Teamwork Intervention Research Articles

Optimizing Teamwork in the Operating Room: A Scoping Review of Actionable Teamwork Strategies.

Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying behaviour is fundamental to closing evidence-practice gaps in healthcare. Current teamwork interventions, however, have yet to be synthesized in this way. This scoping review aimed to identify actionable strategies for use during surgery by mapping the existing literature according to the Action, Actor, Context, Target, Time (AACTT) framework. The databases MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL),Education Resources Information Center (ERIC), Cochrane, Scopus, and PsycINFO were searched from inception to April 5, 2022. Screening and data extraction were conducted in duplicate by pairs of independent reviewers. The search identified 9,289 references after the removal of duplicates. Across 249 studies deemed eligible for inclusion, eight types of teamwork interventions could be mapped according to the AACTT framework: bundle/checklists, protocols, audit and feedback, clinical practice guidelines, environmental change, cognitive aid, education, and other), yet many were ambiguous regardingthe actors and actions involved. The 101 included protocol interventions appeared to be among the most actionable for the OR based on the clear specification of ACCTT elements, and their effectiveness should be evaluated and compared in future work.

Patient Satisfaction With Public Pharmacy Services: Structural and Policy Implications From Greece.

Objectives This study aimed at investigating patient satisfaction with services offered by a certain type of public pharmacies in Greece (National Organisation for Healthcare Provision (EOPYY) pharmacies), tasked with dispensing mostly high-cost drugs, in an effort to highlight the aspects to be optimized. Methods The Patient Satisfaction with Pharmacist Services Questionnaire 2.0 (PSPSQ 2.0) questionnaire was the main instrument of our research. We received 201 full responses from patients themselves and patients' companions who had visited EOPYY pharmacies in Athens, the capital city of Greece, from October 2022 to January 2023. Results Patients seem satisfied with public pharmacies in general. In fact, the professionalism of the pharmacists, the respect that patients have received from them, and the information and explanations that were given by pharmacists, received a very high score. On the other hand, the parameters referred to the information that patients received from pharmacists for the overall improvement of their health had the lowest score, revealing an apparent lag in the field of medicinal advice. Conclusion Without any doubt, patients expect their pharmacists to be more guiding and to better communicate this role. This requires more time to be spent with patients, focused training, teamwork, layout, and other organizational interventions.

Understanding and resolving conflict to create cultures of well-being in diverse teams

The 2022 American Hospital Association (AHA) Study, published by the Task Force on Workforce, reported that 75–93 per cent of healthcare workers reported stress, anxiety, frustration, exhaustion and burnout.1 The AHA Task Force recommendations included an immediate focus on creating a culture of well-being and an ongoing focus on leadership development. Team well-being is a broadly defined term related to team happiness and success. Various teamwork and leadership interventions are used to achieve team well-being, and this has been a high priority for organisations in the last few years as the COVID-19 pandemic resulted in massive rates of burnout and exodus from healthcare. We specifically focus here on diverse teams and the effect of negative conflict resolution on team well-being, specifically through its damaging effect on the formation of a culture of safety and belonging. Belonging and safety are created through subtle cues and messages as well as through the outcomes of threshold moments, such as a conflict. Belonging is particularly important for diverse teams because it is not automatically assumed by team members in the way that homogeneous teams do more easily. Studies have shown that diverse teams are more prone to conflict and that the process of conflict resolution can lead to either an increase in team belonging and connection (and well-being) or further distancing, which is then linked to burnout, disengagement and exodus from the workplace. Therefore, how conflict is managed in diverse teams is of crucial importance for team leaders in order to achieve team belonging and well-being.

