Barriers and Facilitators for Interaction in Cardiopulmonary Resuscitation Teams: A Qualitative Study

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The quality of these interventions depends on the performance and communication of the resuscitation team; therefore, this study was conducted to explain the factors affecting the interaction of cardiopulmonary resuscitation team members. Methods: This qualitative study used a content analysis approach in Iran. It took place over 12 months, from December 2023 to December 2024. The research population was all members of the cardiopulmonary resuscitation teams of educational and medical centers. The researchers started the sampling purposively until they reached data saturation. For data collection, in-depth and semi-structured interviews were conducted. The data were analyzed via 20 MAXQDA software. Results: Data analysis revealed a main category titled "The Complexity of Cardiopulmonary Resuscitation Interactions." Additionally, it identified 5 general categories and 7 subcategories. The general categories and subcategories were: " Consensus in Resuscitation" "Pre-resuscitation Coordination", " Post-resuscitation Debriefing"), " Communication Clarity ", "Interaction in Team rotation" ("Normal Rotation", and "Abnormal Rotation"), "Personal Conflicts" and "Team Leadership Style" ("Autocratic Leadership", "Laissez-faire" and "Participatory Leadership") Conclusion: The results showed that the complex conditions of resuscitation team interactions are influenced by various factors. Therefore, by carefully planning to enhance facilitating factors—such as consensus in resuscitation, communication clarity, normal rotation, and a participatory leadership style—and addressing inhibiting factors—such as personal conflicts, abnormal rotation, and an autocratic leadership style—we can hope for optimal interaction in teamwork, ultimately leading to successful cardiopulmonary resuscitation. Cardiopulmonary resuscitation Team interaction Qualitative study Introduction Sudden cardiac arrest is a leading cause of death worldwide. Annually, between 350,000 to 450,000 people in the United States and 700,000 people in Europe experience cardiac arrest [ 1 , 2 ]. In Iran, cardiovascular diseases account for 80% of deaths [ 3 ]. The outcome of cardiac arrest largely depends on the immediate and effective implementation of basic and advanced cardiac life support measures, with cardiopulmonary resuscitation (CPR) being a critical component [ 4 ]. Despite continuous updates to CPR guidelines, only 6–9% of patients survive cardiac arrest [ 5 ]. In Iran, the mortality rate for CPR exceeds 90%, with a hospital discharge rate of less than 7% [ 3 ]. Although recent advancements have improved survival rates, they remain low [ 6 – 8 ]. CPR is one of the most stressful and chaotic tasks in healthcare [ 9 ]. Improving the quality of CPR is essential, as it directly impacts patient survival rates [ 10 , 11 ]. Survival from cardiac arrest requires a team effort, often involving individuals with diverse skills who may not have prior experience working together [ 12 ]. A team is defined as two or more individuals who interact dynamically, share a common goal, and possess complementary skills [ 13 ]. In high-stress medical emergencies like CPR, technical skills alone are insufficient; effective teamwork and behavioral skills are crucial [ 14 ]. Studies indicate that 70–80% of healthcare errors result from poor communication and understanding within teams, highlighting the importance of effective communication during the resuscitation of critically ill patients [ 15 , 16 ]. The significance of communication in CPR has been widely documented [ 17 – 19 ]. In-hospital cardiac arrest (IHCA) is a complex clinical process where CPR team members often lack prior familiarity with one another [ 20 , 21 ]. In such emergencies, success depends not on individual performance but on the collective interactions of multiple individuals and systems [ 22 ]. To enhance team interaction during CPR, effective strategies are needed. This study aims to identify and explain the factors influencing interactions among CPR team members. Methods STUDY DESIGN AND SETTING This study adopted a qualitative approach, employing conventional content analysis, and was conducted over 12 months, from December 2023 to December 2024. The research took place in the government hospitals of Guilan University of Medical Sciences. We used the COREQ (Consolidating Criteria for Reporting Qualitative Research) checklist to ensure this study was reported with quality. We used Guba and Lincoln's criteria to make sure the findings were valid. These criteria include validity, transferability, reliability, and verifiability. We used several methods to validate the findings. These included maximum diversity sampling, prolonged engagement with the data, peer checking, and participant checking. The verifiability of the findings was ensured by referencing the participants. To ensure transferability, we detailed the methodology. An experienced external observer then reviewed the findings to confirm reliability. PARTICIPANTS The participants consisted of all members of the resuscitation team, including physicians, nurses, anesthesia experts, and residents. Participants who met the inclusion criteria were selected from various departments with diverse experiences and both genders, ensuring maximum diversity within CPR teams. The inclusion criteria included being a member of the resuscitation teams in government hospitals of Guilan University of Medical Sciences, having clinical experience, being involved in CPR operations, being willing to communicate, being able to express their feelings and experiences, and being willing to participate in the study. DATA COLLECTION We used purposive sampling and kept going until we reached data saturation. This means we stopped when no new information came up. We conducted 15 face-to-face and semi-structured interviews with all the participants. The interviewer was a PhD candidate in nursing. He trained in interview techniques. He also has 20 years of experience in resuscitation teamwork at medical centers. The interviews were conducted in private settings with the participants' consent. Following each interview, the data were analyzed before the next interview took place. To gain deeper insights into the participants' experiences, semi-structured interviews were conducted. We used an interview guide based on key teamwork components from research. The interviews were structured around open-ended questions to allow participants to share their perspectives in depth. Examples of these questions included:"What are your interactions like in the CPR team?", "How did you experience factors affecting CPR team interactions?". During the interviews, we asked exploratory questions to learn more about the participants' beliefs and experiences. DATA ANALYSIS The data analysis followed the conventional qualitative content analysis method, which involves interpreting the content of the data based on personal perspectives. The research team extracted categories directly from the text data and identified codes and themes through a systematic classification process. This method aims not only to extract objective content but also to uncover underlying themes and patterns within the participants' responses. Immediately following the interviews, the audio recordings were transcribed verbatim via Word software. Then, we analyzed them with MAXQDA 20 software. The analysis started with several reviews of the interview transcripts. Then, we identified the key semantic units from each interview. These units were then coded. Researchers grouped codes into primary categories based on their semantic similarities and differences. These categories were then grouped into broader ideas based on their relationships and shared themes. Finally, we merged categories that covered similar concepts to form the main categories. Results Over the 12 months, 15 interviews were conducted with 14 participants, as detailed in Table 1 . Table 1 characteristics of the participants Participant Age Gender Occupation Education Experience Duration First Interview Duration Second Interview Duration Cod 1 50 M Nurse, Clinical Instructor PHD 25 55 Cod 2 52 F ICU Nurse Bachelor 26 47 Cod 3 36 F Cardiac Nurse Bachelor 17 25 Cod 4 53 F Anesthesia expert Bachelor 17 42 Cod 5 25 M Emergency Nurse Bachelor 2 45 Cod 6 38 F Clinical Supervisor Master 19 35 25 Cod 7 39 M Cardiac Resident Cardiac Resident 5 56 Cod 8 38 M Anesthesia expert Bachelor 18 55 Cod 9 45 M Clinical Supervisor Master 20 45 Cod 10 55 M General Physician General Physician 20 30 Cod 11 28 F Emergency nurse Bachelor 5 40 Cod 12 53 M physician Emergency medicine specialist 23 42 Cod 13 44 M Clinical Supervisor Master 24 33 Cod 14 30 F Surgical department nurse Bachelor 13 40 The researchers reached data saturation after conducting 15 interviews, as no new codes emerged from the data. One participant was interviewed twice to clarify and expand on their initial responses. The interviews ranged in duration from 25 to 56 minutes, providing in-depth insights into the participants' experiences. The participants had an average age of 42 years, with ages ranging from 25 to 55 years. The group consisted of 6 women and 8 men, ensuring a diverse range of perspectives. Data analysis revealed a main category titled "The Complexity of Cardiopulmonary Resuscitation Interactions." It also identified 5 general categories and 7 subcategories (Table 2 ). These categories and subcategories provided a structured understanding of the factors influencing CPR team interactions, highlighting both facilitators and barriers to effective teamwork during resuscitation efforts. Table 2 the main, general and sub-categories of interaction in cardiopulmonary resuscitation teams Main categories General categories Subcategories The complexity of cardiopulmonary resuscitation interactions Consensus in Resuscitation Pre-resuscitation Coordination Post-resuscitation Debriefing Communication Clarity Interaction in Team Rotation Normal Rotation Abnormal Rotation Personal Conflicts Team Leadership Style Autocratic Leadership Laissez-faire Leadership Participatory Leadership The complexity of cardiopulmonary resuscitation interactions Team interactions during cardiopulmonary resuscitation (CPR) are influenced by various factors. Some factors facilitate effective teamwork, while others create challenges. These factors contribute to the complexity of team interactions. For participants, the barriers and facilitators of interaction held different meanings, significantly impacting their interaction, performance, and responses during resuscitation efforts. 