Due on saturday (8pm Chicago time)

Topic:

Enhancing teamwork across care provider levels:  The manager of a medical-surgical unit has observed and had complaints about, lack of teamwork between the RN’s and the patient care techs (PCT’s).  Your task is to propose a plan to enhance teamwork on the unit

1Ballangrud R, et al. BMJ Open 2020;10:e035432. doi:10.1136/bmjopen-2019-035432

Open access

Longitudinal team training programme
in a Norwegian surgical ward: a
qualitative study of nurses’ and
physicians’ experiences with
teamwork skills

Randi Ballangrud ,1 Karina Aase ,2 Anne Vifladt 1

To cite: Ballangrud R, Aase K,
Vifladt A. Longitudinal team
training programme in a
Norwegian surgical ward: a
qualitative study of nurses’ and
physicians’ experiences with
teamwork skills. BMJ Open
2020;10:e035432. doi:10.1136/
bmjopen-2019-035432

► Prepublication history and
additional material for this
paper are available online. To
view these files, please visit
the journal online (http:// dx. doi.
org/ 10. 1136/ bmjopen- 2019-
035432).

Received 31 October 2019
Revised 27 April 2020
Accepted 18 May 2020

1Department of Health Science
Gjøvik, Norwegian University of
Science and Technology, Gjøvik,
Norway
2Center for Resilience in
Healthcare (SHARE), University
of Stavanger, Stavanger, Norway

Correspondence to
Dr Randi Ballangrud;
randi. ballangrud@ ntnu. no

Original research

© Author(s) (or their
employer(s)) 2020. Re- use
permitted under CC BY- NC. No
commercial re- use. See rights
and permissions. Published by
BMJ.

Strengths and limitations of this study

► In this study, the sample of both nursing staff and
physicians contributes to interprofessional experi-
ences in the implementation of a team training pro-
gramme in a surgical ward.

► The study intervention was based on an evidence-
based team training programme with a standardised
curriculum.

► A longitudinal design enables data collection on
three occasions.

► The sample size was small, leading to a relatively
limited number of participants in the focus group
interviews.

AbStrACt
Objectives Teamwork and interprofessional team training
are fundamental to ensuring the continuity of care and
high- quality outcomes for patients in a complex clinical
environment. Team Strategies and Tools to Enhance
Performance and Patient Safety (TeamSTEPPS) is an
evidence- based team training programme intended to
facilitate healthcare professionals’ teamwork skills. The
aim of this study is to describe healthcare professionals’
experiences with teamwork in a surgical ward before
and during the implementation of a longitudinal
interprofessional team training programme.
Design A qualitative descriptive study based on follow- up
focus group interviews.
Setting A combined gastrointestinal surgery and urology
ward at a hospital division in a Norwegian hospital trust.
Participants A convenience sample of 11 healthcare
professionals divided into three professionally based focus
groups comprising physicians (n=4), registered nurses
(n=4) and certified nursing assistants (n=3).
Interventions The Te

Nursing Inquiry. 2021;00:e12413. wileyonlinelibrary.com/journal/nin  | 1 of 10
https://doi.org/10.1111/nin.12413

© 2021 John Wiley & Sons Ltd

1  |  INTRODUC TION

Global nursing and healthcare workforce shortages, increased de-
mands on healthcare systems and growing healthcare expenditure
have resulted in a focus on the development of strategies to pro-
vide cost- effective health care (All- Party Parliamentary Group on
Global Health (APPG), 2016; National Health and Hospital Reform
Commission (NHHRC), 2009). As part of these strategies, skill mix
and nurse staffing are manipulated to reduce costs and provide qual-
ity care to patients (Aiken et al., 2013; Jacob et al., 2015; NHHRC,
2009). Adding to this, the COVID 19 pandemic has placed further
strain on the healthcare system resulting in the need to build surge
workforce capacity to meet the needs of patients (Al Mutair et al.,
2020; Marshall et al., 2020). Healthcare organisations have been
required to reframe the delivery of patient care examining options
to augment and extend the nursing and healthcare workforce. A

common strategy is a tiered healthcare team approach to patient
care delivery based on the idea of experienced staff supervising
less experienced or lower trained staff members working together
to meet the patients’ needs (Al Mutair et al., 2020; Marshall et al.,
2020). This may occur in situations where tasks traditionally per-
formed by one worker are shifted to another worker (APPG, 2016).

