Teamwork Communication Research Articles

Perceptions of Interdisciplinary Communication Among Correctional Health Care Providers.

Collaborative practice is a health care standard that improves patient outcomes through maximizing the use of resources and mutual work of all health care providers. Since collaborative practice depends on interdisciplinary communication, effective communication training for health care participants is imperative for success. This article presents the results of research that studied perceptions of interdisciplinary communication and collaborative practice among 24 health care personnel in three correctional facilities in Orange County, California. The research explored different approaches in terms of team structure, mutual support, situation monitoring, leadership, and communication practices. The study used questionnaires to examine the perceptions of teamwork and interdisciplinary communication and how they can be impacted by one educational session. The study results are discussed in terms of modern approaches to health care, including evidence-based practice, along with nationwide initiatives for improving the health of inmates with psychiatric issues.

A simulation-based curriculum to introduce key teamwork principles to entering medical students.

BackgroundFailures of teamwork and interpersonal communication have been cited as a major patient safety issue. Although healthcare is increasingly being provided in interdisciplinary teams, medical school curricula have traditionally not explicitly included the specific knowledge, skills, attitudes, and behaviors required to function effectively as part of such teams.MethodsAs part of a new “Foundations” core course for beginning medical students that provided a two-week introduction to the most important themes in modern healthcare, a multidisciplinary team, in collaboration with the Center for Experiential Learning and Assessment, was asked to create an experiential introduction to teamwork and interpersonal communication. We designed and implemented a novel, all-day course to teach second-week medical students basic teamwork and interpersonal principles and skills using immersive simulation methods. Students’ anonymous comprehensive course evaluations were collected at the end of the day. Through four years of iterative refinement based on students’ course evaluations, faculty reflection, and debriefing, the course changed and matured.ResultsFour hundred twenty evaluations were collected. Course evaluations were positive with almost all questions having means and medians greater than 5 out of 7 across all 4 years. Sequential year comparisons were of greatest interest for examining the effects of year-to-year curricular improvements. Differences were not detected among any of the course evaluation questions between 2007 and 2008 except that more students in 2008 felt that the course further developed their “Decision Making Abilities” (OR 1.69, 95% CI 1.07–2.67). With extensive changes to the syllabus and debriefer selection/assignment, concomitant improvements were observed in these aspects between 2008 and 2009 (OR = 2.11, 95% CI: 1.28–3.50). Substantive improvements in specific exercises also yielded significant improvements in the evaluations of those exercises.ConclusionsThis curriculum could be valuable to other medical schools seeking to inculcate teamwork foundations in their medical school’s preclinical curricula. Moreover, this curriculum can be used to facilitate teamwork principles important to inter-disciplinary, as well as uni-disciplinary, collaboration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0808-9) contains supplementary material, which is available to authorized users.

Development of an interprofessional student teaching simulation in team communication skills

Interprofessional education (IPE) has become increasingly the object of focus in undergraduate medical education. Evidence supports the promotion of teamwork and effective communication to improve patient safety and outcomes. Educators are challenged to find meaningful ways to teach these skills to students and there are several barriers that must be addressed to meet this challenge. Educators must work outside of well-established silos within the medical education community to bring learners from various disciplines together. In addition, they must create curriculum that engages all participants and is relevant to the modern learner. Simulation creates a safe, low stress environment in which participants may practice communication and teamwork without risk to themselves or, more importantly, patients. By practicing a high stress, high stakes scenario in the low risk environment of the simulator, learners from various disciplines are able practice these skills in a meaningful way. Cardiac arrest is an example of a common, high impact occurrence that is particularly amenable to interprofessional team based simulation training exercises. We describe the development of an interprofessional student course teaching communication and teamwork culminating in a team run cardiac arrest simulation exercise. This course was designed to use a blended learning model utilizing both pre-course online materials available to participants, a team training exercise utilizing high-fidelity simulation and team debrief with formative assessment. This blended model addressed the challenge of coordinating multiple learners from multiple colleges and schedules.

Development of a self-assessment teamwork tool for use by medical and nursing students.