1. Consensus in Resuscitation "Consensus in Resuscitation" is one of the key dimensions shaping the concept of "the complexity of cardiopulmonary resuscitation interactions." Participants emphasized that consensus is critical for successful resuscitation. Team members should summarize and exchange views on the shortcomings of teamwork, how to perform effectively, and how to fulfill their roles both before and after CPR cases. This can occur during training classes or regular team meetings. This process helps them learn how to interact effectively during resuscitation reflective sessions and demonstrate coordinated and flawless role performance in CPR. 1.1 Pre-resuscitation coordination The concept of "pre-resuscitation coordination" is one of the dimensions of the concept of consensus in resuscitation, as participants emphasized the importance of holding prior coordination sessions to ensure a well-coordinated role during resuscitation. Participant No. 1, a nurse on the resuscitation team and a CPR instructor, stated: "In the post-resuscitation team formation phase, we do not have any meetings where we sit together to discuss what we should do if resuscitation occurs. That is, we don’t address the storming and norming stages that are part of the teamwork process. " Participant No. 3, a nurse with 20 years in the heart department highlighted the need for consensus in resuscitation sessions. She emphasized teaching team skills and coordination tips in training classes. "We didn't have any consensus in resuscitation sessions before or after the resuscitation. They hold training classes for resuscitation, but they don't teach the points that need to be considered for team coordination and the team's duties; it's just a theory class, and technical points are taught." 1.2 Post-resuscitation Debriefing The concept of "Post-resuscitation Debriefing" is one of the dimensions of the concept of consensus in resuscitation. Participants emphasized the importance of these sessions to address skill gaps and improve performance in future resuscitations. Participant No. 5, a nurse in a cardiac emergency department, said: "We sometimes have friendly conversations about the outcome of resuscitation. However, we lack a structured, regular post-resuscitation meeting. Such a meeting could effectively address issues in teamwork and communication, helping us identify areas for improvement and ensuring better coordination in future cases." The concept of "Communication Clarity" is one of the dimensions of the formation of the concept of The Complexity of Cardiopulmonary Resuscitation Interactions. Clear communication is crucial for effective resuscitation teamwork, as participants noted that it enables them to perform cardiopulmonary resuscitation tasks correctly and quickly. Team members must share information clearly and remain informed about the methods and processes involved in resuscitation. In this regard, Participant No. 3 highlighted the issue of incomplete clear communication among members of the cardiopulmonary resuscitation team, stating: "A good leader speaks loudly and clearly when giving instructions. Then, experienced members will also announce when they complete an action. I, who am experienced and understand the importance of this practice, do this consistently. However, unfortunately, this type of training is not provided to novices. For example, I will announce, 'I am injecting the third dose of epinephrine,' but our less experienced colleagues often fail to do this. This lack of communication can lead to improper information exchange, potentially resulting in the patient receiving additional or insufficient medication." Participant No. 4, an anesthesia expert with 17 years of experience in the cardiac emergency department, mentioned the importance of interaction and coordination during shock delivery and its impact on staff safety: " A few years ago, I experienced a situation where there was poor interaction and coordination during shock delivery. The resident was supposed to deliver a shock and should have clearly announced it, but she didn’t. As a result, I was inadvertently exposed to the shock, which caused me to experience severe tachycardia. I had to leave the patient immediately, as I wasn’t feeling well at all." 3. Interaction in Team Rotation "Interaction in Team Rotation" is a key component of understanding the complexity of cardiopulmonary resuscitation interactions. Team members must interact to rotate roles to prevent ineffective performance and disruption of the teamwork order. They must exchange information during role rotation and ensure that critical tasks are handed over at the right moments without disrupting the resuscitation process. 3.1 Normal Rotation "Normal Rotation" is one of the dimensions of the concept of interaction in team rotation. The experiences shared by participants highlight the importance of appropriate and timely rotation of resuscitation team members to prevent disorganization and avoid wasting valuable time during critical situations. Participant No. 2, an ICU nurse with 24 years of clinical experience, emphasized this point, stating: "It is important to know who is responsible for which task during resuscitation. For example, if C takes over A's role or D's role without proper coordination, the team's order will be disrupted. Typically, the medication and chest compression teams switch roles, but they must interact effectively to ensure that information about how many drugs and which ones have been administered is clearly communicated. This transfer of responsibilities must happen seamlessly and without wasting time to maintain the efficiency and effectiveness of the resuscitation effort." 3.2 Abnormal Rotation "Abnormal rotation" is one of the dimensions of the concept of interaction in team rotation and is identified as a factor that hinders effective team interactions. Participants' experiences highlight the critical need to avoid individualism in cardiac massage and to ensure the timely handover of roles among team members to sustain effective performance during resuscitation efforts. According to the American Heart Association (AHA) protocol, effective cardiac massage during cardiopulmonary resuscitation requires that team members performing chest compressions switch roles every 2 minutes, or before they become fatigued. This ensures that compressions remain consistent, high-quality, and effective throughout the resuscitation effort. In this regard, Participant No. 1 highlighted a critical issue: the quality of resuscitation drops significantly if one person continues chest compressions for more than 2 minutes. They explained that this often stems from a feeling of negative competition during resuscitation. The participant noted: "When we ask someone to switch roles, they sometimes refuse, saying, 'No, I'm not tired.' But we know that continuing beyond 2 minutes leads to low-quality resuscitation. The individual may feel that stepping down early is a sign of weakness, so they resist. This creates a kind of negative competition, where the person thinks, 'I'll stay longer to prove I'm stronger" 4. Personal Conflicts The fourth aspect of "The Complexity of Cardiopulmonary Resuscitation Interactions" is "Personal Conflicts." The presence of personal conflicts among team members and the inability to work as a team in cardiopulmonary resuscitation can create significant barriers to establishing effective team interaction. These conflicts may hinder role performance during resuscitation and ultimately lead to the failure of teamwork in critical situations. Participant No. 3 said in this regard: "Because the team members have not had prior meetings or consensus with each other, and sometimes they do not know each other, they may have unresolved conflicts from the past. These conflicts can prevent them from working together as a cohesive team during resuscitation." Participant No. 1 emphasized the importance of prior acquaintance among team members and their ability to work together effectively, particularly in the absence of previous conflicts and said: "We members of the resuscitation team may not see each other until just before the resuscitation operation, and we often don’t know whether we can work effectively as a team with those individuals.For example, I would realize at 11 a.m. that I was a member of the CPR team, and a person from the women's CCU would arrive while another from the men's CCU would come as well. It’s possible that we have unresolved personal conflicts and, as a result, can’t work together cohesively." 5. Team Leadership Style The fifth feature of "The Complexity of Cardiopulmonary Resuscitation Interactions" is "Team Leadership Style." Data analysis revealed that resuscitation teams employ different leadership styles to facilitate interaction and coordination during cardiopulmonary resuscitation. The fifth feature of "The Complexity of Cardiopulmonary Resuscitation Interactions" is the concept of "Team Leadership Style." Data analysis revealed that resuscitation teams employ different leadership styles to facilitate interaction and coordination during cardiopulmonary resuscitation. The dimensions and characteristics of this concept include: autocratic leadership, laissez-faire leadership, and participatory leadership. 5.1 Autocratic Leadership "Autocratic leadership" is one of the dimensions of the concept of team leadership style. Participants' experiences highlighted the one-sided approach of the team leader and their tendency to act based on personal preferences during cardiopulmonary resuscitation (CPR), which often leads to the suppression of team members' participation in decision-making. Participant No. 2 said in this regard: "Sometimes we say, 'Doctor, the patient's rhythm is shockable. Should we shock them?' And the doctor agrees. Other times, they act based on their own preference and say, 'No, give the medication for now,'..." Participant No. 1 also pointed out the individualism of the team leader, who often tries to prove their versatility and said: "In CPR, there is a tendency for individualism, especially among team leaders. Some individuals may want to create the impression that they are all-capable, that they can handle everything. They don’t allow room for participation or input from others, which leads to other team members realizing over time that they have little role in decision-making. As a result, team members gradually become suppressed." 5.2 Laissez-faire Leadership "Laissez-Faire Leadership" is one of the dimensions of the concept of team leadership style. Field notes highlight the lack of supervision over team performance and coordination, as well as the leader's indifference toward the actions taken during cardiopulmonary resuscitation (CPR). Field Note No. 1 provides an example: "The team leader's communication with the members was weak. They were indifferent to reminding team members to switch roles every 2 minutes during chest compressions, coordinating their actions, or ensuring proper drug administration. For instance, after 5 minutes of cardiac and respiratory arrest, the nurse asked the resident, 'Should I administer medication to the patient?' The resident replied, 'Give one or two doses of epinephrine.' The nurse then drew 2 to 3 ampoules into a single syringe and administered the medication to the patient at will, without considering the appropriate timing for drug administration." 