IRF: Institutional Repository FHNW

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Publikation
Video analysis of real‐life shoulder dystocia to assess technical and non‐technical performance
(Wiley, 2024) Hjorth‐Hansen, Kristiane Roed; Rosvig, Lena; Hvidman, Lone; Kierkegaard, Ole; Uldbjerg, Niels; Manser, Tanja; Brogaard, Lise [in: Acta Obstetricia et Gynecologica Scandinavica]
AbstractIntroductionManaging obstetric shoulder dystocia requires swift action using correct maneuvers. However, knowledge of obstetric teams' performance during management of real‐life shoulder dystocia is limited, and the impact of non‐technical skills has not been adequately evaluated. We aimed to analyze videos of teams managing real‐life shoulder dystocia to identify clinical challenges associated with correct management and particular non‐technical skills correlated with high technical performance.Material and MethodsWe included 17 videos depicting teams managing shoulder dystocia in two Danish delivery wards, where deliveries were initially handled by midwives, and consultants were available for complications. Delivery rooms contained two or three cameras activated by Bluetooth upon obstetrician entry. Videos were captured 5 min before and after activation. Two obstetricians assessed the videos; technical performances were scored as low (0–59), average (60–84), or high (85–100). Two other assessors evaluated non‐technical skills using the Global Assessment of Team Performance checklist, scoring 6 (poor) to 30 (excellent). We used a spline regression model to explore associations between these two score sets. Inter‐rater agreement was assessed using interclass correlation coefficients.ResultsInterclass correlation coefficients were 0.71 (95% confidence interval 0.23–0.89) and 0.82 (95% confidence interval 0.52–0.94) for clinical and non‐technical performances, respectively. Two teams had low technical performance scores; four teams achieved high scores. Teams adhered well to guidelines, demonstrating limited head traction, McRoberts maneuver, and internal rotation maneuvers. Several clinical skills posed challenges, notably recognizing shoulder impaction, applying suprapubic pressure, and discouraging women from pushing.Two non‐technical skills were associated with high technical performance: effective patient communication, with teams calming the mother and guiding her collaboration during internal rotational maneuvers, and situation awareness, where teams promptly mobilized all essential personnel (senior midwife, consultant, pediatric team). Team communication, stress management, and task management skills were not associated with high technical performance.ConclusionsVideos capturing teams managing real‐life shoulder dystocia are an effective tool to reveal challenges with certain technical and non‐technical skills. Teams with high technical performance are associated with effective patient communication and situational awareness. Future training should include technical skills and non‐technical skills, patient communication, and situation awareness.
01A - Beitrag in wissenschaftlicher Zeitschrift
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Publikation
Teams an Fachhochschulen und Pädagogische Hochschulen – ein Ort der Kompetenzentwicklung?
(28.06.2024) Kocher, Mirjam; Stucki-Sabeti, Shiva; Vollmer, Albert; Zellweger, Franziska; Eckhardt, Christine; Strauss, Nina-Cathrin; Haldemann, Rea; Sender, Anna; Merz, Nora; Rack, Oliver
06 - Präsentation
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Publikation
Selbstorganisierte Teams in der Pflege und im Operationssaal: Ein Beitrag zum Fachkräftemangel
(17.09.2024) von Arx, Beatrice; Krause, Andreas
Selbstorganisierte Teams in der Pflege und im Operationssaal sind ein Weg, um dem Fachkräftemangel zu begegnen. Die Vor- und Nachteile dieser neuen Organisation werden anhand eines Praxisbeispiels aufgezeigt: Die Generationen Z und Y stellen klare Anforderungen an das Arbeitsumfeld, insbesondere mit Blick auf Freiräume zum selbständigen Arbeiten und klare Abgrenzungen zwischen Job und Freizeit. Mit den aktuellen, starren Strukturen in den Spitälern ist es schwierig, die jungen Generationen zu motivieren, in einem 24/7 Betrieb zu arbeiten. Sie möchten bei den Dienstplänen mitbestimmen und nicht von den Vorgesetzten verplant werden. Die Hirslanden Bern geht diese Herausforderungen mit mehreren Teams an. Mit drei Teams wurden im Jahr 2023 in einer Pilotphase die Planung der Dienstpläne neu ausgerichtet und hin zu selbstorganisierten Teams ausgeweitet. Im Beitrag stellt Beatrice von Arx ein Praxisbeispiel aus den Kliniken Hirslanden Bern vor und zeigt die Vor- und Nachteile dieser neuen Organisation auf. Gemeinsam mit Prof. Dr. Andreas Krause beleuchtet sie verschiedene Stolpersteine, welche bei der Einführung von selbstorganisierten Teams überwunden werden müssen und warum es eine es eine gute Abstimmung im Team sowie zwischen den Führungspersonen braucht.
06 - Präsentation
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Publikation
Exploring differences in patient participation in simulated emergency cases in co-located and distributed rural emergency teams – an observational study with a randomized cross-over design
(BioMed Central, 15.07.2024) Dubois, Hanna; Manser, Tanja; Häbel, Henrike; Härgestam, Maria; Creutzfeldt, Johan [in: BMC Emergency Medicine]
Abstract Background In northern rural Sweden, telemedicine is used to improve access to healthcare and to provide patient-centered care. In emergency care during on-call hours, video-conference systems are used to connect the physicians to the rest of the team – creating ‘distributed teams’. Patient participation is a core competency for healthcare professionals. Knowledge about how distributed teamwork affects patient participation is missing. The aim was to investigate if and how teamwork affecting patient participation, as well as clinicians’ perceptions regarding shared decision-making differ between co-located and distributed emergency teams. Methods In an observational study with a randomized cross-over design, healthcare professionals (n = 51) participated in authentic teams (n = 17) in two scripted simulated emergency scenarios with a standardized patient: one as a co-located team and the other as a distributed team. Team performances were filmed and observed by independent raters using the PIC-ET tool to rate patient participation behavior. The participants individually filled out the Dyadic OPTION questionnaire after the respective scenarios to measure perceptions of shared decision-making. Scores in both instruments were translated to percentage of a maximum score. The observational data between the two settings were compared using linear mixed-effects regression models and the self-reported questionnaire data were compared using one-way ANOVA. Neither the participants nor the observers were blinded to the allocations. Results A significant difference in observer rated overall patient participation behavior was found, mean 51.1 (± 11.5) % for the co-located teams vs 44.7 (± 8.6) % for the distributed teams (p = 0.02). In the PIC-ET tool category ‘Sharing power’, the scores decreased from 14.4 (± 12.4) % in the co-located teams to 2 (± 4.4) % in the distributed teams (p = 0.001). Co-located teams scored in mean 60.5% (± 14.4) when self-assessing shared decision-making, vs 55.8% (± 15.1) in the distributed teams (p = 0.03). Conclusions Team behavior enabling patient participation was found decreased in distributed teams, especially regarding sharing power with the patient. This finding was also mirrored in the self-assessments of the healthcare professionals. This study highlights the risk of an increased power asymmetry between patients and distributed emergency teams and can serve as a basis for further research, education, and quality improvement.
01A - Beitrag in wissenschaftlicher Zeitschrift
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Publikation
06 - Präsentation