Trauma Team Training (TTT) program. METHOD Semi-structured interviews were used to explore trauma team members' experiences and perspectives of the impact of TTT on the team's performance. Trauma team members who had completed TTT were invited to participate in the study. Fifteen participants from various disciplines (nursing, medical, allied health) and specialities (emergency, intensive care, trauma, anaesthetics, allied health) were interviewed. Qualitative data were thematically analysed. RESULTS The overarching finding was that teamwork was the essential component to facilitate a group of skilled experts to collectively perform at an optimum level in emergency trauma care. Four main themes were developed: Leader-follower synergy promotes trauma teamwork; Instability and inconsistency threaten trauma teamwork; Clear communication enhances trauma team decision-making and Team training improves trauma team performance. CONCLUSION A quickly constructed specialty team with unstable membership, will not transform naturally into an expert trauma team. The creation and maintenance of effective trauma teams requires training strategies such as multidisciplinary simulation that target team training and team interaction. Specifically, training should focus on developing non-technical skills for resuscitation trauma teams that have to form quickly and function effectively, often having never met before. As participants were overwhelmingly female, the data generated by this study are not necessarily generalisable to male members of trauma teams.
Collapse
|
34
|
Murphy M, McCloughen A, Curtis K. Enhancing the training of trauma resuscitation flash teams: A mixed methods study. Australas Emerg Care 2018; 21:143-149. [PMID: 30998890 DOI: 10.1016/j.auec.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 11/26/2022]
Abstract
AIMS To determine whether simulated multidisciplinary team training influences teamwork practices and experiences when resuscitating critically injured patients and to generate evidence for training trauma resuscitation flash teams. BACKGROUND Trauma teams perform in stressful situations. They are 'flash' teams, mobilised quickly and comprise of different specialties and disciplines. Simulation is promoted as a training strategy. Significant gaps remain in evaluating the impact of this training on clinical practice. Further research is warranted to determine the most effective way to train trauma resuscitation flash team. DESIGN Final integration phase of a mixed methods embedded experimental study. METHODS Primary quantitative results (time to critical operations, facilitators and barriers to teamwork) were merged with supplementary qualitative results (team members' experiences and perspectives) to explain the influences of simulated multidisciplinary trauma team training on teamwork and patient outcomes. RESULTS Four main themes were developed: communication needs to be specific to the emergency context; collaborative decision-making influences resuscitation situations; standardisation promotes efficient trauma care; proficient leadership empowers multidisciplinary teamwork. CONCLUSION Frontline clinicians identified real-world experiences that enable or impede team performance in trauma resuscitations. Our findings ascertain why multidisciplinary team training enhances team performance and what content should be incorporated in training programmes.
Collapse
Affiliation(s)
- Margaret Murphy
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia; Emergency Department, Westmead Hospital, Westmead, NSW, Australia.
| | | | - Kate Curtis
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia; Emergency Department, Illawarra Shoalhaven, Australia
| |
Collapse
|
35
|
Vermeir P, Blot S, Degroote S, Vandijck D, Mariman A, Vanacker T, Peleman R, Verhaeghe R, Vogelaers D. Communication satisfaction and job satisfaction among critical care nurses and their impact on burnout and intention to leave: A questionnaire study. Intensive Crit Care Nurs 2018; 48:21-27. [DOI: 10.1016/j.iccn.2018.07.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 06/19/2018] [Accepted: 07/01/2018] [Indexed: 11/26/2022]
|
36
|
Ndibu Muntu Keba Kebe N, Chiocchio F, Bamvita JM, Fleury MJ. Variables associated with interprofessional collaboration: The case of professionals working in Quebec local mental health service networks. J Interprof Care 2018; 33:76-84. [PMID: 30156940 DOI: 10.1080/13561820.2018.1515191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study identified variables associated with interprofessional collaboration (IPC) among 315 mental health (MH) professionals working in primary health care (PHC) and specialized teams, within four Quebec (Canada) local service networks (LSNs). IPC was measured with a validated scale, and independent variables were organized according to a four-block conceptual framework that included Individual, Interactional, Organizational and Professional Role Characteristics. Bivariate and multiple linear regression analyses were performed. Five variables were associated with Interactional Characteristics (knowledge sharing, knowledge integration, affective commitment toward the team, team climate, team autonomy), and one variable with Professional Role (multifocal identification) and Individual Characteristics (age), respectively. Findings suggest the importance of positive team climate, knowledge sharing and knowledge integration, professional and team identification (multifocal identification), team commitment and autonomy for strengthening IPC in MH teams. These results suggest that team managers should remain alert to behavioral changes and tensions in their teams that could signal possible deterioration in IPC, while promoting IPC competencies, and interdisciplinary values and skills, in team activities and training programs. As well, the encouragement of team commitment on the part of senior professionals, and support toward their younger counterparts, may enhance IPC in teams.
