Trauma teams in action.

Abstract

Trauma Teams in Action is a portfolio of research and is comprised of three studies: systematic review, cross sectional survey and phenomenological study. Study one examines 25 years of relevant literature up to December 2006 that focused on the education and professional development of civilian trauma team members and the teamwork practices employed in civilian trauma teams. Only 12 studies were included in the results of the review highlighting the lack of quality studies into the topic. It did however provide a basis of knowledge to inform the development of a cross sectional survey. Of the 12 included studies, five related to trauma team training. In particular, information pertaining to course content and delivery methods used, for example the use of simulation. The remaining seven studies provided details of teamwork management practices. Results highlighted details regarding the use of a formed team as opposed to ad-hoc team formation, and the use of a tiering system to provide optimal care to all trauma patients by the most appropriate sized and manned trauma team. Knowledge relating to optimally sized teams, and the use of a horizontal team approach was also identified. Finally, this component of the review identified knowledge relating to the role of the leader and fact that trauma teams with a dedicated team leader were more successful than those teams who did not have an identified team leader. A cross sectional survey (Study Two), examined the current education and professional development of health personnel in the Australian Defence Force (ADF) for the development of trauma/resuscitation team skills. Details related to deployment history and teamwork practices (team composition, scope of practice and team management style utilised) of the participants. The study involved 128 respondents from the Royal Australian Navy and the Royal Australian Air Force Health Services Branch completing an online survey. The study was limited due to difficulties in having Army personnel not being able to participate, but useful information about the education and deployment of Australian Defence Force trauma teams was provided. The study highlights that the majority of respondents who reported that they had completed trauma training and deployed as a member of a trauma team had served in the ADF for longer than 10 years. The study also provided details of the large variety of courses completed by both permanent and reserve personnel, and highlighted the fact that this may reflect inconsistencies in the training provided. Of the 80 respondents who had completed formal trauma training only 38 respondents subsequently provided details of the deployments they had been involved in as a trauma team member. As the study identified issues relating to the number and variety of courses completed, consideration of strategies to ensure consistency of training should be further examined. The outcome of the study identified that respondents feel that they were well prepared to work as members of a military trauma team in a conflict/humanitarian situation. However, the study also indicated there should be more emphasis on multi-disciplinary training and more focus on teamwork skills. A hermeneutic phenomenological study (Study Three), examined the lived experiences of six Australian Defence Force Nursing Officers working as members of trauma teams. The interviews provided a unique opportunity to share participants’ stories and experiences. Six major themes were identified from the interviews. These included; Telling their stories; The role – Who we are and what we do; The environment – Is it so different?; Training- Will it ever fully prepare you?; Working in teams – There’s no ‘i’ in team; and Leadership – Will the real leader please stand up. The participants provided details of their stories and their want for their stories to be told. Information of the role(s) that the participants held with details regarding the uniqueness of being a military nurse and the need to feel a valued member of the team was reported on. The participants also provided details of the environment in which they work. This included details of both the physical environment in regards to the need to work with less and the fact that in the environments in which they are required to work, the need to have a place for everything and the challengers relating to the areas in which they work. The psychosocial environment they had encountered and which included details of the horrors of the environment and the ways in which they cope when place in these situations was also provided. Details of the training undertaken by the participants, in particular the need to prepare them for uncontrollable environments was spoken of, as too, the training conducted in the field. The theme regarding working in teams provided information about the team and who made up these teams and the need to get to know the team members was spoken of. Finally, details relating to the issue of leadership was identified with information pertaining to the role of the leader in the team discussed by the participants. This study has provided a unique opportunity to gain a deeper understanding of a usually closed section of the nursing profession, that of the military nurse.