Maritha Jacobsson

Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training

Objectives Investigate the use of call-out (CO) and closed-loop communication (CLC) during a simulated emergency situation, and its relation to profession, age, gender, ethnicity, years in profession, educational experience, work experience and leadership style. Design Exploratory study. Setting In situ simulator-based interdisciplinary team training using trauma cases at an emergency department. Participants The result was based on 16 trauma teams with a total of 96 participants. Each team consisted of two physicians, two registered nurses and two enrolled nurses, identical to a standard trauma team. Results The results in this study showed that the use of CO and CLC in trauma teams was limited, with an average of 20 CO and 2.8 CLC/team. Previous participation in trauma team training did not increase the frequency of use of CLC while ≥2 structured trauma courses correlated with increased use of CLC (risk ratio (RR) 3.17, CI 1.22 to 8.24). All professions in the trauma team were observed to initiate and terminate CLC (except for the enrolled nurse from the operation theatre). The frequency of team members’ use of CLC increased significantly with an egalitarian leadership style (RR 1.14, CI 1.04 to 1.26). Conclusions This study showed that despite focus on the importance of communication in terms of CO and CLC, the difficulty in achieving safe and reliable verbal communication within the interdisciplinary team remained. This finding indicates the need for validated training models combined with further implementation studies.

Victim−offender mediation in Sweden: Is the victim better off?

In this article we analyse recorded verbal interactions between victims and offenders in the presence of mediators. Our aim is to illuminate how victims interact, communicate and position themselves in relation to the offender. We inquire whether victims benefit from verbal interaction with offenders during a process of mediation. According to this study there are no easy answers. Victims act in diverse ways depending on their aims and the situation. They may act as moral entrepreneurs, adopt consensus-seeking strategies or take oppositional positions. This research may be informative for those who are interested in which benefits victims can achieve when they communicate with offenders in the framework of restorative justice.

Touch massage, a rewarding experience

This study aims to describe and analyze healthy individuals’ expressed experiences of touch massage (TM). Fifteen healthy participants received whole body touch massage during 60 minutes for two separate occasions. Interviews were analyzed by narrative analysis. Four identifiable storyline was found, Touch massage as an essential need, in this storyline the participants talked about a desire and need for human touch and TM. Another storyline was about, Touch massage as a pleasurable experience and the participants talked about the pleasure of having had TM. In the third storyline Touch massage as a dynamic experience, the informants talked about things that could modulate the experience of receiving TM. In the last storyline, Touch massage influences self-awareness, the participants described how TM affected some of their psychological and physical experiences. Experiences of touch massage was in general described as pleasant sensations and the different storylines could be seen in the light of rewarding experiences.

Trauma team leaders’ non-verbal communication : video registration during trauma team training

BackgroundThere is widespread consensus on the importance of safe and secure communication in healthcare, especially in trauma care where time is a limiting factor. Although non-verbal communication has an impact on communication between individuals, there is only limited knowledge of how trauma team leaders communicate. The purpose of this study was to investigate how trauma team members are positioned in the emergency room, and how leaders communicate in terms of gaze direction, vocal nuances, and gestures during trauma team training.MethodsEighteen trauma teams were audio and video recorded during trauma team training in the emergency department of a hospital in northern Sweden. Quantitative content analysis was used to categorize the team members’ positions and the leaders’ non-verbal communication: gaze direction, vocal nuances, and gestures. The quantitative data were interpreted in relation to the specific context. Time sequences of the leaders’ gaze direction, speech time, and gestures were identified separately and registered as time (seconds) and proportions (%) of the total training time.ResultsThe team leaders who gained control over the most important area in the emergency room, the “inner circle”, positioned themselves as heads over the team, using gaze direction, gestures, vocal nuances, and verbal commands that solidified their verbal message. Changes in position required both attention and collaboration. Leaders who spoke in a hesitant voice, or were silent, expressed ambiguity in their non-verbal communication: and other team members took over the leader’s tasks.DiscussionIn teams where the leader had control over the inner circle, the members seemed to have an awareness of each other’s roles and tasks, knowing when in time and where in space these tasks needed to be executed. Deviations in the leaders’ communication increased the ambiguity in the communication, which had consequences for the teamwork. Communication cannot be taken for granted; it needs to be practiced regularly just as technical skills need to be trained. Simulation training provides healthcare professionals the opportunity to put both verbal and non-verbal communication in focus, in order to improve patient safety.ConclusionsNon-verbal communication plays a decisive role in the interaction between the trauma team members, and so both verbal and non-verbal communication should be in focus in trauma team training. This is even more important for inexperienced leaders, since vague non-verbal communication reinforces ambiguity and can lead to errors.

Trauma teams and time to early management during in situ trauma team training

Objectives To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training. Design In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma. Setting An emergency room in an urban Scandinavian level one trauma centre. Participants A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre. Primary outcome HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model. Results Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively). Conclusions Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload.

Victim offender mediation in Sweden : an activity falling apart?

In Sweden, the government has invested considerable resources to implement victim offender mediation (VOM) for young people (under the age of 21). Despite this, the number of mediations is decreasi ...

Classroom bodies : affect, body language, and discourse when schoolchildren encounter national tests in mathematics

ABSTRACT The aim of this paper is to analyse how Swedish grade three children are discursively positioned as pupils when they are taking national tests in mathematics and when they reflect on the testing situation afterwards. With support from theories about affective-discursive assemblages, we explore children’s body language, emotions, and talk in light of the two overarching discourses that we believe frame the classroom: the ‘testing discourse’ and the ‘development discourse’. Through the disciplinary power of these main discourses children struggle to conduct themselves in order to become recognized as intelligible subjects and ‘ideal pupils’. The analysis, when taking into account how affects and discourses intertwine, shows that children can be in ‘untroubled’, ‘troubled’, or ambivalent subject positions.