title: Train-the-trainer intervention to increase nursing teamwork and decrease missed nursing care in acute care patient units.
abstract: BACKGROUND
  Teamwork is essential for patient safety and results in less missed nursing care.
  
  
  OBJECTIVE
  The aim of this study was to test the impact of a train-the-trainer intervention on the level of satisfaction with nursing teamwork and the amount of missed nursing care.
  
  
  METHODS
  This study used a quasiexperimental design with repeated measures taken at pretest, posttest, and 2 months after completion of the intervention. The sample for this study was the nursing staff on three medical-surgical units in three separate acute care hospitals (one unit in each hospital). Three nurses from each unit underwent a training program and then taught the skills and knowledge they acquired to the staff members on their units in three-hour-long sessions. The training involved staff role-playing scenarios based on teamwork problems that occur regularly on inpatient units in acute care hospitals followed by debriefing, which focused on teamwork behaviors (e.g., leadership, team orientation, backup, performance monitoring) and missed nursing care. Four measures were used to test the efficacy of this intervention: The Nursing Teamwork Survey, the MISSCARE Survey, and questions about the knowledge of and satisfaction with teamwork. Return rates for the surveys ranged from 73% to 84%. Follow-up tests individually comparing pretest, posttest, and delayed posttest were conducted within the mixed model and used the Bonferroni correction for multiple comparisons.
  
  
  RESULTS
  Teamwork increased (F = 6.91, df = 259.01, p = .001) and missed care decreased (F = 3.59, df = 251.29, p = .03) over time. Nursing staff also reported a higher level of satisfaction with teamwork and an increase of teamwork knowledge after the intervention.
  
  
  CONCLUSIONS
  The intervention tested in this study shows promise of being an effective and efficient approach to increase nursing teamwork and decrease missed nursing care.
authors.affiliation: Beatrice J. Kalisch, PhD, RN, FAAN, is Titus Distinguished Professor and Director, Innovation and Evaluation, University of Michigan, Ann Arbor. Boqin Xie, MS, RN, is PhD Student; and David L. Ronis, PhD, is Research Scientist, School of Nursing, University of Michigan, Ann Arbor.
authors.forename: Beatrice J
authors.initials: BJ
authors.lastname: Kalisch
authors.forename: Boqin
authors.initials: B
authors.lastname: Xie
authors.forename: David L
authors.initials: DL
authors.lastname: Ronis
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D018794:Problem-Based Learning / Q000458:organization & administration*