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Critical Incidents (critical + incident)
Terms modified by Critical Incidents Selected AbstractsGoing beyond competencies: An exploratory study in defining exemplary workplace learning and performance practitionersPERFORMANCE IMPROVEMENT QUARTERLY, Issue 1 2009Terri Freeman Smith This study was an exploratory investigation used to identify exemplary performance in four of the areas of expertise (AOEs) as described in the American Society for Training and Development's Mapping the Future: New Workplace Learning and Performance Competencies (2004). Qualitative data were collected from the following four AOEs: (1) delivering training, (2) designing learning, (3) improving human performance, and (4) measuring and evaluating. Research suggests that an exemplary performer could have productivity differences 12 times greater than performers at the bottom of the performance scale and 85% greater than an average performer (Hunter, Schmidt, & Judiesch, 1990). Critical incidents were collected from behavioral event interviews of 23 exemplary performers and 9 typical performers. An analysis of the findings suggests that an exemplary performer may hold at least four key behaviors: taking calculated risks, entrepreneurial and visionary planning, documented business performance to support and influence change, and political prudence and leadership savvy. [source] ,Admission into a helping plan': a watershed between positive and negative experiences in breast cancerPSYCHO-ONCOLOGY, Issue 8 2010Sara Lilliehorn Abstract Cancer patients are in an exposed situation that raises certain psychosocial needs in contact with health care. Previous studies have mainly investigated these needs by assessments on pre-defined categories. Objective: The purpose of the present study is, from the patients' perspective, to identify breast cancer patients' psychosocial needs, and to synthesise them in a model reflecting the core of these needs. Methods: Seventy-one patients treated with radiation therapy were consecutively included and repeatedly interviewed about their experiences of health care. ,Critical incidents' where identified from the interviews and analysed due to the similarities,differences technique in grounded theory. Results: Four categories of needs where detected: ,access', ,information', ,treatment' and ,how approached'. These categories and their properties merged into a core category,,admission into a helping plan'. These findings are well understood in terms of attachment theory. In times of immanent danger and stress people strive to find a ,safe haven' to attach to. Cancer patients' ,safe haven' can be described as ,a helping plan'. It is not the result of a separate patient,caregiver relationship but is created by a pattern of individual experiences from all kind of contacts with the health-care system as a whole. Conclusions: The presented model of patients needs as converging into ,admission into a helping plan' may serve as an easily comprehendible model for caregivers, guiding them to contribute to the patient's feeling of security and trust, and thus to the patient's own ,hope work'. Copyright © 2009 John Wiley & Sons, Ltd. [source] Modelling emergency decisions: recognition-primed decision making.JOURNAL OF CLINICAL NURSING, Issue 8 2006The literature in relation to an ophthalmic critical incident Aims., To review and reflect on the literature on recognition-primed decision (RPD) making and influences on emergency decisions with particular reference to an ophthalmic critical incident involving the sub-arachnoid spread of local anaesthesia following the peribulbar injection. Background., This paper critics the literature on recognition-primed decision making, with particular reference to emergency situations. It illustrates the findings by focussing on an ophthalmic critical incident. Design., Systematic literature review with critical incident reflection. Methods., Medline, CINAHL and PsychINFO databases were searched for papers on recognition-primed decision making (1996,2004) followed by the ,snowball method'. Studies were selected in accordance with preset criteria. Results., A total of 12 papers were included identifying the recognition-primed decision making as a good theoretical description of acute emergency decisions. In addition, cognitive resources, situational awareness, stress, team support and task complexity were identified as influences on the decision process. Conclusions., Recognition-primed decision-making theory describes the decision processes of experts in time-bound emergency situations and is the foundation for a model of emergency decision making (Fig. 2). Figure 2. ,Influences and processes of RPD making. Relevance to clinical practice., Decision theory and models, in this case related to emergency situations, inform practice and enhance clinical effectiveness. The critical incident described highlights the need for nurses to have a comprehensive and in-depth understanding of anaesthetic techniques as well as an ability to manage and resuscitate patients autonomously. In addition, it illustrates how the critical incidents should influence the