Teamwork education improves trauma team performance in undergraduate health professional students.
Baker Valerie O'Toole,Cuzzola Ronald,Knox Carolyn,Liotta Cynthia,Cornfield Charles S,Tarkowski Robert D,Masters Carolynn,McCarthy Michael,Sturdivant Suzanne,Carlson Jestin N
Journal of educational evaluation for health professions
PURPOSE:Effective trauma resuscitation requires efficient and coordinated care from a team of providers; however, providers are rarely instructed on how to be effective members of trauma teams. Team-based learning using Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) has been shown to improve team dynamics among practicing professionals, including physicians and nurses. The impact of TeamSTEPPS on students being trained in trauma management in an undergraduate health professional program is currently unknown. We sought to determine the impact of TeamSTEPPS on team dynamics among undergraduate students being trained in trauma resuscitation. METHODS:We enrolled teams of undergraduate health professional students from four programs: nursing, physician assistant, radiologic science, and respiratory care. After completing an online training on trauma resuscitation principles, the participants completed a trauma resuscitation scenario. The participants then received teamwork training using TeamSTEPPS and completed a second trauma resuscitation scenario identical to the first. All resuscitations were recorded and scored offline by two blinded research assistants using both the Team Emergency Assessment Measure (TEAM) and Trauma Team Performance Observation Tool (TPOT) scoring systems. Pre-test and post-test TEAM and TPOT scores were compared. RESULTS:We enrolled a total of 48 students in 12 teams. Team leadership, situational monitoring, and overall communication improved with TeamSTEPPS training (P=0.04, P=0.02, and P=0.03, respectively), as assessed by the TPOT scoring system. TeamSTEPPS also improved the team's ability to prioritize tasks and work together to complete tasks in a rapid manner (P<0.01 and P=0.02, respectively) as measured by TEAM. CONCLUSIONS:Incorporating TeamSTEPPS into trauma team education leads to improved TEAM and TPOT scores among undergraduate health professionals.
Prospective analysis of an interprofessional team training program using high-fidelity simulation of contrast reactions.
Niell Bethany L,Kattapuram Taj,Halpern Elkan F,Salazar Gloria M,Penzias Alexandra,Bonk Shawn S,Forde Joanne C,Hayden Emily,Sande Margaret,Minehart Rebecca D,Gordon James A
AJR. American journal of roentgenology
OBJECTIVE:Successful management of a contrast reaction requires prompt recognition and treatment and effective team dynamics among radiologists, technologists, and nurses. A radiology department implemented a simulation program in which teams of nurses, technologists, and physicians managed simulated contrast reactions. The purpose of this study was to evaluate whether simulation improved the participants' abilities to manage a contrast reaction and work in a team during an emergency. SUBJECTS AND METHODS:Physicians, nurses, and technologists worked in inter-professional teams to manage two high-fidelity simulated adverse contrast reactions. Participants completed surveys before and after the simulation that included knowledge-based questions about the appropriate management of contrast reactions. Surveys also included questions for assessing participants' perceptions of their ability to manage adverse contrast reactions, measured with a 6-point Likert scale. Before and after comparisons were made with the McNemar test with a Bonferroni correction requiring p ≤ 0.003 for significance. For the other analyses, p ≤ 0.05 was considered significant. RESULTS:After completion of the simulation exercises, participants had significant improvement in knowledge (p < 0.001). After the simulation, participants reported significant improvement in their ability to manage an anaphylactoid reaction and their ability to work in a team (p < 0.00001). Participants requested repeat simulation exercises every 6-12 months. CONCLUSION:Simulation exercises improved the self-reported ability of radiology personnel to manage contrast reactions and work in a team during an emergency. Simulation should be incorporated into future educational initiatives to improve patient safety in radiology practices.
Cardiopulmonary arrest in the outpatient setting: enhancing patient safety through rapid response algorithms and simulation teaching.
Scaramuzzo Leah A,Wong Yuk,Voitle Kira Lynn,Gordils-Perez Janet
Clinical journal of oncology nursing
Ambulatory and outpatient centers constantly are challenged with administrating cancer treatments in an efficient and safe way. With the advent of numerous novel cancer medications known to cause hypersensitivity reactions, nurses have become experts in managing these emergencies. However, patients rarely exhibit severe infusion reactions or cardiopulmonary arrest. Outpatient nurse knowledge and comfort with grade 4, life-threatening emergencies requiring cardiopulmonary resuscitative measures often is low because of infrequent occurrence. That is largely a result of nurses' ability to immediately identify the need for emergency intervention, thus preventing the sequelae of patient deterioration that could lead to cardiopulmonary arrest. This article describes how the authors' institution developed methods to improve emergency care by bridging the gap between knowledge and experience of handling life-threatening emergencies.
Changing Team Member Perceptions by Implementing TeamSTEPPS in an Emergency Department.