BackgroundTeamwork training is an essential component of health professional student education. A valid and reliable teamwork self-assessment tool could assist students to identify desirable teamwork behaviours with the potential to promote learning about effective teamwork. The aim of this study was to develop and evaluate a self-assessment teamwork tool for health professional students for use in the context of emergency response to a mass casualty.MethodsThe authors modified a previously published teamwork instrument designed for experienced critical care teams for use with medical and nursing students involved in mass casualty simulations. The 17-item questionnaire was administered to students immediately following the simulations. These scores were used to explore the psychometric properties of the tool, using Exploratory and Confirmatory Factor Analysis.Results202 (128 medical and 74 nursing) students completed the self-assessment teamwork tool for students. Exploratory factor analysis revealed 2 factors (5 items - Teamwork coordination and communication; 4 items - Information sharing and support) and these were justified with confirmatory factor analysis. Internal consistency was 0.823 for Teamwork coordination and communication, and 0.812 for Information sharing and support.ConclusionsThese data provide evidence to support the validity and reliability of the self-assessment teamwork tool for students This self-assessment tool could be of value to health professional students following team training activities to help them identify the attributes of effective teamwork.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0743-9) contains supplementary material, which is available to authorized users.

Preliminary Study on Teamwork Communications in the Healthcare Sector: A Perspective of Electronic Clinical Pathways

Background/Objectives: This paper aims to examine the current situation of teamwork communications in Jordan, verify the existing problems, and to provide the electronic Clinical Pathways as a solution. Methods/Statistical Analysis: A mixed method approach was adopted to verify if any functions of electronic Clinical Pathways were implemented. At first, the ten physicians were interviewed to check if there is any computerized system to support teamwork communications. Secondly, a survey was conducted across physicians and nurses. Finally, the functions of electronic Clinical Pathways were examined by applying Multivariate method (SPSS v. 19). Findings: It was found that both the functions of Clinical Pathways and a support system for teamwork communications were not at all implemented. In other words, the element of teamwork communications is entirely missing in the recent Health Information Systems (HISs). Electronic Clinical Pathways is chosen as the communication tool due to its inherent ability to improve healthcare quality and concurrently reduces the cost of implementation.

Situation Analysis for Clinical Pathways and Teamwork Communication in Healthcare

Background/Objectives: The aim of this paper is to investigate the studies on Clinical Pathways from multidisciplinary domains to realize the situation of Clinical Pathways. Also to predict which discipline should be focused in future research. Methods/Statistical Analysis: Content analyses were used to analyze and classified the studies based on its discipline, by using Google Scholar search engine. The strategy used in this study was based on the content methodology. Findings: studies come from four disciplines which are medicine, computer science, management and Information system. Medicine domain composed 79% of all studies, and others composed 21%. The timeline of this study is limited to four years, while future research in study Clinical Pathways from different perspectives. These finding are open new researches for informatics people to study Clinical pathways from many perspectives. This is the first study on Clinical Pathways from this perspective.

Charting a Key Competency Domain: Understanding Resident Physician Interprofessional Collaboration (IPC) Skills.

Interprofessional collaboration (IPC) is essential for quality care. Understanding residents' level of competence is a critical first step to designing targeted curricula and workplace learning activities. In this needs assessment, we measured residents' IPC competence using specifically designed Objective Structured Clinical Exam (OSCE) cases and surveyed residents regarding training needs. We developed three cases to capture IPC competence in the context of physician-nurse collaboration. A trained actor played the role of the nurse (Standardized Nurse - SN). The Interprofessional Education Collaborative (IPEC) framework was used to create a ten-item behaviorally anchored IPC performance checklist (scored on a three-point scale: done, partially done, well done) measuring four generic domains: values/ethics; roles/responsibilities; interprofessional communication; and teamwork. Specific skills required for each scenario were also assessed, including teamwork communication (SBAR and CUS) and patient-care-focused tasks. In addition to evaluating IPC skills, the SN assessed communication, history-taking and physical exam skills. IPC scores were computed as percent of items rated well done in each domain (Cronbach's alpha > 0.77). Analyses include item frequencies, comparison of mean domain scores, correlation between IPC and other skills, and content analysis of SN comments and resident training needs. One hundred and seventy-eight residents (of 199 total) completed an IPC case and results are reported for the 162 who participated in our medical education research registry. IPC domain scores were: Roles/responsibilities mean = 37% well done (SD 37%); Values/ethics mean = 49% (SD 40%); Interprofessional communication mean = 27% (SD 36%); Teamwork mean = 47% (SD 29%). IPC was not significantly correlated with other core clinical skills. SNs' comments focused on respect and IPC as a distinct skill set. Residents described needs for greater clarification of roles and more workplace-based opportunities structured to support interprofessional education/learning. The IPC cases and competence checklist are a practical method for conducting needs assessments and evaluating IPC training/curriculum that provides rich and actionable data at both the individual and program levels.

