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Kritsotakis G, Gkorezis P, Andreadaki E, Theodoropoulou M, Grigoriou G, Alvizou A, Kostagiolas P, Ratsika N. Nursing practice environment and employee silence about patient safety: The mediating role of professional discrimination experienced by nurses. J Adv Nurs 2021; 78:434-445. [PMID: 34337760 DOI: 10.1111/jan.14994] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/18/2021] [Accepted: 07/20/2021] [Indexed: 12/29/2022]
Abstract
AIMS To examine the associations between nurse work environment with nurses' silence about patient safety and the mediating effects of professional discrimination experienced by nurses. DESIGN Multicentre cross-sectional study. METHODS Between January and April 2019, 607 nurses and nursing assistants from seven hospitals in Greece assessed their clinical environment using the 'Practice Environment Scale of the Nursing Work Index Revised-PES-NWIR', and the silence about patient safety. The 'Experiences of Discrimination Index' was adapted to specifically address experienced discrimination based on the nursing profession. The PROCESS macros for SPSS were used to examine the above associations. FINDINGS Better nurse practice environment, with the exception of 'staffing and resource adequacy' dimension, was directly associated with less experienced professional discrimination, and directly and indirectly associated with less silence about patient safety, through the mediating role of professional discrimination experienced by nurses. CONCLUSIONS Silence about patient safety is dependent on the clinical work environment and may be a response of nurses to discrimination in the work context. Both an improvement in the nurse work environment and a decrease in professional discrimination would minimize silence about patient safety. IMPACT On many occasions, nurses are directly or indirectly discouraged from voicing their concerns about patient safety or are ignored when they do, leading to employee silence and decreasing the standard of care (Alingh et al., BMJ Quality & Safety, 2019, 28, 39; Pope, Journal of Change Management, 2019, 19, 45). Nurses' work-related determinants for silence are not clearly understood in the patient safety context. A favourably evaluated nurse practice environment is associated with less experienced professional discrimination and less silence about patient safety. To minimize silence about patient safety, both the nurse work environment and the experienced professional discrimination should be taken into consideration by nurse and healthcare managers.
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Affiliation(s)
- George Kritsotakis
- Department of Bussiness Administration & Tourism, Hellenic Mediterranean University, Crete, Greece.,School of Social Sciences, Hellenic Open University, Patras, Greece
| | - Panagiotis Gkorezis
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Faculty of Economics and Political Sciences, Aristotle University of Thessaloniki, Thesaloniki, Greece
| | - Eirini Andreadaki
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Aghios Nikolaos General Hospital, Crete, Greece
| | | | | | | | - Petros Kostagiolas
- School of Social Sciences, Hellenic Open University, Patras, Greece.,Department of Archives, Library Science and Museology, School of Information Science and Informatics, Ionian University, Kerkyra, Greece
| | - Nikoleta Ratsika
- Department of Social Work, Hellenic Mediterranean University, Crete, Greece
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Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
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Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
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3
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Barton G, Bruce A, Schreiber R. Teaching nurses teamwork: Integrative review of competency-based team training in nursing education. Nurse Educ Pract 2018; 32:129-137. [DOI: 10.1016/j.nepr.2017.11.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/29/2017] [Indexed: 12/29/2022]
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Relationships Among Nurse Manager Leadership Skills, Conflict Management, and Unit Teamwork. J Nurs Adm 2018; 48:383-388. [PMID: 30028814 DOI: 10.1097/nna.0000000000000633] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study is to examine the relationships among staff nurse perceptions of their nurse manager (NM) leadership ability, conflict management, and team backup on medical-surgical units. BACKGROUND Team backup, an important component of teamwork, is crucial to patient safety and outcomes. A threat to successful teamwork is ineffective conflict management. There is scant knowledge, however, about NM conflict management skills and unit teamwork through the concept of team backup. METHODS Secondary analyses were conducted utilizing data previously collected from a sample of 257 staff nurses. A series of multiple regressions, including a mediation model, were estimated to determine relationships among variables. RESULTS Positive relationships were substantiated among the variables of NM leadership ability, conflict management, and team backup. Staff nurse perceptions of NM leadership ability were a significant predictor of conflict management and team backup. CONCLUSION Findings support the importance of the NM demonstrating skilled leadership and the ability to manage conflicts and to develop team backup. This study further highlights the importance of conflict management as a leadership competency.
