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      Structured evaluation of stress triggers in prehospital emergency medical care : An analysis by questionnaire regarding the professional groups Translated title: Erfassung von Stressauslösern in der prähospitalen Notfallmedizin : Eine Fragebogenerhebung unter Berücksichtigung der Berufsgruppen

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          Abstract

          Background

          Emergency medical services work in the environment of high responsibility teams and have to act under unpredictable working conditions. Stress occurs and has potential of negative effects on tasks, teamwork, prioritization processes and cognitive control. Stress is not exclusively dictated by the situation—the individuals rate the situation of having the necessary skills that a particular situation demands. There are different occupational groups in the emergency medical services in Germany. Training, tasks and legal framework of these groups vary.

          Objective

          The aim of this study was to identify professional group-specific stressors for emergency medical services. These stress situations can be used to design skills building tools to enable individuals to cope with these stressors.

          Material and methods

          The participants were invited to the study via posters and social media. An expert group (minimum 6 months of experience) developed a set of items via a two-step online Delphi survey. The experts were recruited from all professional groups represented in the German emergency medical service. We evaluated the resulting parameters for relevance and validity in a larger collective. Lastly, we identified stress factors that could be grouped in relevant scales. In total 1017 participants (paramedics, physicians) took part in the final validation survey.

          Results

          After validation, we identified a catalogue of stressors with 7 scales and 25 items for EMT (Emergency Medical Technician) paramedics (KMO [Kayser-Meyer-Olkin criterion] 0.81), 6 scales and 24 items for advanced paramedics (KMO 0.82) and 6 scales and 24 items for EMS (Emergency Medical Service) physicians (KMO 0.82). For the professional group of EMT basic, the quality parameters did not allow further processing of the items.

          Professional group-specific scales for EMT paramedics are “professional limitations”, “organizational framework”, “expectations” and “questions of meaning”. For advanced paramedics “appreciation”, “exceptional circumstances” and “legal certainty” were identified. The EMT physicians named “handling third parties”, “tolerance to ambiguity”, “task management” and “pressure to act”. A scale that is representative for all professional groups is “teamwork”. Organizational circumstances occur in all groups. The item “unnecessary missions” for EMT paramedics and “legal concerns with the application of methods” for advanced paramedics are examples.

          Discussion

          Different stressors are relevant for the individual professional groups in the German emergency medical service. The developed catalogue can be used in the future to evaluate the subjective stress load of emergency service professionals. There are stressors that are inherent in the working environment (e.g. pressure to act) and others that can be improved through training (teamwork). We recommend training of general resistance as well as training of specific items (e.g., technical, nontechnical skills). All professionals mentioned items with respect to organizational factors. The responsible persons can identify potential for improvement based on the legal and organizational items. The EMT basic requires further subdivision according to task areas due to its variable applicability.

          Supplementary Information

          The online version of this article (10.1007/s00101-021-00968-x) contains additional tables on stress factors of the surveyed groups. The article and supplementary material are available at www.springermedizin.de. Please enter the title of the article in the search field. The additional material can be found in the article under supplementary information.

          Translated abstract

          Hintergrund

          Rettungsdienste arbeiten unter den Bedingungen von „High Responsibility Teams“ und müssen auch unter unvorhersehbaren Arbeitsbedingungen agieren. Stress tritt auf und hat potenziell negative Auswirkungen auf Aufgaben, Teamarbeit und Priorisierungsprozesse.

          Ziel der Arbeit

          Das Ziel dieser Studie war es, berufsgruppenspezifische Stressoren für den Rettungsdienst zu identifizieren. Die identifizierten stressauslösenden Faktoren können genutzt werden, um Instrumente zum Aufbau von Fähigkeiten zu entwickeln, die es dem Einzelnen ermöglichen, mit diesen Stressoren umzugehen.