Obenrader Connie,Broome Marion E,Yap Tracey L,Jamison Florame
Journal of emergency nursing
INTRODUCTION:The emergency department is an environment where teamwork and communication are of utmost importance and are the foundation for improved patient satisfaction, staff satisfaction, patient safety, and the reduction of clinical errors. An ED staff perceptions of communication and teamwork influences their ability to provide efficient, high quality care to patients. METHODS:The ED team consisted of 57 employees, including nurses, mid-level providers, and non-licensed individuals, who work within, or directly with, the department. This quality improvement project trained 57 members of the ED staff using the TeamSTEPPS training program. Forty-six of the participants completed assessments at all 3 time points (baseline, 2 weeks and one month): Team STEPPS Teamwork Perceptions and Attitudes Questionnaires and The Nursing Culture Assessment Tool (NCAT). RESULTS:Formal group TeamSTEPPS training improved the emergency department team members' perceptions of, and attitudes about, communication and teamwork. DISCUSSION:As a result of TeamSTEPPS training in an Emergency Department, the staff of that department perceived that both teamwork and communication improved. The TeamSTEPPs program should be made sustainable by incorporating the verbiage and tools from the program into policy and culture within the department.
Comparison of the Emergency Severity Index versus the Patient Acuity Category Scale in an emergency setting.
Fong Ru Ying,Glen Wee Sern Sim,Mohamed Jamil Ahmad Khairil,Tam Wilson Wai San,Kowitlawakul Yanika
International emergency nursing
OBJECTIVES:To compare the reliability, validity and resource utilization of the Emergency Severity Index (ESI) and Patient Acuity Category Scale (PACS) triage scales. METHODS:A descriptive, correlational, and cross-sectional design was used. Twenty-seven triage nurses were recruited to test interrater reliability for 20 patient case scenarios. Subsequently, interrater reliability was tested on 300 actual patients. Construct validity was analyzed using patients' hospital dispositions and resources utilized. RESULTS:For patient case scenarios, interrater reliability for both were very good, at 0.87 (95% CI: 0.86-0.88) for ESI and 0.88 (95% CI: 0.87-0.89) for PACS. For actual patients, interrater reliability for both were moderate, at 0.59 (95% CI: 0.50-0.68) for ESI and 0.49 (95% CI: 0.40-0.60) for PACS. Both ESI and PACS demonstrated construct validity with moderate correlations for hospital admissions and the number of resources used. PACS was unable to discriminate between patients that required more or less resources, whereas the ESI can. Patients that required two or more resources had higher rates of admission. CONCLUSIONS:Both triage systems demonstrated moderate interrater reliability and construct validity in triaging actual patients. The ESI has better resource discrimination ability than the PACS and can improve resource management in the ED.
Electrocardiogram interpretation skills among ambulance nurses.
Werner Kristoffer,Kander Kristofer,Axelsson Christer
European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology
BACKGROUND:To describe ambulance nurses' practical electrocardiogram (ECG) interpretation skills and to measure the correlation between these skills and factors that may impact on the level of knowledge. METHODS:This study was conducted using a prospective quantitative survey with questionnaires and a knowledge test. A convenience sample collection was conducted among ambulance nurses in three different districts in western Sweden. The knowledge test consisted of nine different ECGs. The score of the ECG test were correlated against the questions in the questionnaire regarding both general ECG interpretation skill and ability to identify acute myocardial infarction using Mann-Whitney U test, Kruskal-Wallis test and Spearman's rank correlation. RESULTS:On average, the respondents had 54% correct answers on the test and identified 46% of the ECGs indicating acute myocardial infarction. The median total score was 9 of 16 (interquartile range 7-11) and 1 of 3 (IQR 1-2) in infarction points. No correlation between ECG interpretation skill and factors such as education and professional experience was found, except that coronary care unit experience was associated with better results on the ECG test. CONCLUSIONS:Ambulance nurses have deficiencies in their ECG interpretation skills. This also applies to conditions where the ambulance crew has great potential to improve the outcome of the patient's health, such as myocardial infarction and cardiac arrest. Neither education, extensive experience in ambulance service nor in nursing contributed to an improved result. The only factor of importance for higher ECG interpretation knowledge was prior experience of working in a coronary care unit.
Emergency nurses' experience of crisis: A qualitative study.
Vasli Parvaneh,Dehghan-Nayeri Nahid
Japan journal of nursing science : JJNS
AIM:A crisis is an environment created in a rapidly changing and chaotic work setting which is found in a busy emergency department of a hospital with higher intensity. The objective of this study was to define and explore emergency room nurses' description of crisis in critical situations and to identify barriers and mitigating factors that affect how nurses handle crises. METHODS:This study is a qualitative research with a content analysis approach. Eighteen emergency nurses were purposefully selected to take part in this study. Data collection was through face-to-face semistructured interviews until data saturation was finalized. Data analysis was conducted using content analysis. RESULTS:The data analysis consisted of four main categories: (i) loss of balance; (ii) crisis control (anticipation-preparation, resource control, control skills, and supporting nurses); (iii) human factors related to staff (sufficient staff, competent staff, individual characteristics, ability to communicate); and (iv) teamwork (cooperation and reciprocal trust). CONCLUSION:Findings showed the meaning of the crisis and challenges and issues faced by emergency nurses throughout the crisis. Health services authorities can use these results to make comprehensive plans in order to reduce emergency crises.