Making an "Attitude Adjustment": Using a Simulation-Enhanced Interprofessional Education Strategy to Improve Attitudes Toward Teamwork and Communication.

Health care providers must effectively function in highly skilled teams in a collaborative manner, but there are few interprofessional training strategies in place. Interprofessional education (IPE) using simulation technology has gained popularity to address this need because of its inherent ability to impact learners' cognitive frames and promote peer-to-peer dialog. Provider attitudes toward teamwork have been directly linked to the quality of patient care. Investigators implemented a simulation-enhanced IPE intervention to improve staff attitudes toward teamwork and interprofessional communication in the emergency department setting. The 3-hour course consisted of a didactic session highlighting teamwork and communication strategies, 2 simulation scenarios on septic shock and cardiac arrest, and structured debriefing directed at impacting participant attitudes to teamwork and communication. This was a survey-based observational study. We used the TeamSTEPPS Teamwork Attitudes Questionnaire immediately before and after the session as a measurement of attitude change as well as the Hospital Survey on Patient Safety Culture before the session and 1 year after the intervention for program impact at the behavior level. Seventy-two emergency department nurses and resident physicians participated in the course from July to September 2012. Of the 5 constructs in TeamSTEPPS Teamwork Attitudes Questionnaire, 4 had a significant improvement in scores-6.4%, 2.8%, 4.0%, and 4.0% for team structure, leadership, situation monitoring, and mutual support, respectively (P < 0.0001, P = 0.029, P = 0.014, and P = 0.003, respectively). For Hospital Survey on Patient Safety Culture, 3 of 6 composites directly related to teamwork and communication showed a significant improvement-20.6%, 20.5%, and 23.9%, for frequency of event reporting, teamwork within hospital units, and hospital handoffs and transitions, respectively (P = 0.028, P = 0.035, and P = 0.024, respectively). A simulation-enhanced IPE curriculum was successful in improving participant attitudes toward teamwork and components of patient safety culture related to teamwork and communication.

Comunicação e cultura de segurança do paciente no ambiente hospitalar: visão da equipe multiprofissional

Objetivo: analisar a cultura de segurança do paciente em relação à comunicação na visão da equipe multiprofissional hospitalar. Método: pesquisa transversal, descritiva, quantitativa. Participaram 71 profissionais de múltiplas funções/formações de um hospital de ensino público do Paraná que responderam ao questionário “Hospital Survey on Patient Safety Culture”. Fez-se análise estatística descritiva sobre os itens de avaliação das dimensões que melhor retratam cultura de segurança do paciente em relação à comunicação. Resultados: houve boa percepção em relação ao trabalho em equipe e comunicação interna na unidade de trabalho, contudo, com maior expressividade, apontou-se cultura de segurança desfavorável em relação às comunicações e atividades com equipes externas ao setor de trabalho, bem como deficiências na passagem de plantão. Conclusões: há necessidade de incremento na comunicação entre unidades distintas na organização hospitalar, além de medidas que confluam melhorias na passagem de plantão dos setores.

Using Medical Students to Create and Sustain Healthy Work Environments for Professional Advancement in Health Care Systems in Abia State, Nigeria

Introduction : The need for medical students to cordially interact with health care professionals and patients especially those living positively with HIV and AIDS should not be underestimated. Interprofessional education prepares medical students on clinical posting for quality health care services to patients including HIV positive persons who are likely to be discriminated against. Therefore, creating healthy work environments is imperative to ensure patient safety, and enhance staff relationships. Materials and Method : Two days pre-clinical seminar which centered on professionalism, teamwork, interpersonal relationships, and effective communication to guarantee healthy work environments for patients was carried out to prepare 107 medical students for a twelve weeks clinical posting. At the end of the posting, two days post-clinical seminar to harness students’ experiences, views and performances during the clinical posting was conducted. After the seminar, teachers’ observations, remarks as well as students’ experiences, views and performances were grouped together and analyzed qualitatively and quantitatively. Results : A good number of the students 75(70.1%) established good interpersonal relationships with the patients while 63(58.9%) of students had effective interprofessional interaction with other health workers. Also 81(75.7%) of the students indicated that they had good interprofessional interaction with fellow students. Study recorded better health services to clients as evidenced by increase in shared case managements among the students. Students were able to identify pressing challenges in work environments and collaborated with colleagues to find solutions to the challenges. Conclusions : Interprofessional learning can increase students’ understanding of professionalism, teamwork and encourage friendlier environments that will guarantee better health care services to patients.