5.3 Participatory Leadership Participatory leadership" is one of the dimensions of the concept of team leadership style. Participants noted that skilled and and flexible leaders in resuscitation teams consult with team members and accept their logical suggestions. Participant No. 11 said in this regard: "Sometimes the team leader says the patient does not indicate atropine, but we argue, 'Doctor, the patient has a history of bradyarrhythmia, and we should administer atropine.' If the leader has a flexible personality, I feel I have a role in this process. However, if the leader insists, 'No, just administer amiodarone or epinephrine,' then I no longer feel I have a role in the decision-making process." Discussion The study aimed to explain the factors influencing interactions among members of cardiopulmonary resuscitation (CPR) teams. Data analysis led to the identification of a main category titled "The complexity of cardiopulmonary resuscitation interactions." This includes general categories like: consensus in resuscitation, communication clarity, interaction in team rotation, personal conflicts, and team leadership style. These categories explain team members' experiences and the factors that influence their interactions during cardiopulmonary resuscitation. "Consensus in Resuscitation" plays a key role in how team members interact in this study. After participating in cardiopulmonary resuscitation cases, team members should debrief and exchange ideas about how to perform their roles in the form of training classes or regular meetings. According to studies by Marcino and Gordon, hot wash or immediate debriefing sessions are activities typically conducted immediately after an emergency incident to record initial opinions, identify challenges, and provide solutions for current and future problems [ 23 ]. Studies have shown that the use of immediate debriefing sessions not only improves cardiac arrest care in the emergency department, but also leads to improved clinical, educational, and psychological well-being of staff [ 24 – 26 ]. Pre-resuscitation Coordination refers to meetings held before cardiopulmonary resuscitation (CPR) to review roles, responsibilities, and necessary processes. These meetings not only enhance team readiness but also increase the likelihood of a successful resuscitation effort. According to the study by Nallamothu et al., hospitals often use a designated resuscitation team for each shift. Team members typically have other roles during their shift and must leave those tasks to respond to a resuscitation event. Additionally, the composition of the team may change from one CPR case to another, making it difficult for members to identify and address issues in team dynamics. To overcome this challenge, the study emphasizes the importance of holding pre-resuscitation meetings to ensure that all team members are aligned and prepared for their roles [ 27 ]. In the participants' experiences, the concept of "communication clarity" is one of the key factors that facilitate effective interaction within the cardiopulmonary resuscitation (CPR) team. Clear communication is essential for successful teamwork during CPR, as it ensures that all team members share information accurately and are aware of the methods and progress of the resuscitation process. A study by Bogenstätter et al. examined how resuscitation team members shared information with medical professionals during a simulation. The study found that 18% of the information shared was incorrect, with quantitative information (such as defibrillation counts and drug doses) being more prone to errors. This type of data is particularly vulnerable to mistakes because it can change over time and requires precise communication [ 28 ]. Hunziker et al. emphasized the importance of clear communication in supporting teamwork during resuscitation. For example, using specific and clear phrases like, "This is the first defibrillation at 120 J," helps team members recall critical details and stay aligned during the resuscitation process [ 29 ]. The concept of "Interaction in Team Rotation" is another critical factor influencing cardiopulmonary resuscitation (CPR) team interactions. Participants emphasized the importance of correct and timely role assignment and information exchange during role rotation in CPR to prevent ineffective performance and disruptions in teamwork. Interaction in team rotation can be normal. Members may switch roles promptly and share important patient info. This way, patients get effective massages while staff avoid fatigue. Sometimes, team rotation may be abnormal. Members might switch roles without sharing key info or following time standards. This can occur due to reasons such as a desire to demonstrate power or reluctance to hand over responsibilities. As a result, the patient might get poor chest compressions and could also receive the wrong medication. The American Heart Association (AHA) recommends that rescuers performing chest compressions switch roles every two minutes during cardiopulmonary resuscitation (CPR). This practice helps reduce fatigue and ensures that chest compressions remain effective and high-quality [ 2 ]. According to the study by Reyes et al. Fatigue from chest compressions over 2 minutes depends on several factors. These include the rescuers' traits, education, work experience, and the conditions during CPR [ 30 ]. Additionally, Giri et al. emphasized in their study the importance of clear role definition within CPR teams. They stressed that individuals must be aware of their specific roles to perform their duties promptly and effectively [ 31 ]. The concept of "Personal Conflicts" is one of the factors that hinder effective interaction within the cardiopulmonary resuscitation (CPR) team. In the present study, the presence of personal conflicts among team members and the lack of CPR skills were identified as significant barriers to establishing effective team interaction. Studies have shown that if conflicts between healthcare professionals are not addressed, conflicts have negative effects on healthcare teams and the quality and safety of patient care, as they can distract providers from patient care[ 32 – 34 ]. Conflicts within teams can include harsh language (threats, shouting, swearing), blaming, impaired communication, or disruptive behavior [ 35 – 37 ]. According to the study by Kim S et al., conflicts arise when the goals, expectations, and interests of individuals are perceived as incompatible. Conflicts arise between healthcare professionals in multiple specialties and roles, as well as within teams at different stages of patient care. Unresolved conflicts between healthcare professionals can lead to difficult patient care outcomes [ 37 ]. "Team Leadership Style" is an important factor in CPR team interactions. Leadership style refers to the way a leader motivates, guides, and influences their team members to achieve shared goals [ 38 ]. The leadership style depends on many factors. These include the manager's personality, values, skills, and experiences. Internal and external organizational factors also play a role [ 39 ]. These elements collectively influence how effective a leader can be in guiding their team and achieving desired outcomes. In this study, it was found that the Autocratic Leadership Style significantly limits team interactions. Participants reported that the leader of the cardiopulmonary resuscitation (CPR) team rarely consulted them or sought their input. This lack of inclusion suppressed other team members from participating in decision-making, ultimately hindering effective teamwork and collaboration. The study by Thomas E. further supports this finding, highlighting that poor leadership and communication in CPR teams contribute to 70% of perinatal deaths and injuries [ 40 ]. This underscores the critical importance of effective leadership and open communication in ensuring successful resuscitation outcomes. The study by Giltinane CL highlights that autocratic leaders tend to focus on maintaining power. They are often close-minded and controlling. Because of this, some people may find it hard to work with them. Some nursing staff dislikes these leaders for demanding obedience, loyalty, and strict rule-following. However, others thrive under autocratic leadership [ 41 ]. The Laissez-Faire Leadership Style negatively impacts team interactions, as highlighted in this study. Leaders who adopt this style often exhibit indifference and fail to provide adequate supervision or guidance to their team members. This lack of involvement can lead to significant challenges in coordination and cohesion within the team. Inexperienced leaders often use this style. It’s also common among those ready to leave their roles. They prefer to let others take charge [ 42 ]. The study by Easterby-Smith et al. highlights that laissez-faire leadership is often viewed unfavorably, with many not even considering it a true leadership style due to its lack of direction and engagement [ 43 ]. In contrast, the Participatory Leadership Style emerged as a key factor facilitating effective team interactions in the experiences of participants. In this style, the team leader welcomes logical ideas and input from team members, fostering a collaborative environment. This approach not only enhances teamwork but also increases the likelihood of successful resuscitation efforts. The World Health Organization (WHO) study further supports this, emphasizing that participatory leadership values knowledge, experience, skills, and innovation in decision-making. This leadership style relies on the diverse expertise of team members and their active engagement to achieve optimal results [ 42 ]. LIMITATIONS This study presents certain limitations to consider. The results lack generalizability due to the study method and sample size. This study's findings are based on the experiences of CPR team members in government educational and medical centers. We recommend conducting further research in private centers to confirm these results. ETHICAL CONSIDERATIONS This study is part of a doctoral thesis in nursing. It has an ethics code, IR.GUMS.REC.1402.445, from the Ethics Committee at Guilan University of Medical Sciences. The consent form said participation was voluntary. Participants got information both verbally and in writing about the study. They could also leave at any time. The researchers gave participants numbers like 1, 2, and 3. They kept the list for pseudonymization apart from the transcribed material. Conclusion The findings of this study revealed that the complex dynamics of resuscitation team interactions are influenced by various barriers and facilitators. Therefore, by carefully planning to strengthen facilitating factors, such as consensus in resuscitation, communication clarity, normal rotation, and a participatory leadership style and addressing inhibiting factors, such as personal conflicts, abnormal rotation, and an autocratic leadership style, we can achieve optimal teamwork interactions. This means that if members of the cardiopulmonary resuscitation (CPR) team can collaborate effectively, avoid personal conflicts, and reach consensus on their roles and tasks during resuscitation, while adopting a participatory leadership style, they can foster better interaction. Additionally, maintaining clear communication, ensuring timely role transitions, and avoiding individualism during chest compressions can further enhance teamwork. By addressing these factors, we can hope for optimal team interaction, ultimately leading to successful cardiopulmonary resuscitation. Abbreviations CPR: Cardiopulmonary Resuscitation; IHCA: In-hospital cardiac arrest; COREQ: Consolidating Criteria for Reporting Qualitative Research; ICU: Intensive care unit; CCU: Cardiac care unit; AHA: American Heart Association; WHO: World Health Organization; GUMS: Guilan University of Medical Sciences Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the Research Council of Guilan University of Medical Sciences (GUMS), with the IR code: IR.GUMS.REC.1402.445. To participate in the study informed written consent was obtained from the participants. Consent for publication Not applicable. Availability of data and material Data are available by contacting the corresponding author. Competing interests The authors declare there is no financial conflict of interests. Funding The study was not funded and supported Authors' contributions All authors made the design of the study, AES and YS participated in data collection, and data analyzed by AES, NJ, MACH and YS. The final report and article were written by AES, NJ, and YS, and were read and approved by AES, NJ, MACH and YS. The author(s) read and approved the final manuscript. Acknowledgements This study is approved by Guilan University of Medical Sciences. The research team would like to thank and appreciate all the participants for sharing their valuable experiences and all the people who somehow helped us in this study. References Giacoppo DJEHJ. Impact of bystander-initiated cardiopulmonary resuscitation for out-of-hospital cardiac arrest: where would you be happy to have a cardiac arrest? 