Intensive Care Medicine

, Volume 37, Issue 9, pp 1473–1479 | Cite as

Perceived stress and team performance during a simulated resuscitation

  • Sabina Hunziker
  • Laura Laschinger
  • Simone Portmann-Schwarz
  • Norbert K. Semmer
  • Franziska Tschan
  • Stephan Marsch
Original

Abstract

Purpose

Barriers to optimal performance of cardiopulmonary resuscitation may partly relate to human factors, such as stress and specific emotions. The aim of this study was to investigate whether mental stress and different perceived emotions have a negative impact on the performance of rescuers.

Methods

This prospective, observational study was conducted at the Simulator Center of the University Hospital Basel, Switzerland. A total of 120 medical students (70% female) participated in teams of three. They reported levels of perceived stress, feeling overwhelmed, motivation and specific emotions before, during, and after a simulated resuscitation. The association of stress/overload (index of stress and feeling overwhelmed), motivation, and specific emotions with resuscitation performance defined as hands-on time during the first 180 s after cardiac arrest was investigated.

Results

During resuscitation, levels of stress/overload, motivation, and negative emotions were significantly higher as compared to the periods before and after resuscitation. In contrast, positive emotions were highest before and after resuscitation and significantly lower during resuscitation. In general, females reported higher stress/overload and negative emotions, whereas males reported more positive emotions. A multivariate linear regression model showed negative associations of stress/overload (regression coefficient −18.12, 95% CI −30.73, −5.51, p = 0.006) and positive associations of motivation (regression coefficient 13.45, 95% CI 0.95, 25.95, p = 0.036) with resuscitation performance.

Conclusion

A simulated cardiac arrest caused substantial perceived stress/overload and negative emotions, particularly in female students, which adversely impacted resuscitation performance. Further studies are required to expand our findings to more experienced medical professionals and investigate whether stress coping strategies improve resuscitation performance.

Keywords

Stress Resuscitation Human factors Emotion Emotion wheel Outcome Team performance 

Notes

Acknowledgments

SH was supported partly by an unrestricted research grant from the Swiss National Foundation (SNF PBBSP3-128266) and partly by the University of Basel, Switzerland.

Conflict of interest

None declared.

Supplementary material

Supplementary Appendix 1 Stress/overload index, positive emotions and negative emotions in female and male rescuers at different time points of before, during and after resuscitation (JPG 151 KB)

134_2011_2277_MOESM1_ESM.jpg (150 kb)
Supplementary material 1 (JPEG 150 kb)

