Academic journal article Australian Health Review

Examination of the Perception of Communication and Collaboration in a Neonatal Intensive Care Unit: A Decade on, Has It Changed?

Academic journal article Australian Health Review

Examination of the Perception of Communication and Collaboration in a Neonatal Intensive Care Unit: A Decade on, Has It Changed?

Article excerpt

Introduction

Communication between carers is an integral part of providing best overall care for a baby progressing through the neonatal intensive care unit (NICU). Complexity of care and constantly changing circumstances make it impossible for any one individual or professional group to have a thorough understanding of all care aspects. This care is provided by both interdisciplinary and intraprofessional collaboration.

The Institute of Medicine recommended that carers work as teams to increase care quality and decrease errors.1 Effective teamwork requires common goals and coordination of communication.2,3 Communication holds the team together. Communication relates to the exchange of information, opinions and ideas and can be verbal, written, tactile or visual. In an intensive care unit (ICU), 37% of all errors were due to some form of poor communication between carers.4 In an NICU, 22% of errors were due to problems with communication and 8% were due to poor teamwork.5 This difficulty in communication between the carer groups of doctors and nurses has been demonstrated in an adult ICU.6,7 One report a decade ago indicated a similar situation in the NICU.8 Doctors seem to have a different perspective to nurses both in their intraprofessional communication and their concept of teamwork. In 2010, the National Institute of Child Health and Human Development (NICHD) thought there was a gap in knowledge about teamwork in the NICU and that this should be researched, especially in terms of training to develop a safety culture.9

Methods

Design and participants

A questionnaire to assess communication and collaboration (both between nurses and doctors and within their professional group) was distributed and collected within a 4-week period providing a snapshot in a particular NICU. This unit consists of 100 cots in a tertiary maternity hospital and 25 cots in a separate paediatric tertiary hospital. Collaboration, teamwork and 'working together' were interchangeable terms for the purposes of the present study. The questionnaire asked for responses using a Likert measuring scale. Comment was also invited to ascertain any specific issues carers had regarding communication in the unit. A demographic sheet accompanied the questionnaire to obtain basic (non-identifying) data.

All nursing staffwere eligible to participate; this included senior and junior nurses with a mix of clinical and managerial responsibility. No nurses were excluded from completing the questionnaire. Senior doctors were invited (consultants and fellows) to participate. Doctors who were on short-term rotation were excluded.

Ethics approval was received through the Governance Evidence Knowledge and Outcomes (GEKO) clinical auditing system that is hospital based.

Materials

The questionnaire consisted of 41 questions and used both a derivative of the ICU Nurse-Physician questionnaire originally developed by Shortell et al.10 and the Team Work Climate Scale developed by Thomas.7

The ICU Nurse-Physician communication subscale has been used previously.6 All questions were retained from the original work of Shortell et al.10 and these questions assess both intraprofessional and interdisciplinary communication. The range of questions assesses communication in five areas: openness (speaking without fear of repercussion); timeliness (promptness of transfer of relevant information); accuracy; understanding (information comprehensiveness and effectiveness); and satisfaction. The questionnaires were discipline specific, targeting the same information from each discipline.

The Team Work Climate Scale used by Thomas7 in an adult ICU uses seven items to assess working together. Response options for each question on both scales were rated using a five-point Likert scale (1, strongly disagree; 5, strongly agree).

Statistical analysis

Categorical data were summarised using frequency distributions. Questionnaire subscale scores based on the Likert scale were summarised using median, interquartile range and range. …

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