audit cycle with improvements in patient safety. [source] Another type of critical incident with a disposable bladeANAESTHESIA, Issue 4 2009M. Mackenzie No abstract is available for this article. [source] Forces required to remove bougies from tracheal tubes,ANAESTHESIA, Issue 3 2009G. N. B. Jackson Summary Following a critical incident on our labour ward, we investigated the forces required to remove different bougies from different tracheal tubes and the effect of lubrication on ease of removal. Two studies were conducted: firstly examining the differences between six different bougies with a standard tracheal tube, and secondly examining the differences between four different tracheal tubes with a standard bougie. The forces varied amongst both the different bougies (p < 0.0001) and the different tracheal tubes (p < 0.0001). Removal was generally easier with lubrication but when corrected for multiple comparisons this did not reach statistical significance. [source] Distress and post-traumatic stress disorders in high risk professionals: adult attachment style and the dimensions of anxiety and avoidanceCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 4 2006Frédéric Declercq This study examines the relationship between adult attachment and psychological distress in a population of 544 people working for a security company and for the Belgian Red Cross. The results indicate that fearful,avoidant and preoccupied attached individuals report more stress than secure attached and insecure attached individuals of the dismissive type. Next, the same attachment styles appear to differentiate between individuals who do and individuals who do not develop a post-traumatic stress syndrome (PTSD) after being confronted with a critical incident. Breaking the attachment styles into the two underlying dimensions of attachment anxiety and avoidance, our results suggest that anxiety is more of an issue than avoidance in psychological distress and the occurrence of PTSD.,Copyright © 2006 John Wiley & Sons, Ltd. [source] Debriefing critical incidents in the paediatric emergency department: Current practice and perceived needs in Australia and New ZealandEMERGENCY MEDICINE AUSTRALASIA, Issue 6 2009Theane Theophilos Abstract Anecdotally critical incident debriefing (CID) is an important topic for staff in paediatric ED. The present study aimed to determine current baseline CID practices and perceived needs of ED staff. A questionnaire regarding CID practice was circulated to all 13 Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites in Australia and New Zealand (including all tertiary paediatric ED), and completed by 1 senior doctor and 1 senior nurse. All PREDICT sites participated (13 nurses, 13 doctors). Seventy per cent did not currently have a hospital protocol on debriefing and 90% did not have ED-specific guidelines. The most commonly debriefed topics were death of a patient, multi-trauma and sudden infant death syndrome, also ranked highest in importance for debriefing. The median reported debriefs per department were 4 per year (range 0,12), all conducted within a week of the CI with half within 24 h. ED workers most likely to be invited to the CID session were doctors, nurses and social workers (96%). Debriefing was mostly conducted internally (62%) and most likely facilitated by a doctor (81%) or nurse (54%). Debriefing addressed both clinical and emotional issues (89%) within the same session (69%). Debriefing was rated as very important, median of 8/10 by doctors and 10/10 by nurses. Almost 90% of those surveyed indicated that they would like a CID programme and guidelines for their department. Debriefing is perceived as important by senior ED clinicians, yet few ED have formalized guidelines or programmes. Best-practice guidelines should be developed. [source] Determining Critical Incident Nursing Interventions for the Critical Care Setting: A Pilot StudyINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2009Elizabeth Wong CRNA PURPOSE., The purpose of this research survey was to determine which Adult Critical Care Core Nursing Interventions (ACCCNIs) in the Nursing Interventions Classification constitutes a critical incident nursing intervention (CINI). A CINI is defined as any indirect or direct care registered nurse (RN)-initiated treatment performed in response to a life-threatening nursing diagnosis. METHODS., A list of ACCCNIs were sent to 50 critical care RNs in two survey rounds. Responses >80% for each ACCCNI was determined to be a CINI. FINDINGS., Forty-one ACCCNIs were determined to be CINIs. CONCLUSIONS., It is recommended that CINIs be included as a separate Nursing Intervention Classification category to reflect current nursing practice. IMPLICATIONS FOR NURSING PRACTICE., CINIs can enhance RN competency, education, and vigilance, thereby preventing or decreasing the number of deaths that occur from critical incidents. [source] Modelling emergency decisions: recognition-primed decision making.JOURNAL OF CLINICAL NURSING, Issue 8 2006The literature in relation to an ophthalmic critical incident Aims., To review and reflect on the literature on recognition-primed decision (RPD) making and influences