Search

Background: During a critical event in the labor and delivery operating room, it is crucial for team members responding to the situation to be aware of the designated leaders. Visual and verbal cues have been utilized to designate leadership in various healthcare settings; however, previous research has indicated mixed results using visual cues for role designation., Methods: The purpose of this study was to explore the use of the red surgical hat as a visual cue of leadership during obstetric emergency simulation training. We used a mixed-methods design to analyze simulation-based education video and debriefing transcripts., Results: There was a statistically significant difference in the proportion of participants who declared leadership vs. those who donned the red hat. Participants were more likely to visually declare leadership utilizing a red surgical bouffant hat than to verbally declare leadership. Most participants indicated that observing the red hat to detect leadership in the operating room was more effective than when leaders used a verbal declaration to inform others who was leading., Conclusions: Our findings suggest that utilizing a visual cue of leadership with the red surgical bouffant hat improves participant perceptions of communication of the surgical team during an obstetrical critical event in a simulation environment., (© 2024. The Author(s).)

Background: The complexity of caring for patients with cancer has a direct impact on oncology nurses. When a patient with cancer experiences a critical health event, oncology nurses may have concerns about their ability to provide high-quality care for patients in the current healthcare environment. These concerns can negatively affect nurses' emotional well-being and lead to compassion fatigue and burnout., Objectives: This article aims to examine critical event debriefing and identify ways oncology nurses can implement a critical event debriefing framework into their clinical practice., Methods: A literature search was conducted in CINAHL® and PubMed® databases for articles related to critical event debriefing and compassion fatigue and burnout among oncology nurses. A case study demonstrates the use of critical event debriefing on an oncology unit., Findings: Critical event debriefing frameworks can enhance teamwork, help initiate process improvements, and offer psychological support to improve emotional well-being. Additional research is needed about the use of critical event debriefing as a solution to compassion fatigue and burnout among oncology nurses.

In Obstetrics and Gynecologic operating room emergencies, the surgeon cannot both operate and lead a suddenly expanded and redirected team response. However, one of the most often used approaches to interprofessional continuing education designed to improve teams' ability to respond to unanticipated critical events still emphasizes surgeon leadership. We developed Explicit Anesthesia and Nurse Distributed (EXPAND) Leadership to imagine a workflow that might better distribute emergency leadership task responsibilities and practices. The purpose of this exploratory study was to investigate teams' responses to distributing leadership during an interprofessional continuing education simulated obstetrical emergency. We used interpretive descriptive design in a secondary analysis of teams' post-simulation reflective debriefings. One-hundred sixty providers participated, including OB-Gyn surgeons, anesthesiologists, CRNAs, scrub technicians, and nurses. Using reflective thematic analysis, we identified three core themes: 1) The surgeon is focused on the surgical field, 2) Explicit leadership initiates a nurse transition from follower to leader in a hierarchical environment, and 3) Explicit distributed leadership enhances teamwork and taskwork. Continuing education which uses distributed leadership to improve teams' ability to respond to an obstetric emergency is perceived to enhance team members' response to the critical event . The potential for nurses' career growth and professional transformation was an unexpected finding associated with this continuing education which used distributed leadership. Our findings suggest that healthcare educators should consider ways in which distributed leadership may improve teams' response to critical events in the operating room., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: The paper examines the psychological facet of innocent suffering. One can find a description of this phenomenon in social psychology as a factor that affects the belief in a just world, but there is a lack of qualitative scientific data about related psychological features, processes, copings, and consequences on the personality level., Methods: To study innocent suffering, semi-structured in-depth interview was conducted (31 respondents, ~223 minutes per respondent, 6,924 min in total) aimed to gather data about the experiences of innocent sufferings happened to participants. For the analysis of texts, a narrative and content analysis are used within the framework of grounded theory. The reliability of the results is based on expert assessment., Results and Discussion: As a result, six essential properties of innocent sufferings were identified: complexity, stability, distress, injustice, casual incoherence, and breaks of integrity of a life story. The most "popular" life domains, in which participants reported about innocent sufferings, are violence, abuse (physical and psychological), and quitting romantic relationships. It is proposed a scientific definition of innocent suffering and the prototype of the phenomenon., Competing Interests: ES is the founder of 4xxi Software Ltd. The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Smirnov.)

