Should the existing science of teams be applied to fluid teams? An exploration of fluid team effectiveness within the context of healthcare simulation.

Introduction: Fluid teams have become increasingly prevalent and necessary for modern-day issues, yet they differ from more traditional teams, on which much of the current teams literature is based. For example, fluid teams are often comprised of members from different disciplines or organizational divisions who do not have a shared history or future, as they come together to perform a critical, time-sensitive task, and then disband. For these reasons, the mechanisms through which they function and perform may differ from those of more traditional teams, and research is needed to better understand these differences. Methods: To this end, this study utilized critical incident techniques and thematic analysis to examine fluid teams within healthcare, one of the primary contexts in which they are prevalent. Interdisciplinary faculty and students in the medical field who encounter fluid teams within simulation-based education were prompted to reflect on key factors that facilitate or hinder fluid team effectiveness. Results: Primary themes extracted pertained to the conditions fluid teams operate within (e.g., high-stress), the behaviors and emergent states that contribute to their success (e.g., communication), and the KSAO's of value for members of fluid teams to possess (e.g., readiness). These themes were then compared to existing literature, yielding the identification of some similarities but also many important differences between fluid and traditional teams. Discussion: A series of practical recommendations for how to promote fluid team effectiveness is then presented.

Synthesizing implications of a collaborative project on socially sustainable housing policies for the aging population.

OBJECTIVE: Based on findings from four transdisciplinary original research studies on housing issues for the aging population, whereof three had a particular focus on marginalized groups, we report a co-produced synthesis of implications from a collaborative research project on socially sustainable housing policies. Researchers and non-academic partners in the ongoing Thematic Collaboration Initiative Social Rights and Housing for the Aging Population at Lund University collaborated in co-creative activities aiming at policy recommendations. RESULTS: Seven types of implications (i.e., themes) that represent macro and meso level approaches with potential to generate impact on social rights and housing for the aging population were identified. The content of legislation and regulations, financial institution strategies, and housing and neighbourhood development exemplify macro level implications. The three themes education and training, communicating with a diversity of stakeholders, and communicating with the public all relate to an overall need for integrated knowledge translation. The theme involving older adults as a resource delivered insight into underutilized capacities of the diverse target group. As the quest for integrated knowledge translation is growing stronger, this research note contributes to development of co-production approaches to synthesize implications of transdisciplinary collaboration, connecting research, practice and policy on societal challenges that ay population aging.

Developing guidance for the management of intraoperative anaesthetic machine failure.

Intraoperative anaesthetic machine failure represents an immediate risk to patient safety, as well as risking long-term harm in the form of accidental awareness under general anaesthesia. Currently, there is no widely accepted consensus guidance for the management of such an event. Based upon institutional experiences of anaesthetic machine failure and the principles of delivering good-quality care under emergency scenarios, we devised a single-sheet guideline for management of this event. This guidance assigns clear roles in the management of the event, identifies the key priorities for immediate care, and makes provisions for ensuring ongoing high-quality care following the event. Discussion is given to the rationale for the key components, and the importance of involving the whole perioperative team in developing such guidance. Further discussion involves the crucial elements of local implementation, making sure that guidance is location and personnel specific. Key future steps in this important patient safety project are also discussed.

Critical Incidents Scale for Ambulance Work - Denmark (CISAW-D): the development of a screening tool for work exposure to critical events in operative ambulance personnel.