Prior to the pandemic, pressures on healthcare systems interna-
tionally had increased the reliance on the use of unregulated nursing
assistant (NA) roles in the acute hospital setting (Aiken et al., 2016;
Blay & Roche, 2020; Duffield et al., 2014; Kalisch, 2011). To meet
pandemic surge workforce demands, healthcare teams may be addi-
tionally augmented with reassigned or redeployed staff with trans-
ferable skills, healthcare staff re- entering the hospital workforce,
final year students in nursing, medical and allied health courses and
NA roles (Al Mutair et al., 2020). It is imperative when working in
the multi- skilled/ multi- tiered nursing workforce environment that

Received: 8 April 2020  | Revised: 3 March 2021  | Accepted: 12 March 2021
DOI: 10.1111/nin.12413

F E A T U R E A R T I C L E

Transparent teamwork: The practice of supervision and
delegation within the multi- tiered nursing team

Felicity Ann Walker1,2  | Madeleine Ball2,3 | Sonja Cleary2 | Heather Pisani2

1Faculty of Health, Southern Cross
University, Bilinga, QLD, Australia
2School of Health & Biomedical Sciences,
RMIT University, Melbourne, Vic.,
Australia
3School of Health Sciences, University of
Tasmania, Melbourne, Vic., Australia

Correspondence
Felicity Walker, Faculty of Health,
Southern Cross University, Gold Coast
Campus, Southern Cros

J Nurs Manag. 2018;1–8. wileyonlinelibrary.com/journal/jonm  |  1© 2018 John Wiley & Sons Ltd

Accepted: 1 October 2017

DOI: 10.1111/jonm.12582

O R I G I N A L A R T I C L E

Nursing teamwork in a health system: A multisite study

Jennifer A. Kaiser PhD, MSN, RN, CNE, Senior Nurse Researcher1  | Judith B. Westers
MSN, BSN, RN, Director of Pediatric Services2

1Spectrum Health, Grand Rapids, MI, USA
2Helen DeVos Children’s Hospital, Grand
Rapids, MI, USA

Correspondence
Jennifer Kaiser, Spectrum Health, Grand
Rapids, MI, USA.
Email: [email protected]

Funding information
This research did not receive any specific
grant from funding agencies in the public,
commercial, or not- for- profit sectors.

Aim: The aim of this study was to examine how the facets of teamwork exist among
nurse- only teams in acute and continuing care settings.
Background: The health care ‘team’ conventionally describes the interdisciplinary team
in both literature and practice. Nursing- specific teams are rarely considered in the
literature. An examination of this specific professional cohort is important to under-
stand how teamwork exists among those who provide the majority of patient care.
Method: This was a descriptive, comparative, cross- sectional study using the Nursing
Teamwork Survey to measure teamwork of nursing- based teams among 1414 partici-
pants in multiple acute care environments across a large Midwestern health system.
Results: The characteristics of nursing teams were analysed. The results from the sub-
scales within the teamwork model showed that nursing teams had a good understand-
ing of the various roles and responsibilities. However, nurse team members held a
more individualistic rather than collective team- oriented mindset.
Conclusions and Implications for Nursing Management: Increased teamwork has a
positive effect on job satisfaction, staffing efficiencies, retention and care delivery.
Nurse leaders can use the information provided in this study to target the aspects of
highly functioning teams by improving team orientation, trust and backup
behaviours.

K E Y W O R D S

nursing, team, teamwork

1  | AIM

The aim of this study was to examine how the facets of teamwork
exist among nurse- only teams in acute and continuing care settings.
The facets of nursing teams were explored using a similar conceptual
framework to those widely examined in the literature. The principal
objective was to determine how acute care nursing teams align with
the standards of highly effective teams in other professional domains.
Additional questions to be answered included:

(1) What is the average level of nursing teamwork based on the
character

 Improving
Hand-off
Report

Student Names

Team Name and First/Last Names of Participants

Problem 

Report (timing and hand off errors):  The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes.  In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete.  Our task is to propose a change that will address these issues. 

