The impact of teamwork on missed nursing care

Previous studies have shown that missed nursing care is a significant problem in acute care hospitals. Other studies have demonstrated that teamwork is a critical element in assuring patient safety and quality of care. The purpose of this study was to determine if the level of nursing teamwork impacts the extent and nature of missed nursing care. A sample of 2?216 nursing staff members on 50 acute care patient care units in 4 hospitals completed the Nursing Teamwork Survey and the MISSCARE Survey. The response rate was 59.7%. Controlling for occupation of staff members (eg, RN/LPN, NA) and staff characteristics (eg, education, shift worked, experience, etc), teamwork alone accounted for about 11% of missed nursing care. The results of this study show that the level of nursing teamwork impacts the nature and extent of missed nursing care. The study results point to a need to invest in methods of enhancing teamwork in these settings.     

Nursing staff teamwork and job satisfaction

kalisch bj , lee h & rochman m. (2010) Journal of Nursing Management 18, 938–947
Nursing staff teamwork and job satisfaction Aim The aim of the present study was to explore the influence of unit characteristics, staff characteristics and teamwork on job satisfaction with current position and occupation. Background Teamwork has been associated with a higher level of job satisfaction but few studies have focused on the acute care inpatient hospital nursing team. Methods This was a cross-sectional study with a sample of 3675 nursing staff from five hospitals and 80 patient care units. Participants completed the Nursing Teamwork Survey (NTS). Results Participants’ levels of job satisfaction with current position and satisfaction with occupation were both higher when they rated their teamwork higher (P < 0.001) and perceived their staffing as adequate more often (P < 0.001). Type of unit influenced both satisfaction variables (P < 0.05). Additionally, education, gender and job title influenced satisfaction with occupation (P < 0.05) but not with current position. Conclusions Results of this present study demonstrate that within nursing teams on acute care patient units, a higher level of teamwork and perceptions of adequate staffing leads to greater job satisfaction with current position and occupation. Implications for Nursing Management Findings suggest that efforts to improve teamwork and ensure adequate staffing in acute care settings would have a major impact on staff satisfaction.     

武汉市三级甲等医院护理团队合作状况的调查研究

[目的]了解在优质护理服务背景下武汉市2所三级甲等医院护理团队的合作状况.[方法]采用护理团队工作状况问卷,对武汉市1所三级甲等教学医院和1所三级甲等非教学医院877名护士进行调查.[结果]武汉市三级甲等医院护理团队合作总均分及5个维度评分均＞4分;团队组建时间、科室、年龄及职称不同,对护士护理团队合作程度有影响（P＜0.05或P＜0.01）.[结论]在深入推进优质护理服务活动中,武汉市三级甲等医院护理团队合作处于满意水平;需要关注团队组建时间2年内、儿科及低年资、低职称护理人员团队合作情况.     

Effective multidisciplinary teamwork in primary health care

The nature and development of teamwork in primary health care is discussed and some barriers to effective teamwork identified Theories of team effectiveness are outlined and methods of applying these to primary health care teams are explored The 'constituency approach' and the theory of team innovation are examined in more detail Team-building interventions are described as one way of improving team effectiveness but their limitations are also acknowledged The Health Education Authority primary health care team workshops are used as an example of a team-building intervention Research at the MRC/ESRC Social and Applied Psychology Unit, Sheffield University, is described This is evaluating the outcomes of the primary health care team workshops in terms of team effectiveness The research will measure viability (the extent to which the team sufficiently sustains good relationships to continue working together) and team performance (achievement of desired outcomes) pre and post workshop Team effectiveness will be measured through team self-assessment, patient satisfaction and family health service authority designated targets for health promotion The overall aim is to develop a model of team effectiveness for primary health care teams, which can then be used to diagnose and guide teams in their work     

Measuring the influence of a mutual support educational intervention within a nursing team

BackgroundTeamwork is essential to provide the highest quality of care for patients. Feeling supported within a nursing unit is a significant factor in nursing satisfaction, intention to remain in the job, and the capacity to provide safe patient care by Aiken et al [1].PurposeThis study examined mutual support among a nursing team to measure the influence of an educational intervention focusing on Mutual Support from the Team STEPPS curriculum by Agency for Healthcare Research and Quality, AHRQ [2].MethodsThe study design used a Likert scale survey, the Nursing Teamwork Survey, before and following an education intervention adapted from the Team STEPPS curriculum on Mutual Support. Demographic data from the 41 participants were analyzed for impact on educational background, roles and responsibilities, age, and other factors.ResultsPre- Post education intervention results varied among the survey items, although scores demonstrated heightened awareness of teamwork following the educational intervention. The subscale of Backup illustrated the strongest improvement.ConclusionThe study demonstrates that education can have an impact on perceptions and awareness of mutual support among nursing team members. The survey instrument can be used effectively to inform leadership areas for improvement and staff development in the effort to improve team coordination and mutual support.     

