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Background Non-technical skills are the essential cognitive, social, and personal resources contributing to safe and efficient task performance. An assessment tool can facilitate the development and teaching of non-technical skills. The nurse anesthetist non-technical skills tool includes four categories and fifteen elements and is an adaptation of the existing tools for physician anesthetists and Danish nurse anesthetists. The ratings are on a five-step scale, with an option to select “Not Relevant”. Since there doesn’t exist an assessment tool for Swedish nurse anesthetists’ non-technical skills, the aim of the study was to translate and adapt the assessment tool for nurse anesthetists’ non-technical skills to a Swedish context and test its psychometric qualities among nurse anesthetists with experience in teaching nurse anesthetist students and junior nurse anesthetists in clinical settings. Methods In this prospective psychometric evaluation study, sixteen nurse anesthetists were recruited. They rated 12 video clips of simulated anesthesia scenarios after participating in a three-hour calibration workshop. Four weeks later, a test–retest was conducted, which included five video clips. Internal consistency, Interrater reliability, and test–retest reliability were examined. Results Internal consistency showed acceptable results on the element level and Interrater reliability indicated good results. Retest reliability showed poor to moderate reliability. The use of “Not Relevant” varied significantly depending on the length of the video clip and the provider being rated. The raters considered the assessment tool suitable but initially challenging to use for rating non-technical skills among nurse anesthetists and articulate non-technical skills in anesthesia nursing. Conclusions This initial testing of the Swedish nurse anesthetists’ non-technical skills tool shows acceptable psychometric qualities and gives a foundation for future research. However, the rating “Not Relevant” poses challenges that need to be addressed. Nevertheless, the participants consider the assessment of non-technical skills in Swedish nurse anesthetists to be appropriate.

IntroductionThe COVID-19 pandemic flooded intensive care units with patients needing supportive care. In Scandinavia, the greater Stockholm area was among the most affected. This study aimed to capture healthcare workers’ conditions and challenges during this prolonged crisis, including perspectives from the intensive care team.MethodsThe data consist of 22 semistructured individual interviews with regular and temporary healthcare workers involved in the intensive care of COVID-19 patients, including nurse assistants, registered nurses, critical care nurses and consultant and junior physicians. Thematic analysis was used to analyse the data.ResultsThe overarching theme that emerged was trying to create order in chaos.The theme encompassed four categories: adaptation with consequences, learning and growing while sacrificing my health, supporting and balancing staff resources without having enough, and challenging ICU values and standards. Each category comprised multiple subcategories.ConclusionOur study demonstrates challenges and identifies workarounds, support strategies and personnel learning experienced by COVID-19 intensive care teams in delivering patient care, ensuring patient safety and managing staff resilience. The findings can be used to better prepare for future crises.

Background Operating rooms have become more technically complex due to new advanced procedures, which has increased demands on teamwork in the operating room. In response, team training has been proposed to improve team performance, workplace culture, and patient safety. We developed and delivered a simulation-based team training course for entire professional surgical teams. This type of intervention has been proposed by researchers but has not been widely published. The aims of this intervention study were to examine participants’ reactions to the course in terms of their motivation for the training and their self-efficacy in relation to their performance, as well as their views on transferring the lessons learned in the course to their workplace. Methods In a prospective mixed-methods intervention study, operating room professionals participated in a full-day simulation-based teamwork training course. Learning objectives were nontechnical skills, specifically communication and collaboration across the team. Seventy-one staff members representing 5 operating room professions were included, and the average work experience of participants was 6 years. Quantitative data on self-efficacy and situational motivation were collected by questionnaires before and after training. Qualitative data were collected through 5 focus group interviews that took place in direct relation to the courses and included a total of 31 participants. Transcripts were coded and analyzed using thematic analysis. Results All occupations showed a similar pattern in terms of increases in self-efficacy and intrinsic motivation after the training. Analysis of the qualitative data showed that training in one’s profession and in authentic multiprofessional teams was important factors for motivation. Participating staff described an awareness of undesirable communication barriers in surgical teams that can lead to risks for patients. Systematic training was definitely perceived as a means to reduce barriers and improve communication and collaboration. Conclusion Simulation-based training was equally well received by all professional groups. Our results confirm the feasibility of this type of training for professional teams and promising opportunities for improving teamwork skills. The qualitative data reveal both opportunities and limitations for transferring the learning experiences to the workplace.

