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Kuriakose A, Arachchige SP, Emeto TI, Hiskens MI, Hariharan G. Descriptive feedback with targeted education to improve telephonic escalation of care: a simulation-based study. BMC MEDICAL EDUCATION 2024; 24:281. [PMID: 38481232 PMCID: PMC10938749 DOI: 10.1186/s12909-024-05260-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Awareness of communication failures in healthcare has necessitated the implementation of standardized, validated handover tools such as Identification, Situation, Background, Assessment, Recommendation (ISBAR). Although educational sessions improve communication, the effectiveness of individualized care escalation communication training is unknown. The primary aim was to conduct a simulation-based study to assess individualized one-on-one communication training for junior medical doctors for improving care escalation in pediatric emergencies. The secondary aim was to assess the evaluation of the training. METHODS The prospective observational study assessed participants pre- and post-intervention. In Session One, participants presented a written case scenario telephonically to two senior pediatricians. Fifty participants were scored using an 18-item checklist based on the ISBAR tool and "free text" responses. Immediately following case presentations, participants completed individualized one-on-one 30-minute educational sessions regarding self-reflection, didactic teaching, and constructive feedback based on the ISBAR. Session Two included a second case presentation and reassessment. We conducted qualitative analysis of supervisor's feedback on performance and trainee doctor's evaluation of the training. RESULTS There was significant improvement in 8 of the 18 components of the ISBAR checklist. All elements of care escalation were significantly improved, and overall communication was higher post-intervention (P < 0.001); however, no improvement was noted in participants' explorations of differential diagnoses (P = 0.263). The qualitative analysis identified themes of improved urgency in seeking senior support and conversational clarity from supervisors, and improved intervention quality and self-confidence from participants. CONCLUSIONS Individualized communication training may improve pediatric emergency care escalation and communication among junior doctors.
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Affiliation(s)
- Aster Kuriakose
- Department of General Paediatrics, Mackay Base Hospital, 4740, Mackay, QLD, Australia
| | | | - Theophilus I Emeto
- Public Health & Tropical Medicine, College of Public Health, Medical & Veterinary Sciences, James Cook University, 4811, Townsville, QLD, Australia
| | - Matthew I Hiskens
- Mackay Institute of Research and Innovation, Mackay Base Hospital, 475 Bridge Road, 4740, Mackay, QLD, Australia.
| | - Gopakumar Hariharan
- Department of General Paediatrics, Mackay Base Hospital, 4740, Mackay, QLD, Australia
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Yun S, Park HA, Na SH, Yun HJ. Effects of communication team training on clinical competence in Korean Advanced Life Support: A randomized controlled trial. Nurs Health Sci 2024; 26:e13106. [PMID: 38452799 DOI: 10.1111/nhs.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
We conducted a randomized controlled trial to study the effects of interprofessional communication team training on clinical competence in the Korean Advanced Life Support provider course using a team communication framework. Our study involved 73 residents and 42 nurses from a tertiary hospital in Seoul. The participants were randomly assigned to the intervention or control group, forming 10 teams per group. The intervention group underwent interprofessional communication team training with a cardiac arrest simulation and standardized communication tools. The control group completed the Korean Advanced Life Support provider course. All participants completed a communication clarity self-reporting questionnaire. Clinical competence was assessed using a clinical competency scale comprising technical and nontechnical tools. Blinding was not possible due to the educational intervention. Data were analyzed using a Mann-Whitney U test and a multivariate Kruskal-Wallis H test. While no significant differences were observed in communication clarity between the two groups, there were significant differences in clinical competence. Therefore, the study confirmed that the intervention can enhance the clinical competence of patient care teams in cardiopulmonary resuscitation.
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Affiliation(s)
- Soyeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeoun-Ae Park
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Sang-Hoon Na
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee Je Yun
- Seoul National University Hospital, Seoul, Republic of Korea
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AlBalawi I, Alqahtani JS, Al Ghamdi SS, Aldhahir AM, Alnasser M, Alqahtani AS, AlRabeeah SM, Alkhathami M, Almaqati TN, AlDraiwiesh IA, Al Onezei AK, Jebakumar AZ, Alzahrani YA, Oyelade T, Alzahrani EM. Health Sciences Students’ Attitude, Perception, and Experience of Using Educational Simulation in Saudi Arabia: A Cross-Sectional Study. NURSING REPORTS 2022; 12:620-628. [PMID: 36135980 PMCID: PMC9501630 DOI: 10.3390/nursrep12030061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Simulation-based education (SBE) provides a safe, effective, and stimulating environment for training medical and healthcare students. This is especially valuable for skills that cannot be practiced on real patients due to ethical and practical reasons. We aimed to assess medical students’ attitude, perception, and experience of simulation-based medical education in Saudi Arabia. Method: A validated cross-sectional survey, using the KidSIM scale, was conducted to measure the level of perception and experience of students from different health sciences specialties toward integrating simulation as an educational tool. Participants responded to questions investigated the importance of simulation, opportunities for Inter-Professional Education (IPE), communication, roles and responsibilities, and situation awareness. Only students with previous experience of SBE were considered for participation. Result: This survey was completed by 246 participants, of whom 165 (67%) were male students and 228 (93%) were aged between the range of 18–30 years old. Of the respondents, 104 (67%) were respiratory care students, 90 (37%) were anesthesia technology students, and 45 (18%) were nursing students. Most of the participants had previous experience in IPE simulation activities (84%), and more than half of the students (54%) had a grade point average (GPA) ranging between 5.00 and 4.50. Overall, students had positive attitudes toward and beliefs about SBE, with a mean score of 129.76 ± 14.27, on the KidSIM scale, out of 150. Students’ GPA was significantly associated with a better perception to the relevance of simulation (p = 0.005), communication (p = 0.003), roles and responsibilities (p = 0.04), and situation awareness (p = 0.009). GPA is merely the sole predictor for positive attitude toward simulation with coefficient Beta value of 4.285 (p = 0.001). There were no significant correlations between other students’ characteristic variables (gender, specialty, study year, experience in IPE, and prior critical care experience). Conclusion: We found that health sciences students’ perception of SBE in Saudi Arabia is generally positive, and students’ performance is a significant determinant of the positive perception.
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Affiliation(s)
- Ibrahim AlBalawi
- Advanced Clinical Simulation Center, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
- Correspondence: or
| | - Shouq S. Al Ghamdi
- Anesthesia Technology Department, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Abdulelah M. Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Musallam Alnasser
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Abdullah S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Saad M. AlRabeeah
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Mohammed Alkhathami
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Thekra N. Almaqati
- Clinical Laboratory Science Department, Prince Sultan Military College of Health Science, Dammam 34313, Saudi Arabia
| | - Ibrahim A. AlDraiwiesh
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
| | - Ameera K. Al Onezei
- Nursing Department, Prince Sultan Military College of Health Science, Dammam 34313, Saudi Arabia
| | - Arulanantham Zechariah Jebakumar
- Vice Deanship of Post Graduate Studies and Research, Prince Sultan Military College of Health Science, Dammam 34313, Saudi Arabia
| | - Yahya A. Alzahrani
- Respiratory Care Department, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Tope Oyelade
- Division of Medicine, University College London, London WC1E 6BT, UK
| | - Eidan M. Alzahrani
- Department of Physical Therapy, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia
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Hochstrasser SR, Amacher SA, Tschan F, Semmer NK, Becker C, Metzger K, Hunziker S, Marsch S. Gender-focused training improves leadership of female medical students: A randomised trial. MEDICAL EDUCATION 2022; 56:321-330. [PMID: 34473373 PMCID: PMC9291895 DOI: 10.1111/medu.14658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/16/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Recent research suggests that the gender of health care providers may affect their medical performance. This trial investigated (1) the effects of the gender composition of resuscitation teams on leadership behaviour of first responders and (2) the effects of a brief gender-specific instruction on leadership behaviour of female first responders. METHODS This prospective randomised single-blinded trial, carried out between 2008 and 2016, included 364 fourth-year medical students of two Swiss universities. One hundred and eighty-two teams of two students each were confronted with a simulated cardiac arrest, occurring in the presence of a first responder while a second responder is summoned to help. The effect of gender composition was assessed by comparing all possible gender-combinations of first and second responders. The gender-specific instruction focused on the importance of leadership, gender differences in self-esteem and leadership, acknowledgement of unease while leading, professional role, and mission statement to lead was delivered orally for 10 min by a staff physician and tested by randomising female first responders to the intervention group or the control group. The primary outcome, based on ratings of video-recorded performance, was the first responders' percentage contribution to their teams' leadership statements and critical treatment decision making. RESULTS Female first responders contributed significantly less to leadership statements (53% vs. 76%; P = 0.001) and critical decisions (57% vs. 76%; P = 0.018) than male first responders. For critical treatment decisions, this effect was more pronounced (P = 0.007) when the second responder was male. The gender-specific intervention significantly increased female first responder's contribution to leadership statements (P = 0.024) and critical treatment decisions (P = 0.034). CONCLUSIONS Female first responders contributed less to their rescue teams' leadership and critical decision making than their male colleagues. A brief gender-specific leadership instruction was effective in improving female medical students' leadership behaviours.
