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Riley K, Middleton R, Molloy L, Wilson V. Exploring rural Nurses' preparedness and post-resuscitation experiences. An ethnographic study. J Adv Nurs 2024. [PMID: 38923061 DOI: 10.1111/jan.16295] [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: 02/12/2024] [Revised: 05/29/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
AIM The focus of this paper is to provide a detailed ethnographic exploration of rural nurses' experiences of their resuscitation preparedness and the subsequent post-resuscitation period. DESIGN An ethnographic study across two small rural hospital sites in New South Wales, Australia. METHODS Fieldwork was undertaken between December 2020 and March 2022 and included over 240 h of nonparticipant observation, journalling and interviews. Data were analysed using reflexive thematic analysis. RESULTS The first key theme-'Sense of Preparedness'-included three subthemes: 'Gaining experience', 'Issues with training and education' and 'Lack of warning'. The second key theme 'Aftermath' comprised two subthemes: 'Getting on with it' and 'Making sense of the resus'. CONCLUSION This study has highlighted the intricate relationship between resuscitative preparedness and the post-resuscitation period in shaping rural nurse's experiences and their well-being. Rural nurses are asking for an authentic and contextually relevant training experience that mirrors the unique rural challenges they experience. In the absence of frequent resuscitation presentations, the post-resuscitation period should be viewed as a crucible moment that can be leveraged as a valuable learning opportunity enhancing rural nurses' sense of preparedness and the provision of quality resuscitation care. IMPACT Having a greater level of insight into the challenges that rural nurses experience in the pre- and post-resuscitation period is critical. This insight opens the door for fortifying policies and work processes that will better support rural nurses in the resuscitation environment. REPORTING METHOD Reporting complied with COREQ criteria for qualitative research. NO PATIENT OR PUBLIC CONTRIBUTION This study explored the experiences of rural nurses. No patient data were collected.
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Affiliation(s)
- Katherine Riley
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Rebekkah Middleton
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Val Wilson
- Prince of Wales Hospital, South Eastern Sydney Local Health District & Ingham Institute, Sydney, New South Wales, Australia
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Lim HJ, Park JH, Hong KJ, Song KJ, Shin SD. Association between out-of-hospital cardiac arrest quality indicator and prehospital management and clinical outcomes for major trauma. Injury 2024; 55:111437. [PMID: 38403567 DOI: 10.1016/j.injury.2024.111437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION It is unclear whether emergency medical service (EMS) agencies with good out-of-hospital cardiac arrest (OHCA) quality indicators also perform well in treating other emergency conditions. We aimed to evaluate the association of an EMS agency's non-traumatic OHCA quality indicators with prehospital management processes and clinical outcomes of major trauma. METHODS This retrospective cross-sectional study analyzed data from registers of nationwide, population-based OHCA (adult EMS-treated non-traumatic OHCA patients from 2017 to 2018) and major trauma (adult, EMS-treated, and injury severity score ≥16 trauma patients in 2018) in South Korea. We developed a prehospital ROSC prediction model to categorize EMS agencies into quartiles (Q1-Q4) based on the observed-to-expected (O/E) ROSC ratio for each EMS agency. We evaluated the national EMS protocol compliance of on-scene management according to O/E ROSC ratio quartile. The association between O/E ROSC ratio quartiles and trauma-related early mortality was determined in a multi-level logistic regression model by adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI). RESULTS Among 30,034 severe trauma patients, 4,836 were analyzed. Patients in Q4 showed the lowest early mortality rate (5.6 %, 5.5 %, 4.8 %, and 3.4 % in Q1, Q2, Q3, and Q4, respectively). In groups Q1 to Q4, increasing compliance with the national EMS on-scene management protocol (trauma center transport, basic airway management for patients with altered mentality, spinal motion restriction for patients with spinal injury, and intravenous access for patients with hypotension) was observed (p for trend <0.05). Multivariable multi-level logistic regression analysis showed significantly lower early mortality in Q4 than in Q1 (adjusted OR [95 % CI] 0.56 [0.35-0.91]). CONCLUSION Major trauma patients managed by EMS agencies with high success rates in achieving prehospital ROSC in non-traumatic OHCA were more likely to receive protocol-based care and exhibited lower early mortality.
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Affiliation(s)
- Hyouk Jae Lim
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
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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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Bailey CH, Gesch JD. Team Strategies and Dynamics During Resuscitation. Emerg Med Clin North Am 2023; 41:587-600. [PMID: 37391252 DOI: 10.1016/j.emc.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Resuscitations are complex events that require teamwork to succeed. In addition to the technical skills involved, a host of nontechnical skills are critical for optimal medical care delivery. These skills include mental preparation; planning for tasks and roles; leadership to guide resuscitation progress; and clear, closed-loop communication. Concerns and error detection should be escalated in an established format. Debriefing after the event helps identify learning points to carry forward for the next resuscitation. Support of the team providing this intense form of care is crucial to protect the mental health and function of providers.
