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.
Similar content being viewed by others
References
Ali B, Zafari AM (2007) Narrative review: cardiopulmonary resuscitation and emergency cardiovascular care: review of the current guidelines. Ann Intern Med 147:171–179
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
Perkins GD, Hulme J, Bion JF (2002) Peer-led resuscitation training for healthcare students: a randomised controlled study. Intensive Care Med 28:698–700
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
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
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
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
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
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
Scott G, Mulgrew E, Smith T (2003) Cardiopulmonary resuscitation: attitudes and perceptions of junior doctors. Hosp Med 64:425–428
Driskell JE, Salas E (1996) Stress and human performance. Lawrence Erlbaum, Mahwah, pp 1–48
Matthews G (2000) Human performance: cognition stress, and individual differences. Psychology Press, Philadelphia, pp 161–176
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
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
Driskell JA, Salas E, Johnston J (1999) Does stress lead to a loss of team perspective? Group Dyn Theory Res Pract 3:291–302
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
Lazarus RS, Eriksen CW (1952) Effects of failure stress upon skilled performance. J Exp Psychol 43:100–105
Ng W, Diener E, Aurora R, Harter J (2009) Affluence, feelings of stress, and well-being. Soc Indic Res 94:257–271
Folkman S, Moskowitz JT (2000) Positive affect and the other side of coping. Am Psychol 55:647–654
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
Scherer KR (2005) What are emotions? And how can they be measured? Soc Sci Inf 44:693–727
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
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
Lazarus RS (1993) From psychological stress to the emotions—a history of changing outlooks. Annu Rev Psychol 44:1–21
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
Caffrey SL, Willoughby PJ, Pepe PE, Becker LB (2002) Public use of automated external defibrillators. N Engl J Med 347:1242–1247
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
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
Corresponding author
Additional information
S. Hunziker, L. Laschinger, and S. Portmann-Schwarz equally contributed to this work.
Electronic supplementary material
Rights 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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-011-2277-2