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Affiliation(s)
- Seraina Rahel Hochstrasser
- Intensive CareUniversity Hospital BaselBaselSwitzerland
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Simon Adrian Amacher
- Intensive CareUniversity Hospital BaselBaselSwitzerland
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Franziska Tschan
- Department of PsychologyUniversity of NeuchatelNeuchatelSwitzerland
| | | | - Christoph Becker
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Kerstin Metzger
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Sabina Hunziker
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
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Ambati SR, Tamuz M, DeVoe B, Rotjan A, Lesser M, Gangadharan S. Improving Resuscitation Timing: Random Assignment of Interprofessional Team Leaders in Simulated Resuscitation. Pediatr Emerg Care 2022; 38:e978-e982. [PMID: 35100786 DOI: 10.1097/pec.0000000000002507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to assess whether preassigning a team leader influences resuscitation timing using simulation and to examine relationship between response timeliness and designated leader's profession, whether physician or nurse. METHODS This is a prospective study of intervention (leader assigned) and control (no assigned leader) teams of residents and nurses participating in a simulated scenario. The primary outcome was time to bag-valve-mask (BVM) ventilation. A secondary outcome measure compared difference in time to BVM between physician- and nurse-led teams. RESULTS We assessed 25 teams, leader assigned (n = 14) or control (n = 11), composed of 92 clinicians. Leaders emerged in most of the controls (10 of 11). The median time to BVM in the leader-assigned group was 41.5 seconds (interquartile range, 34-49 seconds) compared with 53 seconds (interquartile range, 27-85 seconds) for controls (P = 0.13). In the leader-assigned group, 85% (12 of 14) of teams initiated BVM in less than 1 minute compared with only 54% teams (6 of 11) in controls (P = 0.18). Among the leader-assigned teams, we randomly assigned residents to lead 8 teams and nurses to lead 6 teams. All the nurse-led teams (6 of 6) initiated BVM in less than 1 minute compared with fewer physician-led teams (6 of 8) and only approximately half of controls (6 of 11, P = 0.19). CONCLUSIONS The leader-assigned teams and controls did not differ in resuscitation timeliness. Among leader-assigned teams, the differences in time to BVM between physician- and nurse-led teams were not statistically significant. However, all 6 nurse-led teams demonstrated timely resuscitation, suggesting a direction for future research on the feasibility of bedside nurses taking the lead during resuscitation, pending code team arrival.
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Affiliation(s)
- Shashikanth R Ambati
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Albany Medical Center, Albany
| | | | - Barbara DeVoe
- Patient Safety Institute, Center for Learning and Innovation
| | | | - Martin Lesser
- Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, New Hyde Park
| | - Sandeep Gangadharan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai School of Medicine, New York City, NY
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Janssens S, Simon R, Beckmann M, Marshall S. Shared Leadership in Healthcare Action Teams: A Systematic Review. J Patient Saf 2021; 17:e1441-e1451. [PMID: 29870514 DOI: 10.1097/pts.0000000000000503] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this review were to consolidate the reported literature describing shared leadership in healthcare action teams (HCATs) and to review the reported outcomes related to leadership sharing in healthcare emergencies. METHODS A systematic search of the English language literature before November 2017 was performed using PsycINFO, MEDLINE, PubMed, CINAHL, and EMBASE. Articles describing sharing of leadership functions in HCATs were included. Healthcare teams performing routine work were excluded. Studies were reviewed for type of leadership sharing and sharing-related outcomes. RESULTS Thirty-three articles met the inclusion criteria. A variety of shared leadership models were described across the following three categories: spontaneous collaboration, intuitive working relations, and institutionalized practices. While leadership sharing has the potential for both positive and negative influences on team performance, only six articles reported outcomes potentially attributable to shared leadership. CONCLUSIONS Despite strong evidence for a positive relationship between shared leadership and team performance in other domains, there is limited literature describing shared leadership models in HCATs. The association between shared leadership and team performance in HCATs is a rich area for further investigation.
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Hejjaji V, Chakrabarti AK, Nallamothu BK, Iwashyna TJ, Krein SL, Trumpower B, Kennedy M, Chinnakondepalli K, Malik AO, Chan PS. Association Between Hospital Resuscitation Team Leader Credentials and Survival Outcomes for In-hospital Cardiac Arrest. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1021-1028. [PMID: 34761165 PMCID: PMC8567300 DOI: 10.1016/j.mayocpiqo.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess whether survival rates for in-hospital cardiac arrest (IHCA) vary across hospitals depending on whether resuscitations are typically led by an attending physician, a physician trainee, or a nonphysician. PATIENTS AND METHODS In 2018, we conducted a survey of hospitals participating in the national Get with the Guidelines - Resuscitation registry for IHCA. Using responses from the question "Who typically leads codes at your institution?" we categorized hospitals on the basis of who typically leads their resuscitations: attending physician, physician trainee, or nonphysician. We then compared risk-adjusted hospital rates of return of spontaneous circulation, survival to discharge, and favorable neurological survival from 2015 to 2017 between these 3 hospital groups by using multivariable hierarchical regression. RESULTS Overall, 193 hospitals completed the study survey, representing a total of 44,477 IHCAs (mean age, 65.0±15.5 years; 40.8% were women). Most hospitals had resuscitations led by physicians, with 121 (62.7%) led by an attending physician, 58 (30.0%) by a physician trainee, and 14 (7.3%) by a nonphysician. The risk-standardized rates of survival to discharge were similar across hospitals, regardless of whether resuscitations were typically led by an attending physician, a physician trainee, or a nonphysician (25.6%±4.8%, 25.9%±4.7%, and 25.7%±3.6%, respectively; P=.88). Similarly, there were no differences between the 3 groups in risk-adjusted rates of return of spontaneous circulation (71.7%±6.3%, 73%±6.3%, and 73.4%±6.4%; P=.30) and favorable neurological survival (21.6%±7.1%, 22.7%±6.1%, and 20.9%±6.5%; P=.50). CONCLUSION In hospitals in a national IHCA registry, IHCA resuscitations were usually led by physicians. However, there was no association between a hospital's typical resuscitation team leader credentials and IHCA survival outcomes.
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Affiliation(s)
- Vittal Hejjaji
- Department of Cardiovascular Diseases, Saint Luke’s Mid America Heart Institute, Kansas City, MO
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO
| | - Apurba K. Chakrabarti
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Brahmajee K. Nallamothu
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Internal Medicine, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Theodore J. Iwashyna
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Internal Medicine, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Sarah L. Krein
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Internal Medicine, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Brad Trumpower
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Marci Kennedy
- Department of Cardiovascular Diseases, Saint Luke’s Mid America Heart Institute, Kansas City, MO
| | - Khaja Chinnakondepalli
- Department of Cardiovascular Diseases, Saint Luke’s Mid America Heart Institute, Kansas City, MO
| | - Ali O. Malik
- Department of Cardiovascular Diseases, Saint Luke’s Mid America Heart Institute, Kansas City, MO
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO
| | - Paul S. Chan
- Department of Cardiovascular Diseases, Saint Luke’s Mid America Heart Institute, Kansas City, MO
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO
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Yamane D, McCarville P, Sullivan N, Kuhl E, Lanam CR, Payette C, Rahimi-Saber A, Rabjohns J, Sparks AD, Boniface K, Drake A. Minimizing Pulse Check Duration Through Educational Video Review. West J Emerg Med 2020; 21:276-283. [PMID: 33207177 PMCID: PMC7673890 DOI: 10.5811/westjem.2020.8.47876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/09/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction The American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend pulse checks of less than 10 seconds. We assessed the effect of video review-based educational feedback on pulse check duration with and without point-of-care ultrasound (POCUS). Methods Cameras recorded cases of CPR in the emergency department (ED). Investigators reviewed resuscitation videos for ultrasound use during pulse check, pulse check duration, and compression-fraction ratio. Investigators reviewed health records for patient outcomes. Providers received written feedback regarding pulse check duration and compression-fraction ratio. Researchers reviewed selected videos in multidisciplinary grand round presentations, with research team members facilitating discussion. These presentations highlighted strategies that include the following: limit on pulse check duration; emphasis on compressions; and use of “record, then review” method for pulse checks with POCUS. The primary endpoint was pulse check duration with and without POCUS. Results Over 19 months, investigators reviewed 70 resuscitations with a total of 325 pulse checks. The mean pulse check duration was 11.5 ± 8.8 seconds (n = 224) and 13.8 ± 8.6 seconds (n = 101) without and with POCUS, respectively. POCUS pulse checks were significantly longer than those without POCUS (P = 0.001). Mean pulse check duration per three-month block decreased statistically significantly from study onset to the final study period (from 17.2 to 10 seconds [P<0.0001]) overall; decreased from 16.6 to 10.5 seconds (P<0.0001) without POCUS; and with POCUS from 19.8 to 9.88 seconds (P<0.0001) with POCUS. Pulse check times decreased significantly over the study period of educational interventions. The strongest effect size was found in POCUS pulse check duration (P = −0.3640, P = 0.002). Conclusion Consistent with previous studies, POCUS prolonged pulse checks. Educational interventions were associated with significantly decreased overall pulse-check duration, with an enhanced effect on pulse checks involving POCUS. Performance feedback and video review-based education can improve CPR by increasing chest compression-fraction ratio.