Introduction: Critical incidents in ambulance work are not easily compared to other risk occupations. Understanding types of incidents that can be considered critical in operational ambulance work is important to prevent work-related post-traumatic stress (PTS). Aim: This study aimed to develop a scale of critical incidents in ambulance work and assess its predictive validity in relation to the severity of PTS symptoms. Methods: A total of 1092 open-ended descriptions from Danish ambulance personnel were content analysed to develop a categorical scale that identifies types of events perceived as critical to operative ambulance personnel. Multiple regression was used to assess whether the scale predicted PTS symptoms and to assess the cumulative effect of exposure to these events. Results: The study found that the 1092 descriptions of critical events could be condensed into 28 categories of critical events. These ranged from life-threatening situations and deaths, to more daily events such as handling strong emotional reactions from patients' relatives and working with terminally ill children. The frequency of events significantly predicted the severity of PTS symptoms with low to moderate effect (std beta = 0.2, t(375) = 3.7, p < .001), even when adjusting for known risk factors for post-traumatic stress disorder. Conclusion: This study showed that critical events in ambulance work included events that are not normally considered traumatic, and indicated that understanding the cumulative effect of these events is important when trying to prevent traumatic sequalae in ambulance personnel. The study highlighted the importance of increased focus on non-traumatic incidents that have an ongoing impact on paramedics' mental health and well-being. The Critical Incidents Scale for Ambulance Work - Denmark (CISAW-D) is a promising tool for systematic screening for exposure to critical events in ambulance work.

Exploring the meaning of critical incident stress experienced by undergraduate nursing students: A hermeneutic study.

AIM: To better understand the meaning of clinical related critical incident stress experienced by undergraduate nursing students. BACKGROUND: Undergraduate nursing students who engage in learning in the clinical practice setting may experience critical incidents. DESIGN: Gadamer's philosophical hermeneutics (1960/2013) was used to explore the meaning of clinical related critical incident stress experienced by undergraduate nursing students. METHODS: A purposive sample was used to recruit 11 students who were enrolled in a Canadian university baccalaureate nursing program. Data collection involved conducting semi-structured interviews over 10 months in 2020-2021. The interviews were recorded and transcribed verbatim and the data were analyzed using the interpretive method of hermeneutics. RESULTS: Findings from this research revealed that the student-teacher relationship was influenced by students' experiences of critical incident stress. Students' navigating uncertainty and the need to maintain the optic of perfection had a potential impact on the response to critical incidents. CONCLUSION: This study highlighted that critical incident stress may lead to distress associated with students' altered perception of nursing as a discipline and profession as well as created opportunity for new insights and possibilities.

The blame game- experiences of female residents in obstetrics & gynecology regarding lapses in patient safety.

Objectives: Primary objective was to explore experiences of female residents of Obstetrics and Gynecology (OB/GYN) regarding lapses in patient safety (PS) while secondary objective was to explore factors hampering or favouring improvement of PS in OB/GYN. Methods: In this qualitative narrative study carried out in OB/GYN department of Combined Military Hospital (CMH) Lahore for six months from 1st April to 30th September 2021, six fourth-year residents were asked to write narratives of their personal experiences of medical error (witnessed or committed) in detail and reflect on those experiences, which were then transcribed. Code labels and themes were assigned manually. Interpretation of these themes was done after thematic content analysis. Results: Six, fourth-year female residents with a mean age of 28.6±1.8 participated in the study. Two main themes with sub-themes were identified: 1) Challenges in patient safety (Personal challenges, Workplace challenges, Barriers to PS), 2) Lessons learnt from experiences (Self-improvement and; Promotion of patient safety culture). Heavy workload with long working hours, lack of communication and teamwork, lack of experience and inadequate supervision were major factors involved in PS lapses experienced by residents. Conclusion: Incidents of Patient Safety (PS) lapses had a strong impact on the emotional and professional life of residents. Formal PS training with improvement of working conditions may help promote PS culture.

Availability of opioid agonist treatment and critical incidents in Forensic Clinics for Dependency Diseases in Germany.