Transfer of learning: Radiographers' perceptions of simulation-based educational intervention

AimThe aims of this qualitative descriptive study were to 1) explore and define radiographers' competence in intravenous pharmacotherapy before and after a simulation-based education, 2) examine radiographer's perceptions of transfer of learning into clinical practice. MethodSixteen diagnostic radiographers in one hospitals' Clinical Radiology Unit were individually interviewed before a multidisciplinary simulation-based pharmacotherapy education intervention in 2012 and fourteen were re-interviewed after the intervention 6–7 months later. Data were analyzed using qualitative content analysis. ResultsBefore education the participants reported uncertain competence in pain management during imaging procedures and acute situations. These weak competence areas identified were strengthened and self-confidence grew. The intervention improved the domains of pharmacotherapy-related patient safety; teamwork development and communication skills. In addition, the radiographers indicated that the iv. pharmacotherapy knowledge from simulation learning was transferred to routine work. ConclusionThe results of this study suggest simulation-based education is suitable for radiographers' pharmacotherapy learning. Adequate pain measurement and management are essential during invasive procedures and these skills can be realistically learned in simulations and transferred to clinical practice.

Developing an aquaponics system to learn sustainability and social compromise skills

The goal of this project, one of the proposals of the EPS@ISEP Spring 2014, was to develop an Aquaponics System. Over recent years Aquaponics systems have received increased attention since they contribute to reduce the strain on resources within 1st and 3rd world countries. Aquaponics is the combination of Hydroponics and Aquaculture and mimics a natural environment in order to successfully apply and enhance the understanding of natural cycles within an indoor process. Using this knowledge of natural cycles, it was possible to create a system with capabilities similar to that of a natural environment with the support of electronics, enhancing the overall efficiency of the system. The multinational team involved in the development of this system was composed of five students from five countries and fields of study. This paper describes their solution, involving the overall design, the technology involved and the benefits it can bring to the current market. The team was able to design and render the Computer Aided Design (CAD) drawings of the prototype, assemble all components, successfully test the electronics and comply with the budget. Furthermore, the designed solution was supported by a product sustainability study and included a specific marketing plan. Last but not least, the students involved in this project obtained new multidisciplinary knowledge and improved their sustainable development, social compromise, team work and cross-cultural communication skills

Percepção dos profissionais sobre a estratégia saúde da família em um município do interior do Ceará

Objective: To assess the profissional’s perception of the Family Health Strategy in an inland city of the state of Ceara. Methods: Descriptive study of qualitative approach, conducted from February to April 2015 with health professionals from seven Primary Health Units of Limoeiro do Norte, Ceara and a municipal primary care coordinator. The interviews were recorded in a private place on a previously scheduled date. The information was analyzed through content analysis. The following categories were identified: “Implementation of the Strategy”; “Characterization of the actions of the Strategy”; “Perception of the Strategy by the actors”; and “Difficulties encountered in the Strategy implementation”. The research was approved by the Research Ethics Committee of the University for International Integration of the Afro-Brazilian Lusophony (UNILAB), according to Resolution 466/12. Results: The coordinator had not a clear knowledge of the Strategy implementation process in the city. He highlighted the necessary trusting relationship between professionals and the population for the team to be well accepted in the community, and the importance of a stream of attention in the public health service. Professionals reported satisfaction with the teamwork and good communication between the team members, and they believe they have the necessary training to work in primary care. Additionally, they highlighted the population’s recognition of the work performed, but complained about the lack of support from the municipal management on the provision of inputs for the activities. Conclusion: The participants believe in the importance of teamwork to minimize the Strategy problems, but presented themselves discouraged with the current health situation of the municipality.