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Affiliation(s)
- Caitlin H Bailey
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Julie D Gesch
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA
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Zhang J, Liu S, Jiang L, Hou J, Yang Z. Curcumin Improves Cardiopulmonary Resuscitation Outcomes by Modulating Mitochondrial Metabolism and Apoptosis in a Rat Model of Cardiac Arrest. Front Cardiovasc Med 2022; 9:908755. [PMID: 35665263 PMCID: PMC9160380 DOI: 10.3389/fcvm.2022.908755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022] Open
Abstract
Background Curcumin, a diarylheptanoid chemical compound extracted from curcuma longa, exerts a variety of biological and pharmacological effects in numerous pathological conditions, including ischemia/reperfusion (I/R) injury. In this study, we investigated its role in post-resuscitation myocardial dysfunction in a rat model of cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) by targeting on mitochondrial metabolism and apoptosis. Methods Animals were randomized into three groups: sham, control and curcumin, with fifteen rats in each group. Ventricular fibrillation (VF) was induced in the rats of the control and curcumin groups. The rats in the two groups were untreated for 8 min, followed by CPR for 8 min. Placebo (saline) or curcumin was administered by intraperitoneal injection, respectively, 5 min after successful resuscitation. Myocardial function was measured at baseline and post-resuscitation for 6 h consecutively. Ten rats in each group were closely observed for an additional 66 h to analyze the survival status, and the remaining five were sacrificed for the measurement of mitochondrial parameters and cell apoptosis. Results Compared with the control group, myocardial function was significantly enhanced in the curcumin group, contributing to a better survival status. Curcumin treatment mitigated the depletion of superoxide dismutase (SOD) and the production of malondialdehyde (MDA). The structural damage of mitochondria was also alleviated, with improved conditions of mPTP and ΔΨm. Curcumin boosted the production of ATP and attenuated myocardial apoptosis. Cytochrome C, caspase-3 and its cleavage were suppressed by curcumin. Proteins closely related to the functional performance of mitochondria, including uncoupling protein 2 (UCP2) and uncoupling protein 3 (UCP3) were downregulated, while mitochondrial transcription factor A (mtTFA) was upregulated. Conclusion Curcumin improves the outcomes of CPR via alleviating myocardial dysfunction induced by I/R injury. It exhibits anti-oxidation properties. Moreover, it is capable of ameliorating mitochondrial structure and energy metabolism, as well as inhibiting the mitochondrial apoptosis pathway. UCP2, UCP3, and mtTFA might also be involved in curcumin mediated protective effects on mitochondria.
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Rizkalla C, Garcia-Jorda D, Cheng A, Duff JP, Gottesman R, Weiss MJ, Koot DA, Gilfoyle E. The impact of clinical result acquisition and interpretation on task performance during a simulated pediatric cardiac arrest: a multicentre observational study. CAN J EMERG MED 2022; 24:529-534. [PMID: 35590088 PMCID: PMC9345827 DOI: 10.1007/s43678-022-00313-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 04/06/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The acquisition and interpretation of clinical results during resuscitations is common; however, this can delay critical clinical tasks, resulting in increased morbidity and mortality. This study aims to determine the impact of clinical result acquisition and interpretation by the team leader on critical task completion during simulated pediatric cardiac arrest before and after team training. METHODS This is a secondary data analysis of video-recorded simulated resuscitation scenarios conducted during Teams4Kids (T4K) study (June 2011-January 2015); scenarios included cardiac arrest before and after team training. The scenario included either a scripted paper or a phone call delivery of results concurrently with a clinical transition to pulseless ventricular tachycardia. Descriptive statistics and non-parametric tests were used to compare team performance before and after training. RESULTS Performance from 40 teams was analyzed. Although the time taken to initiate CPR and defibrillation varied depending on the type of interruption and whether the scenario was before or after team training, these findings were not significantly associated with the leader's behaviour [Kruskal-Wallis test (p > 0.05)]. An exact McNemar's test determined no statistically significant difference in the proportion of leaders involved or not in interpreting results between and after the training (exact p value = 0.096). CONCLUSIONS Team training was successful in reducing time to perform key clinical tasks. Although team training modified the way leaders behaved toward the results, this behaviour change did not impact the time taken to start CPR or defibrillate. Further understanding the elements that influence time to critical clinical tasks provides guidance in designing future simulated educational activities, subsequently improving clinical team performance and patient outcomes.