Collapse
Affiliation(s)
- Nicolas Ndibu Muntu Keba Kebe
- a Department of Management, Evaluation and Health Policy , School of Public Health, University de Montréal , Montreal , Quebec , Canada
| | - François Chiocchio
- b Telfer School of Management , University of Ottawa , Ottawa , Ontario , Canada
| | - Jean-Marie Bamvita
- c Department of Psychiatry , McGill University, Douglas Mental Health University Institute Research Centre , Montreal , Quebec , Canada
| | - Marie-Josée Fleury
- c Department of Psychiatry , McGill University, Douglas Mental Health University Institute Research Centre , Montreal , Quebec , Canada
| |
Collapse
|
37
|
Cullati S, Hudelson P, Ricou B, Nendaz M, Perneger TV, Escher M. Internists' and intensivists' roles in intensive care admission decisions: a qualitative study. BMC Health Serv Res 2018; 18:620. [PMID: 30089526 PMCID: PMC6083517 DOI: 10.1186/s12913-018-3438-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensive care Unit (ICU) admission decisions involve collaboration between internists and intensivists. Clear perception of each other's roles is a prerequisite for good collaboration. The objective was to explore how internists and intensivists perceive their roles during admission decisions. METHODS Individual in-depth interviews with 12 intensivists and 12 internists working at a Swiss teaching hospital. Interviews were analyzed using a thematic approach. RESULTS Roles could be divided into practical roles and identity roles. Internist and intensivists had the same perception of each other's practical roles. Internists' practical roles were: recognizing signs of severity when the patient becomes acutely ill, calling the intensivist at the right moment, having the relevant information about the patient and having determined the goals of care. Intensivists' practical roles were: assessing the patient on the ward, giving expert advice, making quick decisions, managing access to the ICU, having the final decision power and, sometimes, deciding whether or not to limit treatment. In complex situations, perceived flaws in performing practical roles could create tensions between the doctors. Intensivists' identity roles included those of leader, gatekeeper, life-death decision maker, and supporting colleague doctors (consultant, senior and helper). These roles could be perceived as emotionally burdensome. Internists' identity roles were those of leader and partner. CONCLUSIONS Despite a common perception of each other's practical roles, tensions can arise between internists and intensivists in complex situations of ICU admission decisions. Training in communication skills and interprofessional education interventions aimed at a better understanding of each other roles would improve collaboration.
