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- PublicationMétadonnées seulementActivities during interruptions in cardiopulmonary resuscitation: a simulator study(2011)
; ;Vetterli, Maria ;Semmer, Norbert K. ;Hunziker, SabinaMarsch, Stephan UOBJECTIVE: Studies investigating the quality of cardiopulmonary resuscitation (CPR) have revealed frequent unnecessary interruptions of life support. The primary objective of the study is to analyze what happens during interruptions. We investigated (a) whether interruptions are filled with "secondary activities", i.e., activities only indirectly related to the primary task of providing life support (e.g., preparatory and diagnostic activities), and (b) whether all group members focus on the same secondary activity during interruptions, thus impeding group coordination, and detracting from the primary task of providing life support. DESIGN: Prospective observational study. SETTING: Twenty teams of general practitioners were videotaped during a simulated cardiac arrest. OUTCOME MEASURES: Resuscitation performance was assessed as hands-on time according to resuscitation guidelines. Unnecessary interruptions were defined as periods the patient received no hands-on support. RESULTS: Teams of general practitioners achieved hands-on time in accordance with the resuscitation guidelines (chest compression/ventilation/defibrillation) during 62% of the time the patient had no pulse. Unnecessary interruptions consumed 32% of the available time. During most of the unnecessary interruption time, team members engaged in secondary medical activities, particularly observing the monitor (47%) and dealing with the defibrillator (47%). During 56% of the unnecessary interruption time, all team members focussed their attention on the same secondary activity, thus neglecting the need for task distribution among team members. CONCLUSIONS: Unnecessary interruptions of CPR occur frequently and consume approximately one-third of the time patients should receive continuous life support. Unnecessary interruptions are mainly characterized by secondary medical activities that may be perceived as meaningful. During the majority of unnecessary interruptions, all team members focus on the same secondary activity, indicating shortcomings in task distribution in the resuscitation team. The findings emphasize the importance of team training with particular emphasis on situational awareness and task distribution.
- PublicationMétadonnées seulementLeadership in medical emergencies depends on gender and personality(2011)
;Streiff, Seraina ; ;Hunziker, Sabina ;Buehlmann, Cyrill ;Semmer, Norbert K. ;Hunziker, PatrickMarsch, Stephan UNTRODUCTION: Leadership is an important predictor of team performance in medical emergencies. There are no data on why some healthcare workers take the lead in emergencies while others do not. Accordingly, the aim of the study was to determine predictors of leadership in a medical emergency. METHODS: Two hundred thirty-seven medical students in fourth year of medical school participated and filled in a questionnaire assessing knowledge, experience, and personality traits. Students were randomly assigned to 79 groups of three. Each group was confronted with a standardized scenario of a simulated witnessed cardiac arrest. The primary outcome was the predictors of the number of leadership statements during the first 3 minutes of the cardiac arrest. RESULTS: In the first 3 minutes of the cardiac arrest, the participants made a median of five leadership statements (range, 0-22; interquartile range, 2). Thirteen participants (5.5%) made no single leadership statement. Multivariate analysis revealed that male gender (unstandardized coefficient, 1.9; P = 0.01), extraversion (unstandardized coefficient, 0.9; P = 0.02), and agreeableness (unstandardized coefficient, -1.1; P = 0.023) predicted leadership statements. Context knowledge, context experience, and other personality traits had no significant effect on leadership. CONCLUSIONS: During the initial phase of a medical emergency, there is a substantial interindividual variation in the amount of leadership. Leadership behavior as assessed by the number of leadership statements is determined by gender and personality and not by knowledge or experience.
- PublicationMétadonnées seulementTeamwork and Leadership in Cardiopulmonary Resuscitation(2011-3-8)
;Hunziker, Sabina ;Johansson, Anna C ; ;Semmer, Norbert K. ;Rock, Laura ;Howell, Michael DMarsch, Stephan UDespite substantial efforts to make cardiopulmonary resuscitation (CPR) algorithms known to healthcare workers, the outcome of CPR has remained poor during the past decades. Resuscitation teams often deviate from algorithms of CPR. Emerging evidence suggests that in addition to technical skills of individual rescuers, human factors such as teamwork and leadership affect adherence to algorithms and hence the outcome of CPR. This review describes the state of the science linking team interactions to the performance of CPR. Because logistical barriers make controlled measurement of team interaction in the earliest moments of real-life resuscitations challenging, our review focuses mainly on high-fidelity human simulator studies. This technique allows in-depth investigation of complex human interactions using precise and reproducible methods. It also removes variability in the clinical parameters of resuscitation, thus letting researchers study human factors and team interactions without confounding by clinical variability from resuscitation to resuscitation. Research has shown that a prolonged process of team building and poor leadership behavior are associated with significant shortcomings in CPR. Teamwork and leadership training have been shown to improve subsequent team performance during resuscitation and have recently been included in guidelines for advanced life support courses. We propose that further studies on the effects of team interactions on performance of complex medical emergency interventions such as resuscitation are needed. Future efforts to better understand the influence of team factors (e.g., team member status, team hierarchy, handling of human errors), individual factors (e.g., sex differences, perceived stress), and external factors (e.g., equipment, algorithms, institutional characteristics) on team performance in resuscitation situations are critical to improve CPR performance and medical outcomes of patients.
