- Umeå, Västerbotten, Sweden
Maria Härgestam
Umeå University, Nursing, Adjunct
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IntroductionThe COVID-19 pandemic was a tremendous challenge to the practice of modern medicine. In this study, we use neo-institutional theory to gain an in-depth understanding of how physicians in Sweden narrate how they position... more
IntroductionThe COVID-19 pandemic was a tremendous challenge to the practice of modern medicine. In this study, we use neo-institutional theory to gain an in-depth understanding of how physicians in Sweden narrate how they position themselves as physicians when practicing modern medicine during the first wave of the pandemic. At focus is medical logic, which integrates rules and routines based on medical evidence, practical experience, and patient perspectives in clinical decision-making.MethodsTo understand how physicians construct their versions of the pandemic and how it impacted the medical logic in which they practice, we analyzed the interviews from 28 physicians in Sweden by discursive psychology.ResultsThe interpretative repertoires showed how COVID-19 created an experience of knowledge vacuum in medical logic and how physicians dealt with clinical patient dilemmas. They had to find unorthodox ways to rebuild a sense of medical evidence while still being responsible for clin...
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Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for... more
Medical multi-professional teams are increasingly collaborating via telemedicine. In distributed team settings, members are geographically separated and collaborate through technology. Developing improved training strategies for distributed teams and finding appropriate instruments to assess team performance is necessary. The Team Emergency Assessment Measure (TEAM), an instrument validated in traditional collocated acute-care settings, was tested for validity and reliability in this study when used for distributed teams. Three raters assessed video recordings of simulated team training scenarios (n = 18) among teams with varying levels of proficiency working with a remotely located physician via telemedicine. Inter-rater reliability, determined by intraclass correlation, was 0.74–0.92 on the TEAM instrument’s three domains of leadership, teamwork, and task management. Internal consistency (Cronbach’s alpha) ranged between 0.89–0.97 for the various domains. Predictive validity was e...
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Additional file 1: Supplementary Table 1. Overview of differences in the educational programme between the control and intervention group. Supplementary Table 2. Goal directed task analysis document case 2. Supplementary Table 3. SAGAT... more
Additional file 1: Supplementary Table 1. Overview of differences in the educational programme between the control and intervention group. Supplementary Table 2. Goal directed task analysis document case 2. Supplementary Table 3. SAGAT questionnaire case 2, freeze one and two.
teams: exploring closed-loop communication during in situ trauma team training
Research Interests: Design and Exploratory
Background When working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task... more
Background When working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes. Method Twenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrume...
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ObjectivesThe assessment of situation awareness (SA), team performance and task performance in a simulation training session requires reliable and feasible measurement techniques. The objectives of this study were to test the... more
ObjectivesThe assessment of situation awareness (SA), team performance and task performance in a simulation training session requires reliable and feasible measurement techniques. The objectives of this study were to test the Airways–Breathing–Circulation–Disability–Exposure (ABCDE) checklist and the Team Emergency Assessment Measure (TEAM) for inter-rater reliability, as well as the application of Situation Awareness Global Assessment Technique (SAGAT) for feasibility and internal consistency.DesignMethodological approach.SettingData collection during team training using full-scale simulation at a university clinical training centre. The video-recorded scenarios were rated independently by four raters.Participants55 medical students aged 22–40 years in their fourth year of medical studies, during the clerkship in anaesthesiology and critical care medicine, formed 23 different teams. All students answered the SAGAT questionnaires, and of these students, 24 answered the follow-up pos...
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Leadership in acute care teams based on knowledge and communication - an interdisciplinary analysis of a serie of in-situ trauma team trainings Efficient communication is one of the key features of good teamwork. Call-outs (CO) and... more
Leadership in acute care teams based on knowledge and communication - an interdisciplinary analysis of a serie of in-situ trauma team trainings Efficient communication is one of the key features of good teamwork. Call-outs (CO) and Closed-loop communication (CLC), as a component of secure and efficient communication, has been extensively taught in the team training context. This paper reports results from a thesis exploring how trauma teams communicate while working. Eighteen in-situ trauma team training sessions were documented with surveys, audio and video for later analysis. Discourse analysis, quantitative content analysis and quantitative methods were used. The use of CO and CLC in the teams was low. CLC initiated by the team leader was associated with a higher likelihood of decision to go to surgery within the training session. CLC initiated by others than the team leaders was associated with longer time taken until the decision to go to definitive care. Using discourse analys...
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Background: For five years our emergency ward has trained non-technical skills using trauma scenarios in a simulator environment. Reflection-on-action was accomplished by 60 minutes video-facilitat ...
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Research Interests: Nursing, Communication, Leadership, Gesture, Nonverbal Communication, and 15 moreMedicine, Humans, Gaze, Coordination, Female, Male, Clinical Sciences, Middle Aged, Adult, Patient Care Team, Non Verbal Communication, Patient Simulation, Interdisciplinary Communication, Omvårdnad, and Anesthesiology and Intensive Care
Research Interests: Nursing, Anaesthetics, Leadership, Medicine, Clinical Decision Making, and 15 moreHumans, Female, Male, Middle Aged, Adult, Patient Care Team, Time Factors, Patient Simulation, Interdisciplinary Communication, Omvårdnad, Emergency Department, Medical Education Training, Trauma Centers, Injury Severity Score, and Anesthesiology and Intensive Care
Background The COVID-19 pandemic has challenged healthcare organizations and puts focus on risk management in many ways. Both medical staff and leaders at various levels have been forced to find solutions to problems they had not... more
Background The COVID-19 pandemic has challenged healthcare organizations and puts focus on risk management in many ways. Both medical staff and leaders at various levels have been forced to find solutions to problems they had not previously encountered. This study aimed to explore how physicians in Sweden narrated the changes in organizational logic in response to the Covid-19 pandemic using neo-institutional theory and discursive psychology. In specific, we aimed to explore how physicians articulated their understanding of if and, in that case, how the organizational logic has changed during this crisis response. Methods The empirical material stems from interviews with 29 physicians in Sweden in the summer and autumn of 2020. They were asked to reflect on the organizational response to the pandemic focusing on leadership, support, working conditions, and patient care. Results The analysis revealed that the organizational logic in Swedish healthcare changed and that the physicians ...
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Background Within trauma teams, effective communication is necessary to ensure safe and secure care of the patient. Deficiencies in communication are one of the most important factors leading to pa ...