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Resuscitation. 2010;81(6):695-702. 10.1016/j.resuscitation.2010.01.024 Chalwin R, Flabouris AJImj. Utility and assessment of non‐technical skills for rapid response systems and medical emergency teams. Intern Med J. 2013;43(9):962-9. 10.1111/imj.12172 Briggs A, Raja AS, Joyce MF, Yule SJ, Jiang W, Lipsitz SR, et al. The role of nontechnical skills in simulated trauma resuscitation. J Surg Res. 2015;72(4):732-9. 10.1016/j.jsurg.2015.01.020 Chan PS, Nallamothu BKJJ. Improving outcomes following in-hospital cardiac arrest: life after death. JAMA. 2012;307(18):1917-8. 10.1001/jama.2012.3504 Marsch SC, Müller C, Marquardt K, Conrad G, Tschan F, Hunziker PRJR. Human factors affect the quality of cardiopulmonary resuscitation in simulated cardiac arrests. Resuscitation. 2004;60(1):51-6. 10.1016/j.resuscitation.2003.08.004 Weaver SJ, Dy SM, Rosen MAJBq, safety. Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf. 2014;23(5):359-72. 10.1136/bmjqs-2013-001848 Marcino D, Gordon KJCCDR. Emergency Response: An overview of the National Microbiology Laboratory emergency management program. Can Commun Dis Rep. 2018;44(5):102. 10.14745/ccdr.v44i05a02 Nocera M, Merritt CJAe, training. Pediatric critical event debriefing in emergency medicine training: an opportunity for educational improvement. AEM Educ Train. 2017;1(3):208-14. 10.1002/aet2.10031 Schmidt M, Haglund KJJoTN, JTN. Debrief in emergency departments to improve compassion fatigue and promote resiliency. J Trauma Nurs. 2017;24(5):317-22. 10.1097/JTN.0000000000000315 Gilmartin S, Martin L, Kenny S, Callanan I, Salter NJBoq. Promoting hot debriefing in an emergency department. BMJ Open Qual. 2020;9(3):e000913. 10.1136/bmjoq-2020-000913 Nallamothu BK, Guetterman TC, Harrod M, Kellenberg JE, Lehrich JL, Kronick SL, et al. How do resuscitation teams at top-performing hospitals for in-hospital cardiac arrest succeed? A qualitative study. Circulation. 2018;138(2):154-63. 10.1161/CIRCULATIONAHA.118.033674 Bogenstätter Y, Tschan F, Semmer NK, Spychiger M, Breuer M, Marsch SJHf. How accurate is information transmitted to medical professionals joining a medical emergency? A simulator study. Hum Factors. 2009;51(2):115-25. 10.1177/0018720809336734 Hunziker S, Johansson AC, Tschan F, Semmer NK, Rock L, Howell MD, et al. Teamwork and leadership in cardiopulmonary resuscitation. J Am Coll Cardiol. 2011;57(24):2381-8. 10.1016/j.jacc.2011.03.017 Reyes M, Díaz C, Cuineme SJJCCR. Quality CPR rescuer alternating every 2 minutes 1 minute vs university hospital clinic in San Rafael, 2018. J Crit Care Res. 2019;12(4):89-94. 10.15406/jccr.2019.12.00447 Giri S, Gyeltshen D, Wangchuk N, Dorji K, Drakpa L, Wangdi S, et al. Improving role allocation for cardiopulmonary resuscitation (CPR) in the emergency department: a quality improvement project. BMC Health Serv Res. 2024;13(3). 10.1136/bmjoq-2024-002870 De Wit FR, Greer LL, Jehn KAJJoap. The paradox of intragroup conflict: a meta-analysis. J Appl Psychol. 2012;97(2):360. 10.1037/a0024844 Azoulay E, Timsit J-F, Sprung CL, Soares M, Rusinova K, Lafabrie A, et al. Prevalence and factors of intensive care unit conflicts: the conflicts study. Am J Respir Crit Care Med. 2009;180(9):853-60. 10.1164/rccm.200810-1614OC Christian CK, Gustafson ML, Roth EM, Sheridan TB, Gandhi TK, Dwyer K, et al. A prospective study of patient safety in the operating room. Surgery. 2006;139(2):159-73. 10.1016/j.surg.2005.07.037 Rogers D, Lingard L, Boehler ML, Espin S, Klingensmith M, Mellinger JD, et al. Teaching operating room conflict management to surgeons: clarifying the optimal approach. Med Educ. 2011;45(9):939-45. 10.1111/j.1365-2923.2011.04040.x Musselman LJ, MacRae HM, Reznick RK, Lingard LAJMe. ‘You learn better under the gun’: intimidation and harassment in surgical education. Med Educ. 2005;39(9):926-34. 10.1111/j.1365-2929.2005.02247.x Kim S, Bochatay N, Relyea-Chew A, Buttrick E, Amdahl C, Kim L, et al. Individual, interpersonal, and organisational factors of healthcare conflict: A scoping review. J Interprof Care. 2017;31(3):282-90. 10.1080/13561820.2016.1272558 Mosadeghrad AM, Ferdosi MJMs-m. Leadership, job satisfaction and organizational commitment in healthcare sector: Proposing and testing a model. Mater Sociomed. 2013;25(2):121. 10.5455/msm.2013.25.121-126 Mosadeghrad AJTDT. Essentials of healthcare organization and management. Tehran: Dibagran Tehran; 2015. Thomas E, Taggart B, Crandell S, Lasky R, Williams A, Love L, et al. Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial. J Perinatol. 2007;27(7):409-14. 10.1038/sj.jp.7211771 Giltinane CLJNs. Leadership styles and theories. Nurs Stand. 2013;27(41). 10.7748/ns2013.06.27.41.35.e7565 World Health Organization. (‎2016)‎. Open mindsets: participatory leadership for health. World Health Organization. https://iris.who.int/handle/10665/251458. Easterby-Smith M, Thorpe R, Jackson PR. Management research. Sage; 2012 Apr 3. Additional Declarations No competing interests reported. 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Annually, between 350,000 to 450,000 people in the United States and 700,000 people in Europe experience cardiac arrest [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In Iran, cardiovascular diseases account for 80% of deaths [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The outcome of cardiac arrest largely depends on the immediate and effective implementation of basic and advanced cardiac life support measures, with cardiopulmonary resuscitation (CPR) being a critical component [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Despite continuous updates to CPR guidelines, only 6\u0026ndash;9% of patients survive cardiac arrest [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Iran, the mortality rate for CPR exceeds 90%, with a hospital discharge rate of less than 7% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although recent advancements have improved survival rates, they remain low [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCPR is one of the most stressful and chaotic tasks in healthcare [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Improving the quality of CPR is essential, as it directly impacts patient survival rates [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Survival from cardiac arrest requires a team effort, often involving individuals with diverse skills who may not have prior experience working together [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A team is defined as two or more individuals who interact dynamically, share a common goal, and possess complementary skills [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In high-stress medical emergencies like CPR, technical skills alone are insufficient; effective teamwork and behavioral skills are crucial [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Studies indicate that 70\u0026ndash;80% of healthcare errors result from poor communication and understanding within teams, highlighting the importance of effective communication during the resuscitation of critically ill patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe significance of communication in CPR has been widely documented [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In-hospital cardiac arrest (IHCA) is a complex clinical process where CPR team members often lack prior familiarity with one another [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In such emergencies, success depends not on individual performance but on the collective interactions of multiple individuals and systems [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. To enhance team interaction during CPR, effective strategies are needed. This study aims to identify and explain the factors influencing interactions among CPR team members.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSTUDY DESIGN AND SETTING\u003c/h2\u003e \u003cp\u003eThis study adopted a qualitative approach, employing conventional content analysis, and was conducted over 12 months, from December 2023 to December 2024. The research took place in the government hospitals of Guilan University of Medical Sciences. We used the COREQ (Consolidating Criteria for Reporting Qualitative Research) checklist to ensure this study was reported with quality. We used Guba and Lincoln's criteria to make sure the findings were valid. These criteria include validity, transferability, reliability, and verifiability. We used several methods to validate the findings. These included maximum diversity sampling, prolonged engagement with the data, peer checking, and participant checking. The verifiability of the findings was ensured by referencing the participants. To ensure transferability, we detailed the methodology. An experienced external observer then reviewed the findings to confirm reliability.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePARTICIPANTS\u003c/h3\u003e\n\u003cp\u003eThe participants consisted of all members of the resuscitation team, including physicians, nurses, anesthesia experts, and residents. Participants who met the inclusion criteria were selected from various departments with diverse experiences and both genders, ensuring maximum diversity within CPR teams. The inclusion criteria included being a member of the resuscitation teams in government hospitals of Guilan University of Medical Sciences, having clinical experience, being involved in CPR operations, being willing to communicate, being able to express their feelings and experiences, and being willing to participate in the study.\u003c/p\u003e\n\u003ch3\u003eDATA COLLECTION\u003c/h3\u003e\n\u003cp\u003eWe used purposive sampling and kept going until we reached data saturation. This means we stopped when no new information came up. We conducted 15 face-to-face and semi-structured interviews with all the participants. The interviewer was a PhD candidate in nursing. He trained in interview techniques. He also has 20 years of experience in resuscitation teamwork at medical centers. The interviews were conducted in private settings with the participants' consent. Following each interview, the data were analyzed before the next interview took place. To gain deeper insights into the participants' experiences, semi-structured interviews were conducted. We used an interview guide based on key teamwork components from research. The interviews were structured around open-ended questions to allow participants to share their perspectives in depth. Examples of these questions included:\"What are your interactions like in the CPR team?