Assessment proposal of teaching and learning strategies in software process improvement

Teaching and learning environments of software process improvement are incorporating new strategies for helping to decrease current weaknesses related to basic-sciences formation, motivation, and communication. One of such strategies includes the usage of gamification principles for achieving student competencies related to teamwork, problem solving, leadership, and effective communication. For assessing the teaching and learning strategies, it is required to consider the following features: i) the student competencies; ii) the didactic proposals and techniques; and, iii) the satisfaction level of the students, regarding the teaching strategy. In this paper, an assessment proposal of teaching and learning strategies in software process improvement is presented, with a preliminary validation method based on gamification principles. Finally, a case study for validating a didactic proposal is presented as a pilot of the assessment proposal.

The impact of cultural differences on technology transfer

Purpose – The purpose of this paper is to quantitatively evaluate which of the elements of five management practice constructs – management commitment, quality practice, team-based work, training, and sharing and understanding – can significantly lessen the adverse impact of cultural differences on efficient technology transfer. Design/methodology/approach – Exploratory factor analysis, confirmatory factor analysis, and structural equation modeling multigroup analysis are used to analyze structured survey data from 223 Japanese manufacturing subsidiaries in Vietnam. Findings – The following are the primary factors that moderate the adverse impact of cultural difference on efficient technology transfer: employees’ understanding of quality; top managements’ communication of clear goals and procedures for technology transfer; the nature of the collaborative teamwork and frequent communication about technical issues among Japanese experts and Vietnamese staff; sending of key Vietnamese technical staff to Japan for technological seminars and on-the-job training while providing them with the appropriate materials and guidelines. Practical implications – Although cultural diversity’s impact on technology transfer may never be problem-free, Japanese and Vietnamese managers should be aware of the effects of differing cultural values and use the appropriate interfaces to minimize cultural problems, maintain a cooperative environment, and transform cultural values into business value. Originality/value – Cross-cultural technology transfer research, from the knowledge-based perspective, has produced interesting findings but has not yet identified which managerial elements effectively reduce the adverse impact of cultural difference on efficient technology transfer. This study addresses that shortcoming through the organizational learning perspective.

Physical Therapists, Telephone Coaches, and Patients With Knee Osteoarthritis: Qualitative Study About Working Together to Promote Exercise Adherence.

Integrated models of care are recommended for people with knee osteoarthritis (OA). Exercise is integral to management, yet exercise adherence is problematic. Telephone-based health coaching is an attractive adjunct to physical therapist-prescribed exercise that may improve adherence. Little is known about the perceptions and interpretations of physical therapists, telephone coaches, and patients engaged in this model of care. The purpose of this study was to explore how stakeholders (physical therapists, telephone coaches, and patients) experienced, and made sense of, being involved in an integrated program of physical therapist-supervised exercise and telephone coaching for people with knee OA. A cross-sectional qualitative design drawing from symbolic interactionism was used. Semistructured interviews with 10 physical therapists, 4 telephone coaches, and 6 patients with painful knee OA. Interviews were audiorecorded, transcribed, and analyzed using thematic analysis informed by grounded theory. Four themes emerged: (1) genuine interest and collaboration, (2) information and accountability, (3) program structure, and (4) roles and communication in teamwork. Patients reported they appreciated personalized, genuine interest from therapists and coaches and were aware of their complementary roles. A collaborative approach, with defined roles and communication strategies, was identified as important for effectiveness. All participants highlighted the importance of sharing information, monitoring, and being accountable to others. Coaches found the lack of face-to-face contact with patients hampered relationship building. Therapists and coaches referred to the importance of teamwork in delivering the intervention. The small number of physical therapists and telephone coaches who delivered the intervention may have been biased toward favorable experiences with the intervention and may not be representative of their respective professions. Integrated physical therapy and telephone coaching was perceived as beneficial by most stakeholders. Programs should be structured but have some flexibility to give therapists and coaches some freedom to adjust treatment to individual patient needs as required. Opportunities for visual communication between telephone coaches and patients could facilitate relationship building.

