Trainee Perspectives on Manikin Death During Mock Codes

Lizotte, Marie-Hélène; Latraverse, Véronique; Moussa, Ahmed; Lachance, Christian; Barrington, Keith J.; Janvier, Annie

doi:10.1542/peds.2014-3910

Cited by 17 publications

(8 citation statements)

References 15 publications

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“…), 30 short educational training programs, 31 and simulation education. 32 This survey and much evidence support that further education and training would likely improve the neonatal EOL standard of care in America.…”

Section: Discussionmentioning

confidence: 84%

Survey on Neonatal End-of-Life Comfort Care Guidelines Across America

Haug

Farooqi

Wilson

et al. 2018

Journal of Pain and Symptom Management

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Context. Infants of age less than one year have the highest mortality rate in pediatrics. The American Academy of Pediatrics published guidelines for palliative care in 2013; however, significant variation persists among local protocols addressing neonatal comfort care at the end-of-life (EOL). Objectives. The purpose of this study was to evaluate current neonatal EOL comfort care practices and clinician satisfaction across America. Methods. After institutional review board approval (516005), an anonymous, electronic survey was sent to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine. Members of the listserv include neonatologists, neonatal fellow physicians, neonatal nurses, and neonatal nurse practitioners from across America (U.S. and Canada). Results. There were 346/3000 (11.5%) responses with wide geographic distribution and high levels of intensive care responding (46.1% Level IV, 50.9% Level III, 3.0% Level II). Nearly half (45.2%) reported that their primary institution did not have neonatal comfort care guidelines. Of those reporting institutional neonatal comfort care guidelines, 19.1% do not address pain symptom management. Most guidelines also do not address gastrointestinal distress, anxiety, or secretions. Thirty-nine percent of respondents stated that their institution did not address physician compassion fatigue. Overall, 91.8% of respondents felt that their institution would benefit from further education/training in neonatal EOL care. Conclusion. Across America, respondents confirmed significant variation and verified many institutions do not formally address neonatal EOL comfort care. Institutions with guidelines commonly appear to lack crucial areas of palliative care including patient symptom management and provider compassion fatigue. The overwhelming majority of respondents felt that their institutions would benefit from further neonatal EOL care training.

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Section: Discussionmentioning

confidence: 84%

Survey on Neonatal End-of-Life Comfort Care Guidelines Across America

Haug

Farooqi

Wilson

et al. 2018

Journal of Pain and Symptom Management

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“…We used this scenario because it had previously been safely used with trainees. 11 However, many of these core behaviors could be applied in other circumstances that are more frequent within the NICU, 4 such as when an infant with respiratory failure becomes bradycardic and eventually dies, with or without extensive cardiopulmonary resuscitation. Developing these "hybrid" technical communication simulations was also appreciated by trainees.…”

Section: Discussionmentioning

confidence: 99%

“…The manikin rarely "dies," although it was demonstrated in an empirical study that this was beneficial to trainees. 11 During the feedback session of that study, research participants recommended "hybrid" mock codes, in which they would practice their technical and communication skills together. 11 In this study, a simulation was designed to identify core behaviors associated with optimal communication with parents during and after an unsuccessful resuscitation and determine if these core behaviors were recognized as important by a wide variety of stakeholders, including bereaved parents.…”

Section: What This Study Addsmentioning

confidence: 99%

“…We used similar methods reported in our previous studies. 11,12 Participants performed a videotaped simulation using a high-fidelity manikin assisted by a Neonatal Resuscitation Program (NRP)-trained provider (neonatal nurse or respiratory therapist). They were informed that 2 actors, playing the role of the parents, would be present at the resuscitation and to interact with them as they would do in practice.…”

Section: Simulation Sessionmentioning

confidence: 99%

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Techniques to Communicate Better With Parents During End-of-Life Scenarios in Neonatology

et al. 2020

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BACKGROUND AND OBJECTIVES: Clinicians are urged to optimize communication with families, generally without empirical practical recommendations. The objective of this study was to identify core behaviors associated with good communication during and after an unsuccessful resuscitation, including parental perspectives. METHODS: Clinicians from different backgrounds participated in a standardized, videotaped, simulated neonatal resuscitation in the presence of parent actors. The infant remained pulseless; participants communicated with the parent actors before, during, and after discontinuing resuscitation. Twenty-one evaluators with varying expertise (including 6 bereaved parents) viewed the videos. They were asked to score clinician-parent communication and identify the top communicators. In open-ended questions, they were asked to describe 3 aspects that were well done and 3 that were not. Answers to open-ended questions were coded for easily reproducible behaviors. All the videos were then independently reviewed to evaluate whether these behaviors were present. RESULTS: Thirty-one participants' videos were examined by 21 evaluators (651 evaluations). Parents and actors agreed with clinicians 81% of the time about what constituted optimal communication. Good communicators were more likely to introduce themselves, use the infant's name, acknowledge parental presence, prepare the parents (for the resuscitation, then death), stop resuscitation without asking parents, clearly mention death, provide or enable proximity (clinician-parent, infant-parent, clinician-infant, mother-father), sit down, decrease guilt, permit silence, and have knowledge about procedures after death. Consistently, clinicians who displayed such behaviors had evaluations .9 out of 10 and were all ranked top 10 communicators. CONCLUSIONS: During a neonatal end-of-life scenario, many simple behaviors, identified by parents and providers, can optimize clinician-parent communication. * P , .05 ** P , .01. Dr Zao contributed to the acquisition of data, interpretation of data (behavior coding), and critically revised the article for important intellectual content; Dr Lachance contributed to the acquisition of data, interpretation of data (quantitative portion), and critically revised the article for important intellectual content; and all authors contributed to the conception and design of the study, ensure that questions relating to accuracy or integrity of any part of the work are appropriately investigated and resolved, agree to be accountable for all aspects of the work, and approved the final version of the article as submitted.

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“…Simulation is well established as a mode of training for effective performance in resuscitation, but it is less often used as a basis for training about what to do when the child dies in spite of attempted resuscitation. Lizotte et al addressed this in a manikin study of neonatal resuscitation 3. Trainees were clear that manikins were not supposed to ’die' and although they recognised that the death scenario was important and reflected real life, the work uncovered the serious cognitive distortion among trainees that technically adequate resuscitation necessarily results in a live patient.…”

mentioning

confidence: 99%