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Tschan, Franziska

Nom
Tschan, Franziska
Affiliation principale
Fonction
Professeure ordinaire
Email
franziska.tschan@unine.ch
Identifiants
https://libra.unine.ch/handle/123456789/497

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  • Publication
    Métadonnées seulement
    Leadership in different resuscitation situations
    (2014)
    Tschan, Franziska 
    ;
    Semmer, Norbert K.
    ;
    Hunziker, Sabina
    ;
    Kolbe, Michaela
    ;
    Jenni, Nadja 
    ;
    Marsch, Stephan U.
  • Publication
    Métadonnées seulement
    Impact 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
    ;
    Tschan, Franziska 
    ;
    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.
  • Publication
    Métadonnées seulement
    ABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial
    (2013-9-6)
    Marsch, Stephan U
    ;
    Tschan, Franziska 
    ;
    Semmer, Norbert
    ;
    Zobrist, Roger
    ;
    Hunziker, Patrick R
    ;
    Hunziker, Sabina
    QUESTIONS UNDER STUDY: After years of advocating ABC (Airway-Breathing-Circulation), current guidelines of cardiopulmonary resuscitation (CPR) recommend CAB (Circulation-Airway-Breathing). This trial compared ABC with CAB as initial approach to CPR from the arrival of rescuers until the completion of the first resuscitation cycle. METHODS: 108 teams, consisting of two physicians each, were randomized to receive a graphical display of either the ABC algorithm or the CAB algorithm. Subsequently teams had to treat a simulated cardiac arrest. Data analysis was performed using video recordings obtained during simulations. The primary endpoint was the time to completion of the first resuscitation cycle of 30 compressions and two ventilations. RESULTS: The time to execution of the first resuscitation measure was 32 ± 12 seconds in ABC teams and 25 ± 10 seconds in CAB teams (P = 0.002). 18/53 ABC teams (34%) and none of the 55 CAB teams (P = 0.006) applied more than the recommended two initial rescue breaths which caused a longer duration of the first cycle of 30 compressions and two ventilations in ABC teams (31 ± 13 vs.23 ± 6 sec; P = 0.001). Overall, the time to completion of the first resuscitation cycle was longer in ABC teams (63 ± 17 vs. 48 ± 10 sec; P <0.0001). CONCLUSIONS: This randomized controlled trial found CAB superior to ABC with an earlier start of CPR and a shorter time to completion of the first 30:2 resuscitation cycle. These findings endorse the change from ABC to CAB in international resuscitation guidelines.
  • Publication
    Métadonnées seulement
    Importance of leadership in cardiac arrest situations: from simulation to real life and back
    (2013-4-18)
    Hunziker, Sabina
    ;
    Tschan, Franziska 
    ;
    Semmer, Norbert
    ;
    Marsch, Stephan
    The 2010 American Heart Association guidelines now re- commend leadership training in Advanced Cardiac Life Support courses. In this review we provide a comprehens- ive summary of data derived from clinical studies that in- vestigated the importance of leadership in cardiopulmon- ary resuscitation (CPR). Only a few, mostly observational, studies have been conducted under real-life conditions be- cause of the high heterogeneity of the situations, diffi- culties in capturing the initial phase of CPR, and ethical issues. Well-controlled studies in the human simulator can fill existing gaps and provide important insights. High-fi- delity video-assisted simulator studies from different re- search groups have shown that a prolonged process of teambuilding is associated with significant shortcomings in CPR, whereas effective leadership improves team per- formance. In addition, randomised controlled studies have provided evidence that medical students receiving leader- ship training subsequently showed improved CPR perform- ance, which was sustained after a follow up of 4 months. In addition, leadership is influenced by gender and other factors such as emotional stress. Future studies are needed to investigate cultural differences and how findings from the simulator can be transferred to real-life situations.
  • Publication
    Métadonnées seulement
    Dynamics and association of different acute stress markers with performance during a simulated resuscitation
    (2012-5)
    Hunziker, Sabina
    ;
    Semmer, Norbert K.
    ;
    Tschan, Franziska 
    ;
    Schuetz, P
    ;
    Mueller, B
    ;
    Marsch, Stephan U
    AIM: Whether mental stress negatively impacts team performance during cardio-pulmonary resuscitation (CPR) remains controversial; this may partly be explained by differences in stress measures used in previous studies. Our aim was to compare self-reported, biochemical and physiological stress measures in regard to CPR performance. METHODS: This prospective, observational study was conducted at the simulator center of the University Hospital Basel, Switzerland. Self-reported (feeling stressed and overwhelmed [stress/overload]), biochemical (plasma cortisol) and physiological (heart rate, heart rate variability) stress measures were assessed in 28 residents (teams of 2) before, during and after resuscitation. Team performance was defined as time to start CPR and hands-on time during the first 180s. RESULTS: At baseline, significant negative correlations of heart rate variability with stress/overload and heart rate, as well as positive correlations of heart rate and cortisol were found. During resuscitation, self-reported, biochemical and physiological stress measures did not correlate significantly. There was no association of baseline stress measures with performance. During CPR, stress/overload was significantly associated with time to start CPR (regression coefficient 12.01 (95% CI 0.65, 23.36), p=0.04), while heart rate was negatively associated with time to start CPR (regression coefficient -0.78 (95% CI -1.44, -0.11), p=0.027) and positively with hands-on time (regression coefficient 2.22 (95% CI 0.53, 3.92), p=0.015). CONCLUSIONS: Self-reported stress (stress/overload) was the only predictor for low CPR performance. Biochemical measures showed no association, and physiological measures (heart rate) showed an inverse association, which may be due to physical activity, limiting its value as a mental stress marker in this acute setting
  • Publication
    Métadonnées seulement
    Leadership in medical emergencies is not gender specific - Reply
    (2012-4-2)
    Marsch, Stephan U
    ;
    Hunziker, Sabina
    ;
    Hunziker, Patrick
    ;
    Tschan, Franziska 
    ;
    Semmer, Norbert K.
  • Publication
    Métadonnées seulement
    Group research using high-fidelity experimental simulations
    (New York: Routledge, 2012)
    Tschan, Franziska 
    ;
    Semmer, Norbert K.
    ;
    Hunziker, Sabina
    ;
    Marsch, Stephan U
  • Publication
    Métadonnées seulement
    Group research unsing hihg-fidelity experimental simulations
    (New York: Routledge, 2012)
    Tschan, Franziska 
    ;
    Semmer, Norbert K.
    ;
    Hunziker, Sabina
    ;
    Marsch, Stephan U
  • Publication
    Métadonnées seulement
    Perceived stress and performance during a simulated resuscitation: A pilot study
    (2011-9-1)
    Hunziker, Sabina
    ;
    Laschinger, Laura
    ;
    Portmann, S
    ;
    Semmer, Norbert K.
    ;
    Tschan, Franziska 
    ;
    Marsch, Stephan U
  • Publication
    Métadonnées seulement
    Teamwork and Leadership in Cardiopulmonary Resuscitation
    (2011-3-8)
    Hunziker, Sabina
    ;
    Johansson, Anna C
    ;
    Tschan, Franziska 
    ;
    Semmer, Norbert K.
    ;
    Rock, Laura
    ;
    Howell, Michael D
    ;
    Marsch, Stephan U
    Despite 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.