Background: Strong patient safety culture and effective teamwork are necessary for patient safety. Registered nurses (RNs) and nursing assistants (NAs) work closely with patients, and effective teamwork and communication skills are essential.Aim: To describe and compare the perceptions of patient safety culture, teamwork, and attitudes toward teamwork among RNs and NAs in hospital wards (medical and intensive care), and to explore the potential associations between teamwork and patient safety culture.Methods: A cross-sectional study was conducted in two hospitals in a single region of Sweden. In one hospital, RNs (n = 103) and NAs (n = 59) in medical care, and RNs (n = 41) and NAs (n = 28) in intensive care were invited to participate. In the other hospital, RNs (n = 67) and NAs (n = 66) involved in medical care were invited. The survey included the Swedish version of Hospital Survey on Patient Safety Culture (S-HSOPS), the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ), and the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ).Results: In total, 155 nurses responded to the survey (response rate = 43%). Overall and in medical care, NAs had a significantly higher score than RNs in "handoffs and transitions" and in intensive care in "information and support to patients and family who have suffered an adverse event" (S-HSOPS). RNs and NAs in intensive care reported higher scores in "communication" (T-TPQ) than RNs and NAs in medical care. Overall and in medical care, RNs had more positive attitudes than NAs in total T-TAQ, "mutual support," and "communication." T-TPQ were associated with "overall perceptions of patient safety" and T-TAQ were associated with "frequency of error reported."Conclusion: This study shows differences between RNs and NAs working in medical and intensive care in their perceptions of patient safety culture, teamwork, and attitudes toward teamwork. Teamwork perceptions are important for overall patient safety.

Aims: To describe nursing students' experiences of a TeamSTEPPS® longitudinal team training program and the application of teamwork skills in clinical practice. Design: A descriptive qualitative design. Methods: Overall, 22 nursing students participated in six online focus group interviews after attending a TeamSTEPPS® team training program from their first semester. The data were audio-recorded, transcribed and analysed using inductive content analysis and reported following the COREQ guidelines. The focus group interviews took place in the students' fifth's semester. Results: The main category “Learning teamwork is not an event; it's a journey” emerged from 3 generic categories and 12 subcategories. The participants reported that grasping the relevance of team training and the use of teamwork skills takes time. Utilizing these skills improved their awareness of being a team member and facilitated learning. Conclusion: Team training raised the participants' awareness of teamwork as an essential component of being a professional nurse. Additionally, understanding the complexity of teamwork takes time.

Background: Teamwork skills are essential to the quality of care and patient safety; nevertheless, team training is limited in Bachelor of Nursing degree programs in Norway. Objectives: The objective of this study was to explore the impact of implementing a TeamSTEPPS® team training intervention on Bachelor of Nursing students' attitudes toward teamwork in health care. Design: A longitudinal quasi-experimental design with pre- and posttests was used. Settings: One intervention group and one control group were recruited from two campuses at a Norwegian university offering a Bachelor of Nursing degree. Participants: Subjects were recruited from a population of 423 students. Methods: For 26 months, the intervention group was exposed to the TeamSTEPPS® team training program with various learning activities to enhance teamwork skills. The intervention group and the control group responded to the Norwegian version of the TeamSTEPPS® Teamwork Attitude Questionnaire (T-TAQ) before the intervention (T0), after ten months (T1), and after 24 months (T2). The students participated in survey T0 and T1 was defined as Sample 1 and students participated in survey T0 and T2 was defined as Sample 2 The data were analyzed with parametric and nonparametric statistics. Results: At T0 there was a significant difference between the intervention and control group. The intervention group showed a significant positive change in the Total T-TAQ score from T0 to T1 and from T0 to T2. The change in mean score differed significantly between the intervention and control group in favor of the intervention group. Conclusions: This study showed that a team training program improved Bachelor of Nursing students' attitudes toward teamwork. Therefore, we recommend that the TeamSTEPPS® team training program be implemented in Bachelor of Nursing programs to facilitate a culture of teamwork.