Team experiences of the root cause analysis process after a sentinel event: a qualitative case study

BackgroundRoot cause analysis (RCA) is a systematic approach, typically involving several stages, used in healthcare to identify the underlying causes of a medical error or sentinel event. This study focuses on how members of a Norwegian RCA team experience aspects of an RCA process and whether it complies with the Norwegian RCA method.MethodBased on a sentinel event in which a child died unexpectedly during childbirth in a Norwegian hospital in 2021, the following research questions are addressed: 1. What was the RCA team’s experience of the RCA process? 2. Was there compliance with the Norwegian RCA method in this case? A case study was chosen out of the desire to understand complex social phenomena and to allow in-depth focus on a case.ResultsThe result covered three main themes. The first theme related to the hospital’s management system and aspects of the case that made it challenging to follow all recommendations in the Norwegian RCA guidelines. The second theme encompassed external and internal assessment. The RCA team was composed of members with methodological and medical expertise. However, the police’s involvement in the case made it complex for the team to carry out the process. The third and final theme covered intrapersonal challenges RCA team members faced. Team members experienced various challenges during the RCA process, including being neutral, dealing with role-related challenges, grappling with ambivalence, and managing the additional time burden and resource constraints. As anticipated in the RCA guidelines, the team’s ability to remain neutral was tested.ConclusionThe findings of this study can help stakeholders better comprehend how an inter-professional RCA teamwork intervention can affect a healthcare organization and enhance the teamwork experience of healthcare staff while facilitating improvements in work processes and patient safety. Additionally, these results can guide stakeholders in creating, executing, utilizing, and educating others about RCA processes.

Issue Information

Journal of Clinical PsychologyVolume 79, Issue 6 p. 1511-1514 ISSUE INFORMATIONFree Access Issue Information First published: 09 May 2023 https://doi.org/10.1002/jclp.23384AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume79, Issue6Case Management for Complex Clinical Situations in Mental Health: Teamwork Interventions that MatterJune 2023Pages 1511-1514 RelatedInformation

Analyzing interprofessional teamwork in the operating room: An exploratory observational study using conventional and alternative approaches

ABSTRACT Intraoperative teamwork is vital for patient safety. Conventional tools for studying intraoperative teamwork typically rely on behaviorally anchored rating scales applied at the individual or team level, while others capture narrative information across several units of analysis. This prospective observational study characterizes teamwork using two conventional tools (Operating Theatre Team Non-Technical Skills Assessment Tool [NOTECHS]; Team Emergency Assessment Measure [TEAM]), and one alternative approach (modified-Systems Engineering Initiative for Patient Safety [SEIPS] model). We aimed to explore the advantages and disadvantages of each for providing feedback to improve teamwork practice. Fifty consecutive surgical cases at a Canadian academic hospital were recorded with the OR Black Box®, analyzed by trained raters, and summarized descriptively. Teamwork performance was consistently high within and across cases rated with NOTECHS and TEAMS. For cases analyzed with the modified-SEIPS tool, both optimal and suboptimal teamwork behaviors were identified, and team resilience was frequently observed. NOTECHS and TEAM provided summative assessments and overall pattern descriptions, while SEIPS facilitated a deeper understanding of teamwork processes. As healthcare organizations continue to prioritize teamwork improvement, SEIPS may provide valuable insights regarding teamwork behavior and the broader context influencing performance. This may ultimately enhance the development and effectiveness of multi-level teamwork interventions.

Interventions to improve teamwork and wellbeing in primary care settings: a mixed method review

Abstract Background General practices are experiencing increasing pressures due to rising demand, declining staff numbers, and knock-on impacts on patient care. The COVID-19 pandemic has added further challenges and reinforced the importance of teamwork and organisational settings. We undertook a mixed-method systematic review to explore which interventions can improve teamwork within primary care and improve inter-sector partnerships with other health and social care services. Methods Five major bibliographic databases were systematically searched for relevant studies from inception to February 2022. We included controlled intervention study designs and linked qualitative studies. For amenable data, meta-analysis is being undertaken using random effects models taking into account the between study heterogeneity (quantified using the I2 statistic) and potential publication bias (funnel plots and Egger's test). The qualitative studies are analysed using thematic analyses. Results The original search yield of 3012 studies, of which 14 studies with 1,534 participants were include in our analyses. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements in the quality of teamwork in primary care. Meta-analysis and narrative synthesis is undertaken to examine the impact of the teamwork interventions on staff outcomes (team attitudes, knowledge, and functioning; wellbeing), and patient outcomes (e.g. quality of patient care, patient satisfaction/experience). Conclusions The findings provide information of immediate importance for the mental health and wellbeing and teamwork support of professionals entering primary care and for the organisation of primary care services.