Report (timing and hand off errors:  Unit managers observed that there was miscommunication between staff during shift report.  Often times leaving out important patient information as well as taking a significant amount of time to relay the information. Our goal it to offer a change that will address these issues. 

Now here is our SWOT analysis starting off with Derrick talking about the strengths.

Majka 

“Communication failures compromise patient treatment, care quality, and safety. It also leads to medical errors, the third leading cause of deaths in the United States” (Ghosh, et all., 2015)

“The varying parties and large amount of complex information included in patient handoff reports frequently contribute to informational gaps and omissions in the handoff report that can lead to sentinel events and patient hard” (Staggers & Blaz, 2013)

“Research has identifed handovers as a risky time in the care process, when information may be lost, distorted or misinterpreted (Borowitz et al 2008, Owen et al. 2009, Philibert 2009)

Report (timing and hand off errors):  The unit manager of a medical surgical unit has observed that change of shift report takes greater than 45 minutes.  In addition, staff has complained that their peers do not include vital data (IV sites, dressing sites, DVT prevention measures….) in report leading to errors, leave patients in disarray, and leave tasks incomplete.  Your task is to propose a change that will address these issues. 

Increase of errors during patient hand-off report leading to missed information and incomplete tasks 

Hand-off report time is taking a greater deal of time 

Our task is to implement the use of SBAR as the standard hand-off report between shifts in order to reduce errors and decrease the time spent giving report. 

2

SWOT

Strengths:
Multidepartment focus addressing handoff report problems(Robins et al., 2017)
Solutions shorten time taken in report while increasing quantity of pertinent information. (Stewart & Hand, 2017)
SBAR is supported by the Joint Commision (Stewart & Hand, 2017)
Proven error reduction due to use of SBAR tool. (Stewart & Hand, 2017)
SBAR

Student Name:

EBP Journal Article in APA format:

Walker, F. A., Ball, M., Cleary, S., & Pisani, H. (2021). Transparent teamwork: The practice of supervision and delegation within the multi‐tiered nursing team.
Nursing Inquiry,
28(4), 1-10. https://doi.org.resu.idm.oclc.org/10.1111/nin.12413

Is this an Evidence Based Article? Name of Journal and Year article was written?


Yes/No

Name of Journal:

Nursing Inquiry

Year: 2021

.2 points

State the problem

What was the goal of the project in the article?

Does this project correlate with your problem? State how?

What are you trying to achieve? Does this article support this goal?

Problem:

The problem is how supervision and delegation of a NA position are practiced in a multi-tier nursing team.

Goal:

To promote the development of transparent nursing practices and mutual understanding in the multi-tier nursing team to facilitate effective supervision and delegation based on informed decision-making and a culture of openness and trust.

State how this article correlates with your group problem and goal.

The article correlates with the problem and goal because it discusses how to enhance teamwork across care provider levels. It outlines how transparent nursing practices can lead to effective supervision and delegation, leading to high-quality patient care. The article shows how effective communication between RNs and NAs, can lead to teamwork, which is what our group project is aiming for. Our goal is to propose a plan to enhance teamwork between the RNs and PCTs on a med/surg unit and that correlates with the article.

.2 points

Strengths (Internal)

What’s was good about your article?

Why was this project successful?

Participants: It was successful because it included NA, nurses and nursing leaders who were policymakers, managers, supervisors, and educators whom all supported the study. Participants had to have direct involvement in the development or implementation of the NA model, worked directly with a NA, or worked in the role of a NA and they were to reflect the stakeholder population. The participants were familiar with the organization’s objectives and policies due to 1+ years of employment.

Research Methods: Data was collected through individual interviews, focus groups, and documentary evidence. Interview and focus groups were audio-recorded and transcribed verbatim and for the interviews, participants

Student Name:

EBP Journal Article in APA format:

Kaiser, J. A., & Westers, J. B. (2018). Nursing teamwork in a health system: A multisite study. Journal of Nursing Management, 26(5), 555–562. https://doi.org/10.1111/jonm.12582

Is this an Evidence-Based Article? Name of Journal and Year article was written?