Collapse
Affiliation(s)
- Stéphane Cullati
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
- Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Bara Ricou
- Intensive Care Unit, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, Department of General Internal Medicine, Geriatrics and Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas V. Perneger
- Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Monica Escher
- Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
38
|
Fleury MJ, Grenier G, Bamvita JM, Vallée C, Farand L, Chiocchio F. Évaluation du Plan d’action en santé mentale (2005-2015) : intégration et performance des réseaux de services. SANTE MENTALE AU QUEBEC 2018. [DOI: 10.7202/1048892ar] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cet article présente les résultats d’un programme de recherche visant à : 1) évaluer l’implantation de la réforme en santé mentale (SM) et ses facteurs favorisant ou entravant dans 11 réseaux locaux de services et la performance d’équipe en SM ; 2) cerner dans quatre réseaux les processus influençant la qualité des services d’équipe ; 3) analyser dans ces mêmes réseaux les effets des structures et des processus d’équipe sur les usagers. Les objectifs de la réforme en SM n’ont été que partiellement atteints dans les réseaux. Les résultats montrent qu’une plus grande utilisation d’outils et d’approches cliniques et des interactions fréquentes entre les équipes et les organisations améliorent la performance. De même, divers processus d’équipe comme l’autonomie, la participation aux processus décisionnels et le partage des connaissances incitent à la performance des professionnels et à la qualité des services. L’intensité des besoins des usagers réduit la capacité des services à répondre aux besoins. Enfin, le rétablissement et la qualité de vie sont fortement corrélés à la continuité et à la diversité des services offerts. Différentes recommandations sont formulées afin d’améliorer les services dont la promotion de cultures organisationnelles plus orientées sur les résultats et la collaboration, le soutien et la formation des professionnels sur l’intégration de pratiques basées sur les données probantes, l’augmentation de l’autonomie des professionnels et leur implication dans les décisions, ainsi que la formalisation de stratégies d’intégration. Enfin, un soutien biopsychosocial diversifié et continu d’intensité variable est recommandé pour améliorer le rétablissement et la qualité de vie des usagers.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Ph. D., Professeure titulaire, Département de psychiatrie, Université McGill, chercheure, Centre de recherche de l’Hôpital Douglas, Montréal
| | - Guy Grenier
- Ph. D., Chercheur associé, Centre de recherche de l’Hôpital Douglas, Montréal
| | - Jean-Marie Bamvita
- M.D., Ph. D., Professionnel de recherche, Centre de recherche de l’Hôpital Douglas, Montréal
| | - Catherine Vallée
- M.D., Ph. D., Professeure agrégée, Département de réadaptation, Université Laval, chercheure, Centre de recherche sur les soins et les services de première ligne de l’Université Laval
| | - Lambert Farand
- M.D., Ph. D., Professeur agrégé, Département de gestion, évaluation et politique de santé, École de santé publique de l’Université de Montréal (ESPUM), chercheur, Institut de recherche de l’ESPUM, Montréal
| | - François Chiocchio
- Ph. D., Professeur agrégé, École de gestion Telfer, Université d’Ottawa ; Chaire de recherche Montfort sur l’organisation des services de santé
| |
Collapse
|
39
|
White BAA, Eklund A, McNeal T, Hochhalter A, Arroliga AC. Facilitators and barriers to ad hoc team performance. Proc (Bayl Univ Med Cent) 2018; 31:380-384. [PMID: 29904320 DOI: 10.1080/08998280.2018.1457879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 10/16/2022] Open
Abstract
Most teams in hospital medicine are ad hoc, meaning that the teams vary in participants. Ad hoc teams can be found in academic teaching hospitals where team members change across shifts and rotations. Due to varying team membership, these teams face significant hurdles, because they lack an opportunity to develop a team identity, shared mental models, and trust. This article discusses facilitators and barriers to effective functioning of ad hoc teams. Communication, conflict management, power, and leadership are areas that either serve as facilitators or barriers to positive team function. In addition to discussing these aspects, solutions and recommendations from practice are shared. Solutions include data about successful teams, communication in those teams, and data about how to improve education and team training. These practical applications can be applied in practice to improve team functioning. Finally, we recommend that additional research be conducted in the area of ad hoc teams, because this type of team is a large part of medicine with a gap in evidence.