Human judgement forecasting tournaments: A feasibility study based on the COVID-19 pandemic with public health practitioners in England

ObjectivesTo explore the viability of running human judgement forecasting tournaments with public health practitioners, and to gather initial data on forecasting accuracy and participant perceptions of forecasting. Study designQuality improvement study comprising two COVID-19 forecasting tournaments using Brier Skill Score scoring and a follow-up participant questionnaire. MethodsOver two forecasting tournaments, public health registrars in the East Midlands, UK, assigned probabilities to future possible binary events relating to COVID-19. Participants also completed a questionnaire on their experiences of forecasting. ResultsThere were 17 participants in the first tournament and nine in the second tournament, with no new participants. In both tournaments, the majority of participants scored a Brier Skill Score above the benchmark of 0. The median Brier Skill Score improved slightly between the two tournaments. Participants reported luck and changing political climates as impacting their performance. Participants reported forecasting in their day job but had received no formal training to do so. ConclusionsForecasting is an important public health skill, and human judgement forecasting tournaments can be run amongst public health practitioners with little time and resource requirements. Further research would help identify whether training, teamwork or other interventions can improve public health forecasting accuracy.

Patients' Perceptions of Quality of Care: A Teamwork Intervention Study in a Surgical Ward.

IntroductionImproving teamwork competencies among health care professionals is important for patient safety. Few previous studies have investigated whether a teamwork intervention has an impact on patients’ perceptions of quality of care.ObjectiveTo investigate patients’ perceptions of quality of care before and after the implementation of a team training program in a surgical ward.MethodsA quasi-experimental pre- and posttest design was used. The TeamSTEPPS® team training program was implemented in a surgical ward. Three groups of consecutively sampled patients responded to the Quality from the Patient's Perspective (QPP) questionnaire including four dimensions with 25 items. In addition to the QPP, six items were developed for this study. In total, 223 patients responded to the questionnaire. The mean age was 59.6 years, and there were 128 males and 94 females.ResultsThe physical-technical condition dimension and four items showed significantly higher scores after six months of intervention. The majority of the patients scored quality of care in the four dimensions as very high at all three time points. Younger patients reported the lowest care quality.ConclusionThe results in this study indicate that the teamwork intervention had a minimal impact on the patients’ perceptions of quality of care, with only significant differences between baseline and six months of intervention in one dimension and three items. At each data collection time point, the numbers of patients who perceived quality of care as modest decreased slightly. Younger patients were more likely to perceive care quality as modest.

Impact of simulation training for teamwork and communication intervention on patient safety in the emergency department

Background: The emergency department (ED) is the hospital division that is most vulnerable to poor communication and teamwork-based medical errors that affect patient safety. One approach to prevent medical errors is by training and assessing healthcare workers using simulation-based (SB) teamwork and communication training. This study aimed to explore the extent to which SB training could improve teamwork and communication and reduce preventable medical errors in the ED. Method: The study was conducted at the Ministry of National Guard Health Affairs, a tertiary care center with a 39-bed ED, in Saudi Arabia. A total of 123 ED healthcare staff participated in the study. This study adopted a single-subject experimental design with the intervention of simulation training in ED cases. The methodology focused on three domains: 1) patient safety in the ED, 2) inter-professional and multidisciplinary simulation team training, and 3) team dynamic enhancement use. Staff perceptions regarding teamwork and communication pre-and post-intervention and the relationship between changes in their perception of performance in the ED and patient outcomes. The chi-square test was used for univariate analysis, and a generalized linear regression model was adjusted for demographics in multivariate analysis. Results: Staff perceptions were collected from all multidisciplinary team members before and after simulation training. The data revealed a significant improvement in overall staff perceptions toward teamwork and communication (8% to 34%, p-value = 0.001). Conclusion: SB communication and teamwork training in the ED resulted in a sustained and measurable improvement in ED staff perceptions toward teamwork and communication. The results suggest that simulation sessions may improve staff perceptions and multidisciplinary team communication during critical situations in the ED.

