Olaf Timmermans

Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events—A cross-sectional survey

AIM To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. BACKGROUND Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. DESIGN A cross-sectional design with a survey. METHOD In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. RESULTS Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. CONCLUSION Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development.

Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors

Aim: To explore the mechanisms through which nurse practice environment dimensions, such as nurse–physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption. Background: Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging. Design: Cross-sectional survey. Method: Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium. Results: Nurse practice environment dimensions predicted nurses’ ratings of job outcome variables as well as quality of care. Features of nurses’ work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care. Conclusion: The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses’ perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services.

A contingency perspective on team learning and innovation in nursing

AIMS To report a correlational study of the relation between team learning activities and implementation-effectiveness of innovations in nursing teams. BACKGROUND Non-compliance to implementation of innovations is a problem in nursing teams. In the literature, team learning is proposed as a facilitator for change. Still, studies reporting the effects of team learning activities on the implementation of innovations in nursing teams are scarce. To address this gap in the literature, this study explored the influence of team learning on the implementation of two innovations. DESIGN A cross-sectional survey. METHODS The survey was conducted in 2008-2009 with a sample of 469 nurses, representing 30 nursing teams from The Netherlands and Belgium. The relationship between variables representing team learning and the use and the knowledge of an incremental (n = 14) or a radical innovation (n = 16) was examined by correlation and multiple regression analyses. RESULTS Correlation analyses revealed positive relationships between the team learning activities handling production-oriented information and implementation-effectiveness of an incremental innovation. In addition, team learning activities about development-oriented information positively affected the implementation of a radical innovation. Multiple regression yielded models that explain 83% of the variance on the use of an incremental variable, 73% on knowledge of a radical innovation, and 80% on use of a radical innovation. CONCLUSION In nursing teams, team learning activities that relate to the production of nursing care affect the implementation of an incremental innovation. The implementation of a radical innovation is effected by team learning activities that relate to the development of the provided nursing care.

Team learning and innovation in nursing, a review of the literature

The capability to learn and innovate has been recognized as a key-factor for nursing teams to deliver high quality performance. Researchers suggest there is a relation between team-learning activities and changes in nursing teams throughout the implementation of novelties. A review of the literature was conducted in regard to the relation between team learning and implementation of innovations in nursing teams and to explore factors that contribute or hinder team learning. The search was limited to studies that were published in English or Dutch between 1998 and 2010. Eight studies were included in the review. The results of this review revealed that research on team learning and innovation in nursing is limited. The included studies showed moderate methodological quality and low levels of evidence. Team learning included processes to gather, process, and store information from different innovations within the nursing team and the prevalence of team-learning activities was contributed or hindered by individual and contextual factors. Further research is needed on the relation between team learning and implementation of innovations in nursing.

Team Learning and Team Composition in Nursing.

Purpose – This study aims to explore team learning activities in nursing teams and to test the effect of team composition on team learning to extend conceptually an initial model of team learning and to examine empirically a new model of ambidextrous team learning in nursing.Design/methodology/approach – Quantitative research utilising exploratory and confirmatory factor analyses, and correlation and multiple regression analyses, were used for empirical validation.Findings – Principal component analyses of the team learning activities scale revealed a five‐factor model, explaining 78 per cent of the variance on the team‐learning scale. Being a nursing team in a community hospital, having high team longevity, and having a high percentage of female nurses explained 33 per cent of team learning.Research limitations/implications – Data aggregation in a cross‐sectional design can be criticised for potential biases. However, statistical assumptions for aggregation were met, and the concepts used in this study w...

Outcome Indicators on Interprofessional Collaboration Interventions for Elderly

Background: Geriatric care increasingly needs more multidisciplinary health care services to deliver the necessary complex and continuous care. The aim of this study is to summarize indicators of effective interprofessional outcomes for this population. Method: A systematic review is performed in the Cochrane Library, Pubmed (Medline), Embase, Cinahl and Psychinfo with a search until June 2014. Results: Overall, 689 references were identified of which 29 studies met the inclusion criteria. All outcome indicators were summarized in three categories: collaboration, patient level outcome and costs. Seventeen out of 24 outcome indicators within the category of ‘collaboration’ reached significant difference in advantage of the intervention group. On ‘patient outcome level’ only 15 out of 32 outcome parameters met statistical significance. In the category of ‘costs’ only one study reached statistical significance. Discussion and conclusion: The overall effects of interprofessional interventions for elderly are positive, but based on heterogeneous outcomes. Outcome indicators of interprofessional collaboration for elderly with a significant effect can be summarized in three main categories: ‘collaboration’, patient level’ and ‘costs’. For ‘collaboration’ the outcome indicators are key elements of collaboration, involved disciplines, professional and patient satisfaction and quality of care. On ‘patient level’ the outcome indicators are pain, fall incidence, quality of life, independence for daily life activities, depression and agitated behaviour, transitions, length of stay in hospital, mortality and period of rehabilitation. ‘Costs’ of interprofessional interventions on short- and long-term for elderly need further investigation. When organizing interprofessional collaboration or interprofessional education these outcome indicators can be considered as important topics to be addressed. Overall more research is needed to gain insight in the process of interprofessional collaboration and so to learn to work interprofessionally.