Debriefing is an essential procedure for identifying medical errors, improving communication, reviewing team performance, and providing emotional support after a critical event. This study aimed to describe the current practice and limitations of debriefing and gauge opinions on the best timing, effectiveness, need for training, use of established format, and expected goals of debriefing among Portuguese anesthesiologists., Methods: We performed a national cross-sectional online survey exploring the practice of anesthesiologists' debriefing practice after critical events in Portuguese hospitals. The questionnaire was distributed using a snowball sampling technique from July to September 2021. Data were descriptively and comparatively analyzed., Results: We had replies from 186 anesthesiologists (11.3% of the Portuguese pool). Acute respiratory event was the most reported type of critical event (96%). Debriefing occurred rarely or never in 53% of cases, 59% of respondents needed more training in debriefing, and only 4% reported having specific tools in their institutions to carry it out. There was no statistical association between having a debriefing protocol and the occurrence of critical events ( P =.474) or having trained personnel ( P =.95). The existence of protocols was associated with lower frequencies of debriefing ( P =.017)., Conclusions: Portuguese anesthesiologists know that debriefing is an essential process that increases patient safety, but among those surveyed, there is a need for an adequate debriefing culture or practice., Trial Registration: Research registry 7741 (https://www.researchregistry.com/browse-the-registry#home)., Competing Interests: J. Berger-Estilita is an associate editor for BMC Medical Education and has received travel expenses from Medtronic for the Save the Brain Initiative training. The remaining authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of PBJ-Associação Porto Biomedical/Porto Biomedical Society.)

This paper examines responses to the 2015 terror attack on Charlie Hebdo , a French satirical magazine, amongst students in a secondary school in Berlin-Neukölln, Germany. The Charlie Hebdo attack occurred in the final weeks of a 19-month ethnographic study in the community. By analyzing the responses in the school to this critical event, we identify what is at stake for Muslim students. Students presented many explanations for why the attack happened, and opinions on whether the attackers' actions were justified. Staff were alarmed about students' viewpoints that they considered "extreme". These dynamics resulted in conflicts and misunderstandings amongst students, and between students and staff. Yet, we show that, rather than the violence itself, or questions about its legitimacy, it was everyday processes in students' lives - e.g., bullying, peer pressure and discrimination, and feelings of being misrepresented and misunderstood - that were central to students' reactions to the event. We suggest that to understand students' reactions, both the immediate and the broader socio-political contexts must be considered, particularly rising xenophobia and processes of polarization in Germany and Europe at large. We thus conclude that to understand young people's reactions to terrorist acts, we need to look beyond initial statements and explore ethnographically how wider contexts shape the actions, reactions, and future orientations of young Muslims in Europe.

Background: Nursing students often experience critical events in the clinical setting and clinical instructors may not be prepared to adequately support them. These students often feel alone and abandoned, increasing their risk of psychological distress., Purpose: A grounded theory study was conducted to explore pre-licensure nursing students' experiences of critical events in the clinical setting. Specific attention was paid to understanding how they are prepared for and supported before, during, and after critical events, and their experiences of psychological distress and psychological recovery., Method: Strauss and Corbin's Grounded Theory methodology was used for this study., Results: Fourteen undergraduate student nurses from universities in the western United States were interviewed. Ten concepts were identified, and a theory of Student Nurses' Experiences of Critical Events in the Clinical Setting emerged., Conclusion: Findings indicate that student nurses need active instructor and/or staff support during critical events, and pre-briefing whenever possible. Debriefing positively affected students' post-event stress response and lack of debrief was associated with post-event psychological distress. Support for students exposed to critical events during clinical experiences should continue in the days, weeks, and months following the event; clinical instructors need to be prepared to provide this support. All faculty members should monitor students for signs of psychological distress and better support students' mental health and emotional wellbeing., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aims and Objectives: The purpose of this paper is to enhance nursing and collaborative practice by presenting a concept analysis of clinical debriefing and introducing an operational definition., Background: Debriefing has taken many forms, using a variety of approaches. Variations and inconsistencies in clinical debriefing, and its related terms, still exist in the clinical setting., Design: Concept analysis., Methods: Walker and Avant's eight-step approach to concept analysis., Results: The defining attributes of clinical debriefing identified in this analysis are described as the five E's: educated/experienced facilitator, environment, education, evaluation and emotions. Antecedents identified in this analysis include the critical event, the desire or need to review such an event and the organizational awareness to execute clinical debriefs. The consequences of clinical debriefings are primarily advantageous and positively impact involved nurses, healthcare teams, patients and organizations. Empirical referents of clinical debriefing are complex and multifactorial. The productivity of a clinical debrief can be enhanced through a series of proposed questions. Together, the defining attributes, antecedents and consequences shape a proposed operational definition of clinical debriefing., Conclusion: Clinical debriefing is a valuable tool within healthcare organizations. Debriefing can be a holistic, interprofessional, collaborative experience when all five defining attributes are present. Further investigation is required to standardise debriefing practices in clinical settings., Relevance to Clinical Practice: A concept analysis on clinical debriefing promotes uniformity of debriefing practices, reflective practice among nurses and healthcare teams, and contributes to nursing science by creating a platform for the development of practice standards, research and theory development., (© 2021 John Wiley & Sons Ltd.)