on emergency decisions with particular reference to an ophthalmic critical incident involving the sub-arachnoid spread of local anaesthesia following the peribulbar injection. Background., This paper critics the literature on recognition-primed decision making, with particular reference to emergency situations. It illustrates the findings by focussing on an ophthalmic critical incident. Design., Systematic literature review with critical incident reflection. Methods., Medline, CINAHL and PsychINFO databases were searched for papers on recognition-primed decision making (1996,2004) followed by the ,snowball method'. Studies were selected in accordance with preset criteria. Results., A total of 12 papers were included identifying the recognition-primed decision making as a good theoretical description of acute emergency decisions. In addition, cognitive resources, situational awareness, stress, team support and task complexity were identified as influences on the decision process. Conclusions., Recognition-primed decision-making theory describes the decision processes of experts in time-bound emergency situations and is the foundation for a model of emergency decision making (Fig. 2). Figure 2. ,Influences and processes of RPD making. Relevance to clinical practice., Decision theory and models, in this case related to emergency situations, inform practice and enhance clinical effectiveness. The critical incident described highlights the need for nurses to have a comprehensive and in-depth understanding of anaesthetic techniques as well as an ability to manage and resuscitate patients autonomously. In addition, it illustrates how the critical incidents should influence the audit cycle with improvements in patient safety. [source] Alexithymia and posttraumatic stress: subscales and symptom clusters,JOURNAL OF CLINICAL PSYCHOLOGY, Issue 10 2010Frédéric Declercq Abstract This study examined the relationship between the emotion-regulating factor alexithymia and the occurrence of posttraumatic stress disorder (PTSD) after critical incidents in a nonclinical sample of 136 nurses and ambulance personnel working in military facilities. The results showed that alexythima accounts for variance in PTSD symptoms. Breaking PTSD into its 4 symptom clusters, alexithymia was found to predict numbing and hyperarousal symptoms but not avoidance or reexperiencing symptoms. Finally, the rarely investigated, but clinically relevant, distinctive subdimensions of alexithymia were examined in relation to the 4 PTSD clusters. The difficulty identifying feelings subscale contributed most to the numbing and hyperarousal PTSD subscales. Clinical implications and future research directions are discussed. © 2010 Wiley Periodicals, Inc. J Clin Psychol 66: 1,14, 2010. [source] Eye movement desensitization and reprocessing (EMDR) in the treatment of war veteransJOURNAL OF CLINICAL PSYCHOLOGY, Issue 8 2008Steven M. Silver Abstract Recent practice guidelines and meta-analyses have designated eye movement desensitization and reprocessing (EMDR) as a first-line treatment for trauma. Eye movement desensitization and reprocessing is an eight-phase therapeutic approach guided by an information-processing model that addresses the combat veteran's critical incidents, current triggers, and behaviors likely to prove useful in his or her future. Two case examples of combat veterans illustrate the ability of EMDR to achieve symptom reduction in a variety of clinical domains (e.g., anxiety, depression, anger, physical pain) simultaneously without requiring the patient to carry out homework assignments or discuss the details of the event. The treatment of phantom limb pain and other somatic presentations is also reviewed. The ability of EMDR to achieve positive effects without homework indicates that it can be effectively employed on consecutive days, making it especially useful during combat situations. © 2008 Wiley Periodicals, Inc. J Clin Psychol: In Session 64:1,11, 2008. [source] Inefficacy of simulator-based training on anaesthesiologists' non-technical skills,ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009Y. A. ZAUSIG Background: Analysis of critical incidents in anaesthesia practice emphasizes the important role of non-technical skills (NTS) in improving patient safety. Therefore, debriefing with regard to NTS has been added to medical management (MM) simulator training to improve acute crisis competencies of anaesthesiologists. The purpose of this study was to compare the NTS and MM performance of two groups of anaesthesiologists in a simulated anaesthesia crisis after undergoing different types of training. Methods: Forty-two anaesthesiologists were randomly assigned to two different training groups, with each group participating in two simulation training sessions. One group's (NTS+MMG) training included extensive debriefing of NTS (resource management, planning, leadership and communication) and MM, while the other group (MMG) received a simpler debriefing that focused solely on MM. The quality and quantity of NTS and quality of MM performance were rated by reviewing the videotapes of the scenarios. Results: NTS+MMG did not prove superior to