IntroductionThe COVID-19 pandemic has had a profound effect on many domains of healthcare. Even in high-income countries such as Sweden, the number of patients has vastly outnumbered the resources in affected areas, in particular during the first wave. Staff caring for patients with COVID-19 in intensive care units (ICUs) faced a very challenging situation that continued for months. This study aimed to describe burnout, safety climate and causes of stress among staff working in COVID-19 ICUs.MethodA survey was distributed to all staff working in ICUs treating patients with COVID-19 in five Swedish hospitals during 2020 and 2021. The numbers of respondents were 104 and 603, respectively. Prepandemic data including 172 respondents from 2018 served as baseline.ResultsStaff exhaustion increased during the pandemic, but disengagement decreased compared with prepandemic levels (p<0.001). Background factors such as profession and work experience had no significant impact, but women scored higher in exhaustion. Total workload and working during both the first and second waves correlated positively to exhaustion, as did being regular ICU staff compared with temporary staff. Teamwork and safety climate remained unchanged compared with prepandemic levels.Respondents reported ‘making a mistake’ as the most stressful of the predefined stressors. Qualitative analysis of open-ended questions identified ‘lack of knowledge and large responsibility’, ‘workload and work environment’, ‘uncertainty’, ‘ethical stress’ and ‘organization and teamwork’ as major causes of stress.ConclusionDespite large workloads, disengagement at work was low in our sample, even compared with prepandemic levels. High levels of exhaustion were reported by the ICU staff who carried the largest workload. Multiple significant causes of stress were identified, with fear of making a mistake the most significant stressor.

Background The rationale for introducing full-scale patient simulators in training to improve patient safety is to recreate clinical situations in a realistic setting. Although high-fidelity simulators mimic a wide range of human features, simulators differ from the body of a sick patient. The gap between the simulator and the human body implies a need for facilitators to provide information to help participants understand scenarios. The authors aimed at describing different methods that facilitators in our dataset used to provide such extra scenario information and how the different methods to convey information affected how scenarios played out. Methods A descriptive qualitative study was conducted to examine the variation of methods to deliver extra scenario information to participants. A multistage approach was employed. The authors selected film clips from a shared database of 31 scenarios from three participating simulation centers. A multidisciplinary research team performed a collaborative analysis of representative film clips focusing on the interplay between participants, facilitators, and the physical environment. After that, the entire material was revisited to further examine and elaborate the initial findings. Results The material displayed four distinct methods for facilitators to convey information to participants in simulation-based teamwork training. The choice of method had impact on the participating teams regarding flow of work, pace, and team communication. Facilitators’ close access to the teams’ activities when present in the simulation suite, either embodied or disembodied in the simulation, facilitated the timing for providing information, which was critical for maintaining the flow of activities in the scenario. The mediation of information by a loudspeaker or an earpiece from the adjacent operator room could be disturbing for team communication. Conclusions In-scenario instruction is an essential component of simulation-based teamwork training that has been largely overlooked in previous research. The ways in which facilitators convey information about the simulated patient have the potential to shape the simulation activities and thereby serve different learning goals. Although immediate timing to maintain an adequate pace is necessary for professionals to engage in training of medical emergencies, novices may gain from a slower tempo to train complex clinical team tasks systematically.

