ESICM LIVES 2022: part 2.

peer reviewe

Disaster medicine and virtual reality simulation: tracking down the factors impacting triage performance

IntroductionMass Casualty Incidents (MCIs) are characterized by an imbalance between limited medical resources in view ofoverwhelming patients’ needs [1]. As a result, Emergency medicine professionals (EMPs) have developed triagesystems to cope with such situations [2]. Environmental, emotional and social factors might impede these triage process,especially when EMPs are facing injured children [3]. Besides, the challenge of replicating complex medical conditions inMCI and providing feedback implies high logistics burden and considerable costs in human resources and timeallocation [4]. Virtual reality (VR) could offer a realistic cost-effective solution to overcome difficulties [5]. We analyzedthe socio-professional and psychological factors potentially mitigating children’s triage during a MCI using an original VRenvironment.MethodsA mixed approach study, involving both qualitative and quantitative methods, was adopted. Ten emergency residentswere immerged in two VR environments simulation: a coach accident in a tunnel and a detonation in a Grand-place. Atpre-immersion, each resident completed a sociodemographic questionnaire. Post-immersion included the Frenchadaptation of the Coping Checklist and a self-efficacy questionnaire. At each stage, participants evaluated their stress.Triage effectiveness was rated by an expert. A qualitative analysis of the debriefings was performed.Results & DiscussionFemales (11.33±0.57) obtained significantly better triage scores (p=0.03) than male (9.71±1.38). We found that the levelof stress at pre-immersion was significantly correlated with the triage scores (r=0.89; p=0.02). Participants’ self-efficacyof and previous training in MCI (p=0.11) were not correlated with triage scores. Qualitative findings revealed difficultiesin identifying deceased children, which conducted to incorrect triage, or inappropriate life-saving interventions (e.g.resuscitation). During debriefings, participants highlighted the pictorial realism leading to higher immersion and a highlevel of stress as previously reported [6]. This exploratory study about the factors influencing triage scoring reveals thatgender and stress before immersion might impact triage performance. Furthermore, our results enable further researchon educative perspectives to develop standardized practices in VR simulations

Relationships Between Internal Factors, Social Factors and the Sense of Presence in Virtual Reality-Based Simulations

Background Virtual Reality (VR) has proven to be an interesting and expanding tool for healthcare education, especially with the impact of the Sense of Presence (SoP) on learning. The study was designed to investigate to what extent users’ social and internal factors might influence the SoP and to further identify members of occupations’ characteristics influencing immersive experiences. Method A cross-sectional study immersing 83 undergraduate students (ambulance attendants, students nurses, and medical students) in a mass casualty incident simulation was performed. Questionnaires were administred to assess personal, environmental, and experiential in pre and post-simulation. Results SoP was associated with gender, disaster medicine education, propensity for immersion, and members of occupations.. Immersion characteristics specific to occupational categories have been identified. Conclusion Personal differences were discovered between ambulance attendants, students nurses, and medical students. Consideration should be given on how best practices could promote the design of VR experiences that cater to professional groups' needs. Identifying in the future what level of experience is needed for a sufficient SoP also seems necessary

Validating a French-language version of Health Communication Assessment Tool: Content validity, test-retest reliability, interrater agreement, and implications for further development

Introduction The assessment of the communication skills of nurses in clinical settings bears both practical and educational significance. Despite the significance of communication skills to realize high-quality patient-care, the development and validation of such an instrument applicable in different cultural contexts is still lacking and faces certain challenges. Additionally, the assessment of nurse-patient communication, which is dynamic and context-bounded, requires a fine-grained instrument, while not compromising the complexities of the skills under assessment. The aim of the present study was to test a French-language version of the Health Communication Assessment Tool (HCAT) (Campbell et al., 2013), on a French-speaking sample in Belgium against different measures of content relevance, validity, and reliability. Based on cognitive fluency perspective, we developed three simulated scenarios registering three levels of skill performance, including low, medium, and high demonstration. Thus, the psychometric properties of the HCAT instrument can be thoroughly examined. Methods Ten experts in communication and 52 nurse educators participated in the study. Firstly, the instrument was translated from English to French using back-translation technique. After semantic equivalence was agreed upon, the experts rated the relevance of the 22 items making up the HCAT, resulting in the removal of one culturally-irrelevant item. Subsequently, the experts and nurse educators rated the communication skills of the nurse in three scenarios. To ensure test-retest reliability, the nurse educators rated the scenarios twice within a four-week interval. The experts’ ratings were used as the gold standard when examining the reliability of the nurse educators’ ratings. Results & Discussion Exploratory and confirmatory factor analyses showed that the instrument could distinguish three aspects of communication skills, i.e. professional presentation, empathy, and trust building. Two-way random intraclass correlation coefficients (ICCs), ranging from 0.917 to 0.982, revealed that interrater agreement was excellent for consistency and absolute average-measures. However, at absolute single-measure, an ICC=0.425 suggested adequate interrater reliability for the medium-performed scenario, which decreased in low-performed (ICC=0.348) and high-performed (ICC=0.176) scenarios. Further, more than half of the items displayed poor test-retest reliability

The Performance of the Health Communication Assessment Tool© (HCAT-f) in Calibrating Different Levels of Nurse Communication Skills in a French-Speaking Context: Evidence and Clinical Implications

Communication skills training is essential in nurse education. Miscommunication may lead to adverse events and unsafe healthcare. To date, valid and reliable instruments to serve both communication training and assessment purposes across different cultural contexts are scarce. The present study empirically tested a French-language version of the Health Communication Assessment Tool© (HCAT-f) across different levels of communication skills performance to establish its reliability and validity through a cognitive fluency framework. Ten experts in communication and 52 nurse educators rated three videos simulating conversations between a nurse and a patient scheduled for lumpectomy. Each video captured a different level of communication skills performed by the nurse: High, medium, and low. Three distinct constructs were identified, i.e., professional presentation, empathy, and trust building. At absolute single-measure, an ICC = .43 suggested adequate interrater reliability of the whole scale for the medium-performed scenario, which decreased in low-performed (ICC = .35) and high-performed (ICC = .18) scenarios. The HCAT-f fulfils the criteria of linguistic equivalence, contextual relevance, and demonstrates acceptable construct validity. It can be used as a summative assessment tool after prior training on scale calibration is in place because interrater agreement was difficult to be established in high and low performance scenarios.