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Affiliation(s)
- David Yamane
- George Washington University, Department of Emergency Medicine, Washington DC.,George Washington University, Department of Anesthesiology and Critical Care Medicine, Washington DC
| | - Patrick McCarville
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Natalie Sullivan
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Evan Kuhl
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Carolyn Robin Lanam
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Christopher Payette
- George Washington University, Department of Emergency Medicine, Washington DC
| | | | - Jennifer Rabjohns
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Andrew D Sparks
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Keith Boniface
- George Washington University, Department of Emergency Medicine, Washington DC
| | - Aaran Drake
- George Washington University, Department of Emergency Medicine, Washington DC
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Vincent A, Semmer NK, Becker C, Beck K, Tschan F, Bobst C, Schuetz P, Marsch S, Hunziker S. Does stress influence the performance of cardiopulmonary resuscitation? A narrative review of the literature. J Crit Care 2020; 63:223-230. [PMID: 33046274 DOI: 10.1016/j.jcrc.2020.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
Cardiopulmonary resuscitation represents a major physical and psychological challenge for all involved health care workers because survival of the patients is closely related to the timely and accurate actions of rescuers. Consequently, rescuers may experience high levels of acute mental stress. Stress, in turn, may influence attentional resources and distractibility, which may affect the quality of resuscitation. This narrative review summarizes the current state of research concerning the influence of stress on resuscitation performance. Peer-reviewed studies retrieved in scientific databases were eligible. We found that rescuers experience high levels of stress and some associations of higher levels of stress with lower resuscitation performance. Finally, few interventional studies assessed whether interventions aiming at reducing levels of stress may have a beneficial effect on resuscitation performance, but results are variable. Although the mechanisms linking stress to performance of emergency teams are still not fully understood, factors such as individual experience and self-confidence of rescuers, gender composition and hierarchy within resuscitation teams may play an important role. This review provides a targeted overview of how stress can be defined and measured, how it may influence emergency situations such as a cardiopulmonary resuscitation, and which interventions have the potential to reduce overwhelming stress.
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Affiliation(s)
- Alessia Vincent
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Norbert K Semmer
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland; Department of Emergency Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Franziska Tschan
- Department of Psychology, University of Neuchâtel, Rue P.-A.-de-Faucigny 2, 1700 Fribourg, Switzerland
| | - Cora Bobst
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Philipp Schuetz
- University Department of Medicine, Kantonsspital Aarau, Haus 7, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland.
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Hazwani TR, Harder N, Shaheen NA, Al Hassan Z, Antar M, Alshehri A, Alali H, Kazzaz YM. Effect of a Pediatric Mock Code Simulation Program on Resuscitation Skills and Team Performance. Clin Simul Nurs 2020. [DOI: 10.1016/j.ecns.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mastoras G, Poulin C, Norman L, Weitzman B, Pozgay A, Frank JR, Posner G. Stress Testing the Resuscitation Room: Latent Threats to Patient Safety Identified During Interprofessional In Situ Simulation in a Canadian Academic Emergency Department. AEM EDUCATION AND TRAINING 2020; 4:254-261. [PMID: 32704595 PMCID: PMC7369481 DOI: 10.1002/aet2.10422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Emergency department (ED) resuscitation is a complex, high-stakes procedure where positive outcomes depend on effective interactions between the health care team, the patient, and the environment. Resuscitation teams work in dynamic environments and strive to ensure the timely delivery of necessary treatments, equipment, and skill sets when required. However, systemic failures in this environment cannot always be adequately anticipated, which exposes patients to opportunities for harm. METHODS As part of a new interprofessional education and quality improvement initiative, this prospective, observational study sought to characterize latent safety threats (LSTs) identified during the delivery of in situ, simulated resuscitations in our ED. In situ simulation (ISS) sessions were delivered on a monthly basis in the EDs at each campus of a large tertiary care academic hospital system, during which a variety of scenarios were run with teams of ED health care professionals. LSTs were identified by simulation facilitators and participants during the case and debriefing and then grouped thematically for analysis. RESULTS During the study period, 22 ISS sessions were delivered, involving 58 cases and reaching 383 ED health care professionals. 196 latent safety threats were identified through these sessions (mean = 3.4 LSTs per case) of which 110 were determined to be "actionable" at a system level. LSTs identified included system/environmental design flaws, equipment problems, failures in department processes, and knowledge/skill gaps. Corrective mechanisms were initiated in 85% of actionable cases. CONCLUSIONS Effective quality improvement and continuing education programs are essential to translate these findings into more resilient patient care. ISS, beyond its role as a training tool for developing intrinsic and crisis resource management skills, can be effectively used to identify system issues in the ED that could expose critically ill patients to harm.
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Affiliation(s)
- George Mastoras
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
| | - Cari Poulin
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
| | - Larry Norman
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
| | - Brian Weitzman
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
| | - Anita Pozgay
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
| | - Jason R. Frank
- Department of Emergency MedicineFaculty of MedicineUniversity of OttawaOttawaOntario
- Royal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
| | - Glenn Posner
- Department of Obstetrics and GynecologyFaculty of MedicineUniversity of OttawaOttawaOntario
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Do User-Applied Safety Labels on Medication Syringes Reduce the Incidence of Medication Errors During Rapid Medical Response Intervention for Deteriorating Patients in Wards? A Systematic Search and Review. J Patient Saf 2020; 15:173-180. [PMID: 28872476 DOI: 10.1097/pts.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intravenous medication errors (MEs) occur during medical emergency situations. An initiative, not yet in common practice, that could address these errors is safety labeling. The aim of this review was to identify and appraise research evidence related to the impact of user-applied medication safety labeling on reducing the incidence of MEs during rapid medical response intervention for patient deterioration in the ward setting. METHODS A systematic search and review framework was used to conduct the review. A comprehensive database search was conducted of BioMed Central, Clinical Trials, Cumulative Index to Nursing and Allied Health Literature, Expanded Academic ASAP, Joanna Briggs Institute, MEDLINE, OVID, ProQuest Central, PubMed, Wiley Online Library, and World Health Organization Library. The Young and Solomon (2009) critical appraisal tool was used to critically appraise the identified research articles. Each article was then analyzed using a thematic network strategy to identify commonality. RESULTS Four primary themes were identified; they were as follows: MEs occur during medical emergency responses (MERs); MEs occur throughout the medication administration process; MERs are stressful and are associated with MEs; and role of medication labeling in reducing MEs during MERs. DISCUSSION Greater vigilance is required by health professionals during the medication administration process. The implementation of specific medication safety labeling into the MER could be beneficial in reducing the overall incidence of MEs. Further research is required to validate the merits of a MER medication safety labeling system.
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Fathi O, Bapat R, G. Shepherd E, Wells Logan J. Golden Hours: An Approach to Postnatal Stabilization and Improving Outcomes. NEONATAL MEDICINE 2019. [DOI: 10.5772/intechopen.82810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Murugan S, Parris P, Wells M. Drug preparation and administration errors during simulated paediatric resuscitations. Arch Dis Child 2019; 104:444-450. [PMID: 30413493 DOI: 10.1136/archdischild-2018-315840] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/25/2018] [Accepted: 10/01/2018] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Very few studies have assessed drug preparation and administration errors during paediatric resuscitation. Current evidence suggests that medication errors in paediatrics are a serious problem. The aim of this study was to evaluate drug preparation and administration errors incurred during the simulated resuscitation of paediatric patients. METHODS This was a prospective observational study performed in the emergency department of a tertiary-level hospital. Teams consisting of two emergency doctors were tasked with preparing and delivering medication during simulated emergency scenarios. Preparation processes were video recorded. All phials, syringes and administered volumes were collected and analysed to determine the accuracy of drug preparation and delivery. Deviations from intended volumes were calculated. MAIN RESULTS A total of 96 dosages were recorded from 24 participants. Most errors were identified in the withdrawal of drug phase (prior to dilution) (13 of 96 doses had a >20% error), and the administration of medication phase (20 of 96 doses had a >20% error). Overall the median time taken to deliver each drug was 79 s (IQR 59, 100 s). The largest percentage errors were seen when a large syringe was used to withdraw or administer a small volume of medication. CONCLUSION The study clearly demonstrated that there were significant errors in the preparation and administration of medication. Training in the preparation and administration of paediatric medications should be available for all emergency nurses and doctors. Correct syringe choice may reduce these errors-smaller syringes should be used for withdrawing or administering smaller volumes.
