Brazil Victoria, Orr Robin, Canetti Elisa F D, Isaacson Warwick, Stevenson Nikki, Purdy Eve
Translational Simulation Collaborative, Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia.
Emergency Department Gold Coast Health Service Gold Coast Queensland Australia.
AEM Educ Train. 2023 Mar 30;7(2):e10852. doi: 10.1002/aet2.10852. eCollection 2023 Apr.
Emergency department (ED) teams frequently perform under conditions of high stress. Stress exposure simulation (SES) is specifically designed to train recognition and management of stress responses under these conditions. Current approaches to design and delivery of SES in emergency medicine are based on principles derived from other contexts and from anecdotal experience. However, the optimal design and delivery of SES in emergency medicine are not known. We aimed to explore participant experience to inform our approach.
We performed an exploratory study in our Australian ED with doctors and nurses participating in SES sessions. We used a three-part framework-sources of stress, the impacts of that stress, and the strategies to mitigate-to inform our SES design and delivery and to guide our exploration of participant experience. Data were collected through a narrative survey and participant interviews and analyzed thematically.
There were 23 total participants (doctors = 12, nurses = 11) across the three sessions. Sixteen survey responses and eight interview transcripts were analyzed, each with equal numbers of doctors and nurses. Five themes were identified in data analysis: (1) experience of stress, (2) managing stress, (3) design and delivery of SES, (4) learning conversations, and (5) transfer to practice.
We suggest that design and delivery of SES should follow health care simulation best practice, with stress adequately induced by authentic clinical scenarios and to avoid trickery or adding extraneous cognitive load. Facilitators leading learning conversations in SES sessions should develop a deep understanding of stress and emotional activation and focus on team-based strategies to mitigate harmful impacts of stress on performance.
急诊科（ED）团队经常在高压力条件下工作。压力暴露模拟（SES）专门设计用于训练在这些条件下识别和管理压力反应。目前急诊医学中SES的设计和实施方法是基于从其他背景和轶事经验中得出的原则。然而，急诊医学中SES的最佳设计和实施尚不清楚。我们旨在探索参与者的经验，为我们的方法提供参考。
我们在澳大利亚的急诊科进行了一项探索性研究，医生和护士参与了SES课程。我们使用了一个由三部分组成的框架——压力源、压力的影响以及缓解压力的策略——来指导我们的SES设计和实施，并指导我们对参与者经验的探索。通过叙述性调查和参与者访谈收集数据，并进行主题分析。
在三次课程中共有23名参与者（医生12名，护士11名）。分析了16份调查回复和8份访谈记录，医生和护士的数量相等。数据分析中确定了五个主题：（1）压力体验，（2）管理压力，（3）SES的设计和实施，（4）学习对话，（5）转化为实践。
我们建议，SES的设计和实施应遵循医疗模拟的最佳实践，通过真实的临床场景充分诱发压力，避免欺骗或增加额外的认知负担。在SES课程中引导学习对话的促进者应深入了解压力和情绪激活，并专注于基于团队的策略，以减轻压力对表现的有害影响。