Yes

Name of Journal: Journal of Nursing Management

Year: 2018

.2 points

State the problem

What was the goal of the project in the article?

Does this project correlate with your problem? State how?

What are you trying to achieve? Does this article support this goal?

Problem: A manager of a medical-surgical unit has seen and had a lot of complaints concerning the lack of teamwork between the registered nurses and the patient care techs; hence necessary measures need to be taken in order to promote teamwork in that unit.

Goal: The goal of the project was to investigate the way different features of teamwork exist among nurse-only teams in acute and continuing health care settings.

This article correlates with our group problem, which is the lack of teamwork between registered nurses and the patient care techs since it outlines the key elements required in order to promote effective teamwork in a health care setting. This article provides great insights on how teamwork can be enhanced in healthcare by focusing on the” Salas’ Big Five” model of teamwork. This model is centered on various teamwork behaviors and provides a practical explanation of the dynamics of teamwork. According to the framework, necessary knowledge, skills and attitudes are needed to promote teamwork. Salas holds that highly effective teams must regularly demonstrate certain knowledge, skills and attitudes, which can also help in dealing with the issue in the medical surgical unit. Based on the article, teamwork between the registered nurses and the patient care techs can be enhanced by having a clear and common purpose, compensating for each other and consistently providing feedback to each other. Other ways of promoting teamwork among the two parties include reallocation of functions, valuing team goals rather than individual goals, anticipating one another’s actions and needs and strongly believing in the team’s collective capability to succeed.

.2 points

Strengths (Internal)

What’s was good about your article?

The nursing teamwork survey, which was utilized in m

Student Name:

EBP Journal Article in APA format:

Ballangrud, R., Aase, K., & Vifladt, A. (2020). Longitudinal team training programme in a Norwegian surgical ward: a qualitative study of nurses’ and physicians’ experiences with teamwork skills.
BMJ open,
10(7), e035432.

Is this an Evidence Based Article? Name of Journal and Year article was written?


Yes

Name of Journal: A qualitative study of nurses’ and physicians’ experiences with teamwork skills

Year: 2019

.2 points

State the problem

What was the goal of the project in the article?

Does this project correlate with your problem? State how?

What are you trying to achieve? Does this article support this goal?

Problem: There is uncertainty in determining the impact of teamwork and interprofessional team training in enhancing continuity in provision of high-quality care in a complex medical setting such as surgical procedures and ward.

Goal: The study aims at describing healthcare professionals’ experiences with teamwork during surgical process following an implementation of longitudinal interprofessional team training programmer.

State how this article correlates with your group problem and goal. The article focuses on the impact of teamwork in complex clinical settings or backgrounds. This aligns with the group problem which is enhancing teamwork between the registered nurses and patient care techs. In both cases, there is analysis of teamwork and the impact it has in ensuring there is provision of high-quality care in complex medical units such as surgical units.

.2 points

Strengths (Internal)

What’s was good about your article?

Why was this project successful? The project was very successful in the approach used in collecting data from the participants of the study. There were three distinct stages to the analysis process: planning, execution, and reporting. The first two stages were conducted by RB and AV with help from KA, and the third stage was conducted by all three authors. During the pre-analysis phase, we treated each interview as a discrete unit of analysis and examined information from Time Points Zero, One, and Two independently. Each interview was read by all three authors multiple times to ensure familiarity with the data, and using the objectives and questions, the researchers lear

ENHANCING TEAMWORK

Tiffini Collier

Kal Haile

Omolola Adebisi

j

2

Problem

Report:  Enhancing teamwork across care provider levels: The manager of a medical-surgical unit has observed and had complaints about, lack of teamwork between the RN’s and the patient care techs (PCT’s).  Our task is to propose a plan to enhance teamwork on the unit