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Affiliation(s)
- Sashen Murugan
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pano Parris
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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15
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Więch P, Sałacińska I, Muster M, Bazaliński D, Kucaba G, Fąfara A, Przybek-Mita J, Januszewicz P. Use of Selected Telemedicine Tools in Monitoring Quality of In-Hospital Cardiopulmonary Resuscitation: A Prospective Observational Pilot Simulation Study. Med Sci Monit 2019; 25:2520-2526. [PMID: 30952832 PMCID: PMC6463638 DOI: 10.12659/msm.913191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to assess the quality of in-hospital cardiopulmonary resuscitation components performed by nurses under simulated conditions, with the use of selected telemedicine tools. Material/Methods This prospective observational pilot simulation study was carried out with a group of 48 nurses working in hospital wards specializing in conservative treatment (HOS/C=22; mean age of 30.27 years; SD 9.30) or interventional therapy (HOS/I=26 nurses; mean age of 30.35 years; SD 9.77). Each nurse performed CPR for two minutes (a sequence of 30 compressions: 2 breaths) on a Laerdal Resusci-Anne manikin that was positioned on an examination couch using a self-inflating bag and face mask in accordance with their knowledge of and skills related to in-hospital resuscitation. The study was conducted in two stages, separated with an intervention (refresh online training by using Polycom RealPresence Group Devices). Analyses of selected chest compression and relaxation parameters were performed with the use of the TrueCPR Coaching Device. Results The finding showed improved compression depth (HOS/C: 46.68 mm vs. 51.50 mm; HOS/I: 46.92 mm vs. 50.57 mm), improved full recoil (HOS/C: 81.68% vs. 94.67%; HOS/I: 75.92% vs. 82.13%), and sustained standard compression rate (HOS/C: 115.23/min vs. 105.11/min; HOS/I: 113.65/min vs. 111.04/min) in the study group, 2 months after the intervention. A significant difference between the groups was observed in the rate of chest compressions with complete recoil (HOS/C: 94.67% vs. HOS/I: 82.13%; p<0.042). Conclusions The use of selected telemedicine tools leads to improved chest compression and relaxation parameters during in-hospital sudden cardiac arrest.
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Affiliation(s)
- Paweł Więch
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | - Izabela Sałacińska
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | - Marek Muster
- Center for Innovative Research in Medical and Natural Sciences, University of Rzeszów, Rzeszów, Poland
| | - Dariusz Bazaliński
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | - Grzegorz Kucaba
- Institute of Midwifery and Medical Lifesaving, Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | - Anna Fąfara
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | | | - Paweł Januszewicz
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
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Larsen T, Beier-Holgersen R, Østergaard D, Dieckmann P. Training residents to lead emergency teams: A qualitative review of barriers, challenges and learning goals. Heliyon 2018; 4:e01037. [PMID: 30603684 PMCID: PMC6304469 DOI: 10.1016/j.heliyon.2018.e01037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/14/2018] [Accepted: 12/07/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE An investigation to determine any consensus in opinions and views in the literature about challenges or barriers in training leadership for emergencies. SUMMARY OF BACKGROUND DATA Leadership in emergencies is reported as being very important for patient outcome. A systematic review failed in 2016 to find any focused leadership training. In the literature, the research has described and focused on developing tools to evaluate leadership. METHOD Articles identified in the systematic review combined with other reviews and opinions were included to incorporate experiences, perceptions and emotions connected with leadership training in emergency situations. Two qualitative content analyses were conducted. The first analysis searched for opinions about leadership and leadership training in emergencies. The method was abductive - inductive qualitative content analysis. The second analysis searched, on the basis of an article written in 1986, statements about challenges regarding leadership training in all articles. This method was directed qualitative content analysis. FINDINGS In total 40 articles covering the years 1986-2016 were analysed. An explicit need for workable leadership training of team leaders in emergencies was identified. The importance of the teamleader in emergencies was repeatedly stressed by 31/40 articles, leadership training is needed or required was stated by 30/40 articles, 27/40 articles described the emergency situation as stressful, complex, chaotic or unpredictable, 17/40 described the importance of self-confidence by the teamleader, and 8/40 described that the situation was perceived as creating concern, anxiety or panic. CONCLUSIONS The literature recommends finding a solution to teach residents to gain courage and confidence in stressful surroundings. The literature recommends finding a way to work with body language, non-verbal communication, attitude and appearance in order to radiate credibility in a setting separated from medical knowledge.
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Affiliation(s)
- Ture Larsen
- Simulation Unit (SimNord), Department of Administration, Nordsjællands Hospital, Denmark
| | | | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
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A search for training of practising leadership in emergency medicine: A systematic review. Heliyon 2018; 4:e00968. [PMID: 30761367 PMCID: PMC6286301 DOI: 10.1016/j.heliyon.2018.e00968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/11/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022] Open
Abstract
Objective This systematic review examines the medical, psychological and educational literature for training in practising leadership of a team leader in emergencies. The objectives of this paper are (1) describe how literature addresses operational training in practising leadership for the emergency medical team-leader (2) enhance understanding of leadership training in the medical environment. Background Worldwide, medical supervisors find it difficult to get students to rise to the occasion as leaders of emergency teams. It appears that many residents feel unprepared to adopt the role as a leader in emergencies. Method A systematic review was conducted (May-December 2016) in accordance with the PRISMA 2009 Checklist. A literature search was conducted against a set of inclusion criteria. Databases searched included PubMed, Psycinfo (via Ovid), and ERIC. Results 27 articles covering the period 1986-2016 were analysed. Four sources of data were identified: Intervention studies practising leadership, intervention studies on simulation and leadership assessment, observation studies assessing leadership, interview/survey studies about the need for leadership training. No workable training in practising leadership in emergencies for doctors was found. The majority of the research projects focused on various different types of taxonomies. Conclusions No consistent and workable leadership training for the emergency medical teamleader was identified. One study for paramedics succeeded in training empowering leadership skills. For many years multiple taxonomies and leadership assessment tools have been developed but failed to come to terms with workable leadership training. The literature describes lack of leadership as highly detrimental to performance during a critical, clinical situation.
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Sawyer T, Lee HC, Aziz K. Anticipation and preparation for every delivery room resuscitation. Semin Fetal Neonatal Med 2018; 23:312-320. [PMID: 30369405 DOI: 10.1016/j.siny.2018.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A majority of babies initiate spontaneous respirations shortly after birth. Up to 10%, however, require resuscitative measures to make the transition from fetus to newborn. Ideally, the need for resuscitation at birth would be predicted before delivery, and a skilled neonatal resuscitation team would be available and ready. This is not always possible. Therefore, neonatal resuscitation teams must be prepared to provide lifesaving resuscitation at every delivery. In this report, we examine risk factors for resuscitation at birth, discuss the importance of communication between obstetric and newborn teams, review key questions to ask before delivery, and investigate antenatal counseling methods. We also investigate ways to prepare for newborn deliveries, including personnel and equipment preparation, and pre-delivery team briefing. Finally, we explore ways in which neonatal resuscitation teams can improve their preparedness through the use of simulation and post-resuscitation debriefing. This report will help neonatal resuscitation teams to anticipate and prepare for every delivery room resuscitation.
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Affiliation(s)
- Taylor Sawyer
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA.
| | - Henry C Lee
- Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University, Stanford, CA, USA
| | - Khalid Aziz
- Department of Pediatrics, Division of Newborn Medicine, University of Alberta, Edmonton, Alberta, Canada
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Larsen T, Beier-Holgersen R, Dieckmann P, Østergaard D. Conducting the emergency team: A novel way to train the team-leader for emergencies. Heliyon 2018; 4:e00791. [PMID: 30263972 PMCID: PMC6156909 DOI: 10.1016/j.heliyon.2018.e00791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/27/2018] [Accepted: 09/11/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Worldwide, medical supervisors find it difficult to get students to rise to the occasion when called upon to act as leaders of emergency teams: many residents/rescuers feel unprepared to adopt the leadership role. The challenge is to address the residents very strong emotions caused by the extremely stressful context. No systematic leadership training takes this aspect into account. AIM The overall aim of the course is to investigate whether, in an emergency, a clinical team leader could apply a conductor's leadership skills. BACKGROUND An orchestral conductor is a specialist in practicing leadership focusing on non-verbal communication. The conductor works with highly trained specialists and must lead them to cooperate and put his interpretation into effect. The conductor works purposefully in order to appear calm, genuine and gain authority. METHOD A conductor and a consultant prepared a course for residents, medical students and nurses, n = 61. Ten × two course days were completed. The exercises were musical and thus safe for the students as there were no clinical skills at stake. The programme aimed to create stress and anxiety in a safe learning environment. CONCLUSION The transfer of a conductor's skills improved and profoundly changed the participating students', nurses' and residents' behaviour and introduced a method to handle anxiety and show calmness and authority. PERSPECTIVES If this course in leadership is to be introduced as a compulsory part of the educating of doctors, the ideal time would be after clinical skills have been acquired, experience gained and routines understood in the clinic.