Background: Failures in situation awareness cause two-thirds of anaesthesia complications. Avatar-based patient monitoring may promote situation awareness in critical situations., Methods: We conducted a prospective, randomised, high-fidelity simulation study powered for non-inferiority. We used video analysis to grade anaesthesia teams managing three 10 min emergency scenarios using three randomly assigned monitoring modalities: only conventional, only avatar, and split-screen showing both modalities side by side. The primary outcome was time to performance of critical tasks. Secondary outcomes were time to verbalisation of vital sign deviations and the correct cause of the emergency, perceived workload, and usability. We used mixed Cox and linear regression models adjusted for various potential confounders. The non-inferiority margin was 10%, or hazard ratio (HR) 0.9., Results: We analysed 52 teams performing 154 simulations. For performance of critical tasks during a scenario, split-screen was non-inferior to conventional (HR=1.13; 95% confidence interval [CI], 0.96-1.33; not significant in test for superiority); the result for avatar was inconclusive (HR=0.98; 95% CI, 0.83-1.15). Avatar was associated with a higher probability for verbalisation of the cause of the emergency (HR=1.78; 95% CI, 1.13-2.81; P=0.012). We found no evidence for a monitor effect on perceived workload. Perceived usability was lower for avatar (coefficient=-23.0; 95% CI, -27.2 to -18.8; P<0.0001) and split-screen (-6.7; 95% CI, -10.9 to -2.4; P=0.002) compared with conventional., Conclusions: This study showed non-inferiority of split-screen compared with conventional monitoring for performance of critical tasks during anaesthesia crisis situations. The patient avatar improved verbalisation of the correct cause of the emergency. These results should be interpreted considering participants' minimal avatar but extensive conventional monitoring experience., (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Many factors come together probabilistically to affect clinician response to critical events in the operating room; no 2 critical events are alike. These factors involve 4 primary domains: (1) the event itself, (2) the individual anesthetist(s), (3) the operating room team, and (4) the resources available and environments in which the event occurs. Appreciating these factors, anticipating how they create vulnerabilities for error and poor response, and actively addressing those vulnerabilities (before events occur as well as during) will help clinicians manage critical event response more effectively and avoid errors., (Copyright © 2020 National Aeronautics and Space Administration. Published by Elsevier Inc. All rights reserved.)

Traumatic aortic rupture (TAR) is a highly fatal injury mechanism resulting from blunt deceleration forces against the descending aorta. The mechanism of TAR is directly attributed to the aorta suffering damage by indirect shearing forces. The descending aorta remains fixed to the posterior chest wall, while the heart and ascending aorta are exerted forward, thus causing the intimal tear. A characteristic triad presents as increased blood pressure in the upper extremities, decreased blood pressure in the lower extremities, and a widened mediastinum on radiography. Early recognition of signs and symptoms of the mechanism of injury is key to initiating early damage control surgery and ultimately decreasing morbidity and mortality. This case report describes the intraoperative management of an elderly female patient with TAR following a motor vehicle collision in a remote location in rural Pennsylvania., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright© by the American Association of Nurse Anesthetists.)

Early recognition of intraoperative critical events is essential in optimizing the health outcomes of surgical patients. Use of simulation in nurse anesthesia education allows students to practice recognizing changes in the patient's condition in a safe learning environment. Second- and third-year student registered nurse anesthetists were randomly assigned to 2 groups to explore differences in recognizing intraoperative myocardial infarction (MI) using highfidelity mannequin simulation vs virtual simulation. One group participated in a virtual simulation first, followed by a high-fidelity mannequin simulation. The other group participated in a high-fidelity mannequin simulation first, then virtual simulation. Second-year students recognized an intraoperative MI faster when using high-fidelity mannequin simulation than when using virtual simulation. However, there was no significant difference among third-year students in the time it took to recognize a critical event when using high-fidelity mannequin simulation vs virtual simulation. These findings indicate that both simulation modalities are useful in evaluating student registered nurse anesthetists' timely recognition of intraoperative critical events such as MI. However, for students with less didactic and clinical practicum experience in the program, such as second-year students, the use of high-fidelity mannequin simulation for recognizing an intraoperative MI may be more beneficial than virtual simulation., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright© by the American Association of Nurse Anesthetists.)