Collapse
Affiliation(s)
- Bobbie Ann A White
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Angela Eklund
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Temple, Texas.,Department of Medicine, Baylor Scott and White Health, Central Division, Temple, Texas
| | - Tresa McNeal
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Temple, Texas.,Department of Medicine, Baylor Scott and White Health, Central Division, Temple, Texas
| | - Angie Hochhalter
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Temple, Texas.,Department of Medicine, Baylor Scott and White Health, Central Division, Temple, Texas
| | - Alejandro C Arroliga
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Temple, Texas.,Department of Medicine, Baylor Scott and White Health, Central Division, Temple, Texas
| |
Collapse
|
40
|
Fleury MJ, Grenier G, Bamvita JM, Chiocchio F. Variables Associated With Perceived Work Role Performance Among Professionals in Multidisciplinary Mental Health Teams Overall and in Primary Care and Specialized Service Teams, Respectively. Eval Health Prof 2017; 42:169-195. [PMID: 28974105 DOI: 10.1177/0163278717734282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study had a dual purpose (1) to identify variables associated with perceived work role performance (WRP) among 315 mental health professionals (MHPs) in Quebec and (2) to compare variables related to WRP in MH primary care teams (PCTs) and specialized service teams (SSTs), respectively. WRP was measured using an adapted version of the work role questionnaire. Variables were organized within five areas: individual characteristics, perceived team attributes, perceived team processes, perceived team emergent states, and geographical and organizational context. Half of the WRP variables were linked to team processes. Knowledge sharing correlated with WRP in both MH PCTs and SSTs. Team attributes had more impact on MH PCTs, while team processes and team emergent states played a larger role among SSTs. The association between WRP and knowledge sharing confirms the need for a systematic training program to promote interdisciplinary collaboration. Integration strategies (e.g., service agreements) could improve collaboration between MH PCTs and SSTs and help MHPs perform more effectively within PCTs.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- 1 Department of Psychiatry, Douglas Mental Health University Institute Research Centre, McGill University, Montreal, Quebec, Canada
| | - Guy Grenier
- 2 Douglas Mental Health University Institute Research Centre, Montreal, Quebec, Canada
| | - Jean-Marie Bamvita
- 2 Douglas Mental Health University Institute Research Centre, Montreal, Quebec, Canada
| | - François Chiocchio
- 3 Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
41
|
Evaluating trauma team performance in a Level I trauma center: Validation of the trauma team communication assessment (TTCA-24). J Trauma Acute Care Surg 2017; 83:159-164. [PMID: 28452896 DOI: 10.1097/ta.0000000000001526] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nontechnical skills (NTS), such as team communication, are well-recognized determinants of trauma team performance and good patient care. Measuring these competencies during trauma resuscitations is essential, yet few valid and reliable tools are available. We aimed to demonstrate that the Trauma Team Communication Assessment (TTCA-24) is a valid and reliable instrument that measures communication effectiveness during activations. METHODS Two tools with adequate psychometric strength (Trauma Nontechnical Skills Scale [T-NOTECHS], Team Emergency Assessment Measure [TEAM]) were identified during a systematic review of medical literature and compared with TTCA-24. Three coders used each tool to evaluate 35 stable and 35 unstable patient activations (defined according to Advanced Trauma Life Support criteria). Interrater reliability was calculated between coders using the intraclass correlation coefficient. Spearman rank correlation coefficient was used to establish concurrent validity between TTCA-24 and the other two validated tools. RESULTS Coders achieved an intraclass correlation coefficient of 0.87 for stable patient activations and 0.78 for unstable activations scoring excellent on the interrater agreement guidelines. The median score for each assessment showed good team communication for all 70 videos (TEAM, 39.8 of 54; T-NOTECHS, 17.4 of 25; and TTCA-24, 87.4 of 96). A significant correlation between TTTC-24 and T-NOTECHS was revealed (p = 0.029), but no significant correlation between TTCA-24 and TEAM (p = 0.77). Team communication was rated slightly better across all assessments for stable versus unstable patient activations, but not statistically significant. CONCLUSION TTCA-24 correlated with T-NOTECHS, an instrument measuring nontechnical skills for trauma teams, but not TEAM, a tool that assesses communication in generic emergency settings. TTCA-24 is a reliable and valid assessment that can be a useful adjunct when evaluating interpersonal and team communication during trauma activations. LEVEL OF EVIDENCE Diagnostic tests or criteria, level II.