Background: Prevalence of substance use disorders, especially opioid use disorders, is high in patients admitted into forensic psychiatric settings. Opioid agonist treatment is a safe, well-established, and effective treatment option for patients that suffer from opioid dependence. Surprisingly, data on the availability and practice of opioid agonist treatment (OAT) options in German Forensic Clinics for Dependency Diseases is rare. Furthermore, essential data on the prevalence of critical incidents such as violent behavior, relapse, or escape from the clinic are missing for this particular treatment setting. Materials and methods: We conducted an observational study on all forensic addiction treatment units in Germany (Sect. 64 of the German Criminal Code). A questionnaire on the availability and practice of OAT was sent to all Forensic Clinics for Dependency Diseases in Germany. Following items were assessed: availability and the total number of patients that received an OAT in 2018, available medication options, specific reasons for start and end of OAT, number of treatments terminated without success, number of successful treatments, and critical incidents such as violent behavior, relapse, escape and reoffending. We compared the forensic clinics that offered OAT with those that did not offer this treatment option. The data were analyzed descriptively. Mean and standard deviation was calculated for metric scaled variables. For categorical variables, absolute and relative frequencies were calculated. The two groups (OAT vs. Non-OAT institutions) were compared concerning the given variables by either using Fishers exact test (categorical variables), t-test (normally distributed metric variables), or Wilcoxon-test (metric variables not normally distributed). Results: In total, 15 of 46 Forensic Clinics for Dependency Diseases participated in the study (33%). In total, 2,483 patients were treated in the participating clinics, 18% were relocated into prison due to treatment termination, and 15% were discharged successfully in 2018. 275 critical incidents were reported: violence against a patient (4%), violence against staff (1.6%), escape (4.7%) and reoffending in (0.5%). In seven clinics treating 1,153 patients, an OAT was available. OAT options in forensic clinics were buprenorphine/naloxone, buprenorphine, methadone, and levomethadone. Regarding critical incidents and successful discharge, no differences were detected in the clinics with or without an OAT. In the clinics that offered an OAT, we found a significantly higher rate of treatment termination without success (p < 0.007) in comparison to clinics without an OAT program. Ninety-nine patients received an OAT, and this treatment was ended due to illegal drug abuse (57%), refusal to give a urine drug sample (71%), and cases where the OAT was given away to other patients (85%). Conclusion: In Forensic Clinics for Dependency Diseases in Germany, OAT is not available in every institution, and thus, access is limited. Critical incidents such as violent behavior against staff or patients and escape are not uncommon in these forensic treatment settings. Further studies are needed to enhance the understanding of OAT practice and the risks for patients and staff.

Healthcare professionals' perceptions of interprofessional teamwork in the emergency department: a critical incident study.

BACKGROUND: Interprofessional teams contribute to patient safety during clinical care. However, little is known about how interprofessional teams manage and cope with critical incidents in the emergency department (ED). Therefore, the study aimed to describe healthcare professionals (HCPs) perceptions of critical incidents linked to the enablers of and barriers to interprofessional teamwork in a high-risk setting, the ED. METHODS: Individual interviews with HCPs regarding events at the ED were held during the period of May 2019-January 2020. The Critical Incident Technique approach was used to guide the interviews and the qualitative analysis. Data were analyzed inductively using qualitative content analysis. RESULTS: Interview participants (n = 28) included 7 physicians (25%), 12 registered nurses (43%), 7 nurse assistants (25%) and 2 administrators (7%). Overall, 108 critical incidents were described. Eight categories that described functional and dysfunctional experiences within interprofessional teamwork were identified: salience of reflection; professional experience makes a difference; demanding physical and psychosocial work environment; balancing communication demands; lacking management support, structure, and planning; tensions between professional role and responsibility; different views on interprofessional teamwork; and confidence in interprofessional team members. CONCLUSION: Findings of this study indicate that poor ED-specific communication and limited professional experience are essential factors in handling critical incidents related to interprofessional teamwork. An important aspect of critical incident management is the ergonomics of the physical work environment and how it enables interprofessional teamwork. This study emphasizes the factors enabling interprofessional teamwork to manage critical incidents in the complex working environment of the ED.

Mortality Salience Effects of Critical Incidents - A Systematic Literature Review and Research Agenda.

