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:

 

 

 

Feynman Problem-Solving Algorithm

‘Why’ is the question to gain understanding. Don’t stop thinking: Ask questions, challenge orthodox thinking and be curious. Thinking like a scientist sounds an ideal approach for nursing education for a dynamic, critical thinking and evidence based curriculum. Feynman provides an energy and enthusiasm for teaching, and breaks down complex topics into relevant and meaningful content. Bill Gates on the great teaching skills of Feynman- The Best Teacher I Never Had.
“Feynman opposed rote learning or unthinking memorization and other teaching methods that emphasized form over function” (Wikipedia, 2018).
The Feynman Problem-Solving Algorithm

Fun To Imagine

Resources

Feynman, R. P., Leighton, R. B., & Sands, M. (2011). Six easy pieces: Essentials of physics explained by its most brilliant teacher. Basic Books.

The Feynman Lectures on Physics. (2013). The Feynman Lectures on Physics. California Institute of Technology.

Gates, B. (2016). The Best Teacher I Never Had. www.gatesnotes.com

Microsoft. (2009). Project Tuva: Richard Feynman’s Messenger Lecture Series.

Wikipedia. (2018). Richard Feynman.

Follow an honorary Twitter account on Richard P Feynman

Nursing Research Process: A Quick Guide

I am currently learning how to use SPSS for statistical analysis to enable some basic statistical analysis to be conducted in nursing research projects. The aim is to be able to run initial data analysis on small clinical focused projects and try to support other nursing colleagues in their project ideas (#community of practice). Understanding more about the data process and how to choose the correct statistical method is a complex process and an ongoing learning objective. Below are some introductory resources that may help you plan your project and provide helpful tips on how to save your data set, analyse the data, create demographic and result tables. Access to a statistician remains key, as they provide so much expertise and understanding around data analysis, and they provide a robustness to the results process. If you have useful research resources please post them in the comment section below and we can develop this post as an ongoing research resource for nurses. As I use SPSS on further projects, more resources will be added into this page.

The Research Question

Consider something that inspires, interests or annoys you- motivation is key, especially if the project is done in own time. Or a quality measure that will help change and enhance practice.

Background

Conduct a literature review to explore the background scientific findings on your topic and then provide a rationale for your study. Why is it important to conduct? Set out your aims and objectives, also any hypothesis if required. When analysing the evidence base, use expert resources such as Joanna Briggs Institute critical appraisal tools.

Study Design

Consider your topic and what data needs to collected to meet the aims and objectives. Will this be a quantitative or qualitative study?

Ethics

Before your collect any data, check in with your hospital or university ethics committee to see what level of ethics your project sits under. Be prepared for some form filling and some unique wordology. If you delve further into the history of ethical standards, be prepared for some moving and challenging cases.

Data Collection 

Prepare a data file, this will depend on the software you have access to. So far the easiest and cheapest way I have found is to use Xcel that can then normally be uploaded into a stats software package (accessed on a University computer) and you can use formula’s from this program to obtain most of the basic stats you will need for a first draft data analysis. Remember, have the variable along the x axis (across the top) and participant number along the y (down the side). Determine and define your variables, also create a code book to label any values. Borrow a book that can guide you through the research steps and the software program. This is the one I used: Pallant, J. (2013). SPSS survival manual. McGraw-Hill Education (UK). If you are a student, check with your university IT team to see what software you can access or download onto your personal computer.

Statistics

Get inspired by Florence Nightingale, who was much more than just the lady and the lamp. You will need to describe the setting, participants and statistical methods. Again a book with statistical advice on how to choose, run and review your result findings will be required, such as Tabachnick & Fidell (2007) Using multivariate statistics. Ideally have a statistician to mentor you through the process.

Results

Return to your literature review and see what types of figures and tables were published in the results sections and replicate this format so you can then compare your results to previous literature. Do the same with the demographic tables, helps determining if mean or median should be used (median more robust I hear you say).

Add these key results and link in with context of background discussion.  What are the implications from your findings, and also any limitations of the study.

Publication Time

Thinking around the bigger picture of healthcare research and publications. Positive or negative data results, we only see a biased picture in that often only positive trials are published so they are what influence healthcare practice.

Pick a journal that fits in with your topic or methodology. Check in with the publisher author guides if you aim to publish, and they will provide clear outlines for structure, content and referencing style.

Resources

Joanna Briggs Institute. (2017). Critical appraisal tools.

Pallant, J. (2013). SPSS survival manual. McGraw-Hill Education (UK).

Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics. Allyn & Bacon/Pearson Education.

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.

 

Eye Gazing

Do we interact and engage with our phones more than we do with our fellow humans? Interesting question, and this is where eye gazing comes in to remind us of the connection and interactions we make though our eyes. These are important questions as we spend our lives connected through work and play in an online world and in particular social media platforms. As the real world becomes entwined with virtual reality and robots, what will our lives look like in the future and how will humans connect? If technology increases in healthcare, what will the nurse-patient relationship look like?

