Development and Evaluation of a Teamwork Improvement Program for Perioperative Patient Safety

10.1097/jnr.0000000000000460

Shinae AHN；Nam-Ju LEE

teamwork ； nursing team ； program development ； patient safety ； operating rooms

The Journal of Nursing Research

29卷6期（2021 / 12 / 01）

1 - 13

英文

Background: Effective teamwork in healthcare teams improves quality of care, which positively impacts on patient safety. Teamwork is especially crucial for perioperative nurses because they provide care as a team in the operating room. Previous research on teamwork training has principally addressed the general aspects of healthcare settings and focused on interdisciplinary teamwork and has rarely considered operative settings and nursing teamwork. Purpose: The aim of this study was to develop a teamwork improvement program for perioperative patient safety and to evaluate the effectiveness of this program. Methods: A quasi-experimental design was applied. We developed a teamwork improvement program based on teamwork competencies that focused on the perioperative nursing practice. This research was conducted at two operating centers in a tertiary hospital in South Korea, and a total of 60 perioperative nurses participated, including 28 nurses from the cancer operating center (experimental group) and 32 nurses from the main operating center (control group). The program consisted of four sessions and was delivered to the experimental group for a period of 2weeks. Following the intervention, the effectiveness of the intervention was measured using a self-report questionnaire, focus group interviews, and program evaluation survey. Data were analyzed using chi-square test, t test, Fisher's exact test, and content analysis. Results: Nearly all (96.4%) of the participants were satisfied with the overall content of the teamwork improvement program. Statistically significant differences were found between the experimental and control groups with regard to teamwork knowledge, teamwork attitudes, communication self-efficacy, and teamwork skills and behaviors. Three themes were elicited from the qualitative analysis, including ＂recognizing the importance and content of teamwork,＂ ＂improving teamwork competencies,＂ and ＂contributing to safe surgery.＂ No significant difference in the incidence of surgical nursing errors was identified between the experimental and control groups within a 4-week period. Conclusions/Implications for Practice: The teamwork improvement program developed in this study was demonstrated as effective in improving perioperative nurses' utilization of teamwork competencies in nursing practice and positively changing teamwork. The findings of this study provide evidence that teamwork training increases nurses' teamwork competencies. The clinical application of teamwork tools using competency-based teamwork training may contribute to patient safety and safe nursing practice.