Critical incidents (CI) trigger acute stress reactions and psychological trauma because of direct or vicarious exposure. These events include natural disasters, wars, terrorist attacks and pandemics, and usually result in deaths and serious physical injuries. Their life-threatening nature makes them reasonable candidates to induce mortality salience (MS). The current review aims to consolidate Terror Management Theory (TMT) research using CIs as MS. A systematic literature review was conducted. Overall, 74 articles with 113 studies were included. Through this review, strong support for MS effects of CI has been found. Consistent with TMT, CIs tend to trigger worldview defence, self-esteem enhancement and relationship seeking. CIs have also been found to impact negatively on individual well-being and organisational health. Recommendations specific to crisis interventions and well-being will be discussed. The review concludes with potential future research directions to strengthen and expand empirical knowledge in CI salience.

Critical incident exposure among custody and noncustody correctional workers: Prevalence and impact of violent exposure to work-related trauma.

BACKGROUND: Correctional workers are at high risk for exposure to trauma, both as direct violence and as threats to their safety and well-being. The distress associated with these critical incidents (CIs) affects mental and physical health. Current tools are limited for detecting CIs in this workforce and are therefore insufficient for addressing correctional worker trauma. METHODS: Community prison employees (N = 105) self-reported CIs using the adapted Correctional Worker Critical Incident Survey (CWCIS). We examined: (1) prevalence of CIs and occurrences, (2) differences in exposures to CIs by custody and noncustody staff, and (3) differences in job satisfaction, posttraumatic stress (PTSD), lower back disease, and health behaviors, such as missed work and sleep. RESULTS: CIs occurred among most staff (59%) and more often for custody staff as compared to noncustody staff. CIs most often experienced were coworker injury, exposure to disease, and badly beaten adults (frequency 10-50). For the 1-9 frequency category, the most described events were: seeing someone dying, life threatened, and coworker injury. PTSD was identified in 44% of staff, and those who experienced CIs reported lower job satisfaction, greater feelings of PTSD, and more work absences than those not experiencing CIs (p < 0.05). CONCLUSIONS: CIs and PTSD are prevalent among custody and noncustody correctional workers; and job dissatisfaction, PTSD, and work absence are significantly worse for those who experienced CIs. The CWCIS detected CIs; future study is needed to inform trauma prevention, reduction, and rehabilitation interventions specific to correctional work.

Exploring Senior High School Students' English Learning Demotivation in Mainland China.

In the last 20 years, much attention has been paid to learners' demotivation. Researchers have conducted many studies on second/foreign language learning demotivation from the perspectives of social culture, social psychology, and so forth. In China, related studies have mainly focused on college students' demotivation; scant attention has been paid to senior high school students. Regarding scale development, although much progress has been made, there remains a need for a scale with high reliability and validity that is suitable for students in the basic education stage. Therefore, based on previous studies and choosing Chinese senior high school students as participants, this research study developed a scale with 55 items, and exploratory factor analysis (EFA) was used to develop a 28-item scale with six dimensions. The six-dimensional construct encompasses teacher knowledge, important others, teacher responsibility, learner-related factors, learning contents, and critical incidents, which are the key factors leading to English learners' demotivation. Among them, the factor of critical incidents is new and has been overlooked by other researchers. Moreover, the descriptive analysis demonstrated the degree to which the demotivators influence learners, and the independent samples t-test found a significant difference in the impact of critical incidents in terms of the students' language proficiency. Ultimately, four suggestions are put forward to remotivate and sustain learners' motivation.

Exposures to Potentially Psychologically Traumatic Events Among Provincial Correctional Workers in Ontario, Canada.