Team learning and context; assessing the relationship between team-learning activities and contextual factors of team-learning environment and team-configurations

Olaf Timmermans1 Roland Van Linge2 Peter Van Petegem3 Joke Denekens4 1Faculty of Medicine, Nursing and Midwifery Science, University of Antwerp, Belgium; 2University Medical Centre Utrecht, Department of Nursing Sciences, Utrecht University, The Netherlands; 3Institute of Education and Information Sciences, University of Antwerp, Belgium; 4Department General Practice, University of Antwerp, Belgium

A cross-sectional pilot study of student's proactive behavior in midwifery education: Validation of a developed questionnaire

OBJECTIVES Midwifery students face major challenges in adapting quickly and effectively to different clinical settings. Proactive behavior, triggered by various individual and/or contextual antecedents, could be a significant added value to cope with these challenges. DESIGN A cross-sectional pilot study was conducted to investigate prognostic factors in proactive behavior in a group of midwifery students. SETTINGS The setting was a Belgian University College for midwifery education. PARTICIPANTS All second and third year midwifery students (n=156). METHODS Students were questioned regarding several prognostic factors: four personal characteristics, seven individual antecedents and three contextual antecedents that might trigger proactive behavior. A proportional odds logistic regression analyses was used to describe the association between prognostic factors and the probability to observe proactive behavior within the group. The strength of the newly developed questionnaire was tested. RESULTS Of all tested prognostic factors, nationality, role breadth self-efficacy, referring to the self-confidence of a midwifery-student to perform tasks that exceed expectations, and control appraisal, describing the importance attached to ones perceived control, were significantly associated with proactive behavior. The overall strength of the questionnaire was ratified. Two of the original questions were deleted, two re-formulated and for one prognostic factor the answer-options were re-formulated. CONCLUSIONS Findings from this pilot study show that midwifery students who have a high role breadth self-efficacy and low control appraisal are more likely to show proactive behavior. Additionally, Dutch students are more likely to show proactive behavior in relation to Belgian students. The questionnaires feasibility was examined and adjustments were made for future research in a larger study to confirm these outcomes. This study can be a support in the individual guidance of midwifery students towards proactive behavior in midwifery.

Learning and Innovation in Health-Care-Based Teams: The Relationships Between Learning, Innovative Behavior at Work, and Implementation of Innovative Practices in Hospitals

Non compliance with implementation of innovations is a major problem in health-care-based teams. In the literature, (team-) learning is proposed as a facilitator for the process of implementing innovations. Still, a comprehensive exploration of learning in health-care-based teams and the relation with innovation is scarce. This chapter explores (team-) learning activities in health-care-based teams and the relation between learning processes at individual, team, and organizational levels and implementation of innovations. A review of the literature was conducted. Theoretical aspects of learning on individual, team, and organizational levels are summarized, as well as the concepts of innovative work behavior and implementation of innovations. In addition, we used data and insights from the studies we performed on learning and innovation in health-care-based teams. Insights from separate empirical studies are synthesized to underbuild the relationships between (team) learning, innovative work behavior, and implementation of innovations in health-care-based teams. Learning in health-care-based teams exists on individual, team, and organizational levels. Especially for learning on team level, the relation with innovative behavior at work and implementation of innovations was demonstrated in different studies. Finally, we show how the theories can be used in practice, by showing how we used the theoretical assumptions on learning in building a master’s-level program in nursing science.

Team Resource Management and Quality of Care

In spite of being characterized by more highly educated professionals and more cutting-edge training facilities, equipment, and more research than ever, healthcare systems are still confronted with serious safety problems. In more than 70% of cases, serious and avoidable medical errors originate in so-called human factors or deficits in “nontechnical” skills—including communication, leadership, teamwork, situational awareness, and decision-making. A major reason behind slow improvement is the cumbersome, hierarchical organizational structure in many healthcare organizations that stand in the way of a safety culture, encourage a “blame culture,” and foster communication errors. Resolving these issues requires a fundamental cultural shift from an individual to a group focus where safety is the shared responsibility of all individual healthcare workers and the entire management team working in a hospital (or other healthcare organization). Because safe care relies on the collective individual expertise of team members as well as teamwork, the interdisciplinary performance of care teams goes hand in hand with the safety culture of the healthcare organization as a whole. Consequently, investments in multidisciplinary teams in teamwork training (i.e., Team Resource Management training) to build nontechnical skills are essential.