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Short simulation exercises to improve emergency department nurses self-efficacy for initial disaster management: Controlled before and after study
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Disaster Medicine and Traumatology.ORCID iD: 0000-0003-1383-375x
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Disaster Medicine and Traumatology.
Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Disaster Medicine and Traumatology.
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2017 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 55, p. 20-25Article in journal (Refereed) Published
Abstract [en]

Introduction: Head nurses at emergency departments often assume responsibility for managing the initial response to a major incident, and to create surge capacity. Training is essential to enable these nurses to perform an effective disaster response. Evaluating the effects of such training is however complicated as real skill only can be demonstrated during a real major incident. Self-efficacy has been proposed as an alternative measure of training effectiveness. Purpose: The aim of this study was to examine if short, small-scale computer-based simulation exercises could improve head emergency nurses general and specific self-efficacy and initial incident management skills. Method: A within-group pretest-posttest design was used to examine 13 head nurses general and specific self efficacy before and after an intervention consisting of three short computer based simulation exercises during a 1-h session. Management skills were assessed using the computer simulation tool DigEmergo. Results: The exercises increased the head nurses general self-efficacy but not their specific self-efficacy. After completing the first two exercises they also exhibited improved management skills as indicated by shorter time to treatment for both trauma and in-hospital patients. Conclusion: This study indicates that short computer based simulation exercises provide opportunities for head nurses to improve management skills and increase their general self-efficacy.

Place, publisher, year, edition, pages
CHURCHILL LIVINGSTONE , 2017. Vol. 55, p. 20-25
Keywords [en]
Management; Mass casualty incident; Nurses; Simulation training; Surge capacity
National Category
Nursing
Research subject
Disaster Medicine
Identifiers
URN: urn:nbn:se:liu:diva-139548DOI: 10.1016/j.nedt.2017.04.020ISI: 000404700900005PubMedID: 28505521OAI: oai:DiVA.org:liu-139548DiVA, id: diva2:1130040
Note

Funding Agencies|Swedish Civil Contingencies Agency (MSB) [2011-4957]

Available from: 2017-08-08 Created: 2017-08-08 Last updated: 2024-06-26
In thesis
1. Studying Simulations with Distributed Cognition
Open this publication in new window or tab >>Studying Simulations with Distributed Cognition
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Simulations are frequently used techniques for training, performance assessment, and prediction of future outcomes. In this thesis, the term “human-centered simulation” is used to refer to any simulation in which humans and human cognition are integral to the simulation’s function and purpose (e.g., simulation-based training). A general problem for human-centered simulations is to capture the cognitive processes and activities of the target situation (i.e., the real world task) and recreate them accurately in the simulation. The prevalent view within the simulation research community is that cognition is internal, decontextualized computational processes of individuals. However, contemporary theories of cognition emphasize the importance of the external environment, use of tools, as well as social and cultural factors in cognitive practice. Consequently, there is a need for research on how such contemporary perspectives can be used to describe human-centered simulations, re-interpret theoretical constructs of such simulations, and direct how simulations should be modeled, designed, and evaluated.

This thesis adopts distributed cognition as a framework for studying human-centered simulations. Training and assessment of emergency medical management in a Swedish context using the Emergo Train System (ETS) simulator was adopted as a case study. ETS simulations were studied and analyzed using the distributed cognition for teamwork (DiCoT) methodology with the goal of understanding, evaluating, and testing the validity of the ETS simulator. Moreover, to explore distributed cognition as a basis for simulator design, a digital re-design of ETS (DIGEMERGO) was developed based on the DiCoT analysis. The aim of the DIGEMERGO system was to retain core distributed cognitive features of ETS, to increase validity, outcome reliability, and to provide a digital platform for emergency medical studies. DIGEMERGO was evaluated in three separate studies; first, a usefulness, usability, and facevalidation study that involved subject-matter-experts; second, a comparative validation study using an expert-novice group comparison; and finally, a transfer of training study based on self-efficacy and management performance. Overall, the results showed that DIGEMERGO was perceived as a useful, immersive, and promising simulator – with mixed evidence for validity – that demonstrated increased general self-efficacy and management performance following simulation exercises.