We know little about potentially psychologically traumatic events (PPTE) exposures among provincial correctional workers in diverse occupational positions and even less regarding how exposure to events are associated with mental health disorders. We designed the current study to unpack and quantify estimates of the frequencies that correctional workers, across occupational roles, experience exposure to diverse incidents. We categorized 1,338 of our 1,487 participants into six occupational categories and our measures included established self-report items measuring PPTE exposure and mental disorder symptoms. Almost all correctional workers reported exposures to most PPTE types. Correctional workers collectively report exposures to physical assault (90.2%) and sudden violent death (81.8%), with many (3.1%-46%) reporting 11+ exposures (M = 10.01, SD = 4.29). We found significant differences in exposure patterns across correctional worker categories; specifically, we found a higher prevalence of exposure to toxic substances, physical assault, assault with a weapon, severe human suffering, sudden accidental or sudden violent death, among those working in institutional correctional services (e.g., governance, correctional officers). PPTE exposure and all assessed mental health disorder symptom profiles were closely related, as correctional workers report high exposure to PPTE. Population attributable fractions indicated that the burden of mental disorders among provincial correction workers might be reduced by between 38%-70% if PPTE exposures were eliminated from the population. We conclude with recommendations for mental health related policies, such as investing in peer and psychologically support, as well as interventions for exposure to PPTE and readiness to inform strategies for employee mental health and well-being.

Medication errors, critical incidents, adverse drug events, and more: a review examining patient safety-related terminology in anaesthesia.

Literature focused on quantifying or reducing patient harm in anaesthesia uses a variety of labels and definitions to represent patient safety-related events, such as 'medication errors', 'adverse events', and 'critical incidents'. This review extracts and compares definitions of patient safety-related terminology in anaesthesia to examine the scope of this variability and inconsistencies. A structured review was performed in which 36 of the 769 articles reviewed met the inclusion criteria. Similar terms were grouped into six categories by similarities in keyword choice (Adverse Event, Critical Incident, Medication Error, Error, Near Miss, and Harm) and their definitions were broken down into three base components to allow for comparison. Our analysis found that the Medication Error category, which encompasses the greatest number of terms, had widely variant definitions which represent fundamentally different concepts. Definitions of terms within the other categories consistently represented relatively similar concepts, though key variations in wording remain. This inconsistency in terminology can lead to problems with synthesising, interpreting, and overall sensemaking in relation to anaesthesia medication safety. Guidance towards how 'medication errors' should be defined is provided, yet a definition will have little impact on the future of patient safety without organisations and journals taking the lead to promote, publish, and standardise definitions.

Prospective analysis of intraoperative critical incidents relevant to anaesthesia in a tertiary care teaching hospital in India.

Background and Aims: Critical incidents associated with anesthesia can affect the patient's outcome, may cause transient damage, and contribute to mortality. We aimed at recording anesthesia-related critical incidents in patients undergoing general surgical, ear, nose, and throat (ENT) and orthopedic surgical procedures in our institution. The critical incidents data were analyzed regarding the cause to establish protocols to prevent recurrences. Material and Methods: We conducted a prospective analysis of voluntarily reported perioperative critical incidents occurring in patients subjected to anesthesia over 1 year. Critical incidents were noted in terms of time (while inducing/intraoperative/while extubating), location (operating theater/recovery room) of the incident, anesthesia-related or surgery-related complications. Data collected were expressed as numbers and proportions to calculate incidence. Results: Anesthesia was administered to 5,645 patients of which 131 (2.32%) patients had critical incidents. Of these 131, 46 (35.11%) patients had more than one critical incident. A total of 216 (3.82%) critical incidents were noted. A majority of the patients were in the age range of 51-60 years. The maximum incidents occurred during the intraoperative period (35.11%) and in the operating theater (86.25%). Of the 216 incidents, 154 (71.30%) were anesthesia-related, 18 (8.33%) were surgery-related, 1 (0.46%) was patient-related and 43 (19.91%) were recovery-related. Of the 216 incidents, cardiovascular-related incidents accounted for the maximum incidents (18.05%, n = 39). Most of the events were preventable. Conclusion: The critical incident reporting system should be encouraged and protocols established to reduce the frequency and severity of these occurrences.

