Teamwork and communication in clinical practice improves with simulation using the TeamSTEPPS program. However, there is limited research about simulation efficacy for improving neonatal resuscitation through enhanced communication. Based on a needs assessment and literature review specific to quality improvement strategies for neonatal resuscitation, an enhanced neonatal resuscitation provider (NRP) course was infused with TeamSTEPPS communication strategies, and an NRP case was adopted for simulation training. Also, utilizing clinician feedback, the flow of the resuscitation documentation was revised. The purpose of this project was to evaluate the perceived level of confidence, satisfaction, and communication skills in nurses performing neonatal resuscitation following the implementation of simulation into NRP training. The simulation exercise was guided by the National League for Nursing / Jeffries Simulation Framework (NLN/JFS). A purposeful sample of nurses (N=61) in a tertiary hospital volunteered to participate in the training and simulation exercise. Demographic information was collected and the Student Satisfaction and Self-Confidence in Learning Scale was used in a nonrandomized descriptive evaluation with a posttest one-group design. The analysis found 49% of the nurses were confident in their resuscitation skills, 50% were satisfied with the simulation experience, and 47% reported communication needed to be improved for an effective resuscitation process. This project contributes to social change by demonstrating enhanced NRP training within a simulated environment results in the integration of communication and teamwork skills essential to improve the process of neonatal resuscitation.

Hospital personnel are commonly tasked with implementing innovative and evidence-based practices. However, successes are often limited and short-lived. One likely explanation is that implementation processes vary between sites, leading to differences in implementation outcomes. In this dissertation, I built on the organizational and implementation science literatures to improve our understanding of implementation processes and how they unfolded in small, rural hospitals in Iowa. I adopted two theoretical perspectives – process and variance models. Process models explain change as a series of steps or phases that organizations go through when implementing changes, while variance models explain variation in change outcomes as a relationship between variables. More specifically, I examined Kotter’s process model of change and tested the proposition that performance on earlier steps influences performance on subsequent steps. I then built on the literature on the Promoting Action on Research Implementation in Health Services (PARIHS) framework to examine the implementation processes from the variance model perspective. I first developed a typology of internal facilitation activities that hospital change agents engaged in throughout the implementation process, and then built on organizational implementation models to assess the influence of management support, time availability and team viability on sustainment and non-sustainment of facilitation activities. This study was based on a qualitative longitudinal evaluation of TeamSTEPPS implementation in critical access hospitals in Iowa. Our research team recruited 17 hospitals attending TeamSTEPPS Master Training in 2011, 2012 and 2013 and followed them for a period of two years, interviewing key informants quarterly to inquire about their goals, strategies and activities, barriers and facilitators, and the progress they were making. My analytic samples for the dissertation included 8-10 hospitals and varied depending on the research questions. For each construct, a group of student coders read and coded the interview transcripts (two coders per transcript) using both inductive and deductive coding approaches. The coded content was reviewed and disagreements discussed in a group meeting until differences have been resolved. To examine the Kotter model, hospitals were scored on their performance on the three phases, which allowed for assessing whether their performance was consistent across the three phases as the model proposes. To develop the typology of facilitation activities, I compared and contrasted the different types of activities to identify the characteristics that distinguish them. To test sustainment of facilitation activities, I used the fuzzy-set Qualitative Comparative Analysis method to calibrate and test the relationships using set-theoretic methods. As needed, I also qualitatively re-examined the cases to identify exemplar cases or identify additional factors that helped develop our understanding of the implementation processes. I found that the Kotter model helped explain the implementation processes in half the hospitals, while the other hospitals followed different trajectories, depending on implementation scope. Next, four types of facilitation activities were identified – Leadership, Buy-in, Customization and Accountability. They are distinguished by who engaged in the activities, what or whom they targeted, and the timing patterns of the activities. I also found that facilitation activities were sustained in hospitals with both senior and middle manager support and whose facilitator team remained viable throughout the implementation process. These findings contributed to our understanding of implementation processes. Individual findings and their implications were discussed. Overall, both process and variance model perspectives provide useful but different insights into implementation processes. I concluded that both perspectives are needed to inform practice and future research.

During childbirth, multiple providers deliver care at the bedside that requires optimal teamwork and communication to prevent patient harm. The complexity of caring for obstetrical patient demands a well-coordinated team to relay information and respond to conditions that can change quickly during childbirth. A patient safety strategy to prevent perinatal harm is Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training. TeamSTEPPS is an evidence-based program based on crew resource management (CRM) principles developed in the aviation and military industries. This process improvement project used the Plan-Do-Study-Act framework and Kotter's change theory to implement TeamSTEPPS training after an increase in patient safety events from 2014 to 2016. A convenience sample of 200 physicians, nurses, respiratory therapists, scrub techs, and patient care techs from perinatal units completed the training in a community hospital setting. The Teamwork Perceptions Questionnaire administered pre- and posttraining show a statistical improvement in teamwork, communication, and situational awareness among nursing staff that correlated with a decrease in safety events. Project limitations include lack of a control group for comparison and lack of physician involvement with training. The positive social impact of TeamSTEPPS training is the decrease in maternal and newborn adverse events surrounding childbirth due to perinatal teams using CRM principles. Over the long term, TeamSTEPPs training may become the standard team training method to improve birth outcomes and support the establishment of a patient safety culture, which may be replicated in perinatal centers around the world.

Teamwork in healthcare is recognized as a significant factor in achieving patient safety and impacting patient outcomes. Despite the general focus on teamwork in healthcare, there has been little research on teamwork among nurses and nursing assistants working on patient care units. The purpose of this doctoral project was to identify, compare, and analyze perceptions of teamwork in a group of nurses and nursing assistants in a community hospital setting where the TeamSTEPPS program has been implemented. The framework of this project was the concept of shared mental model and Imogene King's conceptual system and middle-range theory of goal attainment. Teamwork perceptions were measured using the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ), which is composed of five constructs: (a) team structure, (b) leadership, (c) situation monitoring, (d) mutual support, and (e) communication. Sixty-three nurses and 42 nursing assistants participated in the study. There was a significant difference between nursing assistants and staff nurses with respect to the Total T-TPQ mean score (4.03 and 4.26, respectively; p < 0.03), leadership (4.11 and 4.44, respectively; p < 0.01), and communication (4.13 and 4.35, respectively; p < 0.04). Nurses had a higher level of agreement than nursing assistants for Total T-TPQ, leadership, and communication. The results underscore the need to close the gap between nursing assistants' and nurses' perceptions of teamwork. Hospital and nursing leaders should make significant efforts to improve teamwork to build cohesive and highly functional nursing teams that can improve patient safety and thus create lasting social change.

No description available.

Nursing response to medical emergencies has been an ongoing issue in immigration detention centers. Lack of teamwork and poor communication with medical and security staff have resulted in detainees sustaining injuries during medical emergencies. This project was developed to persuade Immigration and Customs Enforcement Health Service Corps (IHSC) leaders to consider piloting the TeamSTEPPS emergency response curriculum for nurses working in the immigration detention center. Tuckman and Jensen's model of group development will provide guidance to IHSC leaders in understanding the transformational stages of forming a successful team. TeamSTEPPS will address gaps in emergency health care competency by improving collaboration, communication, and detainee outcomes. Evaluation questionnaires will be offered after each training module and several months after the conclusion of the program. Questionnaires will be distributed, analyzed, and interpreted by IHSC leadership or their designee. Implementation of the Team STEPPS curriculum may result in increased staff morale, decreased staff turnover, and improved detainee outcomes.

No description available.

No description available.