How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis

BackgroundDespite substantial implications for healthcare provider practice and patient outcomes, gender has yet to be systematically explored with regard to interprofessional operating room (OR) teamwork. We aimed to explore and describe how gender and additional social identity factors shape experiences and perceptions of teamwork in the OR.MethodsThis study was a qualitative secondary analysis of semi-structured interviews with OR team members conducted between November 2018 and July 2019. Participants were recruited across hospitals in Ontario, Canada. We conducted both purposive and snowball sampling until data saturation was reached. Transcripts were analyzed thematically by two independent research team members, moving from open to axial coding.ResultsSixty-six interviews of OR healthcare professionals were completed: anesthesia (n=17), nursing (n=19), perfusion (n=2), and surgery (n=26). Traditional gender roles, norms, and stereotypes were perceived and experienced by both women and men, but with different consequences. Both women and men participants described challenges that women face in the OR, such as being perceived negatively for displaying leadership behaviours. Participants also reported that interactions and behaviours vary depending on the team gender composition, and that other social identities, such as age and race, often interact with gender. Nevertheless, participants indicated a belief that the influence of gender in the OR may be modified.ConclusionsThe highly gendered reality of the OR creates an environment conducive to breakdowns in communuication and patient safety risks in addition to diminishing team morale, psychological safety, and provider well-being. Consequently, until teamwork interventions adequately account for gender, they are unlikely to be optimally effective or sustainable.

Factors Affecting Occupational Burnout Among Nurses Including Job Satisfaction, Life Satisfaction, and Life Orientation: A Cross-Sectional Study.

PurposeEveryday nursing practice under demanding conditions, high mental and physical strain may result in occupational burnout. There is still a need for studies on the comprehensive identification of burnout among nursing staff. This study aimed to evaluate factors affecting occupational burnout among nurses, including job satisfaction, life satisfaction, and dispositional optimism.MethodsThe study involved 625 survey participants with a mean age of 49.47 years and was conducted between January and December 2018. The inclusion criteria were job experience >1 year, current nurse work activity, and written informed consent to participate in the study. The study used standardized research tools such as Maslach Burnout Inventory (MBI), Life Orientation Test-Revised version (LOT-R), Satisfaction with Life Scale (SWLS), and Satisfaction with Job Scale (SWJS). Also, sociodemographic data were collected using a self-developed questionnaire. The STROBE guidelines were followed.ResultsEmotional exhaustion (EE) was significantly greater in respondents with medium life satisfaction (SWLS). Also, EE was significantly greater in pessimists and those with a neutral orientation than in optimists (LOT-R). Housing conditions and family-related problems were significant factors differentiating depersonalization (DEP). Reduced personal accomplishment (PA) was more significant in respondents with a bachelor’s degree than in those with a master’s degree. Also, decreased PA was significantly greater in respondents with low life satisfaction than those with medium life satisfaction. Life satisfaction and life orientation were significant factors differentiating job dissatisfaction among the health-related and psychological variables.ConclusionBurnout was found to be related to individual, interpersonal and organizational feelings. There was an interrelationship between personality traits, where a higher level of occupational burnout was found among nurses with a pessimist attitude. Health programs should be implemented to identify and eliminate burnout through mental health support, improved communication skills, optimized teamwork, and evidence-based interventions.

