Franziska Tschan

Brief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: A randomized controlled trial

Objective:The influence of teaching leadership on the performance of rescuers remains unknown. The aim of this study was to compare leadership instruction with a general technical instruction in a high-fidelity simulated cardiopulmonary resuscitation scenario. Design:Prospective, randomized, controlled superiority trial, Setting:Simulator Center of the University Hospital Basel in Switzerland. Subjects:Two-hundred thirty-seven volunteer medical students in teams of three. Intervention:During a baseline visit, the medical students participated in a video-taped simulated witnessed cardiac arrest. Participants were thereafter randomized to receive instructions focusing either on correct positions of arms and shoulders (technical instruction group) or on leadership and communication to enhance team coordination (leadership instruction group). A follow-up simulation was conducted after 4 mos. Measurements and Main Results:The primary outcome were the amount of hands-on time, defined as duration of uninterrupted cardiopulmonary resuscitation in the first 180 secs after the onset of the cardiac arrest (hands-on time). Secondary outcomes were time to start cardiopulmonary resuscitation, total leadership utterances, and technical skills. Outcomes were compared based on videotapes coded by two independent researchers. After a balanced performance at baseline, the leadership instruction group demonstrated a longer hands-on time (120 secs; interquartile range, 98–135 vs. 87 secs; interquartile range, 61–108; p < .001), a shorter median time to start cardiopulmonary resuscitation (44 secs; interquartile range, 32–62; vs. 67 secs; interquartile range, 43–79; p = .018), and had more leadership utterances (7; interquartile range, 4–10; vs. 5; interquartile range, 2–8; p = .02) in the follow-up visit. The rate of correct arm and shoulder positions was higher in teams with technical instruction (59%; 19 out of 32; vs. 23%; 7 out of 31; p = .003). Conclusions:Video-assisted leadership and technical instructions after a simulated cardiopulmonary resuscitation scenario showed sustained efficacy after a 4-mo duration. Leadership instructions were superior to technical instructions, with more leadership utterances and better overall cardiopulmonary resuscitation performance.

Teamwork and Leadership in Cardiopulmonary Resuscitation

Despite substantial efforts to make cardiopulmonary resuscitation (CPR) algorithms known to healthcare workers, the outcome of CPR has remained poor during the past decades. Resuscitation teams often deviate from algorithms of CPR. Emerging evidence suggests that in addition to technical skills of individual rescuers, human factors such as teamwork and leadership affect adherence to algorithms and hence the outcome of CPR. This review describes the state of the science linking team interactions to the performance of CPR. Because logistical barriers make controlled measurement of team interaction in the earliest moments of real-life resuscitations challenging, our review focuses mainly on high-fidelity human simulator studies. This technique allows in-depth investigation of complex human interactions using precise and reproducible methods. It also removes variability in the clinical parameters of resuscitation, thus letting researchers study human factors and team interactions without confounding by clinical variability from resuscitation to resuscitation. Research has shown that a prolonged process of team building and poor leadership behavior are associated with significant shortcomings in CPR. Teamwork and leadership training have been shown to improve subsequent team performance during resuscitation and have recently been included in guidelines for advanced life support courses. We propose that further studies on the effects of team interactions on performance of complex medical emergency interventions such as resuscitation are needed. Future efforts to better understand the influence of team factors (e.g., team member status, team hierarchy, handling of human errors), individual factors (e.g., sex differences, perceived stress), and external factors (e.g., equipment, algorithms, institutional characteristics) on team performance in resuscitation situations are critical to improve CPR performance and medical outcomes of patients.

It's not only clients: Studying emotion work with clients and co-workers with an event-sampling approach

A group of 78 young employees in service and non-service professions reported 848 task related interactions at work over 1 week using a variant of the Rochester Interaction Record which measured emotion work requirements, emotional dissonance, and deviance. Multi-level analyses showed that dissonance was more likely in interactions with customers, whereas deviance, that is, the violation of display rules by acting out ones felt emotion, was more likely in co-worker interactions. Well-being in the interaction was lower (a) for interactions with emotion work requirements, (b) for dissonance, even after controlling for felt negative emotions, and (c) for deviance. Negative emotion displayed partially mediated the relationship between deviance and well-being. Regarding the relationship of more stable job related attitudes, psychosomatic complaints, and aggregated scores of social interactions, fewer effects were found than in questionnaire studies, which may be due to the fact that only interactions that lasted at least 10 minutes were assessed, as is customary in research with this instrument. Among the effects found, however, many involved proportions rather than frequency of interactions, which raises the possibility of balancing and legitimizing effects of non-stressful interactions.