\", \"How did you experience factors affecting CPR team interactions?\". During the interviews, we asked exploratory questions to learn more about the participants' beliefs and experiences.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDATA ANALYSIS\u003c/h2\u003e \u003cp\u003eThe data analysis followed the conventional qualitative content analysis method, which involves interpreting the content of the data based on personal perspectives. The research team extracted categories directly from the text data and identified codes and themes through a systematic classification process. This method aims not only to extract objective content but also to uncover underlying themes and patterns within the participants' responses. Immediately following the interviews, the audio recordings were transcribed verbatim via Word software. Then, we analyzed them with MAXQDA 20 software. The analysis started with several reviews of the interview transcripts. Then, we identified the key semantic units from each interview. These units were then coded. Researchers grouped codes into primary categories based on their semantic similarities and differences. These categories were then grouped into broader ideas based on their relationships and shared themes. Finally, we merged categories that covered similar concepts to form the main categories.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOver the 12 months, 15 interviews were conducted with 14 participants, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003echaracteristics of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eExperience Duration\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFirst Interview Duration\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSecond Interview Duration\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNurse, Clinical Instructor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eICU Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCardiac Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnesthesia expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmergency Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClinical Supervisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCardiac Resident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCardiac Resident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnesthesia expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClinical Supervisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGeneral Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGeneral Physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmergency nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ephysician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEmergency medicine specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClinical Supervisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCod 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical department nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe researchers reached data saturation after conducting 15 interviews, as no new codes emerged from the data. One participant was interviewed twice to clarify and expand on their initial responses. The interviews ranged in duration from 25 to 56 minutes, providing in-depth insights into the participants' experiences. The participants had an average age of 42 years, with ages ranging from 25 to 55 years. The group consisted of 6 women and 8 men, ensuring a diverse range of perspectives. Data analysis revealed a main category titled \"The Complexity of Cardiopulmonary Resuscitation Interactions.\" It also identified 5 general categories and 7 subcategories (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These categories and subcategories provided a structured understanding of the factors influencing CPR team interactions, highlighting both facilitators and barriers to effective teamwork during resuscitation efforts.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ethe main, general and sub-categories of interaction in cardiopulmonary resuscitation teams\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubcategories\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eThe complexity of cardiopulmonary resuscitation interactions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eConsensus in Resuscitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-resuscitation Coordination\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-resuscitation Debriefing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication Clarity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInteraction in Team Rotation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormal Rotation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbnormal Rotation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal Conflicts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTeam Leadership Style\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAutocratic Leadership\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLaissez-faire Leadership\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipatory Leadership\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eThe complexity of cardiopulmonary resuscitation interactions\u003c/h2\u003e \u003cp\u003eTeam interactions during cardiopulmonary resuscitation (CPR) are influenced by various factors. Some factors facilitate effective teamwork, while others create challenges. These factors contribute to the complexity of team interactions. For participants, the barriers and facilitators of interaction held different meanings, significantly impacting their interaction, performance, and responses during resuscitation efforts.\u003c/p\u003e \u003cp\u003e1. Consensus in Resuscitation\u003c/p\u003e \u003cp\u003e\"Consensus in Resuscitation\" is one of the key dimensions shaping the concept of \"the complexity of cardiopulmonary resuscitation interactions.\" Participants emphasized that consensus is critical for successful resuscitation. Team members should summarize and exchange views on the shortcomings of teamwork, how to perform effectively, and how to fulfill their roles both before and after CPR cases. This can occur during training classes or regular team meetings. This process helps them learn how to interact effectively during resuscitation reflective sessions and demonstrate coordinated and flawless role performance in CPR.\u003c/p\u003e \u003cp\u003e1.1 Pre-resuscitation coordination\u003c/p\u003e \u003cp\u003e The concept of \"pre-resuscitation coordination\" is one of the dimensions of the concept of consensus in resuscitation, as participants emphasized the importance of holding prior coordination sessions to ensure a well-coordinated role during resuscitation. Participant No. 1, a nurse on the resuscitation team and a CPR instructor, stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"In the post-resuscitation team formation phase, we do not have any meetings where we sit together to discuss what we should do if resuscitation occurs. That is, we don\u0026rsquo;t address the storming and norming stages that are part of the teamwork process. \"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant No. 3, a nurse with 20 years in the heart department highlighted the need for consensus in resuscitation sessions. She emphasized teaching team skills and coordination tips in training classes.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We didn't have any consensus in resuscitation sessions before or after the resuscitation. They hold training classes for resuscitation, but they don't teach the points that need to be considered for team coordination and the team's duties; it's just a theory class, and technical points are taught.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e1.2 Post-resuscitation Debriefing\u003c/p\u003e \u003cp\u003eThe concept of \"Post-resuscitation Debriefing\" is one of the dimensions of the concept of consensus in resuscitation. Participants emphasized the importance of these sessions to address skill gaps and improve performance in future resuscitations. Participant No. 5, a nurse in a cardiac emergency department, said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We sometimes have friendly conversations about the outcome of resuscitation. However, we lack a structured, regular post-resuscitation meeting. Such a meeting could effectively address issues in teamwork and communication, helping us identify areas for improvement and ensuring better coordination in future cases.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe concept of \"Communication Clarity\" is one of the dimensions of the formation of the concept of The Complexity of Cardiopulmonary Resuscitation Interactions. Clear communication is crucial for effective resuscitation teamwork, as participants noted that it enables them to perform cardiopulmonary resuscitation tasks correctly and quickly. Team members must share information clearly and remain informed about the methods and processes involved in resuscitation.\u003c/p\u003e \u003cp\u003eIn this regard, Participant No. 3 highlighted the issue of incomplete clear communication among members of the cardiopulmonary resuscitation team, stating:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"A good leader speaks loudly and clearly when giving instructions. Then, experienced members will also announce when they complete an action. I, who am experienced and understand the importance of this practice, do this consistently. However, unfortunately, this type of training is not provided to novices. For example, I will announce, 'I am injecting the third dose of epinephrine,' but our less experienced colleagues often fail to do this. This lack of communication can lead to improper information exchange, potentially resulting in the patient receiving additional or insufficient medication.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant No. 4, an anesthesia expert with 17 years of experience in the cardiac emergency department, mentioned the importance of interaction and coordination during shock delivery and its impact on staff safety:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\" A few years ago, I experienced a situation where there was poor interaction and coordination during shock delivery. The resident was supposed to deliver a shock and should have clearly announced it, but she didn\u0026rsquo;t. As a result, I was inadvertently exposed to the shock, which caused me to experience severe tachycardia. I had to leave the patient immediately, as I wasn\u0026rsquo;t feeling well at all.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e3. Interaction in Team Rotation\u003c/p\u003e \u003cp\u003e\"Interaction in Team Rotation\" is a key component of understanding the complexity of cardiopulmonary resuscitation interactions. Team members must interact to rotate roles to prevent ineffective performance and disruption of the teamwork order. They must exchange information during role rotation and ensure that critical tasks are handed over at the right moments without disrupting the resuscitation process.