A pilot randomized clinical trial of a teamwork intervention for heart failure care dyads

BackgroundDyadic heart failure (HF) management can improve outcomes for patients and caregivers and can be enhanced through eHealth interventions. ObjectiveTo evaluate the feasibility, acceptability, and preliminary efficacy of an eHealth dyadic teamwork intervention, compared to an attention control condition. MethodsWe recruited 29 HF patient-caregiver dyads from inpatient units and randomized dyads to an intervention or a control group. We calculated enrollment and retention rates, described acceptability using interview and questionnaire data, and computed intervention effect sizes. Results37% of eligible dyads agreed to participate and 93% of randomized participants completed follow-up questionnaires. Participants found both study conditions to be acceptable. Between-group effect sizes suggested that the intervention led to improvements in relationship quality, self-efficacy, and quality of life for patients and caregivers. ConclusionsDyadic recruitment from acute care settings is challenging. Findings provide initial evidence that our intervention can contribute to better health outcomes for HF dyads.

Psychometric testing of the Iranian version of the TeamSTEPPS teamwork perception questionnaire: a cross-cultural validation study

BackgroundThe use of validated questionnaires to assess the perception of teamwork can be an early step in improving team training activities. Team-STEPPS® Teamwork Perception Questionnaire (T-TPQ) has been adapted and validated for hospital setting use in several countries. Due to linguistic and cultural differences, there is need to test the psychometrics of the adapted versions. However, no research have not yet assessed the psychometric properties of the Persian T-TPQ. Therefore, this study aims to assess the internal consistency reliability and construct validity of an Iranian version of the Team-STEPPS® Teamwork Perception Questionnaire (IR-T-TPQ).MethodsTo conduct this study, we undertook a cross-sectional survey approach between May 2020 and January 2021. In total, 404 nurses were recruited by convenience sampling technique from 10 teaching hospitals in Tabriz, Iran. Internal consistency reliability was analyzed using Cronbach’s alpha coefficient. Confirmatory factor analysis was performed to test the construct validity of the instrument.ResultsCronbach’s alpha coefficients for each subscale were acceptable, ranging from 0.84 to 0.92, as well as for the total IR-T-TPQ (α = 0.96). The confirmatory factor analysis demonstrated a five-factor model, all of whose fit indices were acceptable, except for the goodness-of-fit index and normed fit index (χ2 (df) 1332 (550), p < 0.001, Normed chi-square (χ2/df) = 2.423, RMSEA = 0.059, TLI = 0.897, CFI = 0.904, AGFI = 0.814).ConclusionsThe psychometric properties of the IR-T-TPQ resulted in acceptable levels of internal consistency reliability and construct validity, respectively, in Iranian hospital nurses. Further study is needed to compare the teamwork level of nurses in various settings or to evaluate the effectiveness of the teamwork intervention using this validated and reliable tool.

Assessing Surgical Teamwork Competencies During Moments of Uncertainty Using OR Black Box

Teamwork is an essential aspect to maintaining high-quality healthcare. This is especially true during times of uncertainty, when collaborative problem solving is necessary for clinical teams to adapt and deliver safe and effective care. We conducted a prospective observational study using audio/visual analysis captured by OR Black Box. Human factors experts transcribed and coded the videos using an evidence-based teamwork framework, specific to healthcare. We identified teamwork competencies that were either present or absent during moments of uncertainty in the operating room. Four main team roles (nurses, anesthesiologists, surgeons and trainees) were studied. We identified 3539 instances of teamwork, during 180 hours of surgical observation, and categorized them into 7 competencies. Team leadership was expressed significantly more often by surgeons compared to other team members whereas backup behaviour was expressed significantly more by nurses. Understanding how each team role uniquely contributes to teamwork can help develop specific and actionable teamwork interventions, which could ultimately lead to increased safety in the OR.

Barriers and enablers to effective interprofessional teamwork in the operating room: A qualitative study using the Theoretical Domains Framework.

