Team Coordination Style Is an Adaptive, Emergent Property of Interactions Between Critical Care Air Transport Team Personnel.

OBJECTIVE: Critical Care Air Transport (CCAT) teams care for critically ill or injured patients during long-duration flights. Despite the differences between the CCAT domain and a more traditional clinical setting, CCAT clinicians are not explicitly trained how to coordinate care in the aircraft environment. We characterized the team coordination patterns adopted by CCAT teams and explored any links between team coordination style and performance. METHODS: This retrospective study used transcripts from 91 CCAT teams as they completed simulated patient care scenarios during an advanced training course. Qualitative and quantitative measures were used to characterize team behavior. RESULTS: Vocalized content varied by team role, with physicians acting as leaders. The type of content verbalized by each team role depended on the team coordination style. The team coordination style and the content of vocalized messages were not affected by prior team member deployment or the characteristics of particular scenarios, and the team coordination style did not predict measures related to patient status. CONCLUSION: Individual team member coordination behaviors vary depending on the coordination style used by the team as a whole. Coordination style appears to arise from the interactions among individual team members rather than in response to situational factors external to the team.

Immersive Rehearsal in a Simulated Environment.

INTRODUCTION: Recent advancements in virtual environment (VE) technology and the increasing use of VEs for treatment are opening up possibilities for rehearsal in safe and rich environments. Research has shown that VEs can be used to treat individuals with posttraumatic stress disorder (PTSD), but little research has been done to suggest guidelines for creating an effective environment. The aim of this study was to determine the design of systems that would allow military veterans to rehearse potentially stressful events in a VE before having to step into the actual environment. This research evaluated the responses to six stimuli: startle sound, direct eye contact, horizontal movement across the visual field, social conflict, an abandoned item, and a crowded auditorium. Measures used included change in heart rate (ΔHR), change in subjective unit of discomfort scores, and participant behavior. MATERIALS AND METHODS: Thirty-eight participants, both with and without PTSD, experienced two VEs in first person using an Oculus Rift device. The first VE consisted of a tranquil garden, which allowed the participants to practice in the system, whereas baseline data were collected. The second VE was the experimental condition where the participant completed tasks within the VE and encountered stimuli designed to evoke responses from those with PTSD. RESULTS: There was a significant difference in ΔHR between the PTSD and non-PTSD groups (P = .008), and the PTSD group had a higher mean ΔHR for all stimuli. The stimulus type was also significant for all participants (P < .001). Crowded auditorium and startle sound had the largest impact on the participants' ΔHR. Change in subjective unit of discomfort showed a significant interaction between the group factor (PTSD, non-PTSD) and stimulus (P = .043). Individuals with PTSD also presented more avoidance behavior than those without PTSD. CONCLUSIONS: Findings imply that VEs other than virtual combat zones can elicit behavioral, emotional, and physiological responses in individuals with PTSD, and these types of environments should be further studied for use with veterans suffering from PTSD. In future studies, systems should include initial stimuli that can be configured to allow focus on specific past traumatic experiences. Stimuli should also include both a crowded room and a startle noise scenario.

Effects of Topical Anesthetics on Behavior, Plasma Corticosterone, and Blood Glucose Levels after Tail Biopsy of C57BL/6NHSD Mice (Mus musculus).

Tail biopsy is a common procedure that is performed to obtain genetic material for determining genotype of transgenic mice. The use of anesthetics or analgesics is recommended, although identifying safe and effective drugs for this purpose has been challenging. We evaluated the effects of topical 2.5% lidocaine-2.5% prilocaine cream applied to the distal tail tip at 5 or 60 min before biopsy, immersion of the tail tip for 10 seconds in ice-cold 70% ethanol just prior to biopsy, and immersion of the tail tip in 0.5% bupivacaine for 30 s after biopsy. Mice were 7, 11, or 15 d old at the time of tail biopsy. Acute behavioral responses, plasma corticosterone, and blood glucose were measured after biopsy, and body weight and performance in elevated plus maze and open-field tests after weaning. Ice-cold ethanol prior to biopsy prevented acute behavioral responses to biopsy, and both ice-cold ethanol and bupivacaine prevented elevations in corticosterone and blood glucose after biopsy. Tail biopsy with or without anesthesia did not affect body weight or performance on elevated plus maze or open-field tests. We recommend the use of ice-cold ethanol for topical anesthesia prior to tail biopsy in mice 7 to 15 d old.

Decontamination training: with and without virtual reality simulation.

Nurses must be prepared to care for patients following a disaster, including patients exposed to hazardous contaminants. The purpose of this study was to examine the use of virtual reality simulation (VRS) to teach the disaster-specific skill of decontamination. A quasi-experimental design was used to assign nursing students from 2 baccalaureate nursing programs to 1 of 2 groups to learn the disaster skill of decontamination-printed written directions or VRS. Performance, knowledge, and self-efficacy were outcome measures. Although students in the treatment group had significantly lower performance scores than the control group (p = 0.004), students taking part in VRS completed the skill in a significantly shorter amount of time (p = 0.008). No significant group differences were found for self-efficacy (p = 0.172) or knowledge (p = 0.631). However, students in the VRS treatment group reported high levels of satisfaction with VRS as a training method. The disaster-specific skill of decontamination is a low-volume, high-risk skill that must be performed with accuracy to protect both exposed patients and providers performing decontamination. As frontline providers for casualties following a disaster event, emergency nurses must be prepared to perform this skill when needed. Preparation requires cost-effective, timely, and evidence-based educational opportunities that promote positive outcomes. Further investigation is needed to determine the benefits and long-term effects of VRS for disaster education.

Development of an assessment instrument to evaluate performance of the skill of decontamination.

BACKGROUND AND PURPOSE: Nurses must competently demonstrate psychomotor skills. Few reliable and valid instruments are available for psychomotor evaluation for disaster skills, including the skill of decontamination. OBJECTIVES: The purpose of this study was to develop and refine an instrument to measure the skill of decontamination. DESIGN: A seven step instrument development design was implemented that included content validity and reliability as well as inter-rater reliability analysis. SETTING AND PARTICIPANTS: A convenience sample of approximately 140 participants was drawn from two colleges of nursing at two large academic universities. The sample included senior nursing students in either their community or final practicum nursing course. METHODS: Based on a sample of 140 students who participated in a decontamination training experience using virtual reality simulation, a seven step established process for assessment of reliability and validity was implemented to develop a checklist for the skill of decontamination. RESULTS: The final instrument statistics: Content Validity Index for the overall instrument score was 0.94, Internal consistency coefficient=0.607(KR-20) and Inter-rater reliability=0.9114. CONCLUSIONS: This instrument provides a reliable and valid assessment of nurses' competency in performing the skill of decontamination offering a template for educators to develop similar tools.