Table 2 Themes and subthemes with illustrative quotes.
From: Impact of the Neonatal Resuscitation Video Review program for neonatal staff: a qualitative analysis
Theme 1 — Learning from reality | |
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Limited clinical exposure to resuscitations | “But the reality is that with, what, 20 staff members or more that we have, the actual physical numbers that each staff member, particularly the registrars, are going to go to, is it enough for you to say come out the other end of a six-month term and say I’m good at this?” - Doctor 2 (Fellow) “When we teach students, we might only get the very stable CPAP deliveries and then only when they start attending on their own do they get the unstable intubated patient.” - Nurse 10 (Clinical nurse specialist) |
Exposure to a wide range of resuscitations | “I mean, like, the more different experiences, the different scenarios that you see or exposed to, would help you be more prepared to go to a delivery.” - Nurse 9 (Clinical nurse specialist) “But I think I think it would help me feel more prepared, just to have sort of seen what, like, to expect, and have a bit of a framework on what would happen. So, like, for the CDH baby, for example, knowing that they would be intubated immediately. And that’s helpful into seeing what it was like and how they managed it.” - Doctor 8 (Registrar) “But by using this [video review], you’re giving them [junior nurses] the exposure and giving them the education without putting them in a situation that might break them.” - Nurse 1 (Clinical nurse specialist) |
Abstract conceptualization of clinical appraisal skills | “You see that baby on the screen go from blue to pink, you see what’s worked, you see how that team has interacted and responded and what’s worked well, and what hasn’t. It’s just much more, I think, real life and relatable to a lot of people.” - Nurse 1 (Clinical nurse specialist) “I think watching the actual video of the baby in real life who started to turn pink when you started giving IPPV and going up on the oxygen, and then you can see what the [oxygen] sats are doing. So, it’s a lot more helpful watching.” - Nurse 2 (Clinical nurse specialist) |
Observing real-life challenges | “You can see how tricky it is to wipe the baby and get all of the fluid off to make sure that the sticky chest leads stick, like, you know, it’s just those little practical things that you just can’t do when you’ve got a dummy in front of you.” - Nurse 9 (Clinical nurse specialist) “There’s difficulty in finding certain equipment or delaying a procedure or, you know, things don’t quite run to the algorithm, not through anyone’s fault, but just because that’s how real life works. And so, sitting with that it helps you develop that comfort with uncertainty a bit better.” - Doctor 5 (Registrar) |
No tactile component | “To really solidify that learning you need to be in that situation yourself or have a chance to practice those skills in like a safe environment. So, I think that it’s [NRVR] a really good tool. That could also be an even better tool if it was an adjunct to more sim-based learning as well.” - Doctor 1 (Registrar) “There’s probably ways that you can, sort of, like watch a resus video, and then sort of, you know, the next session that week or the next session next week, you can have, like, a more practical session, and sort of, like, maybe practice those principles that you talked about.” - Doctor 3 (Registrar) |
Theme 2 — Immersive self-regulation | |
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Enhanced situational awareness | “It’s really easy to hone in on, you know, providing IPPV to a baby and not thinking about the other things like is the mask the right size? Am I using the right pressures? Do I need to increase oxygen? Should we change the position? When you’re in that moment, it’s really, really easy to get tunnel vision.” - Nurse 1 (Clinical nurse specialist) “You can get a lot out of seeing how you do things from the third person perspective. Yes, how you do things, how others do things. And watching them slower, or, or over and over again. Because you always find new details that you can comment on, be they positive or negative” - Doctor 11 (Neonatologist) |
Improved time perception | “I think it’s good to, like, dissect, like you can go a lot slower. And you know, when [facilitator] goes through, pauses like, ‘What was happening here?’ and then you’re like, Wait, there’s a lot more happening that we can actually process, that you may not have been able to do in real-time, or actually get a sense of, like, time. Sometimes time moves very strangely in a resuscitation.” - Doctor 1 (Registrar) “Probably the time, like, it feels like it’s a long time. But when you watch it back are like, actually, that was quite quick” - Doctor 7 (Fellow) |
Alleviated self-criticism | “It was a positive thing to have gone back and reviewed it and be able to, like, readjust. ’Oh, that [resuscitation] was dreadful, like, that was the most terrible worst thing that could possibly have happened, that was awful.’ But it actually wasn’t, and to try and, like, rationalise it and be a bit more objective and made it much more objective. So, when it’s just your personal memory, it’s a very subjective review.” - Doctor 7 (Fellow) “Sometimes I think I might get a bit stuck in my head thinking about things. So, to kind of actually watch in real time, how you do perform, I might realise I do a little bit better than I think I do.” - Nurse 6 (Registered nurse) |