BackgroundEffective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected gains for patient safety or surgical culture. In order to optimize OR teamwork in a targeted and evidence-based manner, it is first necessary to conduct a comprehensive, theory-informed assessment of barriers and enablers from an interprofessional perspective.MethodsThis qualitative study was informed by the Theoretical Domains Framework (TDF). Volunteer, purposive and snowball sampling were conducted primarily across four sites in Ontario, Canada and continued until saturation was reached. Interviews were recorded, transcribed, and de-identified. Directed content analysis was conducted in duplicate using the TDF as the initial coding framework. Codes were then refined whereby similar codes were grouped into larger categories of meaning within each TDF domain, resulting in a list of domain-specific barriers and enablers.ResultsA total of 66 OR healthcare professionals participated in the study (19 Registered Nurses, two Registered Practical Nurses, 17 anaesthesiologists, 26 surgeons, two perfusionists). The most frequently identified teamwork enablers included people management, shared definition of teamwork, communication strategies, positive emotions, familiarity with team members, and alignment of teamwork with professional role. The most frequently identified teamwork barriers included others’ personalities, gender, hierarchies, resource issues, lack of knowledge of best practices for teamwork, negative emotions, conflicting norms and perceptions across professions, being unfamiliar with team members, and on-call/night shifts.ConclusionsWe identified key factors influencing OR teamwork from an interprofessional perspective using a theoretically informed and systematic approach. Our findings reveal important targets for future interventions and may ultimately increase their effectiveness. Specifically, achieving optimal teamwork in the OR may require a multi-level intervention that addresses individual, team and systems-level factors with particular attention to complex social and professional hierarchies.

Impact of Teamwork and Communication Training Interventions on Safety Culture and Patient Safety in Emergency Departments: A Systematic Review.

This study aimed to narratively summarize the literature reporting on the effect of teamwork and communication training interventions on culture and patient safety in emergency department (ED) settings. We searched PubMed, EMBASE, Psych Info CINAHL, Cochrane, Science Citation Inc, the Web of Science, and Educational Resources Information Centre for peer-reviewed journal articles published from January 1, 1988, to June 8, 2018, that assessed teamwork and communication interventions focusing on how they influence patient safety in the ED. One additional search update was performed in July 2019. Sixteen studies were included from 8700 screened publications. The studies' design, interventions, and evaluation methods varied widely. The most impactful ED training interventions were End-of-Course Critique, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), and crisis resource management (CRM)-based training. Crisis resource management and TeamSTEPPS CRM-based training curriculum were used in most of the studies. Multiple tools, including the Kirkpatrick evaluation model, the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture, the TeamSTEPPS Teamwork Attitudes Questionnaire, the Safety Attitudes Questionnaire, and the Communication and Teamwork Skills Assessment, were used to assess the impact of such interventions. Improvements in one of the domains of safety culture and related domains were found in all studies. Four empirical studies established improvements in patient health outcomes that occurred after simulation CRM training (Kirkpatrick 4), but there was no effect on mortality. Overall, teamwork and communication training interventions improve the safety culture in ED settings and may positively affect patient outcome. The implementation of safety culture programs may be considered to reduce incidence of medical errors and adverse events.

Impact of dedicated infectious disease teamwork on the treatment and prognosis of patients with diabetic foot infection

ObjectiveThe aim was to develop and evaluate the impact of a new model in which the infectious disease (ID) physician and pharmacist work together to treat diabetic foot infections (DFIs). MethodsA quasi-experimental before–after study was conducted. The medical charts of inpatients with DFI admitted between April 1, 2017 and March 31, 2018 were reviewed retrospectively (control group, n = 30). Inpatients diagnosed with DFI between April 1, 2018 and March 31, 2019 were enrolled prospectively as the intervention group and received treatment through dedicated ID teamwork (intervention group, n = 35). ResultsThe distribution of infection severity and levels of metabolic criteria were similar in the two groups. Compared with the control group, the intervention group received adequate initial empirical treatment more frequently (96.8% vs 43.5%, p < 0.001) and had a shorter median duration of fever (1 day vs 7.5 days, p < 0.001). Rates of healing and relapse within 6 months were similar in the two groups, although the intervention group showed more sites of osteomyelitis (p = 0.036) and a higher percentage of polymicrobial infections (48.6% vs 10.0%, p = 0.001). ConclusionThe early and full participation of ID physicians and pharmacists in the treatment of DFI facilitated targeted antimicrobial treatment and improved patient outcomes.

