Identifying team process behaviours of clinical nursing teams working on lower-acuity hospital units : development of an observation tool
Creators: name: Whitehair, Leeann
Publisher: name: Southern Cross University
Year: 2021
Subjects: Behavioural observation tool
Clinical nursing teams
High-reliability organisations
Hospital units
Mixed-methods research
Organisational teamwork
Realism
Realist evaluation
Safety II
Safety organising practices
Team leadership
Team processes
Teamwork
Patient safety

description: Within Australian hospital settings, generally, clinical nursing teams are the teams who care for patients over a 24-hour period. Much of hospital care is situated on lower-acuity hospital units, for example, medical and rehabilitation units. Though nursing teams on these units may not work with extremely complex technology or generally care for patients requiring intensive care or observation, exceptions to normal work may occur so often to be construed as routine. Despite assertions that nurses are pivotal to patient safety, little is known about the team processes clinical nursing teams use during their everyday activities to create successful outcomes and keep their patients safe. This thesis investigates how team processes used by clinical nursing teams working in lower-acuity settings lead to successful outcomes. The underpinning theoretical concepts for this thesis were: Safety II, safety organising practices within high-reliability organisations, and organisational teamwork. Realism was the chosen methodological paradigm of this thesis; a three-phase exploratory sequential mixed-methods design was employed for this research. The setting for the research was a single NSW public hospital, purposive sampling was used, and participants were nurses working across three lower-acuity hospital units. During the qualitative design phase (Phase 1), non-participant observations of nursing teams working on a paediatric unit were collected. Using thematic analysis, observations were analysed and coded to develop 20 behavioural codes, three themes and seven subthemes. For Phase 2 of the research design, these 20 behavioural codes were used to create a coding schema and a novel sequential behavioural observation tool for nursing (SBOT-N). During the quantitative design phase (Phase 3), using the SBOT-N, data on team processes of nursing teams working on a medical and a surgical unit were collected by non-participant observation and analysed using descriptive statistics, correlation analyses, and sequential analyses of code sequences over time in seconds for each shift. Based on the research activities across the entire research design, six new interpretative inferences regarding team processes used by nursing teams working on paediatric, medical and surgical lower-acuity hospital units were found. Moreover, a seventh inference that included six theoretical generalisations of team effectiveness on the relationships between context, mediating mechanisms, and team process outcomes of paediatric nursing teams were found. These inferences have significant implications for professional nurse training, nurse education development and further research.