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Train-the-Trainer Intervention to Increase Nursing Teamwork and Decrease Missed Nursing Care in Acute Care Patient Units

Kalisch, Beatrice J.; Xie, Boqin; Ronis, David L.

doi: 10.1097/NNR.0b013e3182a7a15d

Background: Teamwork is essential for patient safety and results in less missed nursing care.

Objectives: 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.

Discussion: The intervention tested in this study shows promise of being an effective and efficient approach to increase nursing teamwork and decrease missed nursing care.

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.

Accepted for publication July 31, 2013.

The authors acknowledge that funding was provided by the Blue Cross Blue Shield of Michigan Foundation.

The authors have no conflicts of interest to disclose.

Corresponding author: Beatrice J. Kalisch, PhD, RN, FAAN, Nursing Business and Health Systems, School of Nursing, University of Michigan, 400 N. Ingalls Street, Ann Arbor, MI 48109 (e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.