Formalization and Verification of Group Behavior Interactions

Group behavior interactions, such as multirobot teamwork and group communications in social networks, are widely seen in both natural, social, and artificial behavior-related applications. Behavior interactions in a group are often associated with varying coupling relationships, for instance, conjunction or disjunction. Such coupling relationships challenge existing behavior representation methods, because they involve multiple behaviors from different actors, constraints on the interactions, and behavior evolution. In addition, the quality of behavior interactions are not checked through verification techniques. In this paper, we propose an ontology-based behavior modeling and checking system (OntoB for short) to explicitly represent and verify complex behavior relationships, aggregations, and constraints. The OntoB system provides both a visual behavior model and an abstract behavior tuple to capture behavioral elements, as well as building blocks. It formalizes various intra-coupled interactions (behaviors conducted by the same actor) via transition systems (TSs), and inter-coupled behavior aggregations (behaviors conducted by different actors) from temporal, inferential, and party-based perspectives. OntoB converts a behavior-oriented application into a TS and temporal logic formulas for further verification and refinement. We demonstrate and evaluate the effectiveness of the OntoB in modeling multirobot behaviors and their interactions in the Robocup soccer competition game. We show, that the OntoB system can effectively model complex behavior interactions, verify and refine the modeling of complex group behavior interactions in a sound manner.

Students’ reflections on first-year interprofessional teamwork: Phenomenographic evaluation of function and success

Background : While early interprofessional teamwork is of uncertain benefit to patients, it has value for changing attitudes towards interprofessionalism and for developing skills and traits relevant for healthcare students. Exploring and evaluating changes in these skills and attitudes is under-researched, especially in early healthcare education. Reflective assessment, while frequently used to gauge clinical students’ professional skills and attitudes, is hampered by issues related to authenticity and reliability. A potentially more productive use of reflection is for developing skills and attitudes such as self-awareness, communication and respect in early interprofessional teamwork. The aim of the study was to collect and analyse first-year non-clinical students’ reflections in which they specifically evaluated their own and their team’s success and collaboration on an interprofessional teamwork project. Methods : Phenomenographic analysis of summative participant reflections was conducted to demonstrate variations in factors and elements that influenced interprofessional teamwork function and success. Findings: Four factors were perceived to influence team function: individual characteristics, team dynamics, team structure and external factors. From participant responses, four critical elements of successful teamwork emerged: time management, communication, cooperation and leadership. The phenomenographic outcome space shows how variations in the presence of and relationships between these elements produced differences in team function and success. Variation in individual self- awareness and reflective capacity was also identified. Conclusions: This study identified factors and elements that students believe affect collaboration, and how these influence team success. The findings confirm the value of formal reflection in helping students to develop self-awareness in teamwork settings.

Qualitative Assessment of the Learning Outcomes of an International Service Learning Project in Civil Engineering

A qualitative study was performed to determine the learning outcomes of an international service learning project in civil engineering. The university program involves the student-led design and construction of suspended pedestrian bridges in rural Bolivia. Five students traveled to Bolivia for a period of four weeks to oversee the construction of a bridge. The students were asked to keep reflective journals that were guided by a series of writing prompts. We analyzed the qualitative data within a phenomenological framework, which allowed common themes to be identified from the data. The measured learning outcomes include technical competency, adaptability, creativity, global competency, cross-cultural communication skills, and teamwork and interpersonal communication skills. The data are examined in relation to relevant literature and supporting quotes from the students’ journals are provided. Our findings support the ideas that international service learning experiences in engineering strengthen global competency and communication, improve mastery of technical skills, and instill an understanding of the social context of engineering work. Additionally, complications that arose in the field taught the students adaptability, which is defined here as the ability to modify an engineering design to meet the constraints imposed in the field. As a result of our analysis, we propose reflection questions that allow the assessment of technical and non-technical learning outcomes.

Interprofessional simulation-based education enhances student knowledge of health professional roles and care of patients with tracheostomies and Passy-Muir® Valves

An interprofessional simulation-based education activity involving speech language pathology, cardiorespiratory care, and nursing students was integrated into existing curriculum by an interprofessional faculty team. Students were presented with a realistic acute care environment containing a high-fidelity simulator as the patient and standardized patient as the family member. Small groups comprised of students from each discipline (nursing n = 60, speech language pathologists n = 17, respiratory therapists n = 24) worked together in an interactive simulation scenario that included evaluation of patient, tracheostomy care, and speaking valve placement, with an emphasis on interprofessional teamwork and patient communication. Based upon pretest/posttest results, including an attitudinal survey, enhanced knowledge and teamwork associated with health professional roles and responsibilities and the care of tracheostomy patients with speaking valves was found.