Collapse
|
42
|
Abstract
BACKGROUND Briefing of the trauma team before patient arrival is unstructured in many centers. We surveyed trauma teams regarding agreement on patient care priorities and evaluated the impact of a structured, physician-led briefing on concordance during simulated resuscitations. METHODS Trauma nurses at our Level II center were surveyed, and they participated in four resuscitation scenarios, randomized to "briefed" or "nonbriefed." For nonbriefed scenarios, nurses independently reviewed triage sheets with written information. Briefed scenarios had a structured 4-minute physician-led briefing reviewing triage sheets identical to nonbriefed scenarios. Teams included three to four nurses (subjects) and two to four confederates (physicians, respiratory therapists). Each team served as their own control group. Confederates were blinded to nurses' briefed or nonbriefed status. Immediately before, and at the midpoint of each scenario, nurses estimated patients' morbidity and mortality and ranked the top 3 of 16 designated immediate care priorities. Briefed and nonbriefed groups' responses were compared for (1) agreement using intraclass correlation coefficient, (2) concordance with physicians' responses using the Fisher exact test, (3) teamwork via T-NOTECHS ratings by nurses and physicians using t-test, and (4) time to complete clinical tasks using t test. RESULTS Thirty-eight nurses participated. Ninety-seven percent "agreed/strongly agreed" briefing is important, but only 46% agreed briefing was done well. Comparing briefed versus nonbriefed scenarios, nurses' estimation of morbidity and mortality in the briefed scenarios showed significantly greater agreement with each other and with physicians' answers (p < 0.01). Rank lists also better agreed with each other (intraclass correlation coefficient, 0.64 vs 0.59) and with physicians' answers in the briefed scenarios. T-NOTECHS Leadership ratings were significantly higher in the briefed scenarios (3.70 vs 3.39; p < 0.01). Time to completion of key clinical tasks was significantly faster for one of the briefed scenarios. CONCLUSIONS Discordant perceptions of patient care goals was frequently observed. Structured physician-led briefing seemed to improve interprofessional team concordance, leadership, and task completion in simulated trauma resuscitations.
Collapse
|
43
|
Peters VK, Harvey EM, Wright A, Bath J, Freeman D, Collier B. Impact of a TeamSTEPPS Trauma Nurse Academy at a Level 1 Trauma Center. J Emerg Nurs 2017. [PMID: 28629581 DOI: 10.1016/j.jen.2017.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PROBLEM Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired. METHODS Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers. With the increased expectations of a well-orchestrated team and larger number of emergency nurses, our program created the Trauma Nurse Academy. This academy provides a core of experienced nurses with an advanced level of training while decreasing the variability of personnel in the trauma bay. Components of the academy include multidisciplinary didactic education, the Essentials of TeamSTEPPS, and interactive trauma bay learning, to include both equipment and drug use. Once completed, academy graduates participate in the orientation and training of General Surgery and Emergency Medicine residents' trauma bay experience and injury prevention activities. RESULTS Internal and published data have demonstrated growing evidence linking trauma teamwork training to knowledge and self-confidence in clinical judgment to team performance, patient outcomes, and quality of care. IMPLICATIONS FOR PRACTICE Although trauma resuscitations are stressful, high risk, dynamic, and a prime environment for error, new methods of teamwork training and collaboration among trauma team members have become essential.
Collapse
|
44
|
Vermeir P, Downs C, Degroote S, Vandijck D, Tobback E, Delesie L, Mariman A, De Veugele M, Verhaeghe R, Cambré B, Vogelaers D. Intraorganizational Communication and Job Satisfaction Among Flemish Hospital Nurses: An Exploratory Multicenter Study. Workplace Health Saf 2017; 66:16-23. [DOI: 10.1177/2165079917703411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraorganizational communication affects job satisfaction and turnover. The goal of this study was to explore relationships between communication and job satisfaction, intention to leave, and burnout among Flemish hospital nurses. A multicenter questionnaire study was conducted in three hospitals using the Communication Satisfaction Questionnaire, the Turnover Intention subscale of the Questionnaire on the Experience and Evaluation of Work, and the Maslach Burnout Inventory. A visual analog scale measured job satisfaction. The mean job satisfaction score was 7.49/10 (±1.43). Almost 7% of nurse participants (93/1,355) reported a high intent to leave, and 2.9% of the respondents (41/1,454) had a score indicative of burnout. All dimensions of communication were associated with job satisfaction. A low score on any dimension of communication satisfaction, except “Relationship With Employees,” was associated with higher intent to leave and burnout. Study findings support the need for management interventions to enhance efficient communication and ensure high-quality care and patient safety.
