Teamwork skills at T0
| Teamwork skills categories | |
| Communication | All healthcare professionals were mostly satisfied with the information exchange within the ward, with the nurse team leader possessing a central position. A busy schedule allowed the RNs, who often had patient responsibility within both teams, to acquire patient information in different ways, from participation in regular team meetings to ad-hoc meetings with the team leaders. The CNAs appreciated the ‘quiet handover’ used between shifts. When calling up the physicians on duty, the RNs often checked the phone list ahead of the phone call to be prepared, indicating that some physicians needed to have more background information than others. The physicians also emphasised the importance of proper and relevant information from the RNs who can be trusted. |
| Leadership | The two core teams each had a team leader throughout the week, allowing the team leader to become better acquainted with a patient’s medical history and thereby increasing continuity and simplifying the hospital discharge. Not all of the RNs enjoyed being team leaders due to a heavy workload; however, the physicians were satisfied with the arrangement. |
| Situation monitoring | The physicians became familiar with the patients during rounds and through the patient’s medical record, mostly discussing patient-related issues in physicians’ meetings. Similarly, the RNs discussed issues related to patients’ care in nurse meetings, although this may also have resulted in contact with the physicians. Both RNs and CNAs had an active role in the observation of the patients and updating each patient’s care plan, and they were encouraged to stay bedside during the rounds. The Modified Early Warning Score (MEWS)* was recently applied, and the physicians were pleased with the new routines, which was highlighted as an excellent tool to quickly determine the degree of illness of a patient. Moreover, the ward was in the initial phase of using a patient safety whiteboard; thus, these meetings did not work optimally with a frequent absence of physicians. |
| Mutual support | The RNs and CNAs stated that they were flexible in helping each other in the event of an uneven distribution of work, both within the team and between the teams. However, the teamwork was dependent on openness and that team members spoke out when they needed help. They felt listened to and respected by the physicians. All three healthcare professionals groups stated that knowing each other and having fun together strengthened a good working environment and good teamwork. The physicians highlighted that, for the best interest of the patient, good teamwork requires nurses with medical knowledge, clinical experience and continuity with the patient. Nonetheless, the RNs experienced that they did not always have the expected response from the physicians, and the physicians stressed that a large workload requires prioritisation of multiple issues at one time, which may affect the teamwork. According to the RNs, this rarely causes conflicts among healthcare professionals in the ward. Nevertheless, there have been real conflicts, and some have been perceived as a personal attack. |
*MEWS is a tool for bedside evaluation of the systolic blood pressure, pulse rate, respiratory rate, temperature and Alert, Reacting to Voice, Reacting to Pain, Unresponsive score.57
CNA, certified nursing assistant; RN, registered nurse.