Keywords: Trust, connection, healing, bonding, sacred, relaxing, spiritual.

Where Has Human Connection Gone?

 

Eye Gazing With Strangers

 

Resources

Kajimura, S., & Nomura, M. (2016). When we cannot speak: Eye contact disrupts resources available to cognitive control processes during verb generation. Cognition157, 352-357.  [abstract]

Nursing Education Network. (2018). Meet The Avatars: Virtual Reality and Virtual Humans.

SBS. (2018). Look Me In The Eye.

Resus Days

Practice Saving Lives While Playing a Game

Resus Days is a resuscitation game to help healthcare professionals practice some quick-thinking needed for care of cardiopulmonary emergencies. Using gamification to deliver a simulation game for cardiopulmonary resuscitation. Check the below resources, the first level is free to try it out.

The Blurb

Rehearse life-saving decision-making in a fun, game environment. Resus Days is a simulation game for healthcare professionals to practice some quick-thinking needed for care of cardiopulmonary emergencies. You are the team leader in the resuscitation team. Your task is resuscitate the patient until he is back to a normal heart rhythm (normal sinus rhythm). The game includes 7 levels covering cardiac arrest, bradycardia, tachycardia, and simulated megacode. The first level (cardiac arrest) is free to play. If you like it, an in-app purchase will unlock six additional levels.

Keywords: #resuscitology #gamification

The game homepage is: https://resusdays.com

 

 

 

Nursing & Democratic People’s Republic of Korea

This post is one of curiosity and interest in a socialist country that is largely a mystery of what occurs in everyday life. How is the healthcare system, what sort of technology and resources are available, what training do the nurses receive, is it hospital or university based? This post is not based on any knowledge other than searches from the internet and healthcare databases (Cinahl, Embase and Medline). It is also not a political post, so please add helpful and insightful resources focusing on healthcare into the comment’s section to build on the below resources. If anyone has any links to nursing schools in North Korea it would be amazing to hear about nurse training.

Search terms: Nursing and (North Korea or Democratic People’s Republic of Korea).

The formal searches yielded only one relevant article. Many articles exist but they focus on ethical and political viewpoints. Google search was more successful, but it is the unknown of the quality or true picture they provide. See below for resources.

WHO Stats:

  • Health System: Free access for all
  • Life Expectancy: Male 67/Female 74

Remember its very easy to get caught up in ‘our health system is the best’ mentality. When we look outside our own walls, there are some healthcare systems where the principles of ‘healthcare for all’ exist. An example is the Cuban healthcare system and also the work they do in training healthcare professionals in other nations. DPRK 360 provide a different perspective to North Korea, than portrayed in the media.

BBC Panorama: Inside North Korea (2017)

Resources

Barrett, J. (2011). The North Korean Healthcare System: On the Fine Line Between Resilience and Vulnerability.

Cha, J. (2015). Scenes from a North Korean Hospital. The Guardian.

DPRK 360. (2018) A different perspective to North Korea.

Kim, H. K., Lee, O. J., & Baumann, S. L. (2011). Nursing Practice with Families Without a Country. Nursing science quarterly, 24(3), 273-278. [abstract]

Kim, S. (2016). Comparison of North and South Korea Nursing Workforce Training System and Integration Plan. Advanced Science and Technology Letters. Vol.132 (Healthcare and Nursing 2016), pp.233-236.

Wikipedia (2017). Health in North Korea.

Wikipedia (2017). Pyongyang Maternity Hospital.

World Health Organisation. (2018). Democratic People’s Republic of Korea.

NNEC2018 Notes & Thoughts (Day 3)

3 days of education theory- lots of ideas, networking and moving into info overload territory.

Session: Building a Culturally Capable Nursing and Midwifery Workforce

Health For All: Inequalities for Indigenous Peoples

Cultural capability in healthcare and higher education for nursing.

Transformative unlearning and learning.

First Peoples Health Unit

The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) 

International Council of Nurses: Ethics and Human Rights

Australian Human Rights Commission

Aboriginal and Torres Strait Islander Health Strategy Group

‘gettin em n keepin em’ by the Indigenous Nursing Education Working Group 

Fact sheet- The health of Indigenous Peoples: a concern for nursing

Cultural capability framework

 

Session

Synergies Between Education and Healthcare

Focus: Using Educational Leadership Models in Nursing

Leadership framework (Drysdale & Gurr, 2012) – resources from the school sector.

  • Influencing others
  • Setting direction
  • Developing people
  • Developing the organisation
  • Teaching & learning

Educational models to guide development of nurse educators.

Resources

Gurr, D., & Drysdale, L. (2012). Tensions and dilemmas in leading Australia’s schools. School Leadership & Management32(5), 403-420.