Background: In complex healthcare organizations, such as intrapartum care, both patient safety culture and teamwork are important aspects of patient safety. Patient safety culture is important for the values and norms shared by interprofessional teams in an organization, and such values are principles that guide team members’ behavior. The aim of this study was 1) to investigate differences in perceptions of patient safety culture and teamwork between professions (midwives, physicians, nursing assistants) and between labor wards in intrapartum care and 2) to explore the potential associations between teamwork and overall perceptions of patient safety and frequency of events reported. Methods: The design was cross-sectional, using the Swedish version of the Hospital Survey on Patient Safety Culture (14 dimensions) and the TeamSTEPPS® Teamwork Perceptions Questionnaire (5 dimensions). Midwives, physicians, and nursing assistants in three labor wards in Sweden in 2018 were included. Descriptive statistics, the Kruskal–Wallis H test, two-way ANOVA, and standard multiple regression analysis were used. Results: The questionnaires were completed by 184 of the 365 healthcare professionals, giving a response rate of 50.4%. Two-way ANOVA showed a significant main effect of profession on two patient safety culture dimensions and one teamwork dimension and a significant main effect of labor ward on four patient safety culture dimensions and four teamwork dimensions. A significant interaction effect of profession and labor ward was found on four patient safety culture dimensions and four teamwork dimensions. The regression analysis revealed that four out of the five teamwork dimensions explained 40% of the variance in the outcome dimension ´Overall perceptions of patient safety´. Conclusions: The results of the study indicate that profession and labor ward are important for healthcare professionals' perceptions of patient safety culture and teamwork in intrapartum care. Teamwork perceptions are significant for overall patient safety. 

Background: Patient safety in hospitals is being jeopardized, since too many patients experience adverse events. Most of these adverse events arise from human factors, such as inefficient teamwork and communication failures, and the incidence of adverse events is greatest in the surgical area. Previous research has shown the effect of team training on patient safety culture and on different areas of teamwork. Limited research has investigated teamwork in surgical wards. The aim of this study was to evaluate the professional and organizational outcomes of a team training intervention among healthcare professionals in a surgical ward after 6 and 12 months. Systems Engineering Initiative for Patient Safety 2.0 was used as a conceptual framework for the study. Methods: This study had a pre-post design with measurements at baseline and after 6 and 12 months of intervention. The intervention was conducted in a urology and gastrointestinal surgery ward in Norway, and the study site was selected based on convenience and the leaders' willingness to participate in the project. Survey data from healthcare professionals were used to evaluate the intervention. The organizational outcomes were measured by the unit-based sections of the Hospital Survey of Patient Safety Culture Questionnaire, and professional outcomes were measured by the TeamSTEPPS Teamwork Perceptions Questionnaire and the Collaboration and Satisfaction about Care Decisions in Teams Questionnaire. A paired t-test, a Wilcoxon signed-rank test, a generalized linear mixed model and linear regression analysis were used to analyze the data. Results: After 6 months, improvements were found in organizational outcomes in two patient safety dimensions. After 12 months, improvements were found in both organizational and professional outcomes, and these improvements occurred in three patient safety culture dimensions and in three teamwork dimensions. Furthermore, the results showed that one of the significant improved teamwork dimensions "Mutual Support" was associated with the Patient Safety Grade, after 12 months of intervention. Conclusion: These results demonstrate that the team training program had effect after 12 months of intervention. Future studies with larger sample sizes and stronger study designs are necessary to examine the causal effect of a team training intervention in this context.

Background Childbirth could negatively affect the woman's health through adverse events. To prevent adverse events and increase patient safety it is important to detect and learn from them. The aim of the study was to describe adverse events, including the preventability and severity of harm during planned vaginal births, in women giving birth in the labor ward. Methods The study had a descriptive design with a retrospective birth record review to assess the preventability of adverse events using the Swedish version of the Global Trigger Tool. The setting was a labor ward in Sweden with low-risk and risk childbirths. Descriptive statistics, Pearson's Chi-square test and Student's t-test were used. Results A total of 38 adverse events (12.2%) were identified in 311 reviewed birth records. Of these, 28 (73.7%) were assessed as preventable. Third- or fourth-degree lacerations and distended urinary bladder were most prevalent together with anesthesia-related adverse events. The majority of the adverse events were classified into the harm categories of 'prolonged hospital care' (63.2%) and 'temporary harm' (31.6%). No permanent harm were identified, but over two-thirds of the adverse events were assessed as preventable. Conclusions This first study using Global Trigger Tool in a labor ward in Sweden identified a higher incidence of adverse events than previous studies in obstetric care. No permanent patient harm was found, but over two-thirds of the adverse events were assessed as preventable. The results draw particular attention to 3(rd)-or 4(th)-degree lacerations, distended urinary bladder and anesthesia-related adverse events. The feedback on identified adverse events should be used for systematic quality improvement and clinical recommendations how to prevent adverse events must be implemented.

