Train-the-Trainer Intervention to Increase Nursing Teamwork and Decrease Missed Nursing Care in Acute Care Patient Units
ABSTRACT Teamwork is essential for patient safety and results in less missed nursing care.
The aim of this study was to test the impact of a train-the-trainer intervention on the level of satisfaction with nursing teamwork and the amount of missed nursing care.
This study used a quasiexperimental design with repeated measures taken at pretest, posttest, and 2 months after completion of the intervention. The sample for this study was the nursing staff on three medical-surgical units in three separate acute care hospitals (one unit in each hospital). Three nurses from each unit underwent a training program and then taught the skills and knowledge they acquired to the staff members on their units in three-hour-long sessions. The training involved staff role-playing scenarios based on teamwork problems that occur regularly on inpatient units in acute care hospitals followed by debriefing, which focused on teamwork behaviors (e.g., leadership, team orientation, backup, performance monitoring) and missed nursing care. Four measures were used to test the efficacy of this intervention: The Nursing Teamwork Survey, the MISSCARE Survey, and questions about the knowledge of and satisfaction with teamwork. Return rates for the surveys ranged from 73% to 84%. Follow-up tests individually comparing pretest, posttest, and delayed posttest were conducted within the mixed model and used the Bonferroni correction for multiple comparisons.
Teamwork increased (F = 6.91, df = 259.01, p = .001) and missed care decreased (F = 3.59, df = 251.29, p = .03) over time. Nursing staff also reported a higher level of satisfaction with teamwork and an increase of teamwork knowledge after the intervention.
The intervention tested in this study shows promise of being an effective and efficient approach to increase nursing teamwork and decrease missed nursing care.
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ABSTRACT: This study examines what and why nursing care is missed. A sample of 459 nurses in 3 hospitals completed the Missed Nursing Care (MISSCARE) Survey. Assessment was reported to be missed by 44% of respondents while interventions, basic care, and planning were reported to be missed by > 70% of the survey respondents. Reasons for missed care were labor resources (85%), material resources (56%), and communication (38%). A comparison of the hospitals showed consistency across all 3 hospitals. Associate degree nurses reported more missed care than baccalaureate-prepared and diploma-educated nurses. The results of this study lead to the conclusion that a large proportion of all hospitalized patients are being placed in jeopardy because of missed nursing care or errors of omission. Furthermore, changes in Center for Medicare and Medicaid Services (CMS) regulations which will eliminate payment for acute care services when any one of a common set of complications occurs, such as pressure ulcers and patient falls, point to serious cost implications for hospitals.Nursing outlook 01/2009; 57(1):3-9. DOI:10.1016/j.outlook.2008.05.007 · 1.59 Impact Factor
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ABSTRACT: : In a previous study, the nursing staff on 110 patient care units in 10 hospitals participated in a quantitative study of missed nursing care. : The aim of this study was to gain an understanding of the differences in patient care units that had the most missed nursing care with those with the least missed nursing care. : Focus groups were conducted with the registered nurse staff on the 5 units with the most missed nursing care and 5 units with the least missed care. : Ten themes were identified: (a) staffing levels, (b) communication, (c) collective orientation, (d) backup, (e) monitoring, (f) leadership, (g) long tenure, (h) unit size, (i) trust, and (j) accountability. Taken together, the predominant difference found was that units with the least missed care had higher teamwork. : Strategies for developing interventions to decrease missed care and increase teamwork are presented.Health care management review 02/2012; 37(4):320-8. DOI:10.1097/HMR.0b013e318249727e · 1.30 Impact Factor
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ABSTRACT: A series of studies on missed nursing care (i.e., required standard nursing care that is not completed) is summarized. Missed nursing care is substantial and similar levels are found across hospitals. Reasons for missed nursing care are staffing resources, material resources, and communication and these are also similar across hospitals. The higher the staffing levels, the fewer occurrences of missed nursing care. Magnet status and higher levels of teamwork are associated with less missed nursing care, and more missed care leads to a lower level of staff satisfaction. Missed nursing care has been found to be a mediator between staffing levels and patient falls. Patient identified missed nursing care predicts adverse events (i.e., falls, pressure ulcers, new infections etc.).Western Journal of Nursing Research 04/2014; 36(7). DOI:10.1177/0193945914531859 · 1.03 Impact Factor