Skip to main content
Log in

Perceived stress and team performance during a simulated resuscitation

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ali B, Zafari AM (2007) Narrative review: cardiopulmonary resuscitation and emergency cardiovascular care: review of the current guidelines. Ann Intern Med 147:171–179

    PubMed  Google Scholar 

  2. Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP (1993) Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 22:1652–1658

    Article  PubMed  CAS  Google Scholar 

  3. Perkins GD, Hulme J, Bion JF (2002) Peer-led resuscitation training for healthcare students: a randomised controlled study. Intensive Care Med 28:698–700

    Article  PubMed  Google Scholar 

  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 9:3

    Article  PubMed  Google Scholar 

  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 38:1086–1091

    Article  PubMed  Google Scholar 

  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 60:51–56

    Article  PubMed  Google Scholar 

  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 19:277–304

    Article  Google Scholar 

  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):2381–2388

    Google Scholar 

  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 3:389–394

    Article  PubMed  CAS  Google Scholar 

  10. Scott G, Mulgrew E, Smith T (2003) Cardiopulmonary resuscitation: attitudes and perceptions of junior doctors. Hosp Med 64:425–428

    PubMed  Google Scholar 

  11. Driskell JE, Salas E (1996) Stress and human performance. Lawrence Erlbaum, Mahwah, pp 1–48

    Google Scholar 

  12. Matthews G (2000) Human performance: cognition stress, and individual differences. Psychology Press, Philadelphia, pp 161–176

    Google Scholar 

  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 2:257–271

    Google Scholar 

  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 e311–316

    Article  PubMed  Google Scholar 

  15. Driskell JA, Salas E, Johnston J (1999) Does stress lead to a loss of team perspective? Group Dyn Theory Res Pract 3:291–302

    Article  Google Scholar 

  16. Hockey GRJ (1997) Compensatory control in the regulation of human performance under stress and high workload: a cognitive-energetical framework. Biol Psychol 45:73–93

    Article  PubMed  CAS  Google Scholar 

  17. Lazarus RS, Eriksen CW (1952) Effects of failure stress upon skilled performance. J Exp Psychol 43:100–105

    Article  PubMed  CAS  Google Scholar 

  18. Ng W, Diener E, Aurora R, Harter J (2009) Affluence, feelings of stress, and well-being. Soc Indic Res 94:257–271

    Article  Google Scholar 

  19. Folkman S, Moskowitz JT (2000) Positive affect and the other side of coping. Am Psychol 55:647–654

    Article  PubMed  CAS  Google Scholar 

  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 22:831–833

    Article  PubMed  CAS  Google Scholar 

  21. Scherer KR (2005) What are emotions? And how can they be measured? Soc Sci Inf 44:693–727

    Article  Google Scholar 

  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 572–595

    Google Scholar 

  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 80:919–924

    Article  PubMed  Google Scholar 

  24. Lazarus RS (1993) From psychological stress to the emotions—a history of changing outlooks. Annu Rev Psychol 44:1–21

    Article  PubMed  CAS  Google Scholar 

  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 6:78–83

    Article  PubMed  Google Scholar 

  26. Caffrey SL, Willoughby PJ, Pepe PE, Becker LB (2002) Public use of automated external defibrillators. N Engl J Med 347:1242–1247

    Article  PubMed  Google Scholar 

  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 63:295–303

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sabina Hunziker.

Additional information

S. Hunziker, L. Laschinger, and S. Portmann-Schwarz equally contributed to this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (JPEG 150 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hunziker, S., Laschinger, L., Portmann-Schwarz, S. et al. Perceived stress and team performance during a simulated resuscitation. Intensive Care Med 37, 1473–1479 (2011). https://doi.org/10.1007/s00134-011-2277-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-011-2277-2

Keywords

Navigation