Aim: To test the reliability and structural validity of the Norwegian version of the TeamSTEPPS(R) Teamwork Attitudes Questionnaire (T-TAQ) among Bachelor of Nursing students. Design: Cross-sectional study. Methods: Bachelor of Nursing students (N = 1,624) at three campuses in different regions of Norway were invited to complete the survey. The data were analysed with descriptive statistics, Cronbach's alpha and confirmatory factor analysis (CFA). Three models were tested. Model 3 was a post hoc modification with a correlation between four negatively worded items. The data was collected in September 2018 and May-June 2019. Results: A total of 509 students were included in the study. Cronbach's alpha ranged from 0.44-0.70 for the dimensions and was 0.79 for the total questionnaire. The fit indexes of model 3 were as follows: RMSEA = 0.043, chi-square = 724.3 (p < .000), normed chi-square = 1.862, TLI = 0.812 and CFI = 0.832. The questionnaire shows some potential to display attitudes towards teamwork in health care among Bachelor of Nursing students. Low Cronbach's alpha in the dimensions might indicate that the questionnaire should be considered used as a unidimensional questionnaire.

BackgroundEffective teamwork is essential for delivering safe health care. It is important to increase patient safety in healthcare by conducting interprofessional team training with both healthcare professionals and undergraduate students. Validated questionnaires that evaluate team training activities contribute to valuable knowledge regarding changes in attitudes toward teamwork. The aim of the study was to test the reliability and structural validity of the Swedish version of the TeamSTEPPS (R) Teamwork Attitudes Questionnaire (T-TAQ).MethodsThe study had a cross-sectional design. Four hospitals in three health care regions in Sweden participated in the study. In total, 458 healthcare professionals, response rate 39.4%, completed the questionnaire. The T-TAQ, which consists of 30 items and covers five dimensions (Team Structure, Leadership, Situation Monitoring, Mutual Support and Communication), was translated to Swedish. A paper version of the T-TAQ was distributed to healthcare professionals (physicians, registered nurses, midwives, nursing assistants and allied health professionals) from the hospitals. Reliability and validity were tested using Cronbach's alpha and confirmatory factor analysis.ResultsCronbach's alpha was 0.70 for the total T-TAQ and ranged from 0.41 to 0.87 for the individual dimensions. The goodness-of-fit indexes in the confirmatory factor analysis (Model 2) revealed a normed chi-square of 2.96, a root mean square error of approximation of 0.068, a Tucker-Lewis index of 0.785 and a comparative fit index of 0.808.ConclusionsThe Swedish version of the T-TAQ has some potential to measure healthcare professionals' general attitudes toward the core components of teamwork in hospital settings. Further validation studies of the Swedish version of the T-TAQ are required, with samples representing both healthcare professionals and students from various healthcare disciplines and educational levels.

Healthcare professionals' attitudes play a significant role in influencing team behavior, and thereby affect the quality and safety of patient care. Culturally adapted and validated questionnaires may contribute valuable knowledge of professionals' attitudes toward teamwork. The aim of the study was to translate and cross-validate the TeamSTEPPS Teamwork Attitude Questionnaire (T-TAQ) into Norwegian, and to test the questionnaire for psychometric properties among Norwegian healthcare professionals. The T-TAQ, measuring five dimensions of attitude towards teamwork, was translated according to a model of back translation. Healthcare professionals (N = 247) from various hospital settings responded. A Pearson correlation coefficient, confirmatory factor analysis (CFA), test-retest reliability, Cronbach's alpha, and McDonald's omega were conducted. The inter-correlation test of the T-TAQ dimensions ranged from 0.16 to 0.54. The CFA showed a Root Mean Square Error of Approximation of (RMSEA) = 0.061. Test-retest showed Intraclass Correlation Coefficient scores from 0.73 to 0.86, with Cronbach's alpha and McDonald's omega demonstrating values from 0.53 to 0.76 (alpha) and 0.57 to 0.76 (omega) on the five dimensions. The Norwegian version of T-TAQ revealed potential concerning the psychometric property for measuring healthcare professionals' attitudes toward teamwork in hospital settings. Further testing with a sample that is more proportionally composed in terms of an interprofessional mix is therefore proposed.

Aim:To describe healthcare professionals' perceptions of patient safety with a focus on the woman in connection to childbirth.Design: A descriptive and qualitative design with a phenomenographic approach.Methods: Individual qualitative face-to-face interviews with 19 healthcare professionals (midwives, nursing assistants and physicians) were conducted in three labour wards in Sweden. The data were analysed according to Dahlgren and Fallsberg's seven steps.Results: The informants' perceptions of patient safety for the women were identified in four qualitative different descriptive categories: Safeguarding the woman, Safeguarding the birth process, Respecting the individual and the team and Managing workforce and learning. Supportive care and listening to the woman were important for patient safety. It was crucial to follow labour stages and to avoid unnecessary interventions. An open and tolerant atmosphere between the healthcare professionals improved decision-making, and a reasonable workload was essential for ensuring safe care.