Teaching teamwork during the Neonatal Resuscitation Program: A randomized trial

Johns Hopkins University, Baltimore, Maryland, United States
Journal of Perinatology (Impact Factor: 2.07). 07/2007; 27(7):409-14. DOI: 10.1038/
Source: PubMed


To add a team training and human error curriculum to the Neonatal Resuscitation Program (NRP) and measure its effect on teamwork. We hypothesized that teams that received the new course would exhibit more teamwork behaviors than those in the standard NRP course.
Interns were randomized to receive NRP with team training or standard NRP, then video recorded when they performed simulated resuscitations at the end of the day-long course. Outcomes were assessed by observers blinded to study arm allocation and included the frequency or duration of six team behaviors: inquiry, information sharing, assertion, evaluation of plans, workload management and vigilance.
The interns in the NRP with team training group exhibited more frequent team behaviors (number of episodes per minute (95% CI)) than interns in the control group: information sharing 1.06 (0.24, 1.17) vs 0.13 (0.00, 0.43); inquiry 0.35 (0.11, 0.42) vs 0.09 (0.00, 0.10); assertion 1.80 (1.21, 2.25) vs 0.64 (0.26, 0.91); and any team behavior 3.34 (2.26, 4.11) vs 1.03 (0.48, 1.30) (P-values <0.008 for all comparisons). Vigilance and workload management were practiced throughout the entire simulated code by nearly all the teams in the NRP with team training group (100% for vigilance and 88% for workload management) vs only 53 and 20% of the teams in the standard NRP. No difference was detected in the frequency of evaluation of plans.
Compared with the standard NRP, NRP with a teamwork and human error curriculum led interns to exhibit more team behaviors during simulated resuscitations.

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Available from: John Bryan Sexton, Oct 10, 2015
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    • "Two of the included studies illustrated that the speaking-up behaviour of interns and residents improved after intervention [21,22]; three others reported that, after intervention, the number of participants who felt able to speak up in a clinical setting was increased [24-26]. Stevens et al. reported in their case study that, following team training, communication was enhanced by addressing team members by their names and paying more attention to ‘closing the loop’ in verbal communication, but the amount of data presented by the authors was limited [25]. "
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    ABSTRACT: Speaking up is important for patient safety, but often, health care professionals hesitate to voice concerns. Understanding the influencing factors can help to improve speaking-up behaviour and team communication. This review focused on health care professionals' speaking-up behaviour for patient safety and aimed at (1) assessing the effectiveness of speaking up, (2) evaluating the effectiveness of speaking-up training, (3) identifying the factors influencing speaking-up behaviour, and (4) developing a model for speaking-up behaviour. Five databases (PubMed, MEDLINE, CINAHL, Web of Science, and the Cochrane Library) were searched for English articles describing health care professionals' speaking-up behaviour as well as those evaluating the relationship between speaking up and patient safety. Influencing factors were identified and then integrated into a model of voicing behaviour. In total, 26 studies were identified in 27 articles. Some indicated that hesitancy to speak up can be an important contributing factor in communication errors and that training can improve speaking-up behaviour. Many influencing factors were found: (1) the motivation to speak up, such as the perceived risk for patients, and the ambiguity or clarity of the clinical situation; (2) contextual factors, such as hospital administrative support, interdisciplinary policy-making, team work and relationship between other team members, and attitude of leaders/superiors; (3) individual factors, such as job satisfaction, responsibility toward patients, responsibility as professionals, confidence based on experience, communication skills, and educational background; (4) the perceived efficacy of speaking up, such as lack of impact and personal control; (5) the perceived safety of speaking up, such as fear for the responses of others and conflict and concerns over appearing incompetent; and (6) tactics and targets, such as collecting facts, showing positive intent, and selecting the person who has spoken up. Hesitancy to speak up can be an important contributing factor to communication errors. Our model helps us to understand how health care professionals think about voicing their concerns. Further research is required to investigate the relative importance of different factors.
    BMC Health Services Research 02/2014; 14(1):61. DOI:10.1186/1472-6963-14-61 · 1.71 Impact Factor
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    • "Our finding that half of the participants rated debriefing as the most effective aspect of this training is congruent with a considerable body of evidence in the education literature that debriefing “… can have a very powerful effect on learning” [14]. Indeed, studies have shown that feedback through dialogue between the teacher and learner promotes learning [15]. "
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    ABSTRACT: Prompt initiation of appropriate neonatal resuscitation skills is critical for the neonate experiencing difficulty transitioning to extra-uterine life. The use of simulation training is considered to be an indispensable tool to address these challenges. Research has yet to examine the effectiveness of simulation and debriefing for preparation of trainers to train others on the use of simulation and debriefing for neonatal resuscitation. This study determines the degree to which experienced NRP instructors or instructor trainers perceived simulation in combination with debriefing to be effective in preparing them to teach simulation to other health care professionals. Participants' perceptions of knowledge, skills, and confidence gained following a neonatal resuscitation workshop (lectures; scenario development and enactment; video recording and playback; and debriefing) were determined using a pre-post test questionnaire design. Questionnaire scores were subjected to factor and reliability analyses as well as pre- and post-test comparisons. A total of 17 participants completed 2 questionnaires. Principal component extraction of 18 items on the pre-test questionnaire resulted in 5 factors: teamwork, ability to run a simulation, skills for simulation, recognizing cues for simulation and ability to debrief. Both questionnaire scores showed good reliability (alpha: 0.83 - 0.97) and factorial validity. Pre- and post-test comparisons showed significant improvements in participants' perceptions of their ability to: conduct (as an instructor) a simulation (p < .05, eta2 .47); participate in a simulation (p < .05, eta2 .45); recognize cues (p < .05, eta2 .35); and debrief (p < .05, eta2 .41). Simulation training increased participants' perceptions of their knowledge, skills, and confidence to train others in neonatal resuscitation.
    BMC Research Notes 07/2013; 6(1):251. DOI:10.1186/1756-0500-6-251
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    • "Overall, the included studies indicated few and inconsistent results, providing no conclusive evidence for the effectiveness of practice-based interventions. However, a randomized trial in a neonatal unit indicated improved teamwork after participation in a one-day course on teamwork skills and information about human errors (Thomas et al., 2007). It seems possible that more planned and focused efforts to increase the level of collaboration among professionals, such as the one reported here, could have a more direct effect on service quality and staff health and well-being. "
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    ABSTRACT: The main purpose of this study was, firstly, to evaluate the effect of an intervention aimed at improving interprofessional collaboration and service quality, and secondly, to examine if collaboration could predict burnout, engagement and service quality among human service professionals working with children and adolescents. The intervention included the establishment of local interprofessional teams and offering courses. The sample was recruited from six different small municipalities in Northern Norway (N = 93) and a comparison group from four similar municipalities (N = 58). Participation in the project increased the level of collaboration in the intervention group significantly (Hedges' g = 0.36), but not the perceived level of service quality. Hierarchical regression analyses were used to test a model for predicting burnout, engagement and perceived service quality using work-related factors, including collaboration as predictors. Both burnout and engagement were predicted by job demands and resources after controlling for demographic variables and participation in the project. Service quality was mostly predicted by collaboration. Increasing collaboration seems possible by introducing practice-based changes; however, this intervention did not have the desired effect on perceived service quality.
    Journal of Interprofessional Care 01/2012; 26(3):219-25. DOI:10.3109/13561820.2011.647125 · 1.40 Impact Factor
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