The Assessment of Psychological Strain in Work Contexts

Irritation as defined in this paper is the subjectively perceived emotional and cognitive strain in occupational contexts. The structural equivalence of the Arabic, Dutch, English, French, Italian, Russian, Spanish, Turkish, and Polish adaptations of the German Irritation Scale is examined. The Irritation Scale is recommended for application particularly in occupational contexts. In this field it can be used for evaluating interventions, for research on stress at work, and for individual counseling. Exploratory factor analyses, as well as single group and different multiple-group confirmatory factor analyses, were performed. Structural equivalency in terms of equal factor loadings as well as equal factor covariances across all adaptations can be claimed. However, the single group analyses suggest that the hypothesized factor model should be rejected in the English, Russian, Spanish, and Turkish versions, mainly because of borderline values in the RMSEA index.

Performance of first responders in simulated cardiac arrests

Objective:Survival of in-hospital cardiac arrests depends more on first responders than on cardiac arrest teams. The objective of this study was to determine the adherence to algorithms of cardiopulmonary resuscitation of first responders in simulated cardiac arrests in intensive care. A second objective was to assess the effect of the early vs. late availability of a physician on the performance of nurse-based teams acting as first responders. Design:Prospective study. Setting:Patient simulator in a tertiary level intensive care unit. Participants:A total of 20 teams consisting of three registered nurses and one resident each. Interventions:A simulated witnessed cardiac arrest due to ventricular fibrillation occurred in the presence of one nurse while the remaining two nurses could be called to help. Depending on the time of the residents’ arrival, teams were classified as “early” (median arrival 50 secs after the onset of the arrest) or “late” (median arrival 150 secs after the onset of the arrest). Measurements and Main Results:In all teams, the recognition of the arrest and the calling for help occurred in a timely fashion. However, a median of 85 secs (interquartile range [IQ], 130 secs) elapsed until the start of cardiac massage and 100 secs (IQ, 45 secs) to the first defibrillation. Once commenced, cardiac massage and mask ventilation were carried out during 61% (IQ, 33%) and 77% (IQ, 23%) of the possible time only. Delays and interruptions were generally not recalled by the participants. Compared with teams with late arriving residents, teams with early arriving residents administered more countershocks: 4.5 (IQ, 2) vs. 3.5 (IQ, 1.5; p = .026). Conclusions:First responders in intensive care often failed to build a team structure that ensured timely, effective, monitored, and ongoing team activity. The early availability of a physician increased the number of countershocks administered. Self-reporting is unsuitable to reliably assess the quality of cardiopulmonary resuscitation.

Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study

IntroductionThe Glasgow Coma Scale (GCS) is the most widely used scoring system for comatose patients in intensive care. Limitations of the GCS include the impossibility to assess the verbal score in intubated or aphasic patients, and an inconsistent inter-rater reliability. The FOUR (Full Outline of UnResponsiveness) score, a new coma scale not reliant on verbal response, was recently proposed. The aim of the present study was to compare the inter-rater reliability of the GCS and the FOUR score among unselected patients in general critical care. A further aim was to compare the inter-rater reliability of neurologists with that of intensive care unit (ICU) staff.MethodsIn this prospective observational study, scoring of GCS and FOUR score was performed by neurologists and ICU staff on 267 consecutive patients admitted to intensive care.ResultsIn a total of 437 pair wise ratings the exact inter-rater agreement for the GCS was 71%, and for the FOUR score 82% (P = 0.0016); the inter-rater agreement within a range of ± 1 score point for the GCS was 90%, and for the FOUR score 92% (P = ns.). The exact inter-rater agreement among neurologists was superior to that among ICU staff for the FOUR score (87% vs. 79%, P = 0.04) but not for the GCS (73% vs. 73%). Neurologists and ICU staff did not significantly differ in the inter-rater agreement within a range of ± 1 score point for both GCS (88% vs. 93%) and the FOUR score (91% vs. 88%).ConclusionsThe FOUR score performed better than the GCS for exact inter-rater agreement, but not for the clinically more relevant agreement within the range of ± 1 score point. Though neurologists outperformed ICU staff with regard to exact inter-rater agreement, the inter-rater agreement of ICU staff within the clinically more relevant range of ± 1 score point equalled that of the neurologists. The small advantage in inter-rater reliability of the FOUR score is most likely insufficient to replace the GCS, a score with a long tradition in intensive care.