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Affiliation(s)
- Carol Rizkalla
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland.
| | | | - Adam Cheng
- Pediatric Emergency Medicine, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jonathan P Duff
- Pediatrics, Stollery Children's Hospital, Edmonton, AB, Canada
| | | | - Matthew J Weiss
- Pediatrics, Université Laval Faculté de Médecine, Quebec, QC, Canada
| | - Deanna A Koot
- KidSIM Pediatric Simulation Program, Alberta Children's Hospital, Calgary, AB, Canada
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Olson DM, Provencher M, Stutzman SE, Hynan LS, Novakovic S, Guttikonda S, Figueroa S, Novakovic-White R, Yang JP, Goldberg MP. Outcomes From a Nursing-Driven Acute Stroke Care Protocol for Telehealth Encounters. J Emerg Nurs 2022; 48:406-416. [PMID: 35487769 DOI: 10.1016/j.jen.2022.01.013] [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: 11/12/2021] [Revised: 01/06/2022] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Nursing care is widely recognized to be a vital element in stroke care delivery. However, no publications examining clinical education and optimal workflow practices as predictors of acute ischemic stroke care metrics exist. This study aimed to explore the impact of a nurse-led workflow to improve patient care that included telestroke encounters in the emergency department. METHODS A nonrandomized prospective pre- and postintervention unit-level feasibility study design was used to explore how implementing nurse-driven acute stroke care affects the efficiency and quality of telestroke encounters in the emergency department. Nurses and providers in the emergency department received education/training, and then the Nursing-Driven Acute Ischemic Stroke Care protocol was implemented. RESULTS There were 180 acute ischemic stroke encounters (40.3%) in the control phase and 267 (59.7%) in the postintervention phase with similar demographic characteristics. Comparing the control with intervention times directly affected by the nurse-driven protocol, there was a significant reduction in median door-to-provider times (5 [interquartile range 12] vs 2 [interquartile range 9] minutes, P < .001) and in median door-to-computed tomography scan times (9 [interquartile range 18] vs 5 [interquartile range 11] minutes, P < .001); however, the metrics potentially affected by extraneous variables outside of the nurse-driven protocol demonstrated longer median door-to-ready times (21 [interquartile range 24] vs 25 [interquartile range 25] minutes, P < .001). Door-to-specialist and door-to-needle times were not significantly different. DISCUSSION In this sample, implementation of the nurse-driven acute stroke care protocol is associated with improved nurse-sensitive stroke time metrics but did not translate to faster delivery of thrombolytic agents for acute ischemic stroke, emphasizing the importance of well-outlined workflows and standardized stroke code protocols at every point in acute ischemic stroke care.
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Saunders R, Wood E, Coleman A, Gullick K, Graham R, Seaman K. Emergencies within hospital wards: An observational study of the non-technical skills of medical emergency teams. Australas Emerg Care 2020; 24:89-95. [PMID: 32747297 DOI: 10.1016/j.auec.2020.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/28/2020] [Accepted: 07/10/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Medical emergency teams are essential in responding to acute deterioration of patients in hospitals, requiring both clinical and non-technical skills. This study aims to assess the non-technical skills of medical emergency teams during hospital ward emergencies and explore team members perceptions and experiences of the use non-technical skills during medical emergencies. METHODS A multi-methods study was conducted in two phases. During phase one observation and assessment of non-technical skills used in medical emergencies using the Team Emergency Assessment Measure (TEAM™) was conducted; and in the phase two in-depth interviews were undertaken with medical emergency team members. RESULTS Based on 20 observations, mean TEAM™ ratings for non-technical skill domains were: 'leadership' 5.0 out of 8 (±2.0); 'teamwork' 21.6 out of 28 (±3.6); and 'task management' 6.5 out of 8 (±1.4). The mean 'global' score was 7.5 out of 10 (±1.5). The qualitative findings identified three areas, 'individual', 'team' and 'other' contributing factors, which impacted upon the non-technical skills of medical emergency teams. CONCLUSION Non-technical skills of hospital medical emergency teams differ, and the impact of the skill mix on resuscitation outcomes was recognised by team members. These findings emphasize the importance non-technical skills in resuscitation training and well-developed processes for medical emergency teams.
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Affiliation(s)
- Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
| | - Emma Wood
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Adam Coleman
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Karen Gullick
- Hollywood Private Hospital, Nedlands, WA 6009, Australia.
| | - Renée Graham
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
| | - Karla Seaman
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia.
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