ADD A FOOTER

3

Strengths:
The survey developed to assess collaboration in the nursing profession was shown to be reliable, valid, and acceptable in practice. (Kaiser, et al., 2018)
The nurse in charge of the team did an excellent job of coordinating the efforts of the other members, ensuring that everyone did their part and worked together as a unit . (Kaiser, et al., 2018)
Through repeated readings of each interview, all three writers were well acquainted with the data gleaned from the participants’ responses to the goals and questions, which provided rich information about the participants’ experiences with collaboration. (Ballangrud, 2020)
The research found that defined responsibilities, transparency from RNs while delegating and overseeing NAs, and trusting and open communication boosted collaboration.(Walker, 2021)
Weakness
There was no transparency in communication when RNs delegated and supervised. (Walker, 2021
the response rate was below forty per cent, and some of the participants worked in the team for less than six months, making it hard to understand the team’s dynamics fully. (Kaiser, et al., 2018)
Even after recognizing the potential changes after receiving feedback, there was no study conducted to determine the impact of feedback received following the study. (Ballangrud, 2020).
Opportunities
Even after recognizing the potential changes after receiving feedback, there was no study conducted to determine the impact of feedback received following the study.(Ballangrud, 2020)
Results show that the team members felt that they worked well together and always respected and valued one another as team members. (Kaiser, et al., 2018)
The research showed that successful delegation depended on effective communication, teamwork, positive interpersonal relationship, and sharing of knowledge. (Walker, 2021).
Threats
Based on the study, there was no satisfaction and efficacy of the physicians in providing the necessary leadership skills which can help in promoting true teamwork(Kaiser, et al., 2018)
With the narrow scope of study and participants relied on the study, there is higher chances of inappropriate conclusion made from the findings(Ballangrud, 2020).
Research found that some nurses had issues with accountability. The interpretations and how it

10/1/22, 10:21 AM Week 3: Assignment 4 (EBP “PowerPoint Slide 3 – SWOT Analysis”) – NUR4640-03:Leadership & Management in Nursing (2022 Fall Term 1)-15269 – Resurrection University

https://oakpoint.brightspace.com/d2l/lms/dropbox/user/folder_submit_files.d2l?db=42617&grpid=19198&isprv=0&bp=0&ou=18645 1/4

Group EBP Weekly Group Powerpoints
Course: NUR4640-03:Leadership & Management in Nursing (2022 Fall Term 1)-15269

Criteria Exemplary Average Needs Improvement Inadequate Criterion Score

Content

Knowledge / Flow

/ 0.50.5 points

-Follows all

requirements for

the assignment.

-Conveys well-

rounded knowledge

of the topic.

-Well-organized.

-Information flows

in logical and

interesting

sequence.

0 points 0 points

-Follows some

requirements for

the assignment.

-Conveys some

knowledge of the

topic.

-Organization needs

improvement.

-Information does

not flow in logical

and interesting

sequence.

0 points

Does not meet any

of the requirements

10/1/22, 10:21 AM Week 3: Assignment 4 (EBP “PowerPoint Slide 3 – SWOT Analysis”) – NUR4640-03:Leadership & Management in Nursing (2022 Fall Term 1)-15269 – Resurrection University

https://oakpoint.brightspace.com/d2l/lms/dropbox/user/folder_submit_files.d2l?db=42617&grpid=19198&isprv=0&bp=0&ou=18645 2/4

Criteria Exemplary Average Needs Improvement Inadequate Criterion Score

Clarity, Critical

Thinking

/ 0.5

Writing

Composition

(Spelling,

Grammar,

Sentence

Structure)

/ 0.5

0.5 points

– Consistently

analyzes

information, offers

insight, and draws

conclusions.

-Scholarly work.

0 points 0 points 0 points

– Does not

consistently analyze

information, offers

insight, and draws

conclusions.

0.5 points

– Writing, grammar,

spelling, transitions,

readability, and

sentence structure

are error free.

0.3 points

-An occasional error

may occur, but

writing, grammar,

spelling, transitions,

readability, and

sentence structure

are essentially error

free.

0.2 points

-3 to 5 errors in

writing, grammar,

spelling, transitions,

readability, and

sentence structure.

0 points

More than 5 errors

in writing, grammar,

spelling, transitions,

readability, and

sentence structure.

10/1