Explicit Reasoning, Confirmation Bias, and Illusory Transactive Memory A Simulation Study of Group Medical Decision Making

Teamwork is important in medicine, and this includes team-based diagnoses. The influence of communication on diagnostic accuracy in an ambiguous situation was investigated in an emergency medical simulation. The situation was ambiguous in that some of the patients symptoms suggested a wrong diagnosis. Of 20 groups of physicians, 6 diagnosed the patient, 8 diagnosed with help, and 6 missed the diagnosis. Based on models of decision making, we hypothesized that accurate diagnosis is more likely if groups (a) consider more information, (b) display more explicit reasoning, and (c) talk to the room. The latter two hypotheses were supported. Additional analyses revealed that physicians often failed to report pivotal information after reading in the patient chart. This behavior suggested to the group that the chart contained no critical information. Corresponding to a transactive memory process, this process results in what we call illusory transactive memory. The plausible but incorrect diagnosis implied that the two lungs should sound differently. Despite objectively identical sounds, some physicians did hear a difference, indicating confirmation bias. Training physicians in explicit reasoning could enhance diagnostic accuracy.

Adverse effect of noise in the operating theatre on surgical-site infection

The aim of this pilot study was to evaluate the noise level in an operating theatre as a possible surrogate marker for intraoperative behaviour, and to detect any correlation between sound level and subsequent surgical‐site infection (SSI).

Illegitimate tasks as a source of work stress

Illegitimate tasks represent a task-level stressor derived from role and justice theories within the framework of “Stress-as–Offense-to-Self” (SOS; Semmer, Jacobshagen, Meier, & Elfering, 2007). Tasks are illegitimate if they violate norms about what an employee can properly be expected to do, because they are perceived as unnecessary or unreasonable; they imply a threat to ones professional identity. We report three studies testing associations between illegitimate tasks and well-being/strain. In two cross-sectional studies, illegitimate tasks predicted low self-esteem, feelings of resentment towards ones organization and burnout, controlling for role conflict, distributive injustice and social stressors in Study 1, and for distributive and procedural/interactional justice in Study 2. In Study 3, illegitimate tasks predicted two strain variables (feelings of resentment towards ones organization and irritability) over a period of two months, controlling for initial values of strain. Results confirm the unique contribution of illegitimate tasks to well-being and strain, beyond the effects of other predictors. Moreover, Study 3 demonstrated that illegitimate tasks predicted strain, rather than being predicted by it. We therefore conclude that illegitimate tasks represent an aspect of job design that deserves more attention, both in research and in decisions about task assignments.

All in the timing: Considering time at multiple stages of group research

The role of time in measuring group and team temporality constitutes more than a methodological issue—it is a theoretical question. That is, if group interaction is theorized as processual and processes occur through time, then research on team temporality, as well as a range of other issues, must grapple with the methodological implications of our theories. This article contributes to INGRoups aim to advance theory and methods for understanding groups by exploring methodological approaches that allow us to capture a variety of team processes over time. Three case studies address the practical issues involved with employing various types of time-sensitive data collection, time-dependent coding, and time-based analysis, including their advantages and disadvantages. Together, the authors describe diverse field and analytical methods useful for interrogating theoretical assumptions about time in groups. Doing so expands the notion of group temporality to consider the role of both epochal and fungible times at multiple stages of group research.