Collapse
Affiliation(s)
| | | | | | | | | | | | - An Mariman
- Ghent University Hospital
- Ghent University
| | | | | | | | | |
Collapse
|
45
|
Tamayo M, Besoaín-Saldaña A, Aguirre M, Leiva J. Teamwork: relevance and interdependence of interprofessional education. Rev Saude Publica 2017; 51:39. [PMID: 28489187 PMCID: PMC5396499 DOI: 10.1590/s1518-8787.2017051006816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/29/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Determine the perception of university students regarding interprofessional and interdependent work between team members in their inclusion in primary care. METHODS Analytical cross-sectional study. The sampling had a probabilistic, stratified random type with 95% confidence and 5% margin of error. Seven-hundred and four students of Public Universities in Santiago (Chile) answered self-administered questionnaire. RESULTS Ninety-seven point eight of students say that interprofessional work is important; 27.1% of them declare that their university did not seem to show that their study plans were important. The professionals listed as most important in teams are physicians and nurses. CONCLUSIONS Spaces for development and institutional support are key elements to promote interprofessional work. If this competence can involve each academic unit in their different formative spaces there will be a significant contribution to said promotion. Teamwork is a pending task.
Collapse
Affiliation(s)
- M Tamayo
- Departamento de Kinesiología. Facultad de Medicina. Universidad de Chile. Santiago, Chile
| | - A Besoaín-Saldaña
- Departamento de Kinesiología. Facultad de Medicina. Universidad de Chile. Santiago, Chile
| | - M Aguirre
- Departamento de Kinesiología. Facultad de Medicina. Universidad de Chile. Santiago, Chile
| | - J Leiva
- Departamento de Kinesiología. Facultad de Medicina. Universidad de Chile. Santiago, Chile
| |
Collapse
|
46
|
Rehim SA, DeMoor S, Olmsted R, Dent DL, Parker-Raley J. Tools for Assessment of Communication Skills of Hospital Action Teams: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:341-351. [PMID: 27771338 DOI: 10.1016/j.jsurg.2016.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/07/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Hospital action teams comprise interdisciplinary health care providers working simultaneously to treat critically ill patients. Assessments designed to evaluate communication effectiveness or "nontechnical" performance of these teams are essential to minimize medical errors and improve team productivity. Although multiple communication tools are available, the characteristics and psychometric validity of these instruments have yet to be systematically compared. OBJECTIVE To identify assessments used to evaluate the communication or "nontechnical" performance of hospital action teams and summarize evidence to develop and validate these instruments. METHOD A literature search was conducted using MEDLINE/PubMed database to identify original articles related to assessment of communication skills in teams working in acute care medicine not exclusive to emergency room, operating room, prehospital air and ground transport, or code blue/rapid response resuscitations. RESULTS Ten communication assessment tools were identified. Six tools (60%) were designed to measure communication performance of the whole team, whereas 4 tools (40%) were created to assess individual team member's communication skills. Regardless of the type of analysis, the most commonly assessed behavior domains were Leadership, Teamwork, Communication, and Situation awareness. Only 1 of 16 articles describing a particular communication assessment tool reported all the validation criteria, other authors underreported efforts to validate their instruments. CONCLUSION A number of tools designed to measure the communication or "nontechnical" performance of hospital action teams are available. Unfortunately, limited reported validity evidence may hamper the utility of these tools in actual clinical practice until further validation studies are performed.