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Affiliation(s)
- Ture Larsen
- Simulation Unit (SimNord), Department of Administration, Kvalitetsafdelingen, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Randi Beier-Holgersen
- Department of Gastrointestinal Surgery, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Peter Dieckmann
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev Hospital, Herlev Ringvej 75, 25 etage, 2730 Herlev, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark and University of Copenhagen, Herlev Hospital, Herlev Ringvej 75, 25 etage, 2730 Herlev, Copenhagen, Denmark
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Hunziker S, O'Connell KJ, Ranniger C, Su L, Hochstrasser S, Becker C, Naef D, Carter E, Stockwell D, Burd RS, Marsch S. Effects of designated leadership and team-size on cardiopulmonary resuscitation: The Basel-Washington SIMulation (BaWaSim) trial. J Crit Care 2018; 48:72-77. [PMID: 30172964 DOI: 10.1016/j.jcrc.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE During cardiopulmonary resuscitation (CPR), it remains unclear whether designating an individual person as team leader compared with emergent leadership results in better team performance. Also, the effect of CPR team size on team performance remains understudied. METHODS This randomized-controlled trial compared designated versus emergent leadership and size of rescue team (3 vs 6 rescuers) on resuscitation performance. RESULTS We included 90 teams with a total of 408 students. No difference in mean (±SD) hands-on time (seconds) were observed between emergent leadership (106 ± 30) compared to designated leadership (103 ± 27) groups (adjusted difference - 2.97 (95%CI -15.75 to 9.80, p = 0.645), or between smaller (103 ± 30) and larger teams (106 ± 26, adjusted difference 3.53, 95%CI -8.47 to 15.53, p = 0.56). Emergent leadership groups had a shorter time to circulation check and first defibrillation, but the quality of CPR based on arm and shoulder position was lower. No differences in CPR quality measures were observed between smaller and larger teams. CONCLUSIONS Within this international US/Swiss trial, leadership designation and larger team size did not improve hands-on time, but emergent leadership teams initiated defibrillation earlier. Improvements in performance may be more likely to be achieved by optimization of emergent leadership than increasing the size of cardiac arrest teams.
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Affiliation(s)
- Sabina Hunziker
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland.
| | | | - Claudia Ranniger
- Clinical Learning and Simulation Skills (CLASS) Center, The George Washington University, Washington, DC, United States
| | - Lillian Su
- Children's National Medical Center, Washington, DC, United States
| | - Seraina Hochstrasser
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland
| | - Christoph Becker
- Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland; Department of Emergency Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Daryl Naef
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland; Medical Communication and psychosomatic medicine, University Hospital Basel, University of Basel, Switzerland
| | - Elizabeth Carter
- Children's National Medical Center, Washington, DC, United States
| | - David Stockwell
- Patient Safety and the Pediatric Intensive Care Unit, Children's National Medical Center, Washington, DC, United States
| | - Randall S Burd
- Children's National Medical Center, Department of Surgery, Washington, DC, United States
| | - Stephan Marsch
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Switzerland
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21
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Rosenman ED, Fernandez R, Wong AH, Cassara M, Cooper DD, Kou M, Laack TA, Motola I, Parsons JR, Levine BR, Grand JA. Changing Systems Through Effective Teams: A Role for Simulation. Acad Emerg Med 2018; 25:128-143. [PMID: 28727258 DOI: 10.1111/acem.13260] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/16/2017] [Indexed: 01/25/2023]
Abstract
Teams are the building blocks of the healthcare system, with growing evidence linking the quality of healthcare to team effectiveness, and team effectiveness to team training. Simulation has been identified as an effective modality for team training and assessment. Despite this, there are gaps in methodology, measurement, and implementation that prevent maximizing the impact of simulation modalities on team performance. As part of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes," we explored the impact of simulation on various aspects of team effectiveness. The consensus process included an extensive literature review, group discussions, and the conference "workshop" involving emergency medicine physicians, medical educators, and team science experts. The objectives of this work were to: 1) explore the antecedents and processes that support team effectiveness, 2) summarize the current role of simulation in developing and understanding team effectiveness, and 3) identify research targets to further improve team-based training and assessment, with the ultimate goal of improving healthcare systems.
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Affiliation(s)
| | | | - Ambrose H. Wong
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Michael Cassara
- Department of Emergency Medicine Hofstra Northwell School of Medicine Hempstead NY
| | - Dylan D. Cooper
- Department of Emergency Medicine Indiana University School of Medicine IndianapolisIN
| | - Maybelle Kou
- Inova Fairfax Medical Campus Fairfax VA
- Department of Emergency Medicine The George Washington University School of Medicine Washington DC
- Virginia Commonwealth University School of Medicine Richmond VA
| | | | - Ivette Motola
- Division of Emergency Medicine University of Miami Miller School of Medicine Miami FL
| | - Jessica R. Parsons
- Department of Emergency Medicine Drexel College of Medicine Philadelphia PA
| | | | - James A. Grand
- Department of Psychology University of Maryland College Park MD
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Onan A, Simsek N, Elcin M, Turan S, Erbil B, Deniz KZ. A review of simulation-enhanced, team-based cardiopulmonary resuscitation training for undergraduate students. Nurse Educ Pract 2017; 27:134-143. [PMID: 28892727 DOI: 10.1016/j.nepr.2017.08.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 08/16/2017] [Accepted: 08/31/2017] [Indexed: 11/25/2022]
Abstract
Cardiopulmonary resuscitation training is an essential element of clinical skill development for healthcare providers. The International Liaison Committee on Resuscitation has described issues related to cardiopulmonary resuscitation and emergency cardiovascular care education. Educational interventions have been initiated to try to address these issues using a team-based approach and simulation technologies that offer a controlled, safe learning environment. The aim of the study is to review and synthesize published studies that address the primary question "What are the features and effectiveness of educational interventions related to simulation-enhanced, team-based cardiopulmonary resuscitation training?" We conducted a systematic review focused on educational interventions pertaining to cardiac arrest and emergencies that addressed this main question. The findings are presented together with a discussion of the effectiveness of various educational interventions. In conclusion, student attitudes toward interprofessional learning and simulation experiences were more positive. Research reports emphasized the importance of adherence to established guidelines, adopting a holistic approach to training, and that preliminary training, briefing, deliberate practices, and debriefing should help to overcome deficiencies in cardiopulmonary resuscitation training.
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Affiliation(s)
- Arif Onan
- Department of Medical Education and Informatics, Hacettepe University, Faculty of Medicine, Sihhiye Campus, 06100 Altindag, Ankara, Turkey.
| | - Nurettin Simsek
- Department of Computer Education & Instructional Technology, Ankara University, Institute of Educational Sciences, 06590 Cebeci, Ankara, Turkey.
| | - Melih Elcin
- Department of Medical Education and Informatics, Hacettepe University, Faculty of Medicine, Sihhiye Campus, 06100 Altindag, Ankara, Turkey.
| | - Sevgi Turan
- Department of Medical Education and Informatics, Hacettepe University, Faculty of Medicine, Sihhiye Campus, 06100 Altindag, Ankara, Turkey.
| | - Bülent Erbil
- Department of Emergency Medicine, Hacettepe University Faculty of Medicine, Sihhiye Campus 06100 Altindag, Ankara, Turkey.
| | - Kaan Zülfikar Deniz
- Graduate School of Educational Sciences, Ankara University, Institute of Educational Sciences 06590 Cebeci, Ankara, Turkey.
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Kottwitz MU, Hünefeld L, Frank BP, Otto K. The More, the Better?! Multiple vs. Single Jobholders' Job Satisfaction as a Matter of Lacked Information. Front Psychol 2017; 8:1274. [PMID: 28798709 PMCID: PMC5526968 DOI: 10.3389/fpsyg.2017.01274] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 07/12/2017] [Indexed: 11/16/2022] Open
Abstract
In recent decades, the working world has changed dramatically and rising demands on flexibility make the coordination of personal and professional life more difficult. Therefore, it is important that the incumbents are in possession of all necessary information concerning their job. This might be a key issue to remain satisfied. Simultaneously, atypical forms of employment have substantially increased in the labor market; one such form is holding more than one job. While the motives might differ from needing an additional income to broadening job opportunities, practicing several jobs requires coordination and thus, being informed. Building on research regarding organizational constraints and role ambiguity, we hypothesize that the paucity of information is negatively related to (dimensions of) job satisfaction. This effect should be stronger for multiple as compared to single jobbers; specifically when considering the job satisfaction with the social climate, given that being informed by others is an important factor in the coordination of several jobs. Data taken from the BiBB/BAuA-Employment-Survey provide a sample of 17,782 German employees (54% women), including 1,084 multiple jobbers (59% women). Job satisfaction was measured as employees global satisfaction and their satisfaction with facets dimensions: the social climate, structural working conditions, personal growth opportunities, and material incentives they receive for their work. Paucity of information was measured by the frequency of lacked information. Our study indicated that paucity of information was negatively related to both, global and all facets dimensions of job satisfaction. Multiple regression analyses further revealed interaction effects of paucity of information and form of employment. Specifically, the negative correlation of paucity of information with global as well as satisfaction with the social climate was stronger for employees’ holding more than one job. These results were independent of age, gender, organizational tenure, working hours, socioeconomic occupational status, as well as important working conditions (workload and autonomy). Incumbents with less paucity of necessary job-related information are more satisfied, especially when they hold multiple jobs. Supervisors and colleagues are advised to provide all necessary information and to ensure that employees retain it.