- PublicationMétadonnées seulementPerceived stress and performance during a simulated resuscitation: A pilot study(2011-9-1)
;Hunziker, Sabina ;Laschinger, Laura ;Portmann, S ;Semmer, Norbert K. ;Marsch, Stephan U
- PublicationMétadonnées seulementHuman factors in the operating room-The surgeon's view(2012)
;Kurmann, Anita ; ;Semmer, Norbert K. ; ;Candinas, DanielBeldi, Guido
- PublicationMétadonnées seulementImpact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: A randomized controlled trial(2013-9-14)
;Hunziker, Sabina ;Pagani, Simona ;Fasler, Katrin ; ;Semmer, Norbert K.Marsch, Stephan U.Abstract Background: Cardiopulmonary resuscitation (CPR) causes significant stress, which may cause deficiencies in attention and increase distractibility. This may lead to misjudgements of priorities and delays in CPR performance, which may further increase mental stress (vicious cycle). This study assessed the impact of a task- focusing strategy on perceived stress levels and performance during a simulated CPR scenario. Methods: This prospective, randomized-controlled trial was conducted at the simulator-center of the University Hospital Basel, Switzerland. A total of 124 volunteer medical students were randomized to receive instructions about focusing on relevant task elements by posing two task-focusing questions (“what is the patient’s condition?”, “what immediate action is needed?”) when feeling overwhelmed by stress (intervention-group) or a control-group. The primary outcome was the perceived levels of stress and feeling overwhelmed (stress/overload); secondary outcomes were hands-on time, time to start CPR and number of leadership statements. Results: Participants in the intervention-group reported significantly less stress/overload levels compared to the control-group (mean difference: -0.6 (95%CI - 1.3, -0.1), p=0.04). Higher stress/overload was associated with less hands-on time. Leadership statements did not differ between groups, but the number of leadership statements did relate to performance. Hands-on time was higher in the intervention-group, but the difference was not statistically different (difference 5.5 (95%CI -3.1, 14.2), p=0.2); there were no differences in time to start CPR (difference -1.4 (95%CI - 8.4, 5.7), p=0.71). Conclusions: A brief task-focusing strategy decreased perceived stress without significantly affecting performance in a simulated CPR. Further studies should investigate more intense interventions for reducing stress.
- PublicationMétadonnées seulementLeadership in different resuscitation situations(2014)
; ;Semmer, Norbert K. ;Hunziker, Sabina ;Kolbe, Michaela ;Marsch, Stephan U.
- PublicationMétadonnées seulementIllegitimate tasks as a source of Work Stress(2015)
;Semmer, Norbert K. ; ;Meier, Laurenz L. ;Elfering, Achim ;Beehr, Terry A. ;Kaelin, Wolfgang
- PublicationMétadonnées seulementThe effect of positive events at work on after-work fatigue: They matter most in face of adversity(2011)
;Gross, Sven ;Semmer, Norbert K. ;Meier, Laurenz L ;Kälin, Wolfgang ;There is evidence that daily negative events at work enhance fatigue. In contrast, positive events may trigger processes that increase, but also processes that decrease, energetic resources. Accordingly, results regarding a main effect of positive events on fatigue have been mixed. However, a clearer pattern between positive events and fatigue can be expected under adverse circumstances (i.e., accumulation of negative events, high chronic stressors). Positive events may facilitate coping and accelerate recovery processes and, thus, reduce resource drain due to daily negative events and chronic stressors. Predicting fatigue in a diary study with 76 employees, we investigated interactions between daily positive events and (a) daily negative events and (b) chronic social stressors. Multilevel modeling revealed that negative but not positive events were associated with increased end-of-work fatigue. However, positive events interacted with negative events and with chronic social stressors. As expected, positive events were negatively associated with fatigue only on days with many negative events, but not so on days with few negative events. Analogously, positive events were negatively associated with fatigue only among employees with high, compared with low, chronic social stressors. We conclude that the beneficial short-term effects of positive events on energetic resources are largely confined to adverse circumstances. (PsycINFO Database Record (c) 2011 APA, all rights reserved)
- PublicationMétadonnées seulementPsychische Beanspruchung durch illegitime Aufgaben(Wiesbaden: Springer Fachmedien, 2013)
;Semmer, Norbert K. ; ;Meier, Laurenz L. ;Elfering, Achim ;Kälin, Wolfgang ;Immer schneller, immer mehr: Psychische Belastungen bei Wissens- und Dienstleistungsarbeit
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