Interprofessional care for the ICU patient's family: solitary teamwork.

The aim of this study was to explore how interprofessional family care by ICU teams was reflected in their daily work. Data were collected from four ICUs in Norway. Fieldwork and focus groups with ICU nurses and physicians were conducted in addition to dyadic and individual interviews of surgeons and internists. In line with a constructivist grounded theory approach, the core category "solitary teamworking" was constructed. Together with three sub-categories, proximity and distance, silent interprofessional work and a connecting link, this core category conceptualizes interprofessional family care as a form of contradictory cooperation where physicians and nurses alternate between working alone and as a team. The sub-categories reveal three notable characteristics of interprofessional family care: (1) it is emotionally challenging, affected by proximity and distance to the families and between the clinicians, (2) it is silent, at a strategic and organizational level, and (3) nurses and family members have an essential role as a connecting link in the ICU team. Interprofessional family care needs strong involvement by an organization that supports and prioritizes family care, includes family members as an active part of the ICU team and emphasizes interprofessional dialogue.

Information concerning ICU patients' families in the handover-The clinicians' «game of whispers¼: A qualitative study.

AIMS AND OBJECTIVES: To explore how information concerning ICU patients´ families is included in the ICU clinicians' daily handover. BACKGROUND: Handover refers to the transfer of information and care responsibility between clinicians. An effective and precise handover are of great importance to ensure quality of care. Although improvements in handovers have received increasing attention in recent decades, little is known about how information about ICU patients' family members is included in handovers. DESIGN: A qualitative study using Charmaz' constructivist grounded theory approach. METHODS: Data were gathered through participant observation, focus groups, dyadic and individual interviews of physicians and nurses from four ICUs in different Norwegian hospitals. The data consist of 270 observation hours, seven focus groups, three dyadic interviews and two individual interviews. Field notes and transcribed interview data were analysed using constructivist grounded theory approach. COREQ checklist was applied as reporting guideline for this study. FINDINGS: "A game of whispers" emerged as the core category, representing missing information about the patient's family during the handover. Together with three subcategories: "documentation dilemmas," "being updated" and "talking together," the core category explains how transfer of family-related information between clinicians is continually processed and resolved. CONCLUSIONS: This study indicates challenges related to appropriate and high-quality handover concerning ICU patients´ families. Oral handovers are essential in terms of clinicians' need to elaborate on written information and update each other. However, oral transmission involves a high risk of information loss during the handover. Written documentation about the family seems to be inadequate and poorly structured. RELEVANCE TO CLINICAL PRACTICE: The study findings suggest a need for increased awareness in practice and research of the importance of transferring appropriate and reliable information about patients' families between ICU clinicians. User-friendly handover tools and patient records that include information on patients' family members should be developed.

Knowledge and Awareness of Non-Technical Skills Over the Course of an Educational Program in Nursing - A Repeated Cross-Sectional Study.

Background: Non-technical skills (NTS) play an important role in preventing adverse events during hospitalization. Knowledge, awareness and mastery of NTS becomes important key factors in preventing errors. Current status of students and supervisor's knowledge and awareness of NTS are needed in order to construct an educational plan for improvement. Purpose: To examine knowledge and awareness of NTS over the course of continuing education of nurse anaesthetists, emergency care nurses, critical care nurses, and operating room nurses. Methods: A descriptive, repetitive cross-sectional design with a questionnaire was used to evaluate knowledge and awareness in students and their supervisors about NTS at two different time points during the educational program. Cross tabulations were used in comparisons across specialties and between students and supervisors, frequencies to identify the levels of self-reported knowledge/importance/focus in clinical practice/ impact on adverse events. Results: The results showed that there was a numeric difference between the reported knowledge/focus in clinical practice on the one hand and importance/ impact on adverse events on the other, and that this gap was reduced after 12 months of education with special focus on NTS. There was no difference across specialties. Supervisors had higher focus on NTS in clinical practice and on the impact on adverse events, than students at both measurements. Conclusion: These data suggest that NTS may have important potential for improvement if included into learning programs both in education and clinical practice. Integration of NTS in various learning activities seems to strengthen students' competence about NTS.

Description of call handling in emergency medical dispatch centres in Scandinavia: recognition of out-of-hospital cardiac arrests and dispatcher-assisted CPR.

BACKGROUND: The European resuscitation council have highlighted emergency medical dispatch centres as an important key player for early recognition of Out-of-Hospital Cardiac Arrest (OHCA) and in providing dispatcher assisted cardiopulmonary resuscitation (CPR) before arrival of emergency medical services. Early recognition is associated with increased bystander CPR and improved survival rates. The aim of this study is to describe OHCA call handling in emergency medical dispatch centres in Copenhagen (Denmark), Stockholm (Sweden) and Oslo (Norway) with focus on sensitivity of recognition of OHCA, provision of dispatcher-assisted CPR and time intervals when CPR is initiated during the emergency call (NO-CPRprior), and to describe OHCA call handling when CPR is initiated prior to the emergency call (CPRprior). METHODS: Baseline data of consecutive OHCA eligible for inclusion starting January 1st 2016 were collected from respective cardiac arrest registries. A template based on the Cardiac Arrest Registry to Enhance Survival definition catalogue was used to extract data from respective cardiac arrest registries and from corresponding audio files from emergency medical dispatch centres. Cases were divided in two groups: NO-CPRprior and CPRprior and data collection continued until 200 cases were collected in the NO-CPRprior-group. RESULTS: NO-CPRprior OHCA was recognised in 71% of the calls in Copenhagen, 83% in Stockholm, and 96% in Oslo. Abnormal breathing was addressed in 34, 7 and 98% of cases and CPR instructions were started in 50, 60, and 80%, respectively. Median time (mm:ss) to first chest compression was 02:35 (Copenhagen), 03:50 (Stockholm) and 02:58 (Oslo). Assessment of CPR quality was performed in 80, 74, and 74% of the cases. CPRprior comprised 71 cases in Copenhagen, 9 in Stockholm, and 38 in Oslo. Dispatchers still started CPR instructions in 41, 22, and 40% of the calls, respectively and provided quality assessment in 71, 100, and 80% in these respective instances. CONCLUSIONS: We observed variations in OHCA recognition in 71-96% and dispatcher assisted-CPR were provided in 50-80% in NO-CPRprior calls. In cases where CPR was initiated prior to emergency calls, dispatchers were less likely to start CPR instructions but provided quality assessments during instructions.