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Affiliation(s)
- Maria U Kottwitz
- Faculty of Psychology, Work and Organizational Psychology, Philipps University of MarburgMarburg, Germany
| | - Lena Hünefeld
- German Federal Institute for Occupational Safety and HealthDortmund, Germany
| | - Benjamin P Frank
- Faculty of Psychology, Work and Organizational Psychology, Philipps University of MarburgMarburg, Germany
| | - Kathleen Otto
- Faculty of Psychology, Work and Organizational Psychology, Philipps University of MarburgMarburg, Germany
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Teis R, Allen J, Lee N, Kildea S. So you want to conduct a randomised trial? Learnings from a 'failed' feasibility study of a Crisis Resource Management prompt during simulated paediatric resuscitation. ACTA ACUST UNITED AC 2017; 20:37-44. [PMID: 28042009 DOI: 10.1016/j.aenj.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND No study has tested a Crisis Resource Management prompt on resuscitation performance. METHODS We conducted a feasibility, unblinded, parallel-group, randomised controlled trial at one Australian paediatric hospital (June-September 2014). Eligible participants were any doctor, nurse, or nurse manager who would normally be involved in a Medical Emergency Team simulation. The unit of block randomisation was one of six scenarios (3 control:3 intervention) with or without a verbal prompt. The primary outcomes tested the feasibility and utility of the intervention and data collection tools. The secondary outcomes measured resuscitation quality and team performance. RESULTS Data were analysed from six resuscitation scenarios (n=49 participants); three control groups (n=25) and three intervention groups (n=24). The ability to measure all data items on the data collection tools was hindered by problems with the recording devices both in the mannequins and the video camera. CONCLUSIONS For a pilot study, greater training for the prompt role and pre-briefing participants about assessment of their cardio-pulmonary resuscitation quality should be undertaken. Data could be analysed in real time with independent video analysis to validate findings. Two cameras would strengthen reliability of the methods.
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Affiliation(s)
- Rachel Teis
- Midwifery Research Unit, Mater Research Institute and University of Queensland, Mater Health, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Paediatric Intensive Care Unit, Mater Children's Hospital, Mater Health, Raymond Terrace, South Brisbane, Queensland 4101, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, PO Box 456, Virginia, Queensland 4101, Australia
| | - Jyai Allen
- Midwifery Research Unit, Mater Research Institute and University of Queensland, Mater Health, Raymond Terrace, South Brisbane, Queensland 4101, Australia; School of Nursing, Midwifery and Social Work, Level 3, Chamberlain Building (35), University of Queensland, St Lucia, Queensland 4165, Australia.
| | - Nigel Lee
- School of Nursing, Midwifery and Social Work, Level 3, Chamberlain Building (35), University of Queensland, St Lucia, Queensland 4165, Australia
| | - Sue Kildea
- Midwifery Research Unit, Mater Research Institute and University of Queensland, Mater Health, Raymond Terrace, South Brisbane, Queensland 4101, Australia; School of Nursing, Midwifery and Social Work, Level 3, Chamberlain Building (35), University of Queensland, St Lucia, Queensland 4165, Australia; Mothers, Babies and Women's Health, Mater Health, Raymond Terrace, South Brisbane, Queensland 4101, Australia
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Abstract
OBJECTIVE Between May 2010 and September 2011, the University of Minnesota School of Public Health partnered with the Minnesota Department of Health (MDH) to assess the effect of exercises on team performance during public health emergency response. METHODS Participants were divided into 3 research teams exposed to various levels of intervention. Groups consisted of a control group that was given standard MDH training exercises, a didactic group exposed to team dynamics and communication training, and a treatment group that received the didactic training in addition to a post-exercise facilitated debriefing. To assess differences in team performance, teams engaged in 15 functional exercises. RESULTS Differences in team performance across the 3 groups were identified, although there was no trend in team performance over time for any of the groups. Groups demonstrated fluctuation in team performance during the study period. Attitudinal surveys demonstrated an increase in workplace satisfaction and confidence in training among all groups throughout the study period. CONCLUSIONS Findings from this research support that a critical link exists between training type and team performance during public health emergency response. This research supports that intentional teamwork training for emergency response workers is essential for effective public health emergency response. (Disaster Med Public Health Preparedness. 2017;11:7-10).
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Kobras M, Langewand S, Murr C, Neu C, Schmid J. Short lessons in basic life support improve self-assurance in performing cardiopulmonary resuscitation. World J Emerg Med 2016; 7:255-262. [PMID: 27942341 DOI: 10.5847/wjem.j.1920-8642.2016.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are several reasons why resuscitation measures may lead to inferior results: difficulties in team building, delayed realization of the emergency and interruption of chest compression. This study investigated the outcome of a new form of in-hospital cardiopulmonary resuscitation (CPR) training with special focus on changes in self-assurance of potential helpers when faced with emergency situations. METHODS Following a 12-month period of CPR training, questionnaires were distributed to participants and non-participants. Those non-participants who intended to undergo the training at a later date served as control group. RESULTS The study showed that participants experienced a significant improvement in self-assurance, compared with their remembered self-assurance before the training. Their self-assurance also was significantly greater than that of the control group of non-participants. CONCLUSION Short lessons in CPR have an impact on the self-assurance of medical and non-medical personnel.
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Affiliation(s)
- Mario Kobras
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Asklepios Western Clinical Centre, 20 Suurheid, City of Hamburg 22559, Federal Republic of Germany
| | - Sascha Langewand
- Academy of the Rescue Service Cooperation in Schleswig-Holstein, 50 Esmarch Street, City of Heide 25746, Federal Republic of Germany
| | - Christina Murr
- Academy of the Rescue Service Cooperation in Schleswig-Holstein, 50 Esmarch Street, City of Heide 25746, Federal Republic of Germany
| | - Christiane Neu
- Regio Clinical Center GmbH, Sana Group, 71-75 Ramskamp, Elmshorn 25337, County of Pinneberg, Federal Republic of Germany
| | - Jeannette Schmid
- Executive Committee of the Goethe University, Frankfurt a.M., City of Frankfurt 60323, Federal Republic of Germany
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Citolino Filho CM, Santos ES, Silva RDCGE, Nogueira LDS. Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses. Rev Esc Enferm USP 2015; 49:908-14. [DOI: 10.1590/s0080-623420150000600005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/08/2015] [Indexed: 11/22/2022] Open
Abstract
Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR) in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%), the lack of harmony (77.6%) or stress of any member of staff (67.3%), lack of material and/or equipment failure (57.1%), lack of familiarity with the emergency trolleys (98.0%) and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1%) are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.
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Krajina I, Kvolik S, Steiner R, Kovacevic K, Lovric I. Cardiopulmonary resuscitation, chest compression only and teamwork from the perspective of medical doctors, surgeons and anesthesiologists. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e18208. [PMID: 26019895 PMCID: PMC4441776 DOI: 10.5812/ircmj.18208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 11/15/2014] [Accepted: 12/13/2014] [Indexed: 11/16/2022]
Abstract
Background: New resuscitation guidelines that were proposed by the European Resuscitation Council in 2010 have introduced a new method of cardiopulmonary resuscitation (CPR) by chest compressions only for untrained individuals. Objectives: We conducted this study to evaluate differences in attitudes towards CPR among medical doctors, surgeons and anesthesiologists in Osijek University Hospital. A call for help, chest-compression-only resuscitation, mouth-to-mouth ventilation and team-work were recognized as critical points that may influence the outcome. Unfamiliarity with these methods may be indicative of a lack of education in resuscitation and may result in poor outcomes for victims. Patients and Methods: An anonymous survey was conducted on 190 medical professionals: 93 medical doctors, 70 surgeons, and 27 anesthesiologists during year 2012 (mean age 41.9 years). The questions were related to previous education in resuscitation, current resuscitation practices and attitudes towards cardiopulmonary resuscitation. Data were analyzed using ANOVA and Fisher exact test. A P value of < 0.05 was considered statistically significant. Results: The only difference between groups was regarding the male and female ratio, with more male surgeons (45, 55, and 11, P < 0.001). All doctors considered CPR as important, but only anesthesiologists knew how often guidelines in CPR change. Approximately 45% of medical doctors, 48% of surgeons and 77% of anesthesiologists reported that they have renewed their knowledge in CPR within the last five years, whereas 34%, 25% and 22% had never renewed their knowledge in the CPR (P = 0.01 between surgeons anesthesiologists). Furthermore, chest-compression-only was recognized as a valuable CPR technique by 25.8% of medical doctors, 14.3% of surgeons and 59.3% of anesthesiologists (P < 0.001). Anesthesiologists estimated a high risk of infection transmission (62%) and were more likely to refuse mouth-to-mouth ventilation when compared to surgeons (25% vs.10%, P = 0.01). Anesthesiologists are most often called for help by their colleagues, only rarely surgeons call their departmental colleagues and nurses to help in CPR. Conclusions: An insufficient formal education in CPR was registered for all groups, reflecting the lack of familiarity with new CPR methods. A team education, involving doctors and nurses may improve familiarity with CPR and patient outcomes.
