Maria Birkvad Rasmussen
Supervisors: Doris Østergaard, Charlotte Ringsted, Peter Dieckmann and Barry Issenberg.
Funded by: TrygFonden
Doris Østergaard, Charlotte Ringsted, Peter Dieckmann, Barry Issenberg, Eldar Søreide, Jens Rosenberg, Martin Tolsgaard, Jonathan White and Pernille Plenge.
The overall aim of this thesis is to explore training and management of in-hospital resuscitation with focus on the individual; the team and the context in order to further develop training within this field.
This section includes a summary of the three explorative studies included in this thesis.
The first study was an interview study with the aim to learn more about the intended and unintended reactions and experiences of former ALS course participants. The study showed that the standardized algorithm-based course was perceived as being effective in teaching knowledge (algorithms (rules)) and skills, and through this, the participant's confidence in managing in-hospital emergencies was improved. Still, the participants stated that they were not able to apply the learned in in-hospital emergencies where their co-workers were not familiar with the same set of "rules", approach or "language". The study concluded that rules, algorithms and standards that improves efficiency seemed to be effectively trained in these courses, but that along with the right/wrong approach there was not room for training the innovative dimension, needed for adaptive learning and transfer of knowledge and skills to the clinical setting.
The second study aimed to test the findings from the first study in a larger population of former ALS course participants, and to further identify factors relating to the individual, the team, and the setting in emergencies managed well and not managed well respectively. The hypothesis was that by looking at both successes and failures it could to possible to identify factors contributing to efficient performance, and maybe identify potential aspects of the "innovative" dimension of managing in-hospital emergencies. The study demonstrated that three-fourth of the emergencies experienced after participation in an ALS course was perceived as being well managed, which confirmed the finding from study one that the course were perceived to be effective in teaching algorithms and improved participants confidence. There were though significant differences in individual and team factors between well and not well-managed emergencies. The individual providers' ability to apply ALS skills were perceived to be affected by both teamwork skills and co-workers skills. Team related factors associated with well-managed emergencies were related to aspects of coordination and communication, as well as respectful behavior and positive team atmosphere. Though the intensity of setting was identified as a factor perceived to affect management, this was not rated as high as individual and teams factors.
In study three we wanted to explore the team factors further. We changed our study population from former ALS course participants to intensive care unit staff, as we assumed that intensive care staff in general was more experienced individuals who work in an "established"/well defined context. The intensive care staff in this study reported that teamwork and performance in clinical emergencies were affected by team member's knowledge and experience as well as team coordination and team communication and that social relations within the team affected all these factors. Moreover, staff implied that the strength of the social relations affected the perceived importance of team members' knowledge and experience, staff's preferred choice of communication and coordination style, and the need for maintaining or creating formal or informal hierarchies, as well as promoting flexible or adaptive behavior.
Rasmussen MB, Dieckmann P, Barry Issenberg S et al: Long-term intended and unintended experiences after Advanced Life Support training. Resuscitation. 08/2012.
Rasmussen MB, Tolsgaard MG, Dieckmann P et al. Factors relating to the perceived management of emergency situations: A survey of former Advanced Life Support course participants' clinical experiences. Resuscitation 08/2014.