\u003c/p\u003e \u003cp\u003e3.1 Normal Rotation\u003c/p\u003e \u003cp\u003e\"Normal Rotation\" is one of the dimensions of the concept of interaction in team rotation. The experiences shared by participants highlight the importance of appropriate and timely rotation of resuscitation team members to prevent disorganization and avoid wasting valuable time during critical situations.\u003c/p\u003e \u003cp\u003eParticipant No. 2, an ICU nurse with 24 years of clinical experience, emphasized this point, stating:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"It is important to know who is responsible for which task during resuscitation. For example, if C takes over A's role or D's role without proper coordination, the team's order will be disrupted. Typically, the medication and chest compression teams switch roles, but they must interact effectively to ensure that information about how many drugs and which ones have been administered is clearly communicated. This transfer of responsibilities must happen seamlessly and without wasting time to maintain the efficiency and effectiveness of the resuscitation effort.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e3.2 Abnormal Rotation\u003c/p\u003e \u003cp\u003e\"Abnormal rotation\" is one of the dimensions of the concept of interaction in team rotation and is identified as a factor that hinders effective team interactions. Participants' experiences highlight the critical need to avoid individualism in cardiac massage and to ensure the timely handover of roles among team members to sustain effective performance during resuscitation efforts. According to the American Heart Association (AHA) protocol, effective cardiac massage during cardiopulmonary resuscitation requires that team members performing chest compressions switch roles every 2 minutes, or before they become fatigued. This ensures that compressions remain consistent, high-quality, and effective throughout the resuscitation effort.\u003c/p\u003e \u003cp\u003eIn this regard, Participant No. 1 highlighted a critical issue: the quality of resuscitation drops significantly if one person continues chest compressions for more than 2 minutes. They explained that this often stems from a feeling of negative competition during resuscitation. The participant noted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When we ask someone to switch roles, they sometimes refuse, saying, 'No, I'm not tired.' But we know that continuing beyond 2 minutes leads to low-quality resuscitation. The individual may feel that stepping down early is a sign of weakness, so they resist. This creates a kind of negative competition, where the person thinks, 'I'll stay longer to prove I'm stronger\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e4. Personal Conflicts\u003c/p\u003e \u003cp\u003eThe fourth aspect of \"The Complexity of Cardiopulmonary Resuscitation Interactions\" is \"Personal Conflicts.\" The presence of personal conflicts among team members and the inability to work as a team in cardiopulmonary resuscitation can create significant barriers to establishing effective team interaction. These conflicts may hinder role performance during resuscitation and ultimately lead to the failure of teamwork in critical situations. Participant No. 3 said in this regard:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Because the team members have not had prior meetings or consensus with each other, and sometimes they do not know each other, they may have unresolved conflicts from the past. These conflicts can prevent them from working together as a cohesive team during resuscitation.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant No. 1 emphasized the importance of prior acquaintance among team members and their ability to work together effectively, particularly in the absence of previous conflicts and said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"We members of the resuscitation team may not see each other until just before the resuscitation operation, and we often don\u0026rsquo;t know whether we can work effectively as a team with those individuals.For example, I would realize at 11 a.m. that I was a member of the CPR team, and a person from the women's CCU would arrive while another from the men's CCU would come as well. It\u0026rsquo;s possible that we have unresolved personal conflicts and, as a result, can\u0026rsquo;t work together cohesively.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e5. Team Leadership Style\u003c/p\u003e \u003cp\u003eThe fifth feature of \"The Complexity of Cardiopulmonary Resuscitation Interactions\" is \"Team Leadership Style.\" Data analysis revealed that resuscitation teams employ different leadership styles to facilitate interaction and coordination during cardiopulmonary resuscitation.\u003c/p\u003e \u003cp\u003eThe fifth feature of \"The Complexity of Cardiopulmonary Resuscitation Interactions\" is the concept of \"Team Leadership Style.\" Data analysis revealed that resuscitation teams employ different leadership styles to facilitate interaction and coordination during cardiopulmonary resuscitation. The dimensions and characteristics of this concept include: autocratic leadership, laissez-faire leadership, and participatory leadership.\u003c/p\u003e \u003cp\u003e5.1 Autocratic Leadership\u003c/p\u003e \u003cp\u003e\"Autocratic leadership\" is one of the dimensions of the concept of team leadership style. Participants' experiences highlighted the one-sided approach of the team leader and their tendency to act based on personal preferences during cardiopulmonary resuscitation (CPR), which often leads to the suppression of team members' participation in decision-making.\u003c/p\u003e \u003cp\u003eParticipant No. 2 said in this regard:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Sometimes we say, 'Doctor, the patient's rhythm is shockable. Should we shock them?' And the doctor agrees. Other times, they act based on their own preference and say, 'No, give the medication for now,'...\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipant No. 1 also pointed out the individualism of the team leader, who often tries to prove their versatility and said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"In CPR, there is a tendency for individualism, especially among team leaders. Some individuals may want to create the impression that they are all-capable, that they can handle everything. They don\u0026rsquo;t allow room for participation or input from others, which leads to other team members realizing over time that they have little role in decision-making. As a result, team members gradually become suppressed.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e5.2 Laissez-faire Leadership\u003c/p\u003e \u003cp\u003e\"Laissez-Faire Leadership\" is one of the dimensions of the concept of team leadership style. Field notes highlight the lack of supervision over team performance and coordination, as well as the leader's indifference toward the actions taken during cardiopulmonary resuscitation (CPR).\u003c/p\u003e \u003cp\u003eField Note No. 1 provides an example:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The team leader's communication with the members was weak. They were indifferent to reminding team members to switch roles every 2 minutes during chest compressions, coordinating their actions, or ensuring proper drug administration. For instance, after 5 minutes of cardiac and respiratory arrest, the nurse asked the resident, 'Should I administer medication to the patient?' The resident replied, 'Give one or two doses of epinephrine.' The nurse then drew 2 to 3 ampoules into a single syringe and administered the medication to the patient at will, without considering the appropriate timing for drug administration.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e5.3 Participatory Leadership\u003c/p\u003e \u003cp\u003eParticipatory leadership\" is one of the dimensions of the concept of team leadership style. Participants noted that skilled and and flexible leaders in resuscitation teams consult with team members and accept their logical suggestions. Participant No. 11 said in this regard:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Sometimes the team leader says the patient does not indicate atropine, but we argue, 'Doctor, the patient has a history of bradyarrhythmia, and we should administer atropine.' If the leader has a flexible personality, I feel I have a role in this process. However, if the leader insists, 'No, just administer amiodarone or epinephrine,' then I no longer feel I have a role in the decision-making process.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study aimed to explain the factors influencing interactions among members of cardiopulmonary resuscitation (CPR) teams. Data analysis led to the identification of a main category titled \"The complexity of cardiopulmonary resuscitation interactions.\" This includes general categories like: consensus in resuscitation, communication clarity, interaction in team rotation, personal conflicts, and team leadership style. These categories explain team members' experiences and the factors that influence their interactions during cardiopulmonary resuscitation.\u003c/p\u003e \u003cp\u003e\"Consensus in Resuscitation\" plays a key role in how team members interact in this study. After participating in cardiopulmonary resuscitation cases, team members should debrief and exchange ideas about how to perform their roles in the form of training classes or regular meetings. According to studies by Marcino and Gordon, hot wash or immediate debriefing sessions are activities typically conducted immediately after an emergency incident to record initial opinions, identify challenges, and provide solutions for current and future problems [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Studies have shown that the use of immediate debriefing sessions not only improves cardiac arrest care in the emergency department, but also leads to improved clinical, educational, and psychological well-being of staff [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Pre-resuscitation Coordination refers to meetings held before cardiopulmonary resuscitation (CPR) to review roles, responsibilities, and necessary processes. These meetings not only enhance team readiness but also increase the likelihood of a successful resuscitation effort. According to the study by Nallamothu et al., hospitals often use a designated resuscitation team for each shift. Team members typically have other roles during their shift and must leave those tasks to respond to a resuscitation event. Additionally, the composition of the team may change from one CPR case to another, making it difficult for members to identify and address issues in team dynamics. To overcome this challenge, the study emphasizes the importance of holding pre-resuscitation meetings to ensure that all team members are aligned and prepared for their roles [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e In the participants' experiences, the concept of \"communication clarity\" is one of the key factors that facilitate effective