Factors contributing to nursing team work in an
acute care tertiary hospital
By
Polis, Higgs et al. (2017)
Polis, S., M. Higgs, V. Manning, G. Netto and R. Fernandez (2017). "Factors contributing to nursing team
work in an acute care tertiary hospital." Collegian 24(1): 19-25.
Introduction:
Medication error is one of the most common medical errors. Moreover, the medication
error means a disorder in the treatment process, which is followed by a potential or actual
risk of hazard for patient. Nowadays, medication errors have attracted more attention
because of the complications like higher mortality rate and cost of health-care. Studies
show that some factors such as medication miscalculations, lack of knowledge and
proficiency as well as neglecting the hospital's medication protocol due to lack of time,
extreme tiredness, inadequate work experience and inappropriate work environment may
all be related to the medication errors made by the nurses. Some examples of contextual
factors are the lack of competent and skilled staffs, heavy overtime work, long work
days, a crowded ward, necessity of intensive cares, and etc., and some of the knowledgebased causes include, inadequate pharmaceutical knowledge and experience, no
awareness about patients’ and drug mathematical calculations. Since, the medication
errors made by a health-care team including physicians and nurses may affect the
outcome and quality of health-care, in addition to the fact that the nursing personnel are
more involved in medication administration activities than other health-care workers,
identifying the factors contributing to medication errors occurrence from the viewpoint of
nurses will help reduce the medication errors to a minimum and enhance the quality of
nursing services. Effective nursing teamwork is an essential component of quality health
care and patient safety. Understanding which factors foster team work ensures teamwork
qualities are cultivated and sustained. This study aims to investigate which factors are
associated with team work in an Australian acute care tertiary hospital across all inpatient
and outpatient settings. This study used all nurses and midwives rostered to inpatient and
outpatient wards in an acute care 600 bed hospital in Sydney Australia were invited to
participate in a cross sectional survey between September to October 2013. Data were
collected, collated, checked and analysed using Statistical Package for the Social
Sciences (SPSS) Version 21. Factors reporting a significant correlation with where p <
0.05 were analysed in a multiple regression model. Results: A total of 501 surveys were
returned. Nursing teamwork scores ranged between 3.32 and 4.08. Teamwork subscale
Shared Mental Model consistently rated the highest.
Literature Review:
Teamwork is currently a topic of interest in healthcare. There is an expectation that the
various healthcare disciplines will work together to ensure that all patients and families
are receiving optimal care in any health care setting (Estryn-Behar et al., 2007). The
nursing profession tends to focus on teamwork that seeks to ensure safety and satisfaction
for both the patient and staff populations (Nelsey & Brownie, 2012). Teamwork is
thought to benefit members of the patient care team in a number of ways (Rafferty, Ball,
& Aiken, 2001), and effective teamwork has been suggested as a means of overcoming
some of the challenges faced by patient care teams (Nelsey & Brownie, 2012). Effective
teamwork promotes a work environment that has a positive impact on both staff and
patients (Kalisch & Lee, 2009; Rathert & Fleming, 2008).
The nursing profession tends to focus on teamwork that seeks to ensure safety and
satisfaction for both the patient and staff populations (Nelsey & Brownie, 2012). The
current patient population is one that is aging, is more acutely ill, and has higher rates of
chronic illness. This leaves nurses with a heavier workload and less than ideal work
environments (Nelsey & Brownie, 2012), which may impact their participation in
effective teamwork on health care teams. It has been well-documented in the nursing
literature that teamwork is an effective means of improving quality in a workplace, job
satisfaction among health care workers (Kalisch & Begeny, 2005), and quality of patient
care (Miller, et al., 2008; Purdy, Laschinger, Finegan, Kerr, & Olivera, 2010).
Furthermore, patient safety is enhanced by effective nursing teamwork (Kalisch, Weaver,
& Salas, 2009).
Rafferty, Ball, and Aiken (2001) found that teamwork was also associated with greater
staff retention and less job stress and burnout. Thus, teamwork may provide many
benefits to both the staff members working on a patient care unit and the patients under
their care. Teamwork may help with changing individual ideas of patient care from “my”
patient assignment to “our” patient assignment, thus increasing the accountability of the
entire team caring for a particular patient population on a patient care unit. In a
continuously changing work environment, teamwork can be helpful in ensuring that
patient safety is maintained despite ongoing changes in patient condition and workload
(Kalisch & Lee, 2010).
In a continuously changing work environment, teamwork can be helpful in ensuring that
patient safety is maintained despite ongoing changes in patient condition and workload
(Kalisch & Lee, 2010). However, effective teamwork does not necessarily occur amongst
a group of people simply because they are called a “team” or are expected to work
towards a common goal, which is the case of healthcare teams should be safe, quality
patient care (Kalisch, Weaver, & Salas, 2009). Unfortunately, there may be many
situations or circumstances where individuals are working in silos instead of engaging in
effective teamwork (Kalisch & Lee, 2010; Leonard, Graham, & Bonacum, 2004). The
delivery of effective, high quality and safe nursing care has attracted much attention
internationally (Valentine, Nemb hard, & Edmondson, 2011) and more locally in
Australia (O’Connell, Duke, Bennett, Crawford, & Korfiatis, 2006).
Although the various factors influencing team work are well established organisational
structure, individual contribution and team processes play a fundamental role in team
work (Mickan & Rodger, 2000). The benefits of effective teamwork for both patients and
nurses are well documented. For patients team work has been demonstrated to improve
patient safety, reduced errors (Institute of Medicine, 1999; Leonard, Graham, &
Bonacum, 2004; Nadzam, 2009) and reduce mortality (Wheelan, Burchill, & Tilin,
2003). For nurses, teamwork increases job satisfaction, staff retention (Kalisch et al.,
2010; O’Connell et al., 2006) and enables a range of nursing skills and expertise to
effectively and efficiently deliver high quality patient care (O’Connell et al., 2006;
Wheelan et al., 2003). In addition team work provides adequate supervision and/or
mentoring of less experienced nurses (Fairbrother, Jones, & Rivas, 2010; Ferguson &
Cioffi, 2011; Nelsey & Brownie, 2012).
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