Finding the calm within CPR
Whilst we all acknowledge how stressful CPR is how often do we actually consider what contributes to that stress?
Within human healthcare factors that have been attributed to CPR stress include lack of clarity in roles and lack of knowledge about team members (Dijikstra et al 2023). To consider how we may find order in the chaos teams should consider how we can improve role clarity, team familiarity and mutual trust with one another. A consequence of those mentioned stressors is the reduction in communication. With an impact on psychological safety.
A big focus within both the human and veterinary sectors is the shared mental model during CPR.
Decision making typically will originate from the veterinary surgeon, but if we consider applying a shared mental model everyone should feel part of the decision-making process. They would also be able to speak up and help the team with the decision-making process.
With the operating theatre scrub hats have been linked to improved psychological safety and improved communication (Douglas et al 2021). Could they be used and this transferred across into the CPR scenario?
Anecdotally and from experience equipment that is malfunctioning or not present can also contribute to the stress caused by CPR. More than one paper has documented the use of cognitive aids to improve response time and support decision making. Ensuring those aids are present and user friendly will help minimise delays during CPR. Equipment should also be maintained, easy to locate and available.
Cognitive aids during CPR can be instrumental in promoting calmness within CPR. Alongside that regular training and frequent simulations. Both of which again are well utilised in human healthcare. They have value for all team members but have been especially highlighted for their confidence building in new team members (Bukay, A 2023) Simulations should cover both a range of scenarios and number of team members. By doing this we can identify areas for improvement and any potential hurdles. There is also the benefit of building people’s long-term working memory of the CPR specific tasks, plus in time building confidence within the teams.
In summary there are many tools we can utilise for calmer and efficient CPR.
These include, but are not limited to, regular training, a shared mental model, cognitive aids and team familiarity.
Reading list is below, hope this helps.
References
Bukay A. The Effect of Simulation on Newly Licensed Nurses’ Confidence in Initiating Cardiopulmonary Resuscitation: A Narrative Review. Creative Nursing. 2023;29(2):211-215. doi:10.1177/10784535231195489
Douglas N, Demeduik S, Conlan K, Salmon P, Chee B, Sullivan T, Heelan D, Ozcan J, Symons G, Marane C. Surgical caps displaying team members’ names and roles improve effective communication in the operating room: a pilot study. Patient Saf Surg. 2021 Jul 28;15(1):27. doi: 10.1186/s13037-021-00301-w. PMID: 34321063; PMCID: PMC8317270.
Dijkstra, F., de la Croix, A., van Schuppen, H., Meeter, M., & Renden, P. (2023). When routine becomes stressful: A qualitative study into resuscitation team members’ perception of stress and performance. Journal of Interprofessional Care, 38(2), 191–199. https://doi.org/10.1080/13561820.2023.2289507
El-Ashry AM, Elsayed SM, Ghoneam MA, Atta MHR. Compassion fatigue and stress related to cardiopulmonary resuscitation: a study of critical care nurses’ experiences. BMC Nurs. 2023 Dec 18;22(1):482. doi: 10.1186/s12912-023-01640-y. PMID: 38110907; PMCID: PMC10726549.
Greig, P.R., Zolger, D., Onwochei, D.N., Thurley, N., Higham, H. and Desai, N. (2023), Cognitive aids in the management of clinical emergencies: a systematic review. Anaesthesia, 78: 343-355. https://doi.org/10.1111/anae.15939