interaction within the cardiopulmonary resuscitation (CPR) team. Clear communication is essential for successful teamwork during CPR, as it ensures that all team members share information accurately and are aware of the methods and progress of the resuscitation process. A study by Bogenst\u0026auml;tter et al. examined how resuscitation team members shared information with medical professionals during a simulation. The study found that 18% of the information shared was incorrect, with quantitative information (such as defibrillation counts and drug doses) being more prone to errors. This type of data is particularly vulnerable to mistakes because it can change over time and requires precise communication [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Hunziker et al. emphasized the importance of clear communication in supporting teamwork during resuscitation. For example, using specific and clear phrases like, \"This is the first defibrillation at 120 J,\" helps team members recall critical details and stay aligned during the resuscitation process [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe concept of \"Interaction in Team Rotation\" is another critical factor influencing cardiopulmonary resuscitation (CPR) team interactions. Participants emphasized the importance of correct and timely role assignment and information exchange during role rotation in CPR to prevent ineffective performance and disruptions in teamwork. Interaction in team rotation can be normal. Members may switch roles promptly and share important patient info. This way, patients get effective massages while staff avoid fatigue. Sometimes, team rotation may be abnormal. Members might switch roles without sharing key info or following time standards. This can occur due to reasons such as a desire to demonstrate power or reluctance to hand over responsibilities. As a result, the patient might get poor chest compressions and could also receive the wrong medication. The American Heart Association (AHA) recommends that rescuers performing chest compressions switch roles every two minutes during cardiopulmonary resuscitation (CPR). This practice helps reduce fatigue and ensures that chest compressions remain effective and high-quality [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the study by Reyes et al. Fatigue from chest compressions over 2 minutes depends on several factors. These include the rescuers' traits, education, work experience, and the conditions during CPR [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Additionally, Giri et al. emphasized in their study the importance of clear role definition within CPR teams. They stressed that individuals must be aware of their specific roles to perform their duties promptly and effectively [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe concept of \"Personal Conflicts\" is one of the factors that hinder effective interaction within the cardiopulmonary resuscitation (CPR) team. In the present study, the presence of personal conflicts among team members and the lack of CPR skills were identified as significant barriers to establishing effective team interaction. Studies have shown that if conflicts between healthcare professionals are not addressed, conflicts have negative effects on healthcare teams and the quality and safety of patient care, as they can distract providers from patient care[\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Conflicts within teams can include harsh language (threats, shouting, swearing), blaming, impaired communication, or disruptive behavior [\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. According to the study by Kim S et al., conflicts arise when the goals, expectations, and interests of individuals are perceived as incompatible. Conflicts arise between healthcare professionals in multiple specialties and roles, as well as within teams at different stages of patient care. Unresolved conflicts between healthcare professionals can lead to difficult patient care outcomes [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\"Team Leadership Style\" is an important factor in CPR team interactions. Leadership style refers to the way a leader motivates, guides, and influences their team members to achieve shared goals [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The leadership style depends on many factors. These include the manager's personality, values, skills, and experiences. Internal and external organizational factors also play a role [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. These elements collectively influence how effective a leader can be in guiding their team and achieving desired outcomes. In this study, it was found that the Autocratic Leadership Style significantly limits team interactions. Participants reported that the leader of the cardiopulmonary resuscitation (CPR) team rarely consulted them or sought their input. This lack of inclusion suppressed other team members from participating in decision-making, ultimately hindering effective teamwork and collaboration. The study by Thomas E. further supports this finding, highlighting that poor leadership and communication in CPR teams contribute to 70% of perinatal deaths and injuries [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This underscores the critical importance of effective leadership and open communication in ensuring successful resuscitation outcomes. The study by Giltinane CL highlights that autocratic leaders tend to focus on maintaining power. They are often close-minded and controlling. Because of this, some people may find it hard to work with them. Some nursing staff dislikes these leaders for demanding obedience, loyalty, and strict rule-following. However, others thrive under autocratic leadership [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The Laissez-Faire Leadership Style negatively impacts team interactions, as highlighted in this study. Leaders who adopt this style often exhibit indifference and fail to provide adequate supervision or guidance to their team members. This lack of involvement can lead to significant challenges in coordination and cohesion within the team. Inexperienced leaders often use this style. It\u0026rsquo;s also common among those ready to leave their roles. They prefer to let others take charge [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The study by Easterby-Smith et al. highlights that laissez-faire leadership is often viewed unfavorably, with many not even considering it a true leadership style due to its lack of direction and engagement [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In contrast, the Participatory Leadership Style emerged as a key factor facilitating effective team interactions in the experiences of participants. In this style, the team leader welcomes logical ideas and input from team members, fostering a collaborative environment. This approach not only enhances teamwork but also increases the likelihood of successful resuscitation efforts. The World Health Organization (WHO) study further supports this, emphasizing that participatory leadership values knowledge, experience, skills, and innovation in decision-making. This leadership style relies on the diverse expertise of team members and their active engagement to achieve optimal results [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eLIMITATIONS\u003c/h3\u003e\n\u003cp\u003eThis study presents certain limitations to consider. The results lack generalizability due to the study method and sample size. This study's findings are based on the experiences of CPR team members in government educational and medical centers. We recommend conducting further research in private centers to confirm these results.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eETHICAL CONSIDERATIONS\u003c/h2\u003e \u003cp\u003eThis study is part of a doctoral thesis in nursing. It has an ethics code, IR.GUMS.REC.1402.445, from the Ethics Committee at Guilan University of Medical Sciences. The consent form said participation was voluntary. Participants got information both verbally and in writing about the study. They could also leave at any time. The researchers gave participants numbers like 1, 2, and 3. They kept the list for pseudonymization apart from the transcribed material.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study revealed that the complex dynamics of resuscitation team interactions are influenced by various barriers and facilitators. Therefore, by carefully planning to strengthen facilitating factors, such as consensus in resuscitation, communication clarity, normal rotation, and a participatory leadership style and addressing inhibiting factors, such as personal conflicts, abnormal rotation, and an autocratic leadership style, we can achieve optimal teamwork interactions. This means that if members of the cardiopulmonary resuscitation (CPR) team can collaborate effectively, avoid personal conflicts, and reach consensus on their roles and tasks during resuscitation, while adopting a participatory leadership style, they can foster better interaction. Additionally, maintaining clear communication, ensuring timely role transitions, and avoiding individualism during chest compressions can further enhance teamwork. By addressing these factors, we can hope for optimal team interaction, ultimately leading to successful cardiopulmonary resuscitation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCPR: Cardiopulmonary Resuscitation; IHCA: In-hospital cardiac arrest; COREQ: Consolidating Criteria for Reporting Qualitative Research; ICU: Intensive care unit; CCU: Cardiac care unit; AHA: American Heart Association; WHO: World Health Organization; GUMS: Guilan University of Medical Sciences\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the Research Council of Guilan University of Medical Sciences (GUMS), with the IR code: IR.GUMS.REC.1402.445. To participate in the study informed written consent was obtained from the participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available by contacting the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare there is no financial conflict of interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was not funded and supported\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made the design of the study, AES and YS participated in data collection, and data analyzed by AES, NJ, MACH and YS. The final report and article were written by AES, NJ, and YS, and were read and approved by AES, NJ, MACH and YS. The author(s) read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is approved by Guilan University of Medical Sciences. The research team would like to thank and appreciate all the participants for sharing their valuable experiences and all the people who somehow helped us in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGiacoppo DJEHJ. Impact of bystander-initiated cardiopulmonary resuscitation for out-of-hospital cardiac arrest: where would you be happy to have a cardiac arrest? Eur Heart J. 2019;40(3):319-21. 10.1093/eurheartj/ehy911\u003c/li\u003e\n\u003cli\u003ePanchal AR, Bartos JA, Caba\u0026ntilde;as JG, Donnino MW, Drennan IR, Hirsch KG, et al. 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Resuscitation. 2018;125:70-8. 