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. 2023 Feb 16:10:1043041.
doi: 10.3389/fmed.2023.1043041. eCollection 2023.

Leadership during airway management in the intensive care unit: A video-reflexive ethnography study

David J Brewster  1   2   3 , Warwick W Butt  1   4 , Lisi J Gordon  5 , Mahbub A Sarkar  2 , Jonathan L Begley  1   3 , Charlotte E Rees  2   6
Affiliations

Leadership during airway management in the intensive care unit: A video-reflexive ethnography study

David J Brewster et al. Front Med (Lausanne). .

Abstract

Effective leadership is crucial to team performance within the intensive care unit. This novel study aimed to explore how staff members from an intensive care unit conceptualize leadership and what facilitators and barriers to leadership exist within a simulated workplace. It also aimed to identify factors that intersect with their perceptions of leadership. This study was underpinned by interpretivism, and video-reflexive ethnography was chosen as the methodology for the study. The use of both video recording (to capture the complex interactions occurring in the ICU) and team reflexivity allowed repeated analysis of those interactions by the research team. Purposive sampling was used to recruit participants from an ICU in a large tertiary and private hospital in Australia. Simulation groups were designed to replicate the typical clinical teams involved in airway management within the intensive care unit. Twenty staff participated in the four simulation activities (five staff per simulation group). Each group simulated the intubations of three patients with hypoxia and respiratory distress due to severe COVID-19. All 20 participants who completed the study simulations were invited to attend video-reflexivity sessions with their respective group. Twelve of the 20 participants (60%) from the simulations took part in the reflexive sessions. Video-reflexivity sessions (142 min) were transcribed verbatim. Transcripts were then imported into NVivo software for analysis. The five stages of framework analysis were used to conduct thematic analysis of the video-reflexivity focus group sessions, including the development of a coding framework. All transcripts were coded in NVivo. NVivo queries were conducted to explore patterns in the coding. The following key themes regarding participants' conceptualizations of leadership within the intensive care were identified: (1) leadership is both a group/shared process and individualistic/hierarchical; (2) leadership is communication; and (3) gender is a key leadership dimension. Key facilitators identified were: (1) role allocation; (2) trust, respect and staff familiarity; and (3) the use of checklists. Key barriers identified were: (1) noise and (2) personal protective equipment. The impact of socio-materiality on leadership within the intensive care unit is also identified.

Keywords: airway; intensive care unit; intubation; leadership; simulation; video reflective ethnography.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overview of data collection.
Figure 2
Figure 2
Photo of simulated planning by group 3 (From left to right N7, N8, N9, D6, D5).
Figure 3
Figure 3
Photo of simulated procedure by group 4 (From left to right: N11, D8, D7).
Figure 4
Figure 4
Role allocation occurring during clip 2 (referred to in quote 19).
See this image and copyright information in PMC

References

    1. Gordon LJ, Rees CE, Ker JS, Cleland J. Dimensions, discourses and differences: trainees conceptualising healthcare leadership and followership. Med Educ. (2015) 49:1248–62. doi: 10.1111/medu.12832, PMID: - DOI - PubMed
    1. Blumenthal DM, Bernard K, Bohnen J, Bohmer R. Addressing the leadership gap in medicine: residents’ need for systematic leadership development training. Acad Med. (2012) 87:513–22. doi: 10.1097/ACM.0b013e31824a0c47, PMID: - DOI - PubMed
    1. West M, Armit K, Loewenthal L, Eckert R, West T, Lee A. Leadership and Leadership Development in Healthcare: The Evidence Base. London: The Kings Fund; (2015).
    1. Brewster DJ, Butt WW, Gordon LJ, Rees CE. Leadership in intensive care: a review. Anaesth Intensive Care. (2020) 48:266–76. doi: 10.1177/0310057X20937319 - DOI - PubMed
    1. Brewster DJ, Chrimes N, Do TB, Fraser K, Groombridge CJ, Higgs A, et al. . Consensus statement: safe airway society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust. (2020) 212:472–81. doi: 10.5694/mja2.50598, PMID: - DOI - PMC - PubMed

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