Gurr, D. (2014). Successful school leadership across contexts and culturesLeading and Managing20(2), 75.

 

 

 

 

NNEC2018 Notes & Thoughts (Day 2)

Session: Changing World, Change in Clinical Practice

Focus: Overcoming the theory-practice gap

Research translation: slow process of change, translation of evidence

Deimplementation of Practice

The transition from hospital nurse education to Tertiary (university) sector.

Nurse researching and impact by Florence

Difficulty staying up to date through impact of information overload: volume of research, guidelines.

Value of systematic review- to make research manageable. Resources such as:

Resources

Donaldson, M. S., Corrigan, J. M., & Kohn, L. T. (Eds.). (2000). To err is human: building a safer health system (Vol. 6). National Academies Press.

Greenhalgh, T. (2014). How to read a paper: The basics of evidence-based medicine. John Wiley & Sons.

Greenhalgh, T., Howick, J., & Maskrey, N. (2014). Evidence based medicine: a movement in crisis?Bmj348, g3725.

Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: effective implementation of change in patients’ careThe lancet362(9391), 1225-1230.

McGlynn, E. A., Asch, S. M., & Kerr, E. A. (2003). Quality of health care delivered to adults in the United States-Reply. New England Journal of Medicine349(19), 1867-1868.

Niven, D. J., Mrklas, K. J., Holodinsky, J. K., Straus, S. E., Hemmelgarn, B. R., Jeffs, L. P., & Stelfox, H. T. (2015). Towards understanding the de-adoption of low-value clinical practices: a scoping reviewBMC medicine13(1), 255.

 

Session: Educating With The Brain in Mind

Sustainable transformational processes: thinking, practice and culture.

Neuroscience & collaboration (Rock & Cox, 2012): The SCARF® model stands for

  • Status,
  • Certainty,
  • Autonomy,
  • Relatedness and
  • Fairness

Challenge/support framework (Mariani, 1997).

The way the brain forms thoughts by Kahneman: System 1 and 2 (Thinking, fast and slow)

Resources

Kahneman, D. (2011). Thinking, fast and slow. Macmillan.

Mariani, L. (1997). Teacher support and teacher challenge in promoting learner autonomyPerspectives: A Journal of TESOL Italy, XXIII (2). 

Rock, D. (2010). The neuroscience of leadership (Doctoral dissertation, Middlesex University).

Rock, David, and Christine Cox. “SCARF in 2012: Updating the social neuroscience of collaborating with others.” NeuroLeadership Journal 4, no. 4 (2012): 1-16.

Session: Technology and online learning

  • CPD,
  • readiness to learn
  • core competencies
  • alignment between objectives and content (standardisation)

Resources

Blended Learning

Blended Synchronous Learning

Bower, M., Kenney, J., Dalgarno, B., Lee, M. J., Kennedy, G. E., Carter, H., … & Hedberg, J. (2013). Blended synchronous learning: Patterns and principles for simultaneously engaging co-located and distributed learnersElectric Dreams. Proceedings ascilite.

Prensky, M. (2001). Digital natives, digital immigrants part 1On the horizon9(5), 1-6.

Session:  Undergrad Systematic Review on Appraisal 

4 Themes of the review:

Systems Approach

 

Session: Preparing for Practice

  • Self efficacy

Babenko-Mould, Y., Andrusyszyn, M. A., & Goldenberg, D. (2004). Effects of computer-based clinical conferencing on nursing students’ self-efficacy. Journal of Nursing Education43(4), 149-155.

  • Preference for online learning & Task value

Artino Jr, A. R., & Stephens, J. M. (2009). Academic motivation and self-regulation: A comparative analysis of undergraduate and graduate students learning onlineThe Internet and Higher Education12(3-4), 146-151.

Some data analysis statistics: Cronbach’s alpha

Session: The Future of Nursing

Changing world of practice and graduate capabilities.

Missen, K., McKenna, L., & Beauchamp, A. (2014). Graduate nurse program coordinators’ perceptions of role adaptation experienced by new nursing graduates: A descriptive qualitative approachJournal of Nursing Education and Practice4(12), 134.

Missen, K., McKenna, L., & Beauchamp, A. (2016). Graduate nurse program coordinators’ perspectives on graduate nurse programs in Victoria, Australia: A descriptive qualitative approachCollegian23(2), 201-208.

Missen, K., McKenna, L., Beauchamp, A., & Larkins, J. A. (2016). Qualified nurses’ rate new nursing graduates as lacking skills in key clinical areas. Journal of clinical nursing25(15-16), 2134-2143.

End of day thought

Social Media: Low #SoMe engagement use across the conference, organisors and attendees included. Set up Symplur conference hashtag https://www.symplur.com/healthcare-hashtags/nnec2018/