Improving nursing unit teamwork

A lack of teamwork among nursing staff affects care delivery and unit operations. Barriers present in the structure of a typical patient care unit that make it extremely difficult to achieve a high level of teamwork include large team size, lack of familiarity, instability of the work force and assignments, the absence of a common purpose and destiny, and an inhibiting physical environment. The authors discuss strategies to overcome these obstacles to teamwork.     

Congruence of perceptions among nursing leaders and staff regarding missed nursing care and teamwork

The objective of this study was to test the congruence of the perceptions of unit-based nurse leaders (managers, advanced practice nurses) and nursing staff members (registered nurses, nursing assistants, unit secretaries) in acute care hospitals as to the extent and type of missed nursing care and nursing teamwork. Based on the leader-member exchange congruence framework (LMX), nursing staff and nursing leaders completed the MISSCARE Survey, and a segment of the participants completed the Nursing Teamwork Survey. The findings of this study show a lack of LMX congruence between leaders and nursing staff members. Nursing staff report less missed care and lower teamwork than do leaders, and nursing staff list more problems with having adequate material and labor resources than do leaders. LMX congruence has been associated with positive organizational outcomes.     

Measuring the teamwork performance of operating room teams: a systematic review of assessment tools and their measurement properties

ABSTRACT

Teamwork is fundamental to surgical patient safety but is inconsistently measured. While many tools have been developed for elective intraoperative situations, it is unclear which is the most robust. This systematic review aimed to identify tools to measure the teamwork of operating room teams. Studies were included if they examined the measurement properties of these tools. PsycINFO, Embase (via OVID), CINAHL, ERIC, Medline and Medline in Process (via OVID) were searched through to May 3, 2019, as were reference lists of included studies and previously published relevant reviews. Retrieved articles were screened and data extracted in duplicate by two independent reviewers. Quality was assessed using the COSMIN checklist. Of the 2121 references identified, 14 studies of six assessment tools were included. Tools were validated across various specialties, mostly in clinical rather than simulated settings. The Observational Teamwork Assessment for Surgery (OTAS) and Operating Theater Team Non-Technical Skills Assessment Tool (NOTECHS) were the most frequently investigated tools. Though acceptable for assessing teamwork, both NOTECHS and OTAS rely on the questionable assumption that the teamwork of a team is equivalent to the sum of individual performances. Future studies may investigate other assessment tools that assess the whole team as the unit of analysis along with the potential of these tools to provide healthcare providers with meaningful feedback in clinical practice.     

Integration or pragmatic coalition? An evaluation of nursing teams in primary care

Changing structures and organisations in primary care raise questions about the role and fit of traditional nursing disciplines. This paper discusses recent findings from an evaluation of integrated nursing teams. The study design used a mixed method approach measuring workload activity of health visitors, practice nurses and district nurses, through time diaries; and teamwork using the Primary Care Teamwork Questionnaire, in conjunction with semi-structured interviews exploring the views of key stakeholders and the nurses themselves. The main themes arising from the interviews are discussed, taking account of the findings from the assessment of workload and teamwork questionnaire. The key themes addressed are implementation of change, shifting role boundaries, communication and teamwork. The findings indicate that this type of organisational change is concerned predominately with structure, professional and organisational issues rather than patient care. In the teams studied the opportunity of integration led to a pragmatic coalition that encouraged its members to plan, execute and manage change by themselves, according to a vague definition rather than a patient focused agenda. In order to ensure a quality nursing service and avoid old historical rivalries this needs to be addressed as nursing teams are reconfigured in primary care groups.     

Effective health care teams: a model of six characteristics developed from shared perceptions

This study into understanding health care teams began with listening to participants' teamwork experiences. It unfolded through a dialectic of iterations, analyses and critique towards a simplified model comprising six key characteristics of effective teams. Using the complementary theoretical perspectives of personal construct theory and inductive theory building, three research methods were used to collect a range of participant perspectives. A purposive sample of 39 strategic informants participated in repertory grid interviews and clarification questionnaires. A further 202 health care practitioners completed a purpose designed Teamwork in Healthcare Inventory. All responses were transformed through three iterations of interactive data collection, analysis, reflection and interpretation. Unstructured participant perspectives were qualitatively categorised and analysed into hierarchies to determine comparative contributions to effective teamwork. Complex inter-relationships between conceptual categories were investigated to identify four interdependent emerging themes. Finally, a dynamic model of teamwork in health care organisations emerged that has functional utility for health care practitioners. This Healthy Teams Model can be utilised in conjunction with a Reflective Analysis and Team Building Guide to facilitate team members to critically evaluate and enhance their team functioning.     

An intervention to enhance nursing staff teamwork and engagement

Numerous studies have concluded that work group teamwork leads to higher staff job satisfaction, increased patient safety, improved quality of care, and greater patient satisfaction. Although there have been studies on the impact of multidisciplinary teamwork in healthcare, the teamwork among nursing staff on a patient care unit has received very little attention from researchers. In this study, an intervention to enhance teamwork and staff engagement was tested on a medical unit in an acute care hospital. The results showed that the intervention resulted in a significantly lower patient fall rate, staff ratings of improved teamwork on the unit, and lower staff turnover and vacancy rates. Patient satisfaction ratings approached, but did not reach, statistical significance.     

