A qualitative study of expert and team cognition on complex patients in the pediatric intensive care unit*

Custer, Jason W.; White, Elizabeth; Fackler, James C.; Xiao, Yan; Tien, Allen Y.; Lehmann, Harold P.; Nichols, David G.

doi:10.1097/pcc.0b013e31822f1766

Cited by 55 publications

(49 citation statements)

References 29 publications

(21 reference statements)

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“…Kalisch & Hee Lee, 2013). More recently SMM has been described as a significant factor associated with effective team work in areas of critical care and emergency health care settings (Custer et al, 2012;K. Miller et al, 2009;Westli et al, 2010).…”

Section: Nursing Teamworkmentioning

confidence: 99%

Factors contributing to nursing team work in an acute care tertiary hospital

et al. 2017

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Factors contributing to nursing team work in an acute care tertiary hospital Background:Effective nursing teamwork is an essential component of quality health care and patient safety.Understanding which factors foster team work ensures teamwork qualities are cultivated and sustained.Objective: This study aims to investigate which factors are associated with team work in an Australian acute care tertiary hospital across all inpatient and outpatient settings. Methods:All nurses and midwives rostered to inpatient and outpatient wards in an acute care 600 bed hospital in Sydney Australia were invited to participate in a cross sectional survey between September to October 2013. Data were collected, collated, checked and analysed using Statistical Package for the Social Sciences (SPSS) Version 21. Factors reporting a significant correlation with where p<0.05were analysed in a multiple regression model. Results:A total of 501 surveys were returned. Nursing teamwork scores ranged between 3.32 and 4.08.Teamwork subscale Shared Mental Model consistently rated the highest. Mean scores for overall communication between nurses and team leadership were 3.6 (S.D. 0.57) and 3.8 (SD 0.6) respectively. Leadership and communication between nurses were significant predictors of team work p<0.001. Conclusion:Our findings describe factors predictive of teamwork in an acute care tertiary based hospital setting across inpatient and outpatient specialty units. Our findings are of particular relevance in identifying areas of nurse education and workforce planning to improve nursing team work. AimsThis study aims to investigate which factors are associated with nursing team work in a large Australian acute care hospital setting Methods DesignAll nurses and midwives rostered to inpatient and outpatient wards in a acute care 600 bed hospital in Sydney Australia were invited to participate in a cross sectional survey between September to October 2013. Nurses and midwives who were on leave and those who worked on a casual basis during the study period were excluded from the study. Ethical approval was obtained from the South Eastern Sydney Local Health District Human research Ethics Committee and Research Governance 4Office, St George Hospital to undertake a de-identified nursing workforce survey. Nurse and Midwifery Unit Managers were informed of the study and their participation sought .All nurses and midwives were informed of the study through in-services. In order to increase response rate nurses were allotted additional time by hospital management to complete the questionnaire. (Pit, Vo, & Pyakurel, 2014). Questionnaires were returned in a large envelope and placed in a box located on each patient care unit. The questionnaires were collected each day by a research assistant. Data CollectionData were collected relating to nurse workforce demographics, communication between nurses, nursing team work, and perceived model of nursing care. Nurse workforce demographics included; gender, age, designation, education level, new graduate statu...

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Section: Nursing Teamworkmentioning

confidence: 99%

Factors contributing to nursing team work in an acute care tertiary hospital

et al. 2017

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“…While supporting technologies and software could be used to help unify across these differences and enable better teamwork, in many cases that has not occurred. Understanding teamwork and team member needs is important when introducing effective technologies into healthcare (Custer et al 2012). …”

Section: Introductionmentioning

confidence: 99%

“…More recently, Momtahan and Burns explored CWA in cardiac care nursing for the design of a telephone triage system (Momtahan et al 2007). Other researchers have used CWA to analyse patient falls (Lopez et al 2010), workflow decision tools (Effken et al 2008; Effken, Brewer et al 2011), paediatric medicine teams (Lin and Gennari 2011; Custer et al 2012), and medication management (Pingenot, Shanteau, and Sengstacke 2009). While CWA has clearly been useful in healthcare, people work in teams more than individually in this domain.…”

Section: Introductionmentioning

confidence: 99%

Using team cognitive work analysis to reveal healthcare team interactions in a birthing unit

et al. 2014

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Cognitive work analysis (CWA) as an analytical approach for examining complex sociotechnical systems has shown success in modelling the work of single operators. The CWA approach incorporates social and team interactions, but a more explicit analysis of team aspects can reveal more information for systems design. In this paper, Team CWA is explored to understand teamwork within a birthing unit at a hospital. Team CWA models are derived from theories and models of teamworkand leverage the existing CWA approaches to analyse team interactions. Team CWA is explained and contrasted with prior approaches to CWA. Team CWA does not replace CWA, but supplements traditional CWA to more easily reveal team information. As a result, Team CWA may be a useful approach to enhance CWA in complex environments where effective teamwork is required.Practitioner Summary: This paper looks at ways of analysing cognitive work in healthcare teams. Team Cognitive Work Analysis, when used to supplement traditional Cognitive Work Analysis, revealed more team information than traditional Cognitive Work Analysis. Team Cognitive Work Analysis should be considered when studying teams

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“…We were concerned that information may be being miscommunicated, misunderstood or simply not heard. Any of these failings would reduce ‘situation awareness’ and reduce consistency of the mental model of the patients that are communicated across handovers to ensure delivery of high levels of longitudinal care [13]. Specific local factors that may have contributed to communication difficulties included the number of staff on ward rounds (often more than 20 people).…”

Section: Introductionmentioning

confidence: 99%

‘Safety by DEFAULT’: introduction and impact of a paediatric ward round checklist

Sharma

Peters

2013

Crit Care

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IntroductionPoor communication is a source of risk. This can be particularly significant in areas of high clinical acuity such as intensive care. Ward rounds are points where large amounts of information must be communicated in a time-limited environment with many competing interests. This has the potential to reduce effective communication and risk patient safety. Checklists have been used in many industries to improve communication and mitigate risk. We describe the introduction of a ward round safety checklist ‘DEFAULT’ on a paediatric intensive care unit.MethodsA non-blinded, pre- and post-intervention observational study was undertaken in a 12-bedded Level 3 tertiary PICU between July 2009 and December 2011.ResultsWard round stakeholders subjectively liked the checklist and felt it improved communication. Introduction of the ward round checklist was associated with an increase in median days between accidental extubations from 14 (range 2 to 86) to 150 (56 to 365) (Mann–Whitney P <0.0001). The ward round checklist was also associated with an increase in the proportion of invasively ventilated patients with target tidal volumes of <8 ml/kg, which increased from 35 of 71 patients at 08.00 representing a proportion of 0.49 (95% CI 0.38 to 0.60) to 23 of 38 (0.61, 0.45 to 0.74). This represented a trend towards an increased proportion of cases in the target range (z = 1.68, P = 0.09).ConclusionsThe introduction of a ward round safety checklist was associated with improved communication and patient safety.

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A qualitative study of expert and team cognition on complex patients in the pediatric intensive care unit*

Cited by 55 publications

References 29 publications

Factors contributing to nursing team work in an acute care tertiary hospital

Factors contributing to nursing team work in an acute care tertiary hospital

Using team cognitive work analysis to reveal healthcare team interactions in a birthing unit

‘Safety by DEFAULT’: introduction and impact of a paediatric ward round checklist

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