Promoted self-reflection and upward social comparison | “I think especially like, in a nursing role, as well, like, you can see how different nurses communicate with the team. And like, you can compare that to yourself and like, take kind of, yeah, take it as, like an educational point to apply to your practice.” - Nurse 4 (Clinical nurse specialist) “I think watching other how other people do things, helps you decide how you want to do things as well and, and what makes sense to you, and what doesn’t necessarily make sense to you.” - Doctor 3 (Registrar) |
Theme 3 — Complexities in learner psychological safety | |
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Level of comfort watching videos of real resuscitations | “It’s confronting but obviously less confronting is than it is when you’re actually there.” - Nurse 4 (Clinical nurse specialist) “I can kind of look at it [video review] with, you know, less emotional view, more, like, a learning view, rather, whereas there will be some people that will be quite, find it quite confronting.” - Nurse 8 (Clinical nurse specialist) |
Difficult to watch videos with poor outcomes | “If there was a massive bleed or something, or you could see that stuff was going really wrong. And people are trying their best, but they can’t do it, I think it would actually be more confronting on the video, rather than in real life” - Doctor 1 (Registrar) “I think if there was a terrible outcome, I think that’d be difficult.” - Doctor 4 (Fellow) |
Reduces “fear of the unknown” | “And, if I had been played that video back before I’d done anything, I would have been a lot less scared to go to deliveries.” - Nurse 3 (Registered nurse) “I think it would be, like, more of a gentle introduction to deliveries. And then, like, once you’ve got an idea of how a resuscitation should work, then you can sort of add in all those extra elements that you need to learn and remember as well.” - Nurse 6 (Registered nurse) |
Benefit in exposure to poor outcomes through video | “Like, it’s all good seeing everything go well and smoothly. But it also would be beneficial to have, you know, a video of a resus that maybe like required some chest compressions and umbi lines. Because I did get put into that situation once where I went down to take some equipment to ED and ended up being part of a resus doing drugs that was, you know, chest compressions and umbi lines and everything. And sadly, that baby didn’t make it. But I think it would have been good to have been a bit more prepared for what that situation looks like.” - Nurse 6 (Registered nurse) “The baby [in the video] was extremely pale and really flat… And I think watching that was kind of like a, this could be me in a peripheral hospital receiving a really unwell neonate.” - Doctor 8 (Registrar) |
Watching videos of oneself can be uncomfortable | “I think it would be quite like anything like rewatching anything that you’ve done is always mild to moderately painful.” - Doctor 1 (Registrar) “Oh, it’s always awkward to hear your own voice. And see your own face if that happens. So awkward, but I hope that my performance of what I did for the baby would be useful in learning something” - Nurse 10 (Clinical nurse specialist) |
Risk reward calculation — benefits of NRVR supersede discomfort watching self | “I hate it [watching self on video]. But I’ve become more, trained myself to be more comfortable with it. Because we’ve had the opportunity to have video review before. And so, I mentally know that it’s good for me. And it will improve what I do. And so yeah, so I think it’s just a matter of, like, forcing yourself to do it. And then it’s actually not as bad as you think.” - Doctor 7 (Fellow) “Maybe afterwards, it’s a bit embarrassing to listen to your own voice. But it’s good to learn. And it’s good to see how you interacted with other people as well. I’d be up for it, I wouldn’t mind at all.” - Doctor 9 (Registrar) |
Fear of judgment from colleagues | “I think there is a bit of a perception of there might be some criticalness of other team members. And it makes people hesitant to do it because of the fear of critique. So, I’m not worried about it. My impression is that some people worry about that stuff. That may, that might, be a block for some people.” - Doctor 2 (Fellow) “I feel like it would make me a bit more nervous. Like, oh, everyone’s gonna be seeing this and knowing that it’s me.” - Nurse 11 (Registered nurse) |
Theme 4 — Accessing and learning from diverse vantage points | |
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Learning from others’ responses to NRVR | “And I think it exposes us to discuss these things, you know, you learn a lot by having a multi-perspective discussion because we see different things. And so, there’s always things that I didn’t notice that other people are focusing on.” - Doctor 4 (Fellow) “I think it’s good because you can also learn from your peers. They can say, you know, in that situation, I probably would have done X, Y, or Z if they’ve had prior experience.” - Nurse 9 (Clinical Nurse Specialist) |
Facilitating interprofessional discussion | “I liked it to have a multi-disciplinary group rather than just nurses teaching nurses. Good to have a doctor in there… it’s good if we learn to do our resuses as a team rather than you learn this and we learn that and then you’re supposed to work together when we get to it, I think as a teaching team, so then if you’re reviewing, we need to review it as a group, as a team as well.” - Nurse 8 (Clinical nurse specialist) “We [nurses] probably look at certain things differently, compared to how doctors look at it, so good to hear ideas from both sides.” - Nurse 2 (Clinical nurse specialist) |
