Teamwork and team training in the ICU: Where do the similarities with aviation end?

Journal Club Article: Reader, T. W., & Cuthbertson, B. H. (2011). Teamwork and team training in the ICU: Where do the similarities with aviation end?Critical care15(6), 313.

Background

Comparing the lessons learnt and development of team training approaches in the aviation industry to the complex needs of the Intensive Care Unit (ICU). The importance of teamwork and the coordination of behaviours in terms of patient care provided and subsequent outcomes. Higher levels of doctor-nurse collaboration improve safety and mortality rates. The recognised importance of poor communication which has been identified as a factor in medical error.

Team input and team processes = team output

  • Teamwork

“Team skills are important for maintaining safety in both domains, as multidisciplinary teams must work effectively under highly complex, stressful, and uncertain conditions. ”

  • Active & Latent Failures

“team-related ‘active failures’ (for example, failures to communicate the proximity of nearby aircraft) and ‘latent failures’ (for example, lack of team training, poor ergonomic design, and organizational culture) that influence behavior and error in the cockpit.”

  • Decision Making Under Stress

“Techniques include exposing teams to high-stress situations, training pilots to facilitate team discussions before and after stressful team activities, and cross-training aircrew team members to understand the demands and needs of one another’s role. Teams are trained in a multidisciplinary environment…….”

  • Hierarchical Team Structures

The ability to understand other roles, so in stressful events still work together as a team and negative behaviours and attitudes don’t effect performance.

  • Environmental Factors

“Fatigue and stress are known to negatively influence performance in the ICU, and non-technical factors such as team communication, situation awareness, and decision making frequently underlie error.”

Developing a workplace culture based upon safety requires supporting and valuing staff in the high risk environment of ICU, with models of training and supervision that focuses not only on the norms of practice (normative) and educative training, but on restorative and supportive resources to improve stress and burnout, and aid personal development.

Keywords: Intensive Care Unit; Team Performance; Human FactorsTeam Training; Aviation Industry; Cognitive Load; Situation Awareness.

Relevant additional resources around some of the themes identified in this articles to aid collaborative educational teamwork:

 

 

 

Nursing Theories: Back to basics

Nursing is often voted the most trusting profession, is this due to the humanistic approach of traditional nursing or looking further back into the history of nursing and the vocational ‘Florence’ holistic caring approach? As nurses engage in technology to deliver care and encroach into areas of medicine to increase the nursing scope of practice, are we at risk of losing the therapeutic nurse-client relationship?  If we reflect on the fundamentals of nurse training, it was likely based around nurse theory and systems of care, and surprisingly not the core standards that hospitals use as measurements of quality that nurses are faced with on a day to day basis no matter what the level of acuity or staffing. Theorists and models of care such as Benner, Henderson,  Orem, Rogers, Roy and Roper, Logan & Tierney – and each country will likely have certain theories that form the backbone of its nurse training curriculum. Look at the concepts, and see we are still trying to encourage independence, return power to the patient, end pyjama paralysis, provide effective rehabilitation and ensure healthcare is evidence based and ideally available for all.

Keywords: Care, compassion, competence, communication, courage and commitment (The 6 C’s).

Below are some great online resources, don’t forget to revisit those text books gathering dust on your healthcare book shelf.

Books

Online Resources

 

 

 

Journal Club: Factors influencing nurses’ intentions to leave adult critical care

Journal Club Article: Khan, N., Jackson, D., Stayt, L., & Walthall, H. (2018). Factors influencing nurses’ intentions to leave adult critical care settingsNursing in critical care.

 

Background:

“Nurse retention is a global problem across all specialities but is exacerbated in critical care areas where elevated nurse–patient ratios and the use of advance technologies require greater numbers of highly educated and specialized nurses impacting costs and quality of patient care.”

Factors identified in previous research such as working conditions, burnout syndrome, organisational climate, staffing levels, empowerment, personal health and work pressure.

Relevance to practice:

“The shortage of critical care nurses is currently a global issue impacting costs and quality of patient care.”

Method:

A systematic mixed-method literature review.

Findings:

3 themes identified were quality of the work environment, nature of working relationships and traumatic/stressful workplace experiences.

  1. Quality of the work environment

Empowerment and professional development opportunities. Having enough time to recover from night shifts and the impact of inflexible rotations on work–life balance.

2. Nature of working relationships

When conflict occurs with families and relatives. Poor relationships between nurse to manager and nurse to physician, especially not being involved in the decision making process.

3. Traumatic/stressful workplace experiences

Futility in the level of care being provided, caring for the dying patient and decisions to forego life‐sustaining treatments.

Conclusion:

High nursing turnover is a global issue and nurse leaders in critical care areas need to take these findings into consideration when developing strategies to improve turnover and support strategies.