Interprofessional simulation-based education (IPSE) holds the potential to prepare healthcare students to handle the complexity of healthcare. However, complexity and resilience are traditionally not addressed deliberately in IPSE. The aim of this study was to explore the effect of resilience-focused debriefing (RFD) that addresses complexity and resilience, on reflection and teamwork in IPSE for pre-graduate healthcare students. In a convergent mixed methods intervention study, 149 nursing and medical students in their last semester participated in a full-day IPSE course with five progressively challenging scenarios. Fifteen facilitators were instructed to use RFD. Qualitative date, comprised of transcripts from nine debriefings, were analysed using topic analysis. An intervention check was performed to assess the use of RFD. Quantitative data comprised pre-post ratings of team performance in videorecorded scenarios (1 and 5) from 18 groups using the Team Emergency Assessment Measure (TEAM). Additionally, a study-specific rating scale was employed to assess the extent of participants' perceived challenges during scenarios. RFD helped facilitators to guide the students' attention to the complexity of teamwork and how to manage such complex situations successfully by adapting crisis resource management principles and performing resilient actions (e.g., attunement, adaptive leadership), both as individuals and as teams. Applying RFD brought the students' attention to how they were able to succeed despite the difficulties they encountered. Although the assessed team performance was on an acceptable level, students initially had difficulties in recognizing and learning from actions that led to successful outcomes. The significant decrease in the degree of challenges experienced suggests that students developed a greater tolerance for complexity. Nevertheless, the quantitative data showed that there was no pre-post difference in team performance as assessed by TEAM. RFD can be used to increase healthcare students' attention to the complexity of interprofessional teamwork in acute dynamic situations and help them recognize and learn from both successful actions and overcoming challenging situations. Although we did not find a significant gain in team performance, the integrated results suggest that RFD may potentially improve interprofessional teamwork. Further research is warranted to develop instruments measuring team performance that are sensitive to various aspects of resilience, as well as to deepen the understanding of RFD in the simulation-based education.

Background Patient safety education, as well as the safety climate at clinical rotations, has an impact on students’ attitudes. We explored medical students’ self-reported motivation to participate in simulation-based teamwork training (SBTT), with the hypothesis that high scores in patient safety attitudes would promote motivation to SBTT and that intrinsic motivation would increase after training. Methods In a prospective cohort study we explored Swedish medical students’ attitudes to patient safety, their motivation to participate in SBTT and how motivation was affected by the training. The setting was an integrated SBTT course during the surgical semester that focused on non-technical skills and safe treatment of surgical emergencies. Data was collected using the Situational Motivation Scale (SIMS) and the Attitudes to Patient Safety Questionnaire (APSQ). Results We found a positive correlation between students’ individual patient safety attitudes and self-reported motivation (identified regulation) to participate in SBTT. We also found that intrinsic motivation increased after training. Female students in our study scored higher than males regarding some of the APSQ sub-scores and the entire group scored higher or on par with comparable international samples. Conclusion In order to enable safe practice and professionalism in healthcare, students’ engagement in patient safety education is important. Our finding that students’ patient safety attitudes show a positive correlation to motivation and that intrinsic motivation increases after training underpins patient safety climate and integrated teaching of patient safety issues at medical schools in order to help students develop the knowledge, skills and attitudes required for safe practice.

Background High-fidelity patient simulators in team training are becoming popular, though research showing benefits of the training process compared to low-fidelity models is rare. We explored in situ training for paediatric teams in an emergency department using a low-fidelity model (plastic doll) and a high-fidelity paediatric simulator, keeping other contextual factors constant. The goal was to study differences in trainees’ and trainers’ performance along with their individual experiences, during in situ training, using either a low-fidelity model or a high-fidelity paediatric simulator. Methods During a two-year period, teams involved in paediatric emergency care were trained in groups of five to nine. Each team performed one video-recorded paediatric emergency scenario. A case control study was undertaken in which 34 teams used either a low-fidelity model (n = 17) or a high-fidelity paediatric simulator (n = 17). The teams’ clinical performances during the scenarios were measured as the time elapsed to prescribe as well as deliver oxygen. The trainers were monitored regarding frequency of their interventions. We also registered trainees’ and trainers’ mental strain and flow experience. Results Of 225 trainees’ occasions during 34 sessions, 34 trainer questionnaires, 163 trainee questionnaires, and 28 videos, could be analyzed. Time to deliver oxygen was significantly longer (p = 0.014) when a high-fidelity simulator was used. The trainees’ mental strain and flow did not differ between the two types of training. The frequency of trainers interventions was lower (p < 0.001) when trainees used a high-fidelity simulator; trainers’ perceived mental strain was lower (<0.001) and their flow experience higher (p = 0.004) when using high-fidelity simulator. Conclusions Levels of equipment fidelity affect measurable performance variables in simulation-based team training, but trainee s’ individual experiences are similar. We also note a reduction in the frequency of trainers’ interventions in the scenarios as well as their mental strain, when trainees used a high-fidelity simulator.