          Material und Methoden

          Mittels einer zweistufigen Online-Delphi-Befragung, an der Teilnehmer aus allen im deutschen Rettungsdienst vertretenen Berufsgruppen teilnahmen, wurden Items entwickelt. Die daraus resultierenden Parameter wurden in einem größeren Kollektiv auf Relevanz und Validität überprüft. Schließlich wurden Belastungsfaktoren identifiziert, die in relevanten Skalen gruppiert werden konnten. Insgesamt nahmen 1017 Teilnehmer an der abschließenden Befragung teil.

          Ergebnisse

          Nach der Validierung identifizierten wir einen Katalog von Stressoren mit 7 Skalen und 25 Items für Rettungsassistenten (KMO [Kayser-Meyer-Olkin Kriterium] 0,81), 6 Skalen und 24 Items für Notfallsanitäter (KMO 0,82) und 6 Skalen und 24 Items für Notärzte (KMO 0,82). Für die Berufsgruppe der Rettungssanitäter ließen die Gütekriterien keine weitere Bearbeitung der Items zu.

          Diskussion

          Für die einzelnen Berufsgruppen im deutschen Rettungsdienst sind unterschiedliche Stressoren relevant. Der entwickelte Katalog kann in Zukunft zur Bewertung der subjektiven Stressbelastung von Rettungsdienstmitarbeitern eingesetzt werden. Der Rettungssanitäter bedarf aufgrund seiner unterschiedlichen Einsatzgebiete einer weiteren Untergliederung nach Aufgabenbereichen.

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          Most cited references28

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          Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

          Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement. Copyright 2003 Wiley-Liss, Inc.
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            Research guidelines for the Delphi survey technique.

            Consensus methods such as the Delphi survey technique are being employed to help enhance effective decision-making in health and social care. The Delphi survey is a group facilitation technique, which is an iterative multistage process, designed to transform opinion into group consensus. It is a flexible approach, that is used commonly within the health and social sciences, yet little guidance exists to help researchers undertake this method of data collection. This paper aims to provide an understanding of the preparation, action steps and difficulties that are inherent within the Delphi. Used systematically and rigorously, the Delphi can contribute significantly to broadening knowledge within the nursing profession. However, careful thought must be given before using the method; there are key issues surrounding problem identification, researcher skills and data presentation that must be addressed. The paper does not claim to be definitive; it purports to act as a guide for those researchers who wish to exploit the Delphi methodology.
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              The relation of strength of stimulus to rapidity of habit-formation

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                Author and article information

                Contributors
                eismann.hendrik@mh-hannover.de
                vhagemann@uni-bremen.de
                Flentje.Markus@mh-hannover.de
                Journal
                Anaesthesist
                Anaesthesist
                Der Anaesthesist
                Springer Medizin (Heidelberg )
                0003-2417
                1432-055X
                11 May 2021
                11 May 2021
                2022
                : 71
                : 4
                : 291-298
                Affiliations
                [1 ]GRID grid.10423.34, ISNI 0000 0000 9529 9877, Department of Anaesthesiology and Intensive Care Medicine, , Hannover Medical School, ; Carl-Neuberg-Straße 1, 30625 Hannover, Germany
                [2 ]GRID grid.7704.4, ISNI 0000 0001 2297 4381, Faculty of Business Studies and Economics, , University of Bremen, ; Enrique-Schmidt-Straße 1, 28359 Bremen, Germany
                Article
                968
                10.1007/s00101-021-00968-x
                8986693
                33974115
                6515854b-4432-4f22-8c62-26ec48e4255d
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 31 December 2020
                : 10 March 2021
                : 7 April 2021
                Funding
                Funded by: Medizinische Hochschule Hannover (MHH) (3118)
                Categories
                Originalien
                Custom metadata
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2022

                emergency ambulance systems,performance improvement,psychological conditions,quality improvement,stress management,rettungsdienste,leistungssteigerung,psychische rahmenbedingungen,qualitätsverbesserung,stressmanagement

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