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Piloting a Multifaceted Interprofessional Education Program to Improve Physical Therapy and Nursing Students' Communication and Teamwork Skills. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2018. [DOI: 10.1097/jat.0000000000000077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tschannen D, Dorn R, Tedesco C. Improving knowledge and behavior of leadership and followership among the interprofessional team. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:182-188. [PMID: 29965798 PMCID: PMC6129167 DOI: 10.5116/ijme.5b30.9a84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine virtual training on Crew Resource Management (CRM) principles of effective leadership and followership on participants' knowledge, applicability, and intended behaviors. METHODS Graduate students (n=41) from four health disciplines participated in the training, which included a self-learning module (e.g., didactic content and video vignettes) and an optional virtual simulation exercise. Knowledge was examined via a 10-item pre/post knowledge test. Applicability of the training and intended behaviors was measured post-training via an 11-item survey. T-test and Analysis of variance were applied to compare knowledge scores, as well as to determine variation in discipline responses. RESULTS Knowledge improved significantly post-training (t(40)=10.47, p<0.001). Pharmacy students scored significantly lower on the post-knowledge test than medicine and nursing students [F(2,36)=5.99, p=0.006]. On average, participants completing the module reported learning new skills and knowledge (M=4.17, SD=0.54) and intended to use skills/knowledge gained from the training in clinical practice (M=4.29, SD=0.56). No differences were noted among responses from the various disciplines. Those completing the simulation exercise (n=10) found value in the experience, again noting strong application to practice (M=4.9, SD=0.32) and intended use in practice (M=4.9, SD=0.32). CONCLUSIONS The CRM training was valuable and applicable to practice. Use of a virtual platform may provide an avenue for minimizing current barriers to successful interprofessional education by allowing participants to connect in various geographical locations. The module is ready for widespread use in health professional education.
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Relationship Between Psychological Safety and Reporting Nonadherence to a Safety Checklist. J Nurs Care Qual 2018; 33:53-60. [PMID: 28505056 DOI: 10.1097/ncq.0000000000000265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient safety checklists are ubiquitous in health care. Nurses bear significant responsibility for ensuring checklist adherence. To report nonadherence to a checklist and stop an unsafe procedure, a workplace climate of psychological safety is needed. Thus, an analysis of organizational data was conducted to examine the relationship between psychological safety and reports of nonadherence to the central line bundle checklist. Results showed varied perceptions of psychological safety but no relationship with nonadherence. Considerations for this finding and assessing psychological safety are provided.
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Schwartz ME, Welsh DE, Paull DE, Knowles RS, DeLeeuw LD, Hemphill RR, Essen KE, Sculli GL. The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facilities. J Healthc Risk Manag 2017; 38:17-37. [PMID: 29120515 DOI: 10.1002/jhrm.21292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Communication failure is a significant source of adverse events in health care and a leading root cause of sentinel events reported to the Joint Commission. The Veterans Health Administration National Center for Patient Safety established Clinical Team Training (CTT) as a comprehensive program to enhance patient safety and to improve communication and teamwork among health care professionals. CTT is based on techniques used in aviation's Crew Resource Management (CRM) training. The aviation industry has reached a significant safety record in large part related to the culture change generated by CRM and sustained by its recurrent implementation. This article focuses on the improvement of communication, teamwork, and patient safety by utilizing a standardized, CRM-based, interprofessional, immersive training in diverse clinical areas. The Teamwork and Safety Climate Questionnaire was used to evaluate safety climate before and after CTT. The scores for all of the 27 questions on the questionnaire showed an increase from baseline to 12 months, and 11 of those increases were statistically significant. A recurrent training is recommended to maintain the positive outcomes. CTT enhances patient safety and reduces risk of patient harm by improving teamwork and facilitating clear, concise, specific and timely communication among health care professionals.
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Affiliation(s)
- Miriam E Schwartz
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI.,Greater Los Angeles Veterans Affairs (VA) Healthcare System, Los Angeles, CA.,David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Deborah E Welsh
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Douglas E Paull
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI.,University of Michigan, Ann Arbor, MI.,Georgetown University School of Medicine, Washington, D.C
| | - Regina S Knowles
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Lori D DeLeeuw
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Robin R Hemphill
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Keith E Essen
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
| | - Gary L Sculli
- Veterans Health Administration National Center for Patient Safety of the United States Department of Veterans Affairs, Ann Arbor, MI
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Tschannen D. Development of a Virtual Crew Resource Management Training Program to Improve Communication. J Contin Educ Nurs 2017; 48:525-532. [PMID: 29083461 DOI: 10.3928/00220124-20171017-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022]
Abstract
Crew Resource Management (CRM), a method focused on the management of human error and risk reduction, has shown promise in reducing communication failure in health care. The purpose of this project was to develop a virtual training program in CRM principles of effective leadership and followership, and evaluate the applicability to nurses working in the hospital setting. The intervention included the development of a virtual CRM training program consisting of a self-learning module and virtual simulation. Beta testing of the module was conducted by six nurses, followed by an evaluation of the training program by nurses (n = 5) in a general medicine department. Nurses reported the overall program to be worthwhile (X̄= 5; SD = 0.5), with great applicability to nursing care (X̄= 4.5, SD = 0.5). Nurses completing the simulation activity reported strong agreement to CRM applicability and training effectiveness. The CRM training module proved to be applicable to nursing care and is ready for widespread use to improve patient care and communication. J Contin Educ Nurs. 2017;48(11):525-532.