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Affiliation(s)
- Irena Krajina
- Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - Slavica Kvolik
- Faculty of Medicine, University of Osijek, Osijek, Croatia
- Department of Anesthesiology and ICU, Osijek University Hospital, Osijek, Croatia
- Corresponding Author: Slavica Kvolik, Department of Anesthesiology and ICU, Faculty of Medicine, University of Osijek, J. Huttlera 4, 31000 Osijek, Osijek, Croatia. Tel/Fax: +38-531206444, E-mail:
| | - Robert Steiner
- Faculty of Medicine, University of Osijek, Osijek, Croatia
- Department of Cardiology, Osijek University Hospital, Osijek, Croatia
| | | | - Ivan Lovric
- Faculty of Medicine, University of Osijek, Osijek, Croatia
- Department of Surgery, Osijek University Hospital, Osijek, Croatia
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Ballangrud R, Persenius M, Hedelin B, Hall-Lord ML. Exploring intensive care nurses' team performance in a simulation-based emergency situation, - expert raters' assessments versus self-assessments: an explorative study. BMC Nurs 2014; 13:47. [PMID: 25606023 PMCID: PMC4299298 DOI: 10.1186/s12912-014-0047-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 12/09/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Effective teamwork has proven to be crucial for providing safe care. The performance of emergencies in general and cardiac arrest situations in particular, has been criticized for primarily focusing on the individual's technical skills and too little on the teams' performance of non-technical skills. The aim of the study was to explore intensive care nurses' team performance in a simulation-based emergency situation by using expert raters' assessments and nurses' self-assessments in relation to different intensive care specialties. METHODS The study used an explorative design based on laboratory high-fidelity simulation. Fifty-three registered nurses, who were allocated into 11 teams representing two intensive care specialties, participated in a videotaped simulation-based cardiac arrest setting. The expert raters used the Ottawa Crisis Resource Management Global Rating Scale and the first part of the Mayo High Performance Teamwork Scale to assess the teams' performance. The registered nurses used the first part of the Mayo High Performance Teamwork Scale for their self-assessments, and the analyses used were Chi-square tests, Mann-Whitney U tests, Spearman's rho and Intraclass Correlation Coefficient Type III. RESULTS The expert raters assessed the teams' performance as either advanced novice or competent, with significant differences being found between the teams from different specialties. Significant differences were found between the expert raters' assessments and the registered nurses' self-assessments. CONCLUSIONS Teams of registered nurses representing specialties with coronary patients exhibit a higher competence in non-technical skills compared to team performance regarding a simulated cardiac arrest. The use of expert raters' assessments and registered nurses' self-assessments are useful in raising awareness of team performance with regard to patient safety.
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Affiliation(s)
- Randi Ballangrud
- />Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, 651 88, Karlstad, Sweden
- />Department of Nursing, Faculty of Health, Care and Nursing, Gjøvik University College, Teknologivn. 22, 2815 Gjøvik, Norway
| | - Mona Persenius
- />Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, 651 88, Karlstad, Sweden
| | - Birgitta Hedelin
- />Department of Nursing, Faculty of Health, Care and Nursing, Gjøvik University College, Teknologivn. 22, 2815 Gjøvik, Norway
| | - Marie Louise Hall-Lord
- />Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, 651 88, Karlstad, Sweden
- />Department of Nursing, Faculty of Health, Care and Nursing, Gjøvik University College, Teknologivn. 22, 2815 Gjøvik, Norway
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Impact of 'fire drill' training and dedicated obstetric resuscitation code in improving fetomaternal outcome following cardiac arrest in a tertiary referral hospital setting in Singapore. Arch Gynecol Obstet 2014; 291:945-9. [PMID: 25472736 DOI: 10.1007/s00404-014-3559-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
Abstract
Cardiac arrest in pregnancy is a rare but catastrophic obstetric emergency, with a quoted incidence of 1:20,000 pregnancies. Speedy multidisciplinary interventions are crucial for good maternal and foetal outcomes. A perimortem caesarean section (PMCS) initiated within 4 min of onset of cardiac arrest to minimise the effect of aortocaval compression on cardiopulmonary resuscitation (CPR) has been recommended as a key intervention, which is likely to improve survival of both mother and foetus. Sudden collapse is uncommon in pregnant women and their management is more challenging than in a non-pregnant patient. This article aims to emphasise the significance of early identification and management of impending or established maternal cardiac arrest. We propose that a focus on effective and good-quality CPR, utilising key interventions such as early airway control, left uterine displacement and a timely decision for a PMCS with multidisciplinary input is more likely to result in good maternal and foetal survival and neurological outcomes. We also discuss the role of 'fire drill' obstetric training for key staff and the use of a dedicated hospital-wide resuscitation code for managing collapse in obstetric patients in improving survival and outcomes. We present four cases of maternal cardiac arrest managed with PMCS in our hospital, highlighting the evolution in management and with improved outcomes following changes to our resuscitation guidelines, training and workflows.
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Simulated obstetrical trauma: a meeting of the minds in the emergency department. Simul Healthc 2014; 9:270-5. [PMID: 25084291 DOI: 10.1097/sih.0000000000000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Burghofer K, Lackner C. Simulationstraining zwischen „human factors“ und „technical skills“. Notf Rett Med 2014. [DOI: 10.1007/s10049-013-1801-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Chalwin RP, Flabouris A. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams. Intern Med J 2014; 43:962-9. [PMID: 23611153 DOI: 10.1111/imj.12172] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/14/2013] [Indexed: 11/28/2022]
Abstract
Efforts are ongoing to improve outcomes from cardiac arrest and medical emergencies. A promising quality improvement modality is use of non-technical skills (NTS) that aim to address human factors through improvements in performance of leadership, communication, situational awareness and decision-making. Originating in the airline industry, NTS training has been successfully introduced into anaesthesia, surgery, emergency medicine and other acute medical specialities. Some aspects of NTS have already achieved acceptance for cardiac arrest teams. Leadership skills are emphasised in advanced life support training and have shown favourable results when employed in simulated and clinical resuscitation scenarios. The application of NTS in medical emergency teams as part of a rapid response system attending medical emergencies is less certain; however, observations of simulations have also shown promise. This review highlights the potential benefits of NTS competency for cardiac arrest teams and, more importantly, medical emergency teams because of the diversity of clinical scenarios encountered. Discussion covers methods to assess and refine NTS and NTS training to optimise performance in the clinical environment. Increasing attention should be applied to yielding meaningful patient and organisational outcomes from use of NTS. Similarly, implementation of any training course should receive appropriate scrutiny to refine team and institutional performance.
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Affiliation(s)
- R P Chalwin
- Intensive Care Unit, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
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Breckwoldt J, Gruber H, Wittmann A. Simulation Learning. INTERNATIONAL HANDBOOK OF RESEARCH IN PROFESSIONAL AND PRACTICE-BASED LEARNING 2014. [DOI: 10.1007/978-94-017-8902-8_25] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Perkins GD, Yeung J, Considine J. Improving resuscitation quality. Resuscitation 2013; 84:1295-6. [PMID: 23954910 DOI: 10.1016/j.resuscitation.2013.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 08/12/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; Heart of England NHS Foundation Trust, Birmingham B9 5SS, United Kingdom.
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An institutionwide approach to redesigning management of cardiopulmonary resuscitation. Jt Comm J Qual Patient Saf 2013; 39:157-66. [PMID: 23641535 DOI: 10.1016/s1553-7250(13)39022-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite widespread training in basic life support (BLS) and advanced cardiovascular life support (ACLS) among hospital personnel, the likelihood of survival from in-hospital cardiac arrests remains low. In 2006 a university-affiliated tertiary medical center initiated a cardiopulmonary (CPR) resuscitation redesign project. REDESIGNING THE HOSPITAL'S RESUSCITATION SYSTEM: The CPR Committee developed the interventions on the basis of a large-scale view of the process of delivering BLS and ACLS, identification of key decision nodes and actions, and compartmentalization of specific functions. It was proposed that arrest management follow a steady progression in a two-layer scheme from BLS to ACLS. Handouts describing team structure and specific roles were given to all code team providers and house staff at the start of their month-long rotations. To further increase role clarity and team organization, daily morning and evening meetings of the arrest team were instituted. Site-specific BLS training, on-site ACLS refresher training, and defibrillator training were initiated. Project elements also included use of unannounced mock codes to provide system oversight; preparation and distribution of cognitive aids (printed algorithms, dosing guides, and other checklists to ensure compliance with ACLS protocols), identification of patients who may be unstable or a source of concern, event review and analysis of arrests and other critical events, and a CPR website. CONCLUSION A mature hospital-based resuscitation system should include definition of arrest trends and resuscitation needs, development of local methods for approaching the arresting patient, an emphasis on prevention, establishment of training programs tailored to meet specific hospital needs, system examination and oversight, and administrative processes that maximize interaction between all components.
