When routine becomes stressful: A qualitative study into resuscitation team members’ perception of stress and performance

ABSTRACT

Interprofessional teamwork is of high importance during stressful situations such as CPR. Stress can potentially influence team performance. This study explores the perception of stress and its stressors during performance under pressure, to be able to further adjust or develop training. Healthcare professionals, who are part of the resuscitation team in a large Dutch university medical center, discussed their experiences in homogeneous focus groups. Nine focus groups and one individual interview were conducted and analyzed thematically, in order to deepen our understanding of their experiences. Thematic analysis resulted in two scenarios, routine and stress and an analysis of accompanying team processes. Routine refers to a setting perceived as straightforward. Stress develops in the presence of a combination of stressors such as a lack of clarity in roles and a lack of knowledge on fellow team members. Participants reported that stress affects the team, specifically through an altering of communication, a decrease in situational awareness, and formation of subgroups. This may lead to a further increase in stress, and potentially result in a vicious cycle. Team processes in a stressful situation like CPR can be disrupted by different stressors, and might affect the team and their performance. Improved knowledge about the stressors and their effects might be used to design a training environment representative for the performance setting healthcare professionals work in. Further research on the impact of representative training with team-level stressors and the development of a “team brain” might be worthwhile.

KEYWORDS:

• Performance
• resuscitation
• stress
• teams
• teamwork

Acknowledgments

We would like to thank the participants in our study, who gave up their time to be interviewed. Furthermore, we would like to thank dr Ralf Krage for his assistance in recruitment.

Disclosure statement

HS reports grants to his institution from Stryker Emergency Care, the Zoll Foundation and the AMC Foundation, all outside the scope of this study. The other authors have no conflicts of interest to report.

Additional information

Funding

FD received a research grant from the Dutch Research Council (NWO), grant number 023.009.064.

Notes on contributors

FS Dijkstra

FS Dijkstra is a PhD-student in Educational sciences and a lecturer in nursing education. Her research interests are interprofessional teamwork, stress and simulation-based education.

A de la Croix

A de la Croix is a qualitative educational researcher with a background in linguistics. Her main research interest is stimulating reflection in health professions education.

H van Schuppen

H van Schuppen is an anesthesiologist, with a research background in resuscitation. His research interests include prehospital care, human factors, and organization of the chain of survival.

M Meeter

M Meeter is a professor in education sciences and head of department. His research interests are personalized learning, learning analytics and student motivation.

PG Renden

PG Renden is a human movement scientist and a senior lecturer in nursing education. His research interests are professional performance, stress and perceptual motor learning.