Identifying key nursing and team behaviours to achieve high reliability

Area of Science:

• Healthcare quality and safety
• Interdisciplinary team dynamics
• Nursing practice during critical events

Background:

• High reliability in patient care requires both technical and team competence.
• While technical competence is established, team competence during critical events is challenging to assess in interdisciplinary settings.
• Effective communication and collaboration are vital for safe patient outcomes.

Purpose of the Study:

• To measure key nursing behaviors within interdisciplinary teams during critical events.
• To evaluate the extent to which these behaviors contribute to high reliability in patient care.
• To identify specific behavioral markers indicative of effective interdisciplinary interaction.

Main Methods:

• In situ simulation was employed to observe nursing behaviors during simulated critical events.
• Seventeen trials were conducted across four hospital sites.
• Interdisciplinary interactions, particularly communication, were videotaped for detailed evaluation.

Main Results:

• Key nursing behavioral markers were identified, including situational awareness, use of Situation, Background, Assessment, Recommendation-Response (SBAR-R), closed-loop communication, and shared mental models.
• These markers are essential for effective interdisciplinary collaboration.
• The study described specific observable behaviors related to these markers.

Conclusions:

• Essential nursing skills for highly reliable interdisciplinary teams are not consistently demonstrated during critical events.
• Gaps in these observed skills represent potential breaches in patient safety barriers.
• Nurses play a critical role in ensuring team performance and patient safety by effectively transferring information and responding to clinical cues.