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Browsing by Author "Zagarese, Vivian"

Now showing 1 - 4 of 4
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    Episodes of strain experienced in the operating room: impact of the type of surgery, the profession and the phase of the operation
    Keller, Sandra; Yule, Steven; Smink, Douglas S.; Zagarese, Vivian; Safford, Shawn D.; Parker, Sarah H. (2020-12-07)
    Abstract Background Strain episodes, defined as phases of higher workload, stress or negative emotions, occur everyday in the operating room (OR). Accurate knowledge of when strain is most intense for the different OR team members is imperative for developing appropriate interventions. The primary goal of the study was to investigate temporal patterns of strain across surgical phases for different professionals working in the OR, for different types of operations. Methods We developed a guided recall method to assess the experience of strain from the perspective of operating room (OR) team members. The guided recall was completed by surgeons, residents, anesthesiologists, circulating nurses and scrub technicians immediately after 113 operations, performed in 5 departments of one hospital in North America. We also conducted interviews with 16 surgeons on strain moments during their specific operation types. Strain experiences were related to surgical phases and compared across different operation types separately for each profession in the OR. Results We analyzed 693 guided recalls. General linear modeling (GLM) showed that strain varied across the phases of the operations (defined as before incision, first third, middle third and last third) [quadratic (F = 47.85, p < 0.001) and cubic (F = 8.94, p = 0.003) effects]. Phases of operations varied across professional groups [linear (F = 4.14, p = 0.001) and quadratic (F = 14.28, p < 0.001) effects] and surgery types [only cubic effects (F = 4.92, p = 0.001)]. Overall strain was similar across surgery types (F = 1.27, p = 0.28). Surgeons reported generally more strain episodes during the first and second third of the operations; except in vascular operations, where no phase was associated with significantly higher strain levels, and emergency/trauma surgery, where strain episodes occurred primarily during the first third of the operation. Other professional groups showed different strain time patterns. Conclusions Members of the OR teams experience strain differently across the phases of an operation. Thus, phases with high concentration requirements may highly vary across OR team members and no single phase of an operation can be defined as a “sterile cockpit” phase for all team members.
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    Leadership During Action Team Formation: The Influence of Shared Leadership Among Team Members During the Perioperative Process
    Zagarese, Vivian (Virginia Tech, 2020)
    There are many leadership theories that dominate the field of Industrial and Organizational Psychology, however there is a lack of understanding as to which leadership processes may be most appropriate for action teams in high stress environments. Previous research has articulated leadership behaviors, but has largely ignored the temporal processes of leadership, and how it changes throughout the operating team’s tenure. The proposed study investigates two types of leadership, namely shared and autocratic leadership, that take place during critical steps of the perioperative process and relates these leadership behaviors to team dynamics and psychological processes. Specifically, this study builds upon other studies by testing how leadership behaviors are related to levels of psychological safety and the optimization of teamwork and communication among team members. We were also interested in understanding if the surgeon’s perception of past performance of their team has an impact on the amount of trust the leader has in his/her team and if this in turn, has an impact on the type of leadership utilized during the team’s tenure. As an exemplar environment, we explored these dynamics in the operating theater, which is a high stakes environment requiring both technical and non-technical skills, such as leadership, communication, and teamwork. Results show that the correlation between the surgeon’s perceived past performance of the team and the trust the surgeon has in his/her team and the relationship between team’s trust and teamwork and communication were significant at the alpha =.1 level. All other relationships were non-significant.
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    The NOTECHS plus : A Short Scale Designed for Assessing the Non-technical Skills (and more) in the Aviation and the Emergency Personnel
    Ceschi, Andrea; Costantini, Arianna; Zagarese, Vivian; Avi, Eleonora; Sartori, Riccardo (Frontiers, 2019-05-07)
    This research presents the development of a short scale named "NOTECHS+" to measure the Non-Technical Skills (i.e., NOTECHS: Cooperation, Leadership and Managerial skills, Decision-Making, and Situational Awareness), Resilience and Emotion Regulation, in a sector that comprises the aviation and the emergency personnel: the Helicopter Emergency Medical Service (HEMS). The design process of the scale was carried out starting from a review on the behavioral markers used to detect the NOTECHS. Moreover, 70 interviews with HEMS experts have been conducted with the aim of developing Resilience and Emotion Regulation items by considering the different professional profiles (e.g., pilots, nurses, physicians, etc.) which compose the HEMS. Through a pre-assessment procedure, a Q-Sort test was performed on a sample of students (n = 30) to test the logical principles, but also intelligibility and clarity, of the items developed. Once the instrument was defined, 211 participants from the HEMS sector were surveyed to test the theoretical model behind the NOTECHS+ instrument. First exploratory and then confirmatory analysis yielded results that suggested that the 18 items selected conform to a bi-factor model composed of three skill-dimensions: Social skills (i.e., Cooperation, and Leadership and Managerial skills), Cognitive skills (i.e., Decision-Making and Situational Awareness) and Emotional skills (i.e., Resilience and Emotional Regulation). Finally, the study ends with a discussion on the results obtained, including practical implications on assessment and training based on this novel instrument.
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    Reimagining medical workspaces through on-site observations and bodystorming
    Ishida, Aki; Martin, Thomas; Gracanin, Denis; Franusich, David; Buck, Carl; Parker, Sarah H.; Knapp, R. Benjamin; Haley, Vince; Zagarese, Vivian; Tasooji, Reza (2023-01)
    Clinicians in acute care hospitals experience highly stressful situations daily. They work long, variable hours, complete complex technical tasks, and must also be emotionally engaged with patients and families to meet the caring demands of this profession, which can lead to burnout. In response to these challenges, a multi-disciplinary team from Virginia Tech collaborated with Steelcase to study the impact of medical workspaces on the clinician experience and how those workspaces could be improved to reduce some of the sources of burnout. The team sought to identify conditions that could either aid or hinder clinician workflow and affect burnout rate, then based on interviews and in-situ ethnographic studies, generated design concepts for nurse stations, both centralized and mobile. Using digital and physical full-scale prototypes, we enacted clinical care scenarios to seek feedback and reflect on the design.