Collaborating under stress in healthcare requires tailored approaches, not standard training
Healthcare professionals often have to work under intense pressure with colleagues they barely know. Yet training in collaboration under stress is still rarely a structural part of healthcare education. Research by education and family scientist Femke Dijkstra shows that a single, fixed training formula does not work. Effective training requires a tailored approach in which stress is deliberately and safely integrated.
When it really matters, teamwork must come naturally
In the emergency department, during resuscitation, or when a patient suddenly deteriorates, doctors and nurses must act quickly. Teams change constantly and the pressure is high. In such moments, effective communication is crucial for patient safety. Research shows, however, that collaboration under stress differs significantly from teamwork in calm situations - and that education does not yet sufficiently address this. Dijkstra demonstrates that stress affects not only technical skills, but also how people listen, make decisions, and communicate with one another.
Learning from the police and nuclear power plants
To better understand what teams need under pressure, Dijkstra deliberately looked beyond healthcare. She began with a literature review of sectors where working under stress is an everyday reality, such as policing and nuclear power plants. She combined these insights with interviews with doctors and nurses about their experiences in acute situations. In addition, she observed healthcare teams during a resuscitation competition and analyzed how communication and leadership take shape under time pressure. Finally, she examined how nursing students themselves view learning to collaborate in stressful situations.
No “one size fits all”
A key conclusion is that healthcare professionals and students differ greatly in how they experience stress and in what they need to collaborate effectively. Some learn best by being directly exposed to realistic pressure, while others need more structure, reflection, or a gradual buildup. This makes a standard, one-size-fits-all training approach ineffective.
Based on her research, Dijkstra developed training principles to help educators design more flexible and realistic education. For example, students can practice in simulation training where they collaborate under time pressure with unfamiliar colleagues - safe, yet highly realistic.
Directly applicable in healthcare education and beyond
The findings are relevant for nursing and medical education programs, healthcare organizations, and healthcare professionals. On a small scale, the insights are already being applied within Dijkstra’s own program, with broader implementation possible in the near future. Ultimately, patients also benefit: better collaboration under stress reduces the risk of errors when it matters most. The developed principles are not exclusive to healthcare; sectors such as ambulance services, fire brigades, and the police can also use them to better prepare teams for working together under pressure.
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