References

  1. 1.
    Ali B, Zafari AM (2007) Narrative review: cardiopulmonary resuscitation and emergency cardiovascular care: review of the current guidelines. Ann Intern Med 147:171–179PubMedGoogle Scholar
  2. 2.
    Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP (1993) Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 22:1652–1658PubMedCrossRefGoogle Scholar
  3. 3.
    Perkins GD, Hulme J, Bion JF (2002) Peer-led resuscitation training for healthcare students: a randomised controlled study. Intensive Care Med 28:698–700PubMedCrossRefGoogle Scholar
  4. 4.
    Hunziker S, Tschan F, Semmer NK, Zobrist R, Spychiger M, Breuer M, Hunziker PR, Marsch SC (2009) Hands-on time during cardiopulmonary resuscitation is affected by the process of teambuilding: a prospective randomised simulator-based trial. BMC Emerg Med 9:3PubMedCrossRefGoogle Scholar
  5. 5.
    Hunziker S, Buhlmann C, Tschan F, Balestra G, Legeret C, Schumacher C, Semmer NK, Hunziker P, Marsch S (2010) Brief leadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: a randomized controlled trial. Crit Care Med 38:1086–1091PubMedCrossRefGoogle Scholar
  6. 6.
    Marsch SC, Muller C, Marquardt K, Conrad G, Tschan F, Hunziker PR (2004) Human factors affect the quality of cardiopulmonary resuscitation in simulated cardiac arrests. Resuscitation 60:51–56PubMedCrossRefGoogle Scholar
  7. 7.
    Tschan F, Semmer NK, Gautschi D, Hunziker P, Spychiger M, Marsch SU (2006) Leading to recovery: group performance and coordinative activities in medical emergency driven groups. Hum Perform 19:277–304CrossRefGoogle Scholar
  8. 8.
    Hunziker S, Johansson A, Tschan F, Semmer NK, Rock L, Howell MD, Marsch S (2011) Teamwork and leadership in cardiopulmonary resuscitation. J Am Coll Cardiol 57(24):2381–2388Google Scholar
  9. 9.
    Hunziker S, Tschan F, Semmer NK, Howell MD, Marsch S (2010) Human factors in resuscitation: lessons learned from simulator studies. J Emerg Trauma Shock 3:389–394PubMedCrossRefGoogle Scholar
  10. 10.
    Scott G, Mulgrew E, Smith T (2003) Cardiopulmonary resuscitation: attitudes and perceptions of junior doctors. Hosp Med 64:425–428PubMedGoogle Scholar
  11. 11.
    Driskell JE, Salas E (1996) Stress and human performance. Lawrence Erlbaum, Mahwah, pp 1–48Google Scholar
  12. 12.
    Matthews G (2000) Human performance: cognition stress, and individual differences. Psychology Press, Philadelphia, pp 161–176Google Scholar
  13. 13.
    Matthews G, Campbell SE, Falconer S, Joyner LA, Huggins J, Gilliland K, Grier R, Warm JS (2002) Fundamental dimensions of subjective state in performance settings: task engagement, distress, and worry. Emotion 2:257–271Google Scholar
  14. 14.
    Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R (2010) The impact of stress on surgical performance: a systematic review of the literature. Surgery 147:318–330 330 e311–316PubMedCrossRefGoogle Scholar
  15. 15.
    Driskell JA, Salas E, Johnston J (1999) Does stress lead to a loss of team perspective? Group Dyn Theory Res Pract 3:291–302CrossRefGoogle Scholar
  16. 16.
    Hockey GRJ (1997) Compensatory control in the regulation of human performance under stress and high workload: a cognitive-energetical framework. Biol Psychol 45:73–93PubMedCrossRefGoogle Scholar
  17. 17.
    Lazarus RS, Eriksen CW (1952) Effects of failure stress upon skilled performance. J Exp Psychol 43:100–105PubMedCrossRefGoogle Scholar
  18. 18.
    Ng W, Diener E, Aurora R, Harter J (2009) Affluence, feelings of stress, and well-being. Soc Indic Res 94:257–271CrossRefGoogle Scholar
  19. 19.
    Folkman S, Moskowitz JT (2000) Positive affect and the other side of coping. Am Psychol 55:647–654PubMedCrossRefGoogle Scholar
  20. 20.
    Marsch SCU, Tschan F, Semmer N, Spychiger M, Breuer M, Hunziker PR (2005) Unnecessary interruptions of cardiac massage during simulated cardiac arrests. Eur J Anaesthesiol 22:831–833PubMedCrossRefGoogle Scholar
  21. 21.
    Scherer KR (2005) What are emotions? And how can they be measured? Soc Sci Inf 44:693–727CrossRefGoogle Scholar
  22. 22.
    Ellsworth PC, Scherer KR (2003) Appraisal processes in emotions. In: Davidson RJ, Scherer KR, Goldsmith HH (eds) Handbook of affective sciences. Oxford, Oxford University Press, pp 572–595Google Scholar
  23. 23.
    Muller MP, Hansel M, Fichtner A, Hardt F, Weber S, Kirschbaum C, Ruder S, Walcher F, Koch T, Eich C (2009) Excellence in performance and stress reduction during two different full scale simulator training courses: a pilot study. Resuscitation 80:919–924PubMedCrossRefGoogle Scholar
  24. 24.
    Lazarus RS (1993) From psychological stress to the emotions—a history of changing outlooks. Annu Rev Psychol 44:1–21PubMedCrossRefGoogle Scholar
  25. 25.
    Streiff S, Tschan F, Hunziker S, Buehlmann C, Semmer NK, Hunziker P, Marsch S (2011) Leadership in medical emergencies depends on gender and personality. Simul Healthc 6:78–83PubMedCrossRefGoogle Scholar
  26. 26.
    Caffrey SL, Willoughby PJ, Pepe PE, Becker LB (2002) Public use of automated external defibrillators. N Engl J Med 347:1242–1247PubMedCrossRefGoogle Scholar
  27. 27.
    Schneider L, Sterz F, Haugk M, Eisenburger P, Scheinecker W, Kliegel A, Laggner AN (2004) CPR courses and semi-automatic defibrillators–life saving in cardiac arrest? Resuscitation 63:295–303PubMedCrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Sabina Hunziker
    • 1
    • 2
  • Laura Laschinger
    • 2
  • Simone Portmann-Schwarz
    • 2
  • Norbert K. Semmer
    • 3
  • Franziska Tschan
    • 4
  • Stephan Marsch
    • 2
  1. 1.Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Harvard Medical SchoolBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Medical Intensive Care UnitUniversity Hospital BaselBaselSwitzerland
  3. 3.University of BernBernSwitzerland
  4. 4.University of NeuchâtelNeuchâtelSwitzerland

Personalised recommendations