1. Agency for Healthcare Research and Quality. (2017). TeamSTEPPS® Teamwork Attitudes Questionnaire manual. https://www.ahrq.gov/teamstepps/instructor/reference/teamattitudesmanual.html
2. Agency for Healthcare Research and Quality. (2019). TeamSTEPPS 2.0. https://www.ahrq.gov/teamstepps/instructor/index.html
3. Ahn, S. A.,Lee, N.-J.(2016).The effect of operating room nursing and medical staff teamwork and perception of patient safety culture on the performance of surgical patient safety protocol.Journal of Korean Critical Care Nursing,9(1),27-39.
4. Australian Commission on Safety and Quality in Health Care(2005).National patient safety education framework.
5. Baik, D.,Zierler, B.(2019).RN job satisfaction and retention after an interprofessional team intervention.Western Journal of Nursing Research,41(4),615-630.
6. Barton, G.,Bruce, A.,Schreiber, R.(2018).Teaching nurses teamwork: Integrative review of competency-based team training in nursing education.Nurse Education in Practice,32,129-137.
7. Canadian Patient Safety Institute. (2008). The safety competencies. http://www.patientsafetyinstitute.ca/en/toolsResources/safetyCompetencies/Pages/default.aspx
8. Clapper, T. C.,Ng, G. M.(2013).Why your TeamSTEPPS™ program may not be working.Clinical Simulation in Nursing,9(8),e287-e292.
9. Cooke, M.(2016).TeamSTEPPS for health care risk managers: Improving teamwork and communication.Journal of Healthcare Risk Management,36(1),35-45.
10. Cronenwett, L.,Sherwood, G.,Barnsteiner, J.,Disch, J.,Johnson, J.,Mitchell, P.,Sullivan, D. T.,Warren, J.(2007).Quality and safety education for nurses.Nursing Outlook,55(3),122-131.
11. Dahl, A. B.,Abdallah, A. B.,Maniar, H.,Avidan, M. S.,Bollini, M. L.,Patterson, G. A.,Steingerg, A.,Scaggs, K.,Dribin, B. V.,Ridley, C. H.(2017).Building a collaborative culture in cardiothoracic operating rooms: Pre- and postintervention study protocol for evaluation of the implementation of TeamSTEPPS training and the impact on perceived psychological safety.BMJ Open,7(9),Article e017389.
12. Faul, F.,Erdfelder, E.,Buchner, A.,Lang, A. G.(2009).Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses.Behavior Research Methods,41(4),1149-1160.
13. Gaston, T.,Short, N.,Ralyea, C.,Casterline, G.(2016).Promoting patient safety: Results of a TeamSTEPPS® initiative.The Journal of Nursing Administration,46(4),201-207.
14. Henriksen, K.(Ed.),Battles, J. B.(Ed.),Keyes, M. A.(Ed.),Grady, M. L.(Ed.)(2008).Advances in patient safety: New directions and alternative approaches.Agency for Healthcare Research and Quality.
15. Hsieh, H.-F.,Shannon, S. E.(2005).Three approaches to qualitative content analysis.Qualitative Health Research,15(9),1277-1288.
16. Hughes, A. M.,Gregory, M. E.,Joseph, D. L.,Sonesh, S. C.,Marlow, S. L.,Lacerenza, C. N.,Benishek, L. E.,King, H. B.,Salas, E.(2016).Saving lives: A meta-analysis of team training in healthcare.Journal of Applied Psychology,101(9),1266-1304.
17. Hwang, J.-I.(2015).What are hospital nurses’ strengths and weaknesses in patient safety competence? Findings from three Korean hospitals.International Journal for Quality in Health Care,27(3),232-238.
18. Hwang, J.-I.,Ahn, J.(2015).Teamwork and clinical error reporting among nurses in Korean hospitals.Asian Nursing Research,9(1),14-20.
19. Kaiser, J. A.,Westers, J. B.(2018).Nursing teamwork in a health system: A multisite study.Journal of Nursing Management,26(5),555-562.
20. Kalisch, B. J.,Curley, M.,Stefanov, S.(2007).An intervention to enhance nursing staff teamwork and engagement.Journal of Nursing Administration,37(2),77-84.
21. Kalisch, B. J.,Lee, H.,Rochman, M.(2010).Nursing staff teamwork and job satisfaction.Journal of Nursing Management,18(8),938-947.
22. Kalisch, B. J.,Lee, K. H.(2010).The impact of teamwork on missed nursing care.Nursing Outlook,58(5),233-241.
23. Keebler, J. R.,Dietz, A. S.,Lazzara, E. H.,Benishek, L. E.,Almeida, S. A.,Toor, P. A.,King, H. B.,Salas, E.(2014).Validation of a teamwork perceptions measure to increase patient safety.BMJ Quality and Safety,23(9),718-726.
24. Kirkpatrick, D. L.,Kirkpatrick, J. D.(2006).Evaluating training programs.Berrett-Koehler.
25. Lee, N.-J.(2015).Undergraduate nursing students’ perceptions of patient safety competencies.2015 QSEN National Forum Conference,San Diego, CA.:
26. Lee, S.-H.,Khanuja, H. S.,Blanding, R. J.,Sedgwich, J.,Pressimone, K.,Ficke, J. R.,Jones, L. C.(2021).Sustaining teamwork behaviors through reinforcement of TeamSTEPPS principles.Journal of Patient Safety,17(7),e582-e586.
27. National Patient Safety Agency. (2011). ‘How to guide’: Five steps for safe surgery. https://www.patientsafetysolutions.com/docs/January_11_2011_NPSA_UK_How_to_Guide_Five_Steps_to_Safer_Surgery.htm
28. Parker, A. L.,Forsythe, L. L.,Kohlmorgen, I. K.(2019).TeamSTEPPS®: An evidence-based approach to reduce clinical errors threatening safety in outpatient settings: An integrative review.Journal of Healthcare Risk Management,38(4),19-31.
29. Sherwood, G.,Barnsteiner, J.(2017).Quality and safety in nursing: A competency approach to improving outcomes.Wiley-Blackwell.
30. Sonoda, Y.,Onozuka, D.,Hagihara, A.(2018).Factors related to teamwork performance and stress of operating room nurses.Journal of Nursing Management,26(1),66-73.
31. Staines, A.,Lécureux, E.,Rubin, P.,Baralon, C.,Farin, A.(2019).Impact of TeamSTEPPS on patient safety culture in a Swiss maternity ward.International Journal for Quality in Health Care,32,618-624.
32. The Joint Commission. (2016b). Sentinel event data root causes by event type. https://www.jointcommission.org/sentinel_event.aspx
33. The Joint Commission. (2016a). Speak up campaigns. https://www.jointcommission.org/speakup.aspx
34. Thomas, L.,Galla, C.(2013).Building a culture of safety through team training and engagement.BMJ Quality and Safety,22(5),425-434.
35. Tsang, S.,Royse, C. F.,Terkawi, A. S.(2017).Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine.Saudi Journal of Anaesthesia,11(5),80-89.
36. Vertino, K. A.(2014).Evaluation of a TeamSTEPPS© initiative on staff attitudes toward teamwork.The Journal of Nursing Administration,44(2),97-102.
37. World Health Organization(2009).WHO guidelines for safe surgery: Safe surgery saves lives.Author.
38. World Health Organization(2011).Patient safety curriculum guide: Multi-professional edition.Author.