Collapse
Affiliation(s)
- Shady A Rehim
- Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Stephanie DeMoor
- Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Richard Olmsted
- University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Daniel L Dent
- University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Jessica Parker-Raley
- Division of Trauma, University of Texas Health Science Center San Antonio, San Antonio, Texas.
| |
Collapse
|
47
|
Reeves S, Clark E, Lawton S, Ream M, Ross F. Examining the nature of interprofessional interventions designed to promote patient safety: a narrative review. Int J Qual Health Care 2017; 29:144-150. [DOI: 10.1093/intqhc/mzx008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/01/2017] [Indexed: 11/13/2022] Open
|
48
|
Raley J, Meenakshi R, Dent D, Willis R, Lawson K, Duzinski S. The Role of Communication During Trauma Activations: Investigating the Need for Team and Leader Communication Training. JOURNAL OF SURGICAL EDUCATION 2017; 74:173-179. [PMID: 27422732 DOI: 10.1016/j.jsurg.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 04/29/2016] [Accepted: 06/02/2016] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Fatal errors due to miscommunication among members of trauma teams are 2 to 4 times more likely to occur than in other medical teams, yet most trauma team members do not receive communication effectiveness training. A needs assessment was conducted to examine trauma team members' miscommunication experiences and research scientists' evaluations of live trauma activations. The purpose of this study is to demonstrate that communication training is necessary and highlight specific team communication competencies that trauma teams should learn to improve communication during activations. DESIGN Data were collected in 2 phases. Phase 1 required participants to complete a series of surveys. Phase 2 included live observations and assessments of pediatric trauma activations using the assessment of pediatric resuscitation team assessments (APRC-TA) and assessment of pediatric resuscitation leader assessments (APRC-LA). SETTING Data were collected at a southwestern pediatric hospital. Trauma team members and leaders completed surveys at a meeting and were observed while conducting activations in the trauma bay. Trained research scientists and clinical staff used the APRC-TA and APRC-LA to measure trauma teams' medical performance and communication effectiveness. PARTICIPANTS The sample included 29 healthcare providers who regularly participate in trauma activations. Additionally, 12 live trauma activations were assessed monday to friday from 8am to 5pm. RESULTS Team members indicated that communication training should focus on offering assistance, delegating duties, accepting feedback, and controlling emotional expressions. Communication scores were not significantly different from medical performance scores. None of the teams were coded as effective medical performance and ineffective team communication and only 1 team was labeled as ineffective leader communication and effective medical performance. CONCLUSIONS Communication training may be necessary for trauma teams and offer a deeper understanding of the communication competencies that should be addressed. The APRC-TA and APRC-LA both include team communication competencies that could be used as a guide to design training for trauma team members and leaders. Researchers should also continue to examine recommendations for improved team and leader communication during activations using in-depth interviews and focus groups.
Collapse
Affiliation(s)
- Jessica Raley
- Division of Trauma, Department of Surgery, UT Health Science Center San Antonio, San Antonio, Texas.
| | - Rani Meenakshi
- Division of Trauma, Department of Surgery, UT Health Science Center San Antonio, San Antonio, Texas
| | - Daniel Dent
- Division of Trauma, Department of Surgery, UT Health Science Center San Antonio, San Antonio, Texas
| | - Ross Willis
- Division of Trauma, Department of Surgery, UT Health Science Center San Antonio, San Antonio, Texas
| | - Karla Lawson
- Dell Children's Medical Center of Central Texas, Austin, Texas
| | - Sarah Duzinski
- Dell Children's Medical Center of Central Texas, Austin, Texas
| |
Collapse
|
49
|
Ruter D, Um J, Evans DC, Boulger C, Jones C. Implementation of a Trauma Activation Checklist. Am Surg 2017. [DOI: 10.1177/000313481708300102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel Ruter
- The Ohio State University College of Medicine Columbus, Ohio
| | - Joy Um
- The Ohio State University College of Medicine Columbus, Ohio
| | - David C. Evans
- Division of Trauma, Critical Care, and Burns Department of Surgery, The Ohio State University College of Medicine Columbus, Ohio
| | - Creagh Boulger
- Department of Emergency Medicine The Ohio State University College of Medicine Columbus, Ohio
| | - Christian Jones
- Division of Acute Care Surgery, Department of Surgery Johns Hopkins University School of Medicine Baltimore, Maryland
| |
Collapse
|
50
|
Lapierre A, Gauvin-Lepage J, Lefebvre H. La collaboration interprofessionnelle lors de la prise en charge d’un polytraumatisé aux urgences : une revue de la littérature. Rech Soins Infirm 2017:73-88. [DOI: 10.3917/rsi.129.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|