MEDICAL EMERGENCY TEAMS: graduate nurses interactions, attitudes and

perceptions during resuscitation events in the non-critical care environment

Jamie RanseResearch Coordinator

Intensive Care UnitThe Canberra Hospital

OVERVIEW

• Background

• Purpose

• Methods

• Findings

• Discussion

• Recommendations

BACKGROUND

• Previous research has explored the resuscitation experience of:– Bystanders– Laypersons– Volunteer first aiders– Junior doctors– Critical care nurses and – General nurses

• Graduate Nurse transition experience

PURPOSE

The purpose of this research was to explore, describe and interpret the lived experience of graduate nurses who have participated in an in-hospital resuscitation event within the non-critical care environment.

METHODS

Design • Hermeneutic phenomenological

Population and Sample• Convenience sample • Six graduate nurses

Data Collection and Analysis• Focus groups • Thematic analysis

FINDING

Four main themes:

• Needing to decide• Having to act

• Feeling connected

• Being supported

FINDINGS: needing to decide

… the CNC was just outside, so I said “come in, have a look, I need to call a MET” … (Liz)

One of the educators said to me “they [the MET] are not going to be happy that you called it” … (Ali)

… it started off smoothly … once the MET came in they push you out of the road … it went to utter chaos … (Kathy)

… there are too many people involved … too many Chiefs and not enough Indians. (Zoe)

FINDINGS: having to act

… [I was] unsure as to the first step to take … (Ali)

… I will just try, do the best that I can, but don’t expect me to have the knowledge and the skill. (Liz)

You secure yourself in that role, like you were as a student … I have no responsibility here. (Zoe)

… I found it [a simulated resuscitation event] was similar to a real code (resuscitation event), it’s kind of chaotic … (Zoe)

FINDINGS: feeling connected

I just wanted to run the other way. (Megan)

… I felt very, very stressed … [the patient in cardiac arrest]was lying in the corridor, I had just pushed the emergencytrolley down [to the patients location] and [I decided] I will getthe oxygen and the mask. So I ran to a patient’s bedside tograb a mask … I didn’t even think it’s in the trolley that I have just pushed. (Zoe)

… they’re interesting ... an amazing experience, sometimes you think that was great. (Liz)

It was exciting … and gave me a lot more confidence. (Jess)

FINDINGS: being supported

… the MET team comes and everyone disappears …everyone goes and you’re stuck there … [the MET] need things and you can’t go because you are scribing … (Megan)

… [ward nurses will support you] if you are in tears. (Megan)

DISCUSSION

• Graduate nurses feel stressed in new situations• Similar experience to other cohort

• Lack of an opportunity to debrief• Resuscitation events are chaotic

• Decision making• Graduate nurses don’t feel publicly tested

RECOMMENDATIONS: practice

• Non-critical care nurses need to be encouraged to remain involved in the resuscitation process following the arrival of the Medical Emergency Team

• Strategies should be employed to ensure an optimal number of people are involved

• Participants should be provided with an opportunity to participate in a formal debriefing session

RECOMMENDATIONS: education

• Non-critical care staff should undertake education and training in advanced life support

• Extend beyond basic life support

• Simulation that replicates the realities of resuscitation

RECOMMENDATIONS: research

• Holistic picture of in-hospital resuscitation from other cohorts

• Determine the effectiveness of coping strategies

MORE INFORMATION

Ranse J, Arbon P. Graduate nurses’ lived experience of in-hospital resuscitation: a hermeneutic phenomenological approach. Australian Critical Care. 2008. [accepted]