Police Stress and Deleterious Outcomes: Efforts Towards Improving Police Mental Health.

Police officers are subjected, daily, to critical incidents and work-related stressors that negatively impact nearly every aspect of their personal and professional lives. They have resisted openly acknowledging this for fear of being labeled. This research examined the deleterious outcomes on the mental health of police officers, specifically on the correlation between years of service and change in worldviews, perception of others, and the correlation between repeated exposure to critical events and experiencing Post-Traumatic Symptoms. The Cumulative Career Traumatic Stress Questionnaire- Revised (Marshall in J Police Crim Psychol 21(1):62-71, 2006) was administered to 408 current and prior law enforcement officers across the United States. Significant correlations were found between years of service and traumatic events; traumatic events and post-traumatic stress symptoms; and traumatic events and worldview/perception of others. The findings from this study support the literature that perpetual long-term exposure to critical incidents and traumatic events, within the scope of the duties of a law enforcement officer, have negative implications that can impact both their physical and mental wellbeing. These symptoms become exacerbated when the officer perceives that receiving any type of service to address these issues would not be supported by law enforcement hierarchy and could, in fact, lead to the officer being declared unfit for duty. Finally, this research discusses early findings associated with the 2017 Law Enforcement Mental Health and Wellness Act and other proactive measures being implemented within law enforcement agencies who are actively working to remove the stigma associated with mental health in law enforcement.

Actions taken affecting lead time in the care pathway for low-priority patients with a suspected stroke: A critical incident study.

BACKGROUND: The time delay from alerted ambulance to arrival at the stroke unit is crucial for patients suffering a suspected stroke. This is a recognized problem why additional explorative knowledge regarding actions taken are needed. AIM: To explore actions taken by nurses that affect lead times in the care pathway from the alerted ambulance to the stroke unit, for low-priority patients suffering a suspected stroke. METHOD: The design of the study was explorative and descriptive and used a qualitative approach based on Critical Incident Technique (CIT). Twenty-two nurses involved in the stroke care pathway at an university hospital in western Sweden were interviewed about their actions that affected the lead time. RESULTS: Actions undertaken affected lead time in the stroke care pathway for low-priority patients related to "promoting the care chain process" and "taking control of the situation". CONCLUSIONS: The staff within all parts of the care pathway affected the lead time, individually as well as via interaction between departments. This calls for the need of further collaboration and consensus concerning how to facilitate a smooth care pathway.

Dimensions of hospital workplace violence: Patient violence towards the healthcare team.

AIMS AND OBJECTIVES: To investigate the cognitive dimensions nurses use when perceiving patient-to-healthcare provider workplace violence. BACKGROUND: The concept of workplace violence, especially with respect to healthcare settings, has been well documented. Healthcare workers are at particular risk for experiencing violence from their patients, though these incidents often go unreported. Experiencing violence in the workplace has been associated with numerous negative outcomes, including absenteeism, burnout and diminished quality of care. However, little emphasis has been placed on understanding the concept of violence itself, or why one type of violence might go unreported whilst another is readily communicated to officials. DESIGN: A card-sorting, multidimensional scaling design. METHODS: Thirty two nurses completed the card-sorting task. Using multidimensional scaling (MDS), 75 reported incidents of violence were considered. SPIRIT research reporting checklist followed. RESULTS: Nurses categorise patient violence in three dimensions: physical versus verbal, active versus threatening and more versus less severe. Implications for further research and intervention are discussed. CONCLUSIONS: Violence in the hospital workplace is a complex perception by the healthcare worker that cannot be captured by a single dimension. RELEVANCE TO CLINICAL PRACTICE: This study provides a theoretical framework for understanding the complexity of patient-to-provider violence in a hospital setting. It sheds light on why only a minority of such events are reported. This model can serve as a foundation for future research exploring interventions for hospital violence.