Keywords: Burnout; Culture: Nurse Retention; Stress; Teamwork.

Additional Resource: Best Nursing Degree from Shanna Shafer (BSN) regarding shortage of nurses and also nurse faculty in the US, and reshaping the future of nursing and nurse education.

 

The Top Ten Websites in Critical Care Medicine Education Today (Journal Club)

Journal Club Article: Wolbrink, T. A., Rubin, L., Burns, J. P., & Markovitz, B. (2018). The Top Ten Websites in Critical Care Medicine Education TodayJournal of intensive care medicine, 0885066618759287.

Background

Looks at the rapid growth of online educational resources in the critical care environment. From another review by Kleinpell et al (2011) which identified 135 websites, only 67 now are still available online. This demonstrates a rapidly changing environment and provides a rationale for this papers focus.

Methods

  • Literature review and web search.
  • Website assessment using the Critical Care Medical Education Website Quality Evaluation Tool (CCMEWQET).
  • Evaluation and ranking of identified websites.

Results

  • 97 websites relevant critical care websites were identified and scored.
  • Common types of resources, included blog posts, podcasts, videos, online journal clubs, and interactive components such as quizzes.
  • Almost one quarter of websites (n 22) classified as Free Open Access to Medicine (FOAM) websites.
  • Top 10 websites analysed and described. “Most often included an editorial process, high-quality and appropriately attributed graphics and multimedia, scored much higher for comprehensiveness and ease of access, and included opportunities for interactive learning.”

The Top Ten 

In alphabetical order:

FOAM Highlight

“The majority of FOAM website domains were not educational, nonprofit, or governmental. The FOAM websites were updated more recently than the other critical care medicine educational websites” (pg. 5).

References

Kleinpell, R., Ely, E. W., Williams, G., Liolios, A., Ward, N., & Tisherman, S. A. (2011). Web-based resources for critical care educationCritical Care Medicine39(3), 541-553.

Olusanya, O., Day, J., Kirk-Bayley, J., & Szakmany, T. (2017). Free Open Access Med (ical edu) cation for critical care practitionersJournal of Intensive Care Medicine.

Wolbrink, T. A., Rubin, L., Burns, J. P., & Markovitz, B. (2018). The Top Ten Websites in Critical Care Medicine Education TodayJournal of Intensive Care Medicine. 0885066618759287.

Mix It Up Book Club: The Classics

Inspiration and thought can come from an array of sources. I have recently tried to make a focused effort on adjusting the balance of healthcare and normal reading material that I read, incorporating the classics onto my ‘to do’ reading list. This approach is part of that work/life balance ethos that can become skewed when all your focus is on studies or completing a work based project. Avoiding that path to burnout is key.

Book Club:

  • Orwell, G. (1945). Animal Farm. New American Library.
  • Orwell, G. (1950). 1984. New American Library.

 

 

 

 

 

 

 

Avoiding the clear political messages, the importance of finding individuality and choice is very real when one considers the way social media platforms may track and direct our focus. Will future generations have a multitude of choice when engaging in life and work in the online world, or will only a handful of multinational corporations exist?

Keywords: Big Brother; Thought Police; Totalitarian Dystopia; Orwellian.

References

Orwell, G. (1945). Animal Farm. New American Library.

Orwell, G. (1950). 1984. New American Library.

Penguin Books (2018). Your Classic Books Reading Challenge.

Wikipedia (2018) Nineteen Eighty-Four.

Want Your Graduates to Succeed? Teach Them to Think!

Journal Club Article: Caputi, L. J., & Kavanagh, J. M. (2018). Want Your Graduates to Succeed? Teach Them to Think!. Nursing education perspectives39(1), 2-3. [abstract]

Thinkers and Knowledge Workers

This guest editorial discusses the importance and need for the preparation of new graduate nurses for the complex demands of professional practice they are about to enter. The challenge of the “explosion of knowledge, intensify the need to produce graduates able to succeed in the demanding world of healthcare as thinkers and knowledge workers.” 

The power to think in an age of information technology that brings information overload, add to this the increase in healthcare knowledge, research publications and curriculum content overload, the world the graduate nurse now enters is very different with each passing year and academia needs to deliver appropriate education.

Critical Thinking & Reasoning

The transition shock into practice from undergraduate to qualified nurse and the subsequent responsibilities are well known , with the subsequent impact on turnover rates for newly qualified nurses (Duchscher, 2009). Marry all this with increased inpatient acuity yet decreased length of hospital stay, and the healthcare system is a stressful and challenging work environment. Linking quality care delivery with the competency of the nurses is key, with critical thinking and reasoning, essential components of the preparation-practice gap.