Use of problem based learning activity to improve attitudes regarding inter-professional collaborative teamwork in mental health nursing students: An evaluation study

Inter-professional collaboration results in improved processes, quality, cost-effectiveness, and outcomes in health care. Despite benefits of collaboration, little is known about effective nursing education approaches in collaboration. A pre-test, post-test brief longitudinal educational evaluation design was implemented utilizing a teamwork attitudes questionnaire to explore thirty-six Midwestern United States undergraduate nursing students' attitudes about collaborative care. An electronic educational module about collaborative nursing practice was used. Also, participants developed visual representations (maps) of collaborative care teams utilizing reverse case-study approach. The TAQ tool demonstrated significantly improved students' valuation of teamwork after the electronic module activity (t = 5.976, p = 0.000) and increased the identification of need for administrative support for effective teamwork (t = 33.53, 0.000). Collaborative team map drawings demonstrated that patient's frequently fail to identify themselves (75%) and social workers (70%) as part of their care team. Patients (58.3%) and students (77.8%) however, frequently identified family members as important to care. Further study should identify how nurses can fully engage and sustain involvement of family members and social workers in collaborative mental health care. Benefit in student nurses' attitudes about teamwork was found after a brief educational learning module about collaboration.     

Team effectiveness in academic primary health care teams

Primary health care is undergoing significant organizational change, including the development of interdisciplinary health care teams. Understanding how teams function effectively in primary care will assist training programs in teaching effective interprofessional practices. This study aimed to explore the views of members of primary health care teams regarding what constitutes a team, team effectiveness and the factors that affect team effectiveness in primary care. Focus group consultations from six teams in the Department of Family Medicine at Queen's University were recorded and transcribed and qualitative analysis was used to identify themes. Twelve themes were identified that related to the impact of dual goals/obligations of education and clinical/patient practice on team relationships and learners; the challenges of determining team membership including nonattendance of allied health professionals except nurses; and facilitators and barriers to effective team function. This study provides insight into some of the challenges of developing effective primary care teams in an academic department of family medicine. Clear goals and attention to teamwork at all levels of collaboration is needed if effective interprofessional education is to be achieved. Future research should clarify how best to support the changes required for increasingly effective teamwork.     

A survey on teamwork status in caring for patients with heart failure: A cross-sectional study

As a result of the complex nature of chronic heart failure (HF), these patients require an interprofessional team approach for care and treatment. This is because an interprofessional approach can manage resources more effectively and improve treatment efficacy. This research was done to evaluate the status of teamwork in caring for HF patients. In this cross-sectional study, the views of 308 members of the care team were collected through the use of Team Assessment Questionnaire (TAQ). The mean and standard deviation of teamwork was 2.4 ± 0.3. There was a significant difference between the teamwork status (total TAQ score) and age, gender and job experience (p < 0.05). The highest mean was for the team leadership dimension of the questionnaire (2.5 ± 0.5) while the lowest was for team foundation (2.4 ± 0.3). Results indicated that the status of teamwork is almost moderate. Teamwork in caring for HF patients was influenced by many factors, including age, gender, and job experience. Teamwork can be enhanced by establishing the equality of women and men’s rights, continuous training and attention to proportional age and gender combinations.     

Perceptions of Teamwork Among Blood and Marrow Transplant and Immune Cell Therapy Nursing Staff at a Cancer Center: A Multimethod Study

This multimethod study investigated nursing staff’s perception of teamwork within blood and marrow transplant and immune cell therapy units. Higher teamwork scores (Nursing Teamwork Survey) were related to higher job satisfaction and teamwork satisfaction. Perceptions of adequate staffing corresponded with higher teamwork scores. Higher levels of education were related to Team Leadership and Backup subscales. Thematic analysis identified themes for presence (cohesiveness, helping without asking, shared goal of patient care) and absence of teamwork (not helping one another, negative impact on patient care, chaos, tension). Three themes emerged for improving teamwork: take initiative to help, communication, treat one another positively.     

Difficulties in collaboration: a critical incident study of interprofessional healthcare teamwork

The challenge for members of interprofessional teams is to manage the team processes that occur in all teamwork while simultaneously managing their individual professional identities. The aim of this study was to identify and describe difficulties perceived by health professionals in interprofessional teamwork. Utterances on verbal actions and resolutions were also explored to enable a discussion of the implications for interprofessional learning. Individual interviews using a Critical Incident Technique were performed with 18 Swedish professionals working in healthcare teams, and examined with qualitative content analysis. The main findings show difficulties related to the team dynamic that arose when team members acted towards one another as representatives of their professions, difficulties that occurred when the members' various knowledge contributions interacted in the team, and difficulties related to the influence of the surrounding organization. The perceived consequences of the difficulties, beyond individual consequences, were restrictions on the use of collaborative resources to arrive at a holistic view of the patient's problem, and barriers to providing patient care and service in the desired manner. This paper also discusses how experiences of managing difficulties entailed various forms of interprofessional learning situations.