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Hunziker S, Pagani S, Fasler K, Tschan F, Semmer NK, Marsch S. Impact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: a randomized controlled trial. BMC Emerg Med 2013; 13:8. [PMID: 23607331 PMCID: PMC3640892 DOI: 10.1186/1471-227x-13-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 04/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) causes significant stress for the rescuers which may cause deficiencies in attention and increase distractibility. This may lead to misjudgements of priorities and delays in CPR performance, which may further increase mental stress (vicious cycle). This study assessed the impact of a task-focusing strategy on perceived stress levels and performance during a simulated CPR scenario. METHODS This prospective, randomized-controlled trial was conducted at the simulator-center of the University Hospital Basel, Switzerland. A total of 124 volunteer medical students were randomized to receive a 10 minute instruction to cope with stress by loudly posing two task-focusing questions ("what is the patient's condition?", "what immediate action is needed?") when feeling overwhelmed by stress (intervention group) or a control group. The primary outcome was the perceived levels of stress and feeling overwhelmed (stress/overload); secondary outcomes were hands-on time, time to start CPR and number of leadership statements. RESULTS Participants in the intervention group reported significantly less stress/overload levels compared to the control group (mean difference: -0.6 (95% CI -1.3, -0.1), p=0.04). Higher stress/overload was associated with less hands-on time. Leadership statements did not differ between groups, but the number of leadership statements did relate to performance. Hands-on time was longer in the intervention- group, but the difference was not statistically significant (difference 5.5 (95% CI -3.1, 14.2), p=0.2); there were no differences in time to start CPR (difference -1.4 (95% CI -8.4, 5.7), p=0.71). CONCLUSIONS A brief stress-coping strategy moderately decreased perceived stress without significantly affecting performance in a simulated CPR. Further studies should investigate more intense interventions for reducing stress. TRIAL REGISTRATION NCT01645566.
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Affiliation(s)
- Sabina Hunziker
- Medical Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland.
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Fernandez Castelao E, Russo SG, Riethmüller M, Boos M. Effects of team coordination during cardiopulmonary resuscitation: a systematic review of the literature. J Crit Care 2013; 28:504-21. [PMID: 23602030 DOI: 10.1016/j.jcrc.2013.01.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 12/28/2012] [Accepted: 01/01/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this study is to identify and evaluate to what extent the literature on team coordination during cardiopulmonary resuscitation (CPR) empirically confirms its positive effect on clinically relevant medical outcome. MATERIAL AND METHODS A systematic literature search in PubMed, MEDLINE, PsycINFO and CENTRAL databases was performed for articles published in the last 30 years. RESULTS A total of 63 articles were included in the review. Planning, leadership, and communication as the three main interlinked coordination mechanisms were found to have effect on several CPR performance markers. A psychological theory-based integrative model was expanded upon to explain linkages between the three coordination mechanisms. CONCLUSIONS Planning is an essential element of leadership behavior and is primarily accomplished by a designated team leader. Communication affects medical performance, serving as the vehicle for the transmission of information and directions between team members. Our findings also suggest teams providing CPR must continuously verbalize their coordination plan in order to effectively structure allocation of subtasks and optimize success.
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Clarke S, Lyon RM, Short S, Crookston C, Clegg GR. A specialist, second-tier response to out-of-hospital cardiac arrest: setting up TOPCAT2: Table 1. Emerg Med J 2013; 31:405-7. [DOI: 10.1136/emermed-2012-202232] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hirokawa RY, Daub K, Lovell E, Smith S, Davis A, Beck C. Using a Human Patient Simulator to Study the Relationship Between Communication and Nursing Students’ Team Performance. J Nurs Educ 2012; 51:647-51. [DOI: 10.3928/01484834-20120927-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 06/27/2012] [Indexed: 11/20/2022]
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Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation*. Crit Care Med 2012; 40:2617-21. [DOI: 10.1097/ccm.0b013e3182591fda] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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[Communication in intensive care medicine]. Med Klin Intensivmed Notfmed 2012; 107:249-54. [PMID: 22526120 DOI: 10.1007/s00063-011-0060-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
Communication plays a crucial role in the intensive care unit. Posttraumatic stress syndromes develop in a significant number of patients and their relatives after being in an intensive care unit. The syndromes may persist for several years. Regular open and empathic communication with patients and family members reduces the frequency and severity of the disease. Among the physicians and nurses in the intensive care unit, there is a high prevalence of burnout syndrome. The precipitating factors are mostly conflicts within the working staff, work overload and end-of-life situations. Working team communication reduces the rate of exhaustion syndromes. Rounds of discussions among the work groups are the basis for a healthy team structure. Inadequate communication, e.g., during emergencies or shift change, endangers the safety of patients and in the worst case, results in treatment mistakes. Measures for improved communication in the intensive care unit should always be implemented.
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Impact of resuscitation system errors on survival from in-hospital cardiac arrest. Resuscitation 2011; 83:63-9. [PMID: 21963583 DOI: 10.1016/j.resuscitation.2011.09.009] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 09/09/2011] [Accepted: 09/11/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND An estimated 350,000-750,000 adult, in-hospital cardiac arrest (IHCA) events occur annually in the United States. The impact of resuscitation system errors on survival during IHCA resuscitation has not been evaluated. The purpose of this paper was to evaluate the impact of resuscitation system errors on survival to hospital discharge after IHCA. METHODS AND RESULTS We evaluated subjective and objective errors in 118,387 consecutive, adult, index IHCA cases entered into the Get with the Guidelines National Registry of Cardiopulmonary Resuscitation database from January 1, 2000 through August 26, 2008. Cox regression analysis was used to determine the relationship between reported resuscitation system errors and other important clinical variables and the hazard ratio for death prior to hospital discharge. Of the 108,636 patients whose initial IHCA rhythm was recorded, resuscitation system errors were committed in 9,894/24,467 (40.4%) of those with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) and in 22,599/84,169 (26.8%) of those with non-VF/pVT. The most frequent system errors related to delay in medication administration (>5 min time from event recognition to first dose of a vasoconstrictor), defibrillation, airway management, and chest compression performance errors. The presence of documented resuscitation system errors on an IHCA event was associated with decreased rates of return of spontaneous circulation, survival to 24h, and survival to hospital discharge. The relative risk of death prior to hospital discharge based on hazard ratio analysis was 9.9% (95% CI 7.8, 12.0) more likely for patients whose initial documented rhythm was non-VF/pVT when resuscitation system errors were reported compared to when no errors were reported. It was 34.2% (95% CI 29.5, 39.1) more likely for those with VF/pVT. CONCLUSIONS The presence of resuscitation system errors that are evident from review of the resuscitation record is associated with decreased survival from IHCA in adults. Hospitals should target the training of first responders and code team personnel to emphasize the importance of early defibrillation, early use of vasoconstrictor medication, and compliance with ACLS protocols.
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Hunziker S, Laschinger L, Portmann-Schwarz S, Semmer NK, Tschan F, Marsch S. Perceived stress and team performance during a simulated resuscitation. Intensive Care Med 2011; 37:1473-9. [PMID: 21695475 DOI: 10.1007/s00134-011-2277-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 05/30/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Barriers to optimal performance of cardiopulmonary resuscitation may partly relate to human factors, such as stress and specific emotions. The aim of this study was to investigate whether mental stress and different perceived emotions have a negative impact on the performance of rescuers. METHODS This prospective, observational study was conducted at the Simulator Center of the University Hospital Basel, Switzerland. A total of 120 medical students (70% female) participated in teams of three. They reported levels of perceived stress, feeling overwhelmed, motivation and specific emotions before, during, and after a simulated resuscitation. The association of stress/overload (index of stress and feeling overwhelmed), motivation, and specific emotions with resuscitation performance defined as hands-on time during the first 180 s after cardiac arrest was investigated. RESULTS During resuscitation, levels of stress/overload, motivation, and negative emotions were significantly higher as compared to the periods before and after resuscitation. In contrast, positive emotions were highest before and after resuscitation and significantly lower during resuscitation. In general, females reported higher stress/overload and negative emotions, whereas males reported more positive emotions. A multivariate linear regression model showed negative associations of stress/overload (regression coefficient -18.12, 95% CI -30.73, -5.51, p = 0.006) and positive associations of motivation (regression coefficient 13.45, 95% CI 0.95, 25.95, p = 0.036) with resuscitation performance. CONCLUSION A simulated cardiac arrest caused substantial perceived stress/overload and negative emotions, particularly in female students, which adversely impacted resuscitation performance. Further studies are required to expand our findings to more experienced medical professionals and investigate whether stress coping strategies improve resuscitation performance.
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Affiliation(s)
- Sabina Hunziker
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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