Interventions to promote teamwork, delegation and communication among registered nurses and nursing assistants: An integrative review.

To understand the strategies to influence patient outcomes by synthesizing existing evidence on effective interventions for teamwork, delegation and communication between registered nurses and nursing assistants. Three-quarters of deaths in hospitals are related to breakdowns in teamwork and communication. Acute care systems utilize teams of registered nurses and nursing assistants for primary delivery of nursing care. Research has been conducted to improve the partnership between the dyad. Literature reviews are needed to synthesize the effectiveness of delegation and communication interventions between registered nurses and nursing assistants on patient outcomes. The authors applied Whittemore and Knafl's integrative review methodology to conduct an integrative review of the literature. Databases searched included Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PubMed along with reference searches. Included articles were intervention studies related to teamwork, delegation or communication between registered nurses and nursing assistants, and published from 2000 to 2019. Methodological quality was assessed utilizing the Mixed Methods Appraisal Tool. The Systems Engineering Initiative for Patient Safety model 2.0 was applied as a guiding framework to analyse the findings. Seven articles met the inclusion criteria. The interventions in these articles focused on building a foundation of trust and respect through simulation, education and mindful communication. Four of the seven articles measured patient outcomes including patient falls, hospital-acquired pressure injuries and patient satisfaction. Three articles reported decreased patient falls, two articles reported increased patient satisfaction, while one article reported a reduction in pressure injury. Five of the studies reported improved teamwork and/or communication, and two studies reported improved job satisfaction. There has been limited research on the impact of the registered nurse-nursing assistant relationship on patient safety and care outcomes. The existing research demonstrates a need for interventions to foster a dynamic and effective relationship between registered nurses and nursing assistants. There is a need for more interventional studies linking improved teamwork, delegation and communication between the registered nurse and nursing assistant to patient outcomes such as falls and hospital-acquired pressure injury. Several interventions exist to improve teamwork and communication between the registered nurse-nursing assistant dyad. Leaders need to assess their own culture and develop interventions to build and maintain high-functioning teams. Future research is necessary to develop interventions aimed at improving delegation from registered nurses to nursing assistants for applicable activities.

Systematic review of interventions to improve constant observation on adult inpatient psychiatric wards.

Constant observation is frequently conducted on inpatient psychiatric units to manage patients at risk of harming themselves or others. Despite its widespread use, there is little evidence of the efficacy of the practice or of its impact on patients and nursing staff. Unnecessary use of this practice can be restrictive and distressing for all involved and can cause considerable strain on healthcare resources. We sought to review interventions aiming to improve the quality and safety of constant observation or to reduce unnecessary use of this restrictive practice on adult inpatient psychiatric wards. A systematic search conducted in December 2018 using PubMed, PsycINFO, CINAHL, EMBASE and Google Scholar identified 24 studies with interventions related to constant observation. Only 16 studies evaluated a total of 13 interventions. The most common intervention components were changes to team, education and training for staff, changes to record keeping and assessment, and involving patients in care. A range of outcome measures were used to evaluate interventions. Over half of the interventions showed some positive impact on constant observation. One study recorded patient feedback. All interventions were targeted towards mental health nurses. Overall, there is no consensus on how best to improve the safety and quality of constant observations or reduce its unnecessary use. Studies vary widely in design, intervention and outcome measures. Existing research does however suggest that teamwork interventions can improve the patient experience of constant observation and safely reduce their degree and frequency. Priorities for future research on constant observations are highlighted.