This thesis demonstrates that distributed cognition, using DiCoT, is a useful framework for understanding, designing and evaluating simulated environments. In addition, the thesis conceptualizes and re-interprets central constructs of human-centered simulation in terms of distributed cognition. In doing so, the thesis shows how distributed cognitive processes relate to validity, fidelity, functionality, and usefulness of human-centered simulations. This thesis thus provides a new understanding of human-centered simulations that is grounded in distributed cognition theory.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 94
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1913
National Category
Human Computer Interaction
Identifiers
urn:nbn:se:liu:diva-145307 (URN)10.3384/diss.diva-145307 (DOI)9789176853481 (ISBN)
Public defence
2018-04-19, Ada Lovelace, B-huset, Campus Valla, Linköping, 13:15 (English)
Opponent
Supervisors
Available from: 2018-03-20 Created: 2018-03-20 Last updated: 2018-03-21Bibliographically approved
2. Resilience in medical incident command
Open this publication in new window or tab >>Resilience in medical incident command
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Natural and manmade disasters are becoming more common and are creating increasingly complex response challenges. In Sweden, the responsibility for disaster management and disaster preparedness lies with the regions. Disaster preparedness includes the provision of training and exercises in medical command and control to establish the ability to create surge capacity. Resilience can serve as a theoretical perspective to identify crucial capabilities for managing disasters and can be defined within the domain of disaster medicine, as the ability to withstand, absorb, and react to the impact of disasters while preserving and augmenting essential health services, and subsequently recovering to the system’s original state or adapting to a new one. Research on resilience in medical command and control may contribute to evidence-based teaching and training for medical incident command. The aim of this thesis is to contribute to new knowledge about resilience in medical command and control and how to implement resilience in disaster management teaching and training.  

Methods: This thesis is based on four studies using a mix of qualitative and qualitative methods with both deductive and inductive approaches. In study I, a within-group pretest–posttest design was used to examine 13 head nurses´ general and specific self-efficacy before and after an intervention of three short computer-based simulation exercises. Study II was a case study focusing on a regional medical incident command taking part in a capability development program combining education, training, and exercises. In study III, an experienced medical incident command participated in a functional exercise and behaviors were captured through observations, video, and audio recordings. Using the markers and strategies analytic framework, observable behavior that exemplified resilient practice were identified. Study IV was a semi-structured, retrospective, in-depth interview study with an inductive design relying on the Critical Decision Method   

Results: Study I showed an increase in head nurses´ general but not specific self-efficacy. They also exhibited improved management skills, as indicated by shorter time-to-treatment for both trauma patients and in-hospital patients in the last exercise. Study II offers an example of how a resilience concept can be introduced to, contextualized, and operationalized with medical incident command personnel through a combination of education, training, and exercises. Study III shows an empirical link from resilience concepts to observable behaviors during an exercise in medical command and control. Study IV identified factors affecting decision-making in medical command and control during the early phase of COVID-19.  

Conclusions: The results contribute valuable insights to the understanding of challenges, strategies, education, and training methods related to resilience in medical command and control. 

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2024. p. 107
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1907
Keywords
Disaster medicine, Medical command and control, Resilience, Teaching, Training
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-205542 (URN)10.3384/9789180755788 (DOI)9789180755771 (ISBN)9789180755788 (ISBN)
Public defence
2024-09-27, Katastrofmedicinskt Centrum, Campus Valla, Linköping, 09:00 (English)
Opponent
Supervisors
Note

Funding: This research was a part of the Center for Advanced Research in Emer-gency Response (CARER) and financed by The Swedish Civil Contin-gency Agency, Forum Securitatis and AFA Insurance (grant number 2001656).

2024-06-26: ISBN (PDF) and ISSN was corrected in the e-version. 

Available from: 2024-06-26 Created: 2024-06-26 Last updated: 2024-06-26Bibliographically approved

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