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Improving Nursing Communication Skills in an Intensive Care Unit Using Simulation and Nursing Crew Resource Management Strategies: An Implementation Project. J Nurs Care Qual 2017; 32:331-339. [PMID: 27875384 DOI: 10.1097/ncq.0000000000000241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Effective interprofessional communication is critical to patient safety. This pre-/postimplementation project used a multifaceted educational strategy with high-fidelity simulation to introduce evidence-based communication tools, adapted from Nursing Crew Resource Management, to intensive care unit nurses. Results indicated that participants were satisfied with the education, and their perceptions of interprofessional communication and knowledge improved. Teams (n = 16) that used the communication tools during simulation were more likely to identify the problem, initiate key interventions, and have positive outcomes.
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Abstract
Simulation has had a long and varied history in many different fields, including aviation and the military. A look into the past to briefly touch on some of the major historical aspects of simulation in aviation, military, and health care will give readers a broader understanding of simulation's historical roots and the relationship to patient safety. This review may also help predict what the future may hold for simulation in nursing. Health care, like aviation, is driven by safety, more specifically patient safety. As the link between simulation and patient safety becomes increasingly apparent, simulation will be adopted as the education and training method of choice for such critical behaviors as communication and teamwork skills.
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Affiliation(s)
- Michelle Aebersold
- Michelle Aebersold is a Clinical Associate Professor, University of Michigan School of Nursing, 426 North Ingalls, Ann Arbor, MI 48109
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Speaking up behaviours (safety voices) of healthcare workers: A metasynthesis of qualitative research studies. Int J Nurs Stud 2016; 64:42-51. [PMID: 27684321 DOI: 10.1016/j.ijnurstu.2016.09.014] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND A critical characteristic of effective teams in any setting is when each member is willing to speak up to share thoughts and ideas to improve processes. In spite of attempts by healthcare systems to encourage employees to speak up, employee silence remains a common cause of communication breakdowns, contributing to errors and suboptimal care delivery. Nurses in particular have reported low confidence in their communication abilities, and cite the belief that speaking up will not make a difference. OBJECTIVE To develop an understanding of how nurses and other healthcare workers relate to safety voice behaviors and how this might influence clinical practice. DATA SOURCES A search of the PubMed, CINAHL, and Academic Search Premier databases was conducted using keywords employee, nurse, qualitative, speak up, silence, safety, voice, and safety voice identified 372 articles with 11 retained after a review of the abstracts. Studies took place in Australia, Bulgaria, Canada, Hong Kong, East Africa, Ireland, Korea, New Zealand, Sweden, Switzerland, and the United States representing 504 healthcare workers including 354 nurses. METHODS This interpretive meta-synthesis of 11 qualitative articles published from 2005 to 2015 was conducted using a social constructivist approach with thematic analysis. RESULTS The four themes identified are: 1) hierarchies and power dynamics negatively affect safety voice, 2) open communication is unsafe and ineffective, 3) embedded expectations of nurse behavior affect safety voice, and 4) nurse managers have a powerful positive or negative affect on safety voice. CONCLUSIONS Healthcare workers worldwide report multiple social and hierarchy related fears surrounding the utilization of safety voice behaviors. Hesitance to speak up is pervasive among nurses, as is low self-efficacy related to safety voice. The presence of caring leaders, peer support, and an organizational commitment to safe, open cultures, may improve safety voice utilization among nurses and other healthcare workers.
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Targeted communication intervention using nursing crew resource management principles. J Nurs Care Qual 2016; 30:7-11. [PMID: 25279547 DOI: 10.1097/ncq.0000000000000073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Speaking up: factors and issues in nurses advocating for patients when patients are in jeopardy. J Nurs Care Qual 2016; 30:53-62. [PMID: 25084469 DOI: 10.1097/ncq.0000000000000081] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although speaking up to protect patients is a key ethical and moral mandate for nurses, silence still prevails in many situations. On the basis of concepts of safety culture, generational theory, personal cultural literature, advocacy theory, oppressed group theory, and moral distress theory, the author conducted a literature review and offers a new theoretical framework. The proposed theory identifies primary factors of speaking up: generational, personal culture, and organizational.
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Sculli GL, Fore AM, Sine DM, Paull DE, Tschannen D, Aebersold M, Seagull FJ, Bagian JP. Effective followership: A standardized algorithm to resolve clinical conflicts and improve teamwork. J Healthc Risk Manag 2015; 35:21-30. [PMID: 26227290 DOI: 10.1002/jhrm.21174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In healthcare, the sustained presence of hierarchy between team members has been cited as a common contributor to communication breakdowns. Hierarchy serves to accentuate either actual or perceived chains of command, which may result in team members failing to challenge decisions made by leaders, despite concerns about adverse patient outcomes. While other tools suggest improved communication, none focus specifically on communication skills for team followers, nor do they provide techniques to immediately challenge authority and escalate assertiveness at a given moment in real time. This article presents data that show one such strategy, called the Effective Followership Algorithm, offering statistically significant improvements in team communication across the professional continuum from students and residents to experienced clinicians.
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