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Resilience in medical incident command
Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
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 [en]
Disaster medicine, Medical command and control, Resilience, Teaching, Training
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-205542DOI: 10.3384/9789180755788ISBN: 9789180755771 (print)ISBN: 9789180755788 (electronic)OAI: oai:DiVA.org:liu-205542DiVA, id: diva2:1878108
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
List of papers
1. Short simulation exercises to improve emergency department nurses self-efficacy for initial disaster management: Controlled before and after study
Open this publication in new window or tab >>Short simulation exercises to improve emergency department nurses self-efficacy for initial disaster management: Controlled before and after study
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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
Keywords
Management; Mass casualty incident; Nurses; Simulation training; Surge capacity
National Category
Nursing
Research subject
Disaster Medicine
Identifiers
urn:nbn:se:liu:diva-139548 (URN)10.1016/j.nedt.2017.04.020 (DOI)000404700900005 ()28505521 (PubMedID)
Note

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

Available from: 2017-08-08 Created: 2017-08-08 Last updated: 2024-06-26
2. Operationalising resilience for disaster medicine practitioners: capability development through training, simulation and reflection
Open this publication in new window or tab >>Operationalising resilience for disaster medicine practitioners: capability development through training, simulation and reflection
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2020 (English)In: Cognition, Technology & Work, ISSN 1435-5558, E-ISSN 1435-5566, Vol. 22, no 3, p. 667-683Article in journal (Refereed) Published
Abstract [en]

Resilience has in recent decades been introduced as a term describing a new perspective within the domains of disaster management and safety management. Several theoretical interpretations and definitions of the essence of resilience have been proposed, but less work has described how to operationalise resilience and implement the concept within organisations. This case study describes the implementation of a set of general resilience management guidelines for critical infrastructure within a Swedish Regional Medical Command and Control Team. The case study demonstrates how domain-independent guidelines can be contextualised and introduced at an operational level, through a comprehensive capability development programme. It also demonstrates how a set of conceptual and reflective tools consisting of educational, training and exercise sessions of increasing complexity and realism can be used to move from high-level guidelines to practice. The experience from the case study demonstrates the value of combining (1) developmental learning of practitioners’ cognitive skills through resilience-oriented reflection and interaction with dynamic complex open-ended problems; (2) contextualisation of generic guidelines as a basis for operational methodological support in the operational environment; and (3) the use of simulation-based training as part of a capability development programme with increasing complexity and realism across mixed educational, training and exercise sessions. As an actual example of a resilience implementation effort in a disaster medicine management organisation, the study contributes to the body of knowledge regarding how to implement the concept of resilience in operational practice.

Place, publisher, year, edition, pages
Springer, 2020
National Category
Information Systems, Social aspects
Research subject
Disaster Medicine
Identifiers
urn:nbn:se:liu:diva-163882 (URN)10.1007/s10111-019-00587-y (DOI)000554718300015 ()2-s2.0-85073820651 (Scopus ID)
Note

Funding agencies: Horizon 2020 the European Unions Framework Programme for Research and Innovation (H2020/2014-2020)European Union (EU) [653289]; Swedish Civil Contingencies Agency (MSB)

Available from: 2020-02-24 Created: 2020-02-24 Last updated: 2024-06-26Bibliographically approved
3. Connecting resilience concepts to operational behaviour: A disaster exercise case study
Open this publication in new window or tab >>Connecting resilience concepts to operational behaviour: A disaster exercise case study
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2022 (English)In: Journal of Contingencies and Crisis Management, ISSN 0966-0879, E-ISSN 1468-5973, Vol. 30, no 2, p. 127-136Article in journal (Refereed) Published
Abstract [en]

Contemporary crisis management studies often make use of the concept of resilience. However, resilience as a term has a wide variety of meanings and has been criticized as lacking operationalization and empirical validation. The current study aimed to link resilience concepts to observable behaviour within a disaster medicine management system. Resilience concepts, captured in so-called capability cards and further operationalized into six resilience prerequisites, were used in the study. An experienced crisis management team participated in a large-scale crisis management exercise and behaviours were captured through observations, video and audio recordings. Using a markers and strategies analytical framework, two blinded raters classified observable behaviours that exemplified resilient practice. The analysis showed a high degree of agreement (79%) between the combined operationalized capability cards and resilience prerequisites and the empirical classification of behaviours. The current study shows an empirical link from resilience concepts to observable behaviours during an exercise. Observed episodic narratives exemplify empirically connected specific strategies to specific resilience markers. These results demonstrate a method with observed narratives for analyzing resilience in crisis management teams using a markers and strategies approach. Future studies can use the results to create structured observation protocols to evaluate resilient behaviours in crisis management teams.

Place, publisher, year, edition, pages
Wiley, 2022
Keywords
command and control; crisis management; modelling; resilience
National Category
Business Administration
Identifiers
urn:nbn:se:liu:diva-178490 (URN)10.1111/1468-5973.12373 (DOI)000674493400001 ()
Note

Funding Agencies|Swedish Civil Contingencies Agency (MSB); European UnionEuropean Commission [653289]

Available from: 2021-08-25 Created: 2021-08-25 Last updated: 2024-06-26

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567891011 11 of 11
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