MMG with regard to behavioural and MM markers. The quality of NTS performances correlated significantly (P<0.01) with the quantity of NTS demonstration, and also correlated significantly with the MM actions (P<0.01) in both groups. Conclusion: A single session of training including debriefing of NTS and MM did not improve the NTS performances of anaesthesiologists when compared with anaesthesiologists who only received MM training. This might indicate that a more frequent or individual training is needed to improve participants' NTS performance. [source] Teamwork and patient safety in dynamic domains of healthcare: a review of the literatureACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009T. MANSER Aims/Background: This review examines current research on teamwork in highly dynamic domains of healthcare such as operating rooms, intensive care, emergency medicine, or trauma and resuscitation teams with a focus on aspects relevant to the quality and safety of patient care. Results: Evidence from three main areas of research supports the relationship between teamwork and patient safety: (1) Studies investigating the factors contributing to critical incidents and adverse events have shown that teamwork plays an important role in the causation and prevention of adverse events. (2) Research focusing on healthcare providers' perceptions of teamwork demonstrated that (a) staff's perceptions of teamwork and attitudes toward safety-relevant team behavior were related to the quality and safety of patient care and (b) perceptions of teamwork and leadership style are associated with staff well-being, which may impact clinician' ability to provide safe patient care. (3) Observational studies on teamwork behaviors related to high clinical performance have identified patterns of communication, coordination, and leadership that support effective teamwork. Conclusion: In recent years, research using diverse methodological approaches has led to significant progress in team research in healthcare. The challenge for future research is to further develop and validate instruments for team performance assessment and to develop sound theoretical models of team performance in dynamic medical domains integrating evidence from all three areas of team research identified in this review. This will help to improve team training efforts and aid the design of clinical work systems supporting effective teamwork and safe patient care. [source] Situations influencing habits in diet and exercise among nurses working night shiftJOURNAL OF NURSING MANAGEMENT, Issue 5 2006M. PERSSON RNT Objectives, The aim of the investigation was to describe situations with a significant influence on healthy diet and exercise habits among nurses working night shift. Methods, A qualitative descriptive design with a Critical Incident Technique approach was used. Situations were collected by means of interviews with 27 registered/enrolled community nurses. Results, A total of 143 situations were identified comprising two main areas: coping ability at work and coping ability during leisure hours. Coping ability at work included 81 critical incidents grouped into two categories: the nurses' diet and exercise habits were influenced by social interaction with colleagues at work and by the disruption to their circadian rhythm. Coping ability during leisure hours included 62 critical incidents grouped into two categories: the diet and exercise habits were influenced when the nurses recovered from the disruption to their circadian rhythm and when they took advantage of the freedom of action offered by night work. Conclusions, By identifying the factors that influence diet and exercise habits among nurses working night shift, strategies can be developed in order to strengthen the factors with a positive influence. [source] A cluster randomized controlled trial to determine the efficacy of Trauma Risk Management (TRiM) in a military population,JOURNAL OF TRAUMATIC STRESS, Issue 4 2010Neil Greenberg Trauma Risk Management is a peer-support program that aims to promote help-seeking in the aftermath of traumatic events. Prior to its implementation, the British military conducted a randomized controlled trial of Trauma Risk Management against standard care in 12 warships; 6 were randomized to use Trauma Risk Management after collecting baseline measurements. Follow up after 12,18 months found no significant change in psychological health or stigma scores in either group; however, the studied vessels only encountered low numbers of critical incidents. Additionally, measurements of organizational functioning were modestly better in the Trauma Risk Management ships. The authors conclude that within organizations using Trauma Risk Management may be beneficial and may, in time, lead to a valuable cultural shift. [source] Describing clinical teachers' characteristics and behaviours using critical incidents and repertory gridsMEDICAL EDUCATION, Issue 7 2006Praminthra Chitsabesan Context, Completion of a rating questionnaire is the method used most frequently to evaluate a teacher's performance. Questionnaires that largely assess ,high-inference' teaching characteristics, such as ,enthusiasm' and ,friendliness', require the observer to make a judgement about the teacher but do not describe what the teacher actually did and so have limited use in providing feedback. Measures of ,low-inference' teaching behaviours (i.e. those that are concrete and observable), such as frequency, amount or types of verbal interaction, do not demonstrate how these are linked to good teaching. Objectives, To describe high-inference teacher characteristics and define the associated low-inference behaviours. Methods, A purposive sample of consultants, postgraduate and undergraduate students, nurse lecture practitioners and patients were selected for semistructured interviews using repertory grids and critical incidents to elicit preferred characteristics and behaviours of clinical teachers. Interviews were audiotaped, transcribed and then content-analysed using a framework to pair teachers' characteristics and their behaviours. Results, We identified a variety of preferred high-inference characteristics and their associated observable and recordable low-inference behaviours. Discussion, We carried out a study that included all participants in clinical teaching and found that participants differed in their preferred characteristics and behaviours. It is important for future research to look at behaviours interdependently, rather than alone, and to take into account the evidence that participants tend to infer characteristics rather than think in terms of behaviours. This information will be used to inform the development of a formative tool for evaluating clinical teaching. [source] Does a new undergraduate curriculum based on Tomorrow's Doctors prepare house officers better for their first post?MEDICAL EDUCATION, Issue 12 2003A qualitative study of the views of pre-registration house officers using critical incidents Introduction, In 1994 Manchester University introduced an integrated undergraduate medical course using problem-based learning (PBL) throughout. The study reported here explored whether there were any differences between the new course graduates (NCGs) and the traditional course graduates (TCGs) in the types of scenarios they recalled as ,critical incidents', or challenging cases, while working as pre-registration house officers (PRHOs). The focus is on differences rather than causal links. Method, We used semistructured interviews to generate our data. Twenty-four traditional course graduates and 23 new course graduates were interviewed approximately 3 months after starting their first PRHO placement. Results, We identified 4 types of critical incidents relating to: clinical practice; limitations of competence; emotional involvement; and communication. Traditional course graduates reported difficulties in making patient management decisions, whereas the NCGs were better at dealing with uncertainty, knowing their limits and asserting their rights for support. Communication difficulties and coping with emotional involvement were common across both groups of graduates and hence remain problems in relation to being prepared for the role of a PRHO. Conclusions, Graduates of the new, integrated curriculum seemed to be much better at dealing with uncertainty, knowing their personal limits and asserting their rights for support when they felt these limits had been reached. Communication difficulties and emotional involvement remain major factors in the transition from student to PRHO. [source] The evaluation consultant's life cycle: Theory, practice, and implications for learningNEW DIRECTIONS FOR EVALUATION, Issue 111 2006Gail V. Barrington This chapter examines the stages of growth of six independent consultants, the critical incidents that led to stage change, and training requirements to support this development. [source] Professional identity as a resource for talk: exploring the mentor,student relationshipNURSING INQUIRY, Issue 4 2008Pam Shakespeare This paper discusses a study examining how mentors in nurse education make professional judgments about the clinical competence of their pre-registration nursing students. Interviews were undertaken with nine UK students and 15 mentors, using critical incidents in practice settings as a focus. The study was undertaken for the English National Practice-Based Professional Learning Centre for Excellence in Teaching and Learning. This paper reports on the conversation analytic thread of the work. The mentor role with pre-registration nursing students is not only supportive but involves formal assessment. Central to the relationship is communication. In professional education, communication is seen as a skill to be applied and assessed in practice settings but is also the medium mentors and mentees use to talk about the relationship. Analysis of excerpts of conversation in the interviews shows that episodes of communication are used as topics of conversation to establish professional identity. It also reveals that judgments about the extent of professional capacity of both students and mentors are grounded in everyday behaviours (for example, enthusiasm, indifference and confidence) as well as professional competence. In addition to focusing on clinical issues, mentors