Objectives: Public health interventions are increasingly represented as complex systems. Research tools for capturing the dynamic of interventions processes, however, are practically non-existent. This paper describes the development and proof of concept process of an analytical tool, the critical event card (CEC), which supports the representation and analysis of complex interventions' evolution, based on critical events., Methods: Drawing on the actor-network theory (ANT), we developed and field-tested the tool using three innovative health interventions in northeastern Brazil. Interventions were aimed to promote health equity through intersectoral approaches; were engaged in participatory evaluation and linked to professional training programs. The CEC developing involve practitioners and researchers from projects. Proof of concept was based on document analysis, face-to-face interviews and focus groups., Results: Analytical categories from CEC allow identifying and describing critical events as milestones in the evolution of complex interventions. Categories are (1) event description; (2) actants (human and non-human) involved; (3) interactions between actants; (4) mediations performed; (5) actions performed; (6) inscriptions produced; and (7) consequences for interventions., Conclusions: The CEC provides a tool to analyze and represent intersectoral internvetions' complex and dynamic evolution.

Most anesthesia providers will experience at least one perioperative critical incident during their career, potentially causing critical incident stress symptoms that may affect their ability to provide patient care. The purpose of this descriptive pilot investigation of Certified Registered Nurse Anesthetists (CRNAs) was to determine if their knowledge of the psychological and physical ramifications of critical incidents, coping strategies to deal with critical incident stress, and satisfaction with departmental handling of critical incidents improved when a formal, institutionally relevant critical incident stress management policy and protocol was developed and implemented. Knowledge of the effects of a critical incident, available coping strategies, and the perceived value of a stress management support protocol were assessed by surveys conducted before and after the implementation of a formal educational program. The results demonstrated that knowledge of critical incident stress and coping strategies improved with a staff educational program, with 25 of 26 respondents (96%) reporting that having a departmental critical incident stress management policy and protocol in place was valuable. This pilot investigation indicates that supportive protocols and education programs for critical incident stress management are beneficial and increase the CRNAs' confidence in their ability to cope with critical incidents., Competing Interests: The authors have declared no financial relationships with any commercial interest related to the content of this activity. The authors did not discuss off-label use within the article.

Objective: Identification of modifiable risk factors for hypotension during critical care transport is important to optimize patient preparation, crew training, and patient safety. We set out to determine the incidence of hemodynamic deterioration after administration of opioids or sedatives during critical care transport, and identify patient- and transport-level predictors., Methods: We assembled a retrospective cohort of adults undergoing urgent critical care transport between January 1, 2005, and December 31, 2010. The primary outcome was post-medication hypotension, defined by new hypotension or new vasopressor within 10 minutes of medication administration., Results: Opioids or sedatives were administered 28,592 times in 8,328 patient transports, with 159 episodes of post-medication hypotension (0.6% of all medication administrations). Mechanical ventilation (adjusted odds ratio [OR] 4.9; 95% confidence interval [95%CI] 2.7-8.9), baseline vasopressor requirement (adjusted OR 2.1; 95%CI 1.3-3.4), transport duration (adjusted OR 1.5; 95%CI 1.1-2.2) per log unit increment of duration), surgical diagnosis (adjusted OR 4.1; 95%CI 1.6-10.7 compared to trauma), and ACP crew level (adjusted OR 2.4 compared to baseline of CCP; 95%CI 1.5-3.8) were all associated with an increased odds of post-medication hypotension. ACP crew level remained associated with increased post-medication hypotension in a sensitivity analysis of 1,242 propensity-matched pairs (crude OR for ACP vs. CCP 3.0; 95%CI 1.4-6.5)., Conclusions: Post-medication hypotension occurred once in every 160 drug administrations and was associated with mechanical ventilation, baseline hemodynamic instability, transport duration, surgical diagnosis, and ACP crew. These findings provide targets for improvements in patient preparation, crew training, and clinical practices.