Assessing Emergency Nurses' Clinical Competency: An Exploratory Factor Analysis Study.
Ghanbari Atefeh,Hasandoost Fateme,Lyili Ehsan Kazemnezhad,Khomeiran Rasoul Tabari,Momeni Maryam
Iranian journal of nursing and midwifery research
BACKGROUND:Nursing as a clinical discipline is developing in the emergency wards. Health care systems should continuously assess and prioritize indicators of clinical competency in these wards. The lack of clear standards of clinical competency indicators challenges evaluation. The purpose of this study was to determine clinical competency indicators and its priority based on nurses' views in educational and therapeutic centers in Guilan. MATERIALS AND METHODS:The Q methodology was conducted in three phases, that is, phase I (determining the clinical competency indicators), phase II (classifying clinical competency indicators by an expert panel), and phase III (prioritizing clinical competency indicators). The subjects were selected by convenience sampling among nurses working in the emergency wards of teaching hospitals affiliated to Guilan in 2013. Finally, clinical competency indicators were prioritized using exploratory factor analysis. RESULTS:In the prioritizing phase, data were collected from 710 nurses over two months. Five factors with 30 general competencies were found in three domains: communication, professional maturity, and personality characteristics. Six factors with 37 specific competencies were also found in two domains: scientific and technical capabilities and basic clinical skills that can provide a structured instrument for assessing clinical competence in emergency nurses. CONCLUSIONS:Achieved competencies can be used as a reference for nursing education and practice in emergency. Further research on health care system is needed in order to achieve a reliable and valid instrument.
Nurse-Led Competency Model for Emergency Physicians: A Qualitative Study.
Daouk-Öyry Lina,Mufarrij Afif,Khalil Maya,Sahakian Tina,Saliba Miriam,Jabbour Rima,Hitti Eveline
Annals of emergency medicine
STUDY OBJECTIVE:To develop a competency model for emergency physicians from the perspective of nurses, juxtapose this model with the widely adopted Accreditation Council for Graduate Medical Education (ACGME) model, and identify competencies that might be unique to the nurses' perspective. METHODS:The study relied on secondary data originally collected as part of nurses' assessment of emergency physicians' nonclinical skills in the emergency department (ED) of an academic medical center in the Middle East. Participants were 36 registered nurses who had worked in the ED for at least 2 years and had worked for at least 2 shifts per month with the physician being evaluated. RESULTS:Through content analysis, a nurse-led competency model was identified, including 8 core competencies encompassing 33 subcompetencies. The 8 core competencies were emotional intelligence; problem-solving and decisionmaking skills; operations management; patient focus; patient care, procedural skills, and medical knowledge; professionalism; communication skills; and team leadership and management. When the developed model was compared with the ACGME model, the 2 models diverged more than they converged. CONCLUSION:The nurses' perspective offered distinctive insight into the competencies needed for physicians in an emergency medicine environment, indicating the value of nurses' perspective and shedding light on the need for more systematic and more methodologically sound studies to examine the issue further. The differences between the models highlighted the competencies that were unique to the nurse perspective, and the similarities were indicative of the influence of different perspectives and organizational context on how competencies manifest.
Competency framework for specialist critical care nurses: A modified Delphi study.
Zhang Xiaoning,Meng Kun,Chen Shuang
Nursing in critical care
BACKGROUND:The specialist critical care nurse plays a vital role in the delivery of evidence-based practice, and specific competency guidance has been established to facilitate critical care nursing practice and education development in many developed countries. However, no research has been conducted to develop a competency framework for specialist critical care nurses in China. AIMS AND OBJECTIVES:To construct a competency framework specific to specialist critical care nurses in China. DESIGN AND METHODS:A two-phased procedure was implemented. In phase 1, a literature review and four focus groups were used to develop the initial competency framework, which consisted of 101 statements. During phase 2, three rounds of a modified Delphi process were conducted and involved a national panel of 30 experts, including physicians, specialist critical care nurses, managers, and educators, who responded to the survey using a 5-point Likert-type scale to indicate their level of agreement with the competency framework. A 75% threshold for each competency was used to achieve panel consensus. RESULTS:Experts in the field of critical care responded to rounds 1 (n = 29), 2 (n = 28), and 3 (n = 28). Seventy-eight competencies were agreed upon after round 1, increasing to 88 after round 2 and 92 after round 3. The final competency framework was classified into six domains: evidence-based practice, complex decisions, professionalism, communication and co-operation, education and development, and leadership. CONCLUSION:The output of this study is an expert consensus competency framework that provides a sound foundation for the assessment and training of specialist critical care nurses. RELEVANCE TO CLINICAL PRACTICE:The proposed competency framework should be used to assess nursing performance, promote continuing professional development, and further improve the delivery of quality health care and optimal patient outcomes.