can and do use mundane communication as a resource for judgments about competence. [source] Librarians's reflective practice in electronic reserves: An exploration of sources of copyright knowledge and professional developmentPROCEEDINGS OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE & TECHNOLOGY (ELECTRONIC), Issue 1 2007Jomkwan Polparsi he research question of this study was what formal and informal sources librarians use in dealing with electronic reserves and in developing their copyright knowledge. The exploration of the sources of copyright knowledge was expected to drive issues and challenges in library practice to emerge, and to influence the design of further in-depth study. The study employs a qualitative, naturalistic data collection methodology and an inductive data analysis methodology. The study applies Schon's reflection theory as a sensitizing theoretical framework to help understand the processes of librarians' decision about electronic reserves. To date, three librarians have been interviewed. In interviews, librarians thought aloud critical incidents of electronic reserves requests and the sources of copyright knowledge they use. Qualitative analysis was carried out through in-depth analysis of interview transcripts and follow-up interviews for clarification and confirmations of the findings. The analysis aimed at formal and informal sources that librarians use and on evidence of reflection-on-action. The findings point to both formal and informal sources, and suggest that the sources represent social and institutional cues that undermine practice and decision making. Issues emerged are that librarians and stakeholders debate over copyright fair use guidelines and standards in electronic reserves, and over different meanings of fair use. To better understand library practice, it is important to explore social and institutional cues embedded in the real world. [source] Aggression in Very High-Risk Youth: Examining Developmental Risk in an Inpatient Psychiatric PopulationAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 4 2007Paul Boxer The goal of this study was to examine the utility of clinical records of psychiatrically hospitalized youth for predicting critical incidents during treatment. Intake data from inpatients (N = 484, mean age = 14 years) in a secure psychiatric facility were coded for the presence of theoretically based individual and contextual risk factor information and analyzed prospectively to predict youths' involvement in incidents of seclusion and restraint. Findings indicated that whereas several individual and contextual risk factors accounted for the likelihood of a youth becoming involved in seclusion or restraint, only histories of various types of aggression, number of prior residential placements and body mass index could predict the extent of this involvement. The implications of these findings with respect to ecologically valid research and empirically informed practice with high-risk youth are discussed. [source] A national survey of the use of bite guards and critical incidents involving the laryngeal mask airwayANAESTHESIA, Issue 5 2003J.P. Blackburn First page of article [source] Training for critical incidentsANAESTHESIA, Issue 7 2000M. J. Fairbrass No abstract is available for this article. [source] Does a new undergraduate curriculum based on Tomorrow's Doctors prepare house officers better for their first post?MEDICAL EDUCATION, Issue 12 2003A qualitative study of the views of pre-registration house officers using critical incidents Introduction, In 1994 Manchester University introduced an integrated undergraduate medical course using problem-based learning (PBL) throughout. The study reported here explored whether there were any differences between the new course graduates (NCGs) and the traditional course graduates (TCGs) in the types of scenarios they recalled as ,critical incidents', or challenging cases, while working as pre-registration house officers (PRHOs). The focus is on differences rather than causal links. Method, We used semistructured interviews to generate our data. Twenty-four traditional course graduates and 23 new course graduates were interviewed approximately 3 months after starting their first PRHO placement. Results, We identified 4 types of critical incidents relating to: clinical practice; limitations of competence; emotional involvement; and communication. Traditional course graduates reported difficulties in making patient management decisions, whereas the NCGs were better at dealing with uncertainty, knowing their limits and asserting their rights for support. Communication difficulties and coping with emotional involvement were common across both groups of graduates and hence remain problems in relation to being prepared for the role of a PRHO. Conclusions, Graduates of the new, integrated curriculum seemed to be much better at dealing with uncertainty, knowing their personal limits and asserting their rights for support when they felt these limits had been reached. Communication difficulties and emotional involvement remain major factors in the transition from student to PRHO. [source] | ||||||||||||||||||||||||||||