Transformational Teams in Nursing: The Relationship of Constructs of Teamwork and Nurse-Sensitive Indicators

Purpose:
The purpose of this research was to investigate the relationship of nursing teamwork within acute care medical-surgical nursing units and specific nurse-sensitive patient outcomes including pressure ulcers, patient falls, and catheter-associated urinary tract infections.

Background/Significance:
Over a decade ago, a landmark study identified the need to address issues of preventable adverse patient outcomes. There is an ongoing critical need to understand the relationship of skills such as nursing teamwork, and the occurrence of nurse-sensitive indicators such as falls, pressure ulcers and infections. Building upon a framework entitled the Donabedian Model of Patient Safety, the research question of this study was: How does nursing teamwork affect nurse-sensitive patient outcomes?

Methods:
A mixed methods design with correlational analysis compared eight nursing units' teamwork data, collected using the Nursing Teamwork Survey, with unit outcome measurements of pressure ulcers, falls, and urinary catheter associated infections as measured by National Database of Nursing Quality Indicators. Follow-up qualitative focus groups were conducted to provide phenomenological insight, inductive reasoning, and triangulate findings. Participants (n=154)from the non-probability convenience sample were derived from one mid-eastern United States hospital, and were employed as either Registered Nurses or unlicensed assistive personnel in one of eight acute medical-surgical environments.

Results:
Central tendency data indicated that teams with higher levels of teamwork reported less negative outcomes, providing clinical significance. Statistically significant correlations were also noted including one between intra-shift teamwork and unassisted falls, r = -.618, p<.05. Analysis also indicated a relationship between the teamwork construct of Shared Mental Model and unassisted falls, r = -.571, p<.05. A chart identifies additional relationships between teamwork variables and the nurse-sensitive outcomes. Qualitative data provided three themes resulting in the emerging concept of Transformational Nursing Teams and the role of nursing teamwork in the provision of quality care.

Conclusions and Implications for Practice:
Strategies to improve teamwork may have value in impacting nurse-sensitive outcomes. Other conclusions related to the lack of a model of teamwork within nursing, team training adaptations to address the uniqueness of nursing, and the unique educational needs of licensed and unlicensed team members.