Stress in healthcare professionals
What are the consequences of stress on caregivers' memory and attention?
Stress has significant consequences on the memorization and attention of caregivers, particularly in life-threatening emergency situations.
Here is a summary of the main effects:
Impaired working memory
Stress reduces the ability of caregivers to process multiple pieces of information simultaneously. This can lead to crucial oversights, such as not remembering that a patient is on anticoagulants or has specific allergies.
Long-term memory impairment
Stress can also affect the ability to recall previously known information. This means that well-mastered knowledge can become inaccessible in situations of intense stress.
Decreased concentration
Stress causes physiological manifestations such as tachycardia, tremors, and a sensation of mental confusion, which can reduce the ability to concentrate on a given task. This phenomenon is sometimes described as 'attentional deafness' or 'attentional blindness,' where caregivers do not correctly perceive the visual or auditory information present in front of them.
These consequences can have a direct impact on the quality of care provided, increasing the risk of medical errors and compromising patient safety. Stress management strategies, such as team communication training and the use of simulation techniques, are recommended to mitigate these effects and improve the performance of healthcare professionals in stressful situations.
What techniques can help reduce stress among caregivers in emergency situations?
Several techniques can help reduce stress in caregivers in emergency situations:
Communication techniques
Closed loop communication
This three-step method (message emission, repetition by the recipient, confirmation by the sender) secures the transmission of critical information and reduces communication errors.
Situation reports
These brief pauses in the action allow the leader to inform the team of the current situation, objectives, and actions to be taken. This helps to maintain a shared awareness of the situation and reduce anxiety related to uncertainty.
Using SAED
This structured tool (Situation, Background, Assessment, Recommendation) helps organize and effectively transmit important information about the patient, thereby reducing the risk of omissions and misunderstandings.
Stress management techniques
Simulation training
Simulation training allows caregivers to familiarize themselves with emergency situations in a controlled environment, which can reduce anxiety during real-life situations.
Active listening
This communication technique, developed by Carl Rogers and Thomas Gordon, fosters a climate of trust and respect within the team, which can help reduce interpersonal stress.
Culture of "daring to speak up"
Encouraging all team members to speak up and share their observations or suggestions can reduce hierarchy-related stress and improve collective decision-making.
Organizational strategies
Clarifying roles
Clearly defining the responsibilities of each team member can reduce the anxiety associated with uncertainty about the tasks to be accomplished.
Pre-intervention briefings
Brief meetings before an emergency intervention can help mentally prepare the team and anticipate potential challenges.
Post-intervention debriefings
These sessions allow the team to discuss the experience, express their emotions, and identify areas for improvement, which can reduce long-term stress.
By implementing these techniques, care teams can create a more serene and effective working environment, even in life-threatening emergency situations. It is important to note that these methods require regular practice and commitment from the whole team to be fully effective.
Sources
Jacobsson M, Hargestam M, Hultin M, et al. Flexible knowledge repertoires: communication by leaders in trauma teams. Scand J Trauma Resusc Emerg Med 2012;20:44
Buchanan TW, Tranel D. Stress and emotional memory retrieval: effects of sex and cortisol response. Neurobiol Learn Mem 2008;89(2):134-41
Cannon WB. Bodily Changes in Pain, Hunger, Fear and Rage. New York, NY: D. Appleton & Company, 1915
Selye H. A syndrome produced by diverse nocuous agents. Nature 1936 ;138:32
Arora S, Sevdalis N, Nestel D, et al. The impact of stress on surgical performance: a systematic review of the literature. Surgery 2010;147(3):318-30
Harvey A, Bandiera G, Nathens AB, et al. Impact of stress on resident performance in simulated trauma scenarios. J Trauma Acute Care Surg 2012;72(2):497-503
Fraser K, McLaughlin K. Temporal pattern of emotions and cognitive load during simulation training and debriefing. Med Teach 2019;41(2):184-189
Ignacio J, Dolmans D, Scherpbier A, et al. Stress and anxiety management strategies in health professions' simulation training: a review of the literature. BMJ Simul Technol Enhanc Learn 2016;2(2):42-46
Cros J. Securing communication, in Fuzier R, Jaulin F, Human factors in health, Arcueil: John Libbey Eurotext, 2023, 119-124
Cros J. Better communication between caregivers, Arcueil, Arnette, John Libbey Eurotext 2018
Härgestam M, Lindkvist M, Brulin C, et al. Communication in interdisciplinary teams: exploring closed-loop communication during in situ trauma team training. BMJ Open 2013;21;3(10):e003525
Burke CS, Salas E, Wilson-Donnelly K, et al. How to turn a team of experts into an expert medical team: guidance from the aviation and military communities. Qual Saf Health Care 2004;13(Suppl 1):i96-104
Tirtiaux G. Mieux réussir ensemble, Seraing : Edipro, 2019
https://sfar.org/facteurs-humains-en-situations-critiques/ (last accessed 2/04/2024)
Cornic H, Brunel E. Intra- and interprofessional transmissions, in Fuzier R, Jaulin F, Human factors in health, Arcueil: John Libbey Eurotext, 2023, 119-124
https://www.has-sante.fr/jcms/c_1776178/fr/saed-un-guide-pour-faciliter-la-communication-entre-professionnels-de-sante (last accessed 1/04/2024)
Starmer AJ, Sectish TC, Simon DW, et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident
handoff bundle. JAMA 2013;310(21):2262-70
Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. N Engl J Med. 2014;371(19):1803-12
El-Shafy IA, Delgado J, Akerman M, et al. Closed-Loop Communication Improves Task Completion in Pediatric Trauma Resuscitation. J Surg Educ. 2018;75(1):58-64
Bourgeon L, Bensalah M, Vacher A, et al. Role of emotional competence in residents' simulated emergency care performance: a mixed-methods study. BMJ Qual
Saf 2016;25(5):364-71.
Allan CK, Thiagarajan RR, Beke D, et al. Simulation-based training delivered directly to the pediatric cardiac intensive care unit engenders preparedness, comfort and decreased anxiety among multidisciplinary resuscitation teams. J Thorac Cardiovasc Surg 2010;140(3):646-52
Diaz MCG, Dawson K. Impact of Simulation-Based Closed-Loop Communication Training on Medical Errors in a Pediatric Emergency Department. Am J Med Qual 2020;35(6):474-478