Tanner’s Clinical Judgement Model

Academia must use a framework to teach clinical reasoning and clinical judgement such as Tanner’s (2006) 4 Step Approach to Clinical Reasoning:

  1. Noticing
  2. Interpreting
  3. Responding
  4. Reflecting

Summary

“The key to new-graduate success and improving patient outcomes might well lie in the way we teach students to think – something to think about.”

KeywordsCritical thinking; Knowledge worker; Reflection; Take the time; Motivation; Think, Think.

 

References

Caputi, L. J., & Kavanagh, J. M. (2018). Want Your Graduates to Succeed? Teach Them to Think!. Nursing education perspectives39(1), 2-3. [abstract]

Duchscher, J. E. B. (2009). Transition shock: the initial stage of role adaptation for newly graduated registered nursesJournal of advanced nursing65(5), 1103-1113.

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursingJournal of nursing education45(6).

Outliers: The Story of Success (Book Club)  

Book Club: Gladwell, M. (2008). Outliers: The Story of Success. Hachette UK. [sample here]

It’s More Than Just Talent

Outliers are “people who are invariably the beneficiaries of hidden advantages and extraordinary opportunities and cultural legacies that allow them to learn and work hard and make sense of the world in ways others cannot” (Gladwell, 2008).

Contributors To Success

    • Practice makes perfect- the 10,000 hours practice rule (Deliberate Practice).
    • The importance of cut off points in the calendar year in sport and schooling, related to age, development and subsequent opportunities.
    • Opportunity: the right time and place, what is happening to the wider world at the time of the person’s key development stages.
    • The impact of legacy.
    • Examples provided of the success stories of Bill Joy, Bill Gates & The Beatles.
    • IQ is not enough. The Terman IQ study of the gifted demonstrates that intelligence does not equal success (Terman, 1959).

Malcolm Gladwell Explains

 

References

Gladwell, M. (2008). Outliers: The story of success. Hachette UK. [sample here]

Kaufman, S. (2009). The Truth about the Termites. Psychology Today.

Nursing Education Network. (2017). Deliberate Practice: Practice like you play.

Terman, L. (1959). The Gifted Group at Mid-Life: Thirty-five Years Follow-up of the Superior ChildStanford University Press.

Wikipedia (2017) Outliers.

An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators

Journal Club Article: Breytenbach, C., ten Ham-Baloyi, W., & Jordan, P. J. (2017). An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators. Nursing Education Perspectives38(4), 193-197. [abstract]

Keywords: Evidence-Based Teaching; integrative review; teaching; nurse educator.

Background

Evidence-based teaching strategies in nursing education are fundamental to promote an in-depth understanding of information. The teaching strategies of nurse educators should be based on sound evidence or best practice.

Method

Integrative literature review of sixteen studies.

Findings

Eight teaching strategies were identified:

  1. E-learning
  2. Concept mapping
  3. Internet-based learning (IBL)
  4. Web-based learning
  5. Gaming
  6. Problem-based learning (PBL)
  7. Case studies
  8. Evidence-based learning (EBL)

The following three strategies of concept mapping, IBL and EBL provided the highest level increase in knowledge.

Conclusion

All teaching strategies enhanced the learning experience, but more research is needed. A multi-modal approach to teaching and delivering content is required to suit the content, situation and learner.

Reference

Breytenbach, C., ten Ham-Baloyi, W., & Jordan, P. J. (2017). An Integrative Literature Review of Evidence-Based Teaching Strategies for Nurse Educators. Nursing Education Perspectives38(4), 193-197. [abstract]

Journals For The Nurse Educator To Follow

Keeping up to date with the latest clinical nursing and healthcare developments is a challenging process, then throw in additional education focused literature and your into information overload territory.  To keep relevant and aware of current healthcare educational focused research, here are some resources that may help (no conflict of interest to report). As ever please add any suggestions of other resources you know about in the comments section at the bottom of this post and I will update the below resource list.

Journals To Follow: 

To organise your favourite journals or browse collections to keep up with the latest research:

A few predatory journals also exist out there in publishing land so beware.

The Chimp Paradox: Book Club

Book: Peters, S. (2013). The Chimp Paradox: The Mind Management Program to Help You Achieve Success, Confidence, and Happiness. Tarcher.

Optimising the Performance of the Human Mind: Steve Peters at TEDxYouth

References

Chimp Management (2017) The Chimp Model.

Fotheringham, A. (2012). Dr Steve Peters: From chimps to champs.

Peters, S. (2013). The Chimp Paradox: The Mind Management Program to Help You Achieve Success, Confidence, and Happiness. Tarcher.

Wikipedia (2017) Steve Peters (psychiatrist).