10.1016/j.resuscitation.2018.01.025\u003c/li\u003e\n\u003cli\u003eGoodarzi A, Jalali A, Almasi A, Naderipour A, Kalhori RP, Khodadadi AJGjohs. Study of survival rate after cardiopulmonary resuscitation (CPR) in hospitals of Kermanshah in 2013. Glob J Health Sci. 2014;7(1):52. 10.5539/gjhs.v7n1p52\u003c/li\u003e\n\u003cli\u003eChopra A, Wong N, Ziegler C, Morrison LJR. Systematic review and meta-analysis of hemodynamic-directed feedback during cardiopulmonary resuscitation in cardiac arrest. Resuscitation. 2016;101:102-7. 10.1016/j.resuscitation.2016.01.025\u003c/li\u003e\n\u003cli\u003eNeumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, et al. Part 1: executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18_suppl_2):S315-S67. 10.1161/CIR.0000000000000252\u003c/li\u003e\n\u003cli\u003eSilverplats J, Str\u0026ouml;ms\u0026ouml;e A, \u0026Auml;ng B, S\u0026ouml;dersved K\u0026auml;llestedt M-LJPo. Attitudes towards cardiopulmonary resuscitation situations and associations with potential influencing factors\u0026mdash;A survey among in-hospital healthcare professionals. PLoS One. 2022;17(7):e0271686. 10.1371/journal.pone.0271686\u003c/li\u003e\n\u003cli\u003eGhasemi A, Rezapour-Nasrabad R, Mokhlesabadifarahan T, Alizadeh Z, Beygi N, Fereidouni Z, et al. Exploring the challenges affecting the quality of cardiopulmonary resuscitation from the perspective of Emergency Medical Service personnel: a qualitative study. BMC Emerg Med. 2021;40(2):154-63. 10.5281/zenodo.4711637\u003c/li\u003e\n\u003cli\u003eDyson K, Bray J, Smith K, Bernard S, Finn JJR. A systematic review of the effect of emergency medical service practitioners\u0026rsquo; experience and exposure to out-of-hospital cardiac arrest on patient survival and procedural performance. Resuscitation. 2014;85(9):1134-41. 10.1016/j.resuscitation.2014.05.020\u003c/li\u003e\n\u003cli\u003eClarke S, Apesoa-Varano EC, Barton JJBo. Code Blue: methodology for a qualitative study of teamwork during simulated cardiac arrest. BMJ Open. 2016;6(1):e009259. 10.1136/bmjopen-2015-009259\u003c/li\u003e\n\u003cli\u003eSalas E, Diaz-Granados D, Klein C, Burke CS, Stagl KC, Goodwin GF, et al. Does team training improve team performance? A meta-analysis. Hum Factors. 2008;50(6):903-33. 10.1518/001872008X375009\u003c/li\u003e\n\u003cli\u003eWeinstock P, Halamek LPJPCoNA. Teamwork during resuscitation. Pediatr Clin North Am. 2008;55(4):1011-24. 10.1016/j.pcl.2008.04.001\u003c/li\u003e\n\u003cli\u003eCalder LA, Mastoras G, Rahimpour M, Sohmer B, Weitzman B, Cwinn AA, et al. Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis. Int J Emerg Med. 2017;10:1-9. 10:1-9. 10.1186/s12245-017-0149-4\u003c/li\u003e\n\u003cli\u003eSchaefer HG, Helmreich RL, Scheidegger DJR. Human factors and safety in emergency medicine. Resuscitation. 1994;28(3):221-5. 10.1016/0300-9572(94)90067-1\u003c/li\u003e\n\u003cli\u003eAndersen PO, Jensen MK, Lippert A, \u0026Oslash;stergaard DJR. Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams. Resuscitation. 2010;81(6):695-702. 10.1016/j.resuscitation.2010.01.024\u003c/li\u003e\n\u003cli\u003eChalwin R, Flabouris AJImj. Utility and assessment of non‐technical skills for rapid response systems and medical emergency teams. Intern Med J. 2013;43(9):962-9. 10.1111/imj.12172\u003c/li\u003e\n\u003cli\u003eBriggs A, Raja AS, Joyce MF, Yule SJ, Jiang W, Lipsitz SR, et al. The role of nontechnical skills in simulated trauma resuscitation. J Surg Res. 2015;72(4):732-9. 10.1016/j.jsurg.2015.01.020\u003c/li\u003e\n\u003cli\u003eChan PS, Nallamothu BKJJ. Improving outcomes following in-hospital cardiac arrest: life after death. JAMA. 2012;307(18):1917-8. 10.1001/jama.2012.3504\u003c/li\u003e\n\u003cli\u003eMarsch SC, M\u0026uuml;ller C, Marquardt K, Conrad G, Tschan F, Hunziker PRJR. Human factors affect the quality of cardiopulmonary resuscitation in simulated cardiac arrests. Resuscitation. 2004;60(1):51-6. 10.1016/j.resuscitation.2003.08.004\u003c/li\u003e\n\u003cli\u003eWeaver SJ, Dy SM, Rosen MAJBq, safety. Team-training in healthcare: a narrative synthesis of the literature. BMJ Qual Saf. 2014;23(5):359-72. 10.1136/bmjqs-2013-001848\u003c/li\u003e\n\u003cli\u003eMarcino D, Gordon KJCCDR. Emergency Response: An overview of the National Microbiology Laboratory emergency management program. Can Commun Dis Rep. 2018;44(5):102. 10.14745/ccdr.v44i05a02\u003c/li\u003e\n\u003cli\u003eNocera M, Merritt CJAe, training. Pediatric critical event debriefing in emergency medicine training: an opportunity for educational improvement. AEM Educ Train. 2017;1(3):208-14. 10.1002/aet2.10031\u003c/li\u003e\n\u003cli\u003eSchmidt M, Haglund KJJoTN, JTN. Debrief in emergency departments to improve compassion fatigue and promote resiliency. J Trauma Nurs. 2017;24(5):317-22. 10.1097/JTN.0000000000000315\u003c/li\u003e\n\u003cli\u003eGilmartin S, Martin L, Kenny S, Callanan I, Salter NJBoq. Promoting hot debriefing in an emergency department. BMJ Open Qual. 2020;9(3):e000913. 10.1136/bmjoq-2020-000913\u003c/li\u003e\n\u003cli\u003eNallamothu BK, Guetterman TC, Harrod M, Kellenberg JE, Lehrich JL, Kronick SL, et al. How do resuscitation teams at top-performing hospitals for in-hospital cardiac arrest succeed? A qualitative study. Circulation. 2018;138(2):154-63. 10.1161/CIRCULATIONAHA.118.033674\u003c/li\u003e\n\u003cli\u003eBogenst\u0026auml;tter Y, Tschan F, Semmer NK, Spychiger M, Breuer M, Marsch SJHf. How accurate is information transmitted to medical professionals joining a medical emergency? A simulator study. Hum Factors. 2009;51(2):115-25. 10.1177/0018720809336734\u003c/li\u003e\n\u003cli\u003eHunziker S, Johansson AC, Tschan F, Semmer NK, Rock L, Howell MD, et al. Teamwork and leadership in cardiopulmonary resuscitation. J Am Coll Cardiol. 2011;57(24):2381-8. 10.1016/j.jacc.2011.03.017\u003c/li\u003e\n\u003cli\u003eReyes M, D\u0026iacute;az C, Cuineme SJJCCR. Quality CPR rescuer alternating every 2 minutes 1 minute vs university hospital clinic in San Rafael, 2018. J Crit Care Res. 2019;12(4):89-94. 10.15406/jccr.2019.12.00447\u003c/li\u003e\n\u003cli\u003eGiri S, Gyeltshen D, Wangchuk N, Dorji K, Drakpa L, Wangdi S, et al. Improving role allocation for cardiopulmonary resuscitation (CPR) in the emergency department: a quality improvement project. BMC Health Serv Res. 2024;13(3). 10.1136/bmjoq-2024-002870\u003c/li\u003e\n\u003cli\u003eDe Wit FR, Greer LL, Jehn KAJJoap. The paradox of intragroup conflict: a meta-analysis. J Appl Psychol. 2012;97(2):360. 10.1037/a0024844\u003c/li\u003e\n\u003cli\u003eAzoulay E, Timsit J-F, Sprung CL, Soares M, Rusinova K, Lafabrie A, et al. Prevalence and factors of intensive care unit conflicts: the conflicts study. Am J Respir Crit Care Med. 2009;180(9):853-60. 10.1164/rccm.200810-1614OC\u003c/li\u003e\n\u003cli\u003eChristian CK, Gustafson ML, Roth EM, Sheridan TB, Gandhi TK, Dwyer K, et al. A prospective study of patient safety in the operating room. Surgery. 2006;139(2):159-73. 10.1016/j.surg.2005.07.037\u003c/li\u003e\n\u003cli\u003eRogers D, Lingard L, Boehler ML, Espin S, Klingensmith M, Mellinger JD, et al. Teaching operating room conflict management to surgeons: clarifying the optimal approach. Med Educ. 2011;45(9):939-45. 10.1111/j.1365-2923.2011.04040.x\u003c/li\u003e\n\u003cli\u003eMusselman LJ, MacRae HM, Reznick RK, Lingard LAJMe. \u0026lsquo;You learn better under the gun\u0026rsquo;: intimidation and harassment in surgical education. Med Educ. 2005;39(9):926-34. 10.1111/j.1365-2929.2005.02247.x\u003c/li\u003e\n\u003cli\u003eKim S, Bochatay N, Relyea-Chew A, Buttrick E, Amdahl C, Kim L, et al. Individual, interpersonal, and organisational factors of healthcare conflict: A scoping review. J Interprof Care. 2017;31(3):282-90. 10.1080/13561820.2016.1272558\u003c/li\u003e\n\u003cli\u003eMosadeghrad AM, Ferdosi MJMs-m. Leadership, job satisfaction and organizational commitment in healthcare sector: Proposing and testing a model. Mater Sociomed. 2013;25(2):121. 10.5455/msm.2013.25.121-126\u003c/li\u003e\n\u003cli\u003eMosadeghrad AJTDT. Essentials of healthcare organization and management. Tehran: Dibagran Tehran; 2015.\u003c/li\u003e\n\u003cli\u003eThomas E, Taggart B, Crandell S, Lasky R, Williams A, Love L, et al. Teaching teamwork during the Neonatal Resuscitation Program: a randomized trial. J Perinatol. 2007;27(7):409-14. 10.1038/sj.jp.7211771\u003c/li\u003e\n\u003cli\u003eGiltinane CLJNs. Leadership styles and theories. Nurs Stand. 2013;27(41). 10.7748/ns2013.06.27.41.35.e7565\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (\u0026lrm;2016)\u0026lrm;. Open mindsets: participatory leadership for health. World Health Organization. https://iris.who.int/handle/10665/251458.\u003c/li\u003e\n\u003cli\u003eEasterby-Smith M, Thorpe R, Jackson PR. Management research. Sage; 2012 Apr 3.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cardiopulmonary resuscitation, Team interaction, Qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-6397160/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6397160/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eCardiac arrest is a dangerous situation whose outcome depends on immediate interventions called cardiopulmonary resuscitation(CPR). The quality of these interventions depends on the performance and communication of the resuscitation team; therefore, this study was conducted to explain the factors affecting the interaction of cardiopulmonary resuscitation team members.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis qualitative study used a content analysis approach in Iran. It took place over 12 months, from December 2023 to December 2024. The research population was all members of the cardiopulmonary resuscitation teams of educational and medical centers. The researchers started the sampling purposively until they reached data saturation. For data collection, in-depth and semi-structured interviews were conducted. The data were analyzed via 20 MAXQDA software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Data analysis revealed a main category titled \"The Complexity of Cardiopulmonary Resuscitation Interactions.\" Additionally, it identified 5 general categories and 7 subcategories. The general categories and subcategories were: \" Consensus in Resuscitation\" \"Pre-resuscitation Coordination\", \" Post-resuscitation Debriefing\"), \" Communication Clarity \", \"Interaction in Team rotation\" (\"Normal Rotation\", and \"Abnormal Rotation\"), \"Personal Conflicts\" and \"Team Leadership Style\" (\"Autocratic Leadership\", \"Laissez-faire\" and \"Participatory Leadership\")\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe results showed that the complex conditions of resuscitation team interactions are influenced by various factors. Therefore, by carefully planning to enhance facilitating factors—such as consensus in resuscitation, communication clarity, normal rotation, and a participatory leadership style—and addressing inhibiting factors—such as personal conflicts, abnormal rotation, and an autocratic leadership style—we can hope for optimal interaction in teamwork, ultimately leading to successful cardiopulmonary resuscitation.\u003c/p\u003e","manuscriptTitle":"Barriers and Facilitators for Interaction in Cardiopulmonary Resuscitation Teams: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-28 09:10:31","doi":"10.21203/rs.3.rs-6397160/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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