Informing other staff what is expected from them in their assigned area, was not an easy task to be done at the studied units. It was prohibited by 2 things, first one was due to the common theme of “every nurse should be kept in her/his tasks and cases” which resulted in some of nurses were unwilling to even respond to new colleagues who needed guidance in some assigned tasks, additionally they saw that provision of guidance others was not of their business. The second explanation was nurse leaders were assuming themselves so busy to extent that hinder them to interact with staff nurses, specially the new or supplemented one, they were waiting until the staff nurses came to them and ask for what they expected to do in their tasks as well as they relayed on the old staff nurses who were working inside the units at these situations.
The current study results were inconsistent with Ahmed and Abed (2016) who illustrated that there was high perception of teamwork among the staff nurses in the ICUs at South Valley University Hospitals. This was particularly evident in the domain of SMM (94.8%). Ahmed and Abed (2016) revealed that all items of the domain of SMM had medians of 5.00. From their point of view, this is an expected finding since the work in ICUs is usually very organized with every nurse being fully aware of own and other colleagues’ responsibilities and duties. This would lead streamlining of work under a shared model, with less conflict, mutual respect, and more commitment (Ahmed & Abed, 2016).
After implementation of the NTW training program, nursing staff respected the issue of sharing any work related information even they were documented or only observed whatever they were asked about or no .Additionally nursing staff became willing to trust one another as every one of them would not hurt others and they would work for the good of all. They assumed the full responsibility to guide and assist each new staff and inform them about their expected tasks that they should follow.
Following the observed NTW elements of the closed loop communication dimension, the results of the study indicated that there were statistically significant differences between its elements during (pre, immediately post-program implementation and three months later) where obviously all items’ mean scores increased immediately post-program implementation compared to preprogram and relatively gained small decrease three months later. The results indicated that the majority of the study participants were observed highly not performing the element of “criticizing positively other staff while giving an comment” which increased post program implementation and relatively gained small decrease three months later followed by highly performing the element of “using judgmental words while giving any comment to other staff” which decreased post program implementation and increased three months later.
The idea here, is the apparent communication tension between nursing staff as they have been observed for being destructive in their comments usually while talking with members at the same level or lower. They always commented on the negative things rather than the positive ones, as for example one nurse was waiting for junior nurse for endorsing her the case at the moment that she came late and the old one talked to her loudly and said that “ why do you come late? You are new nurse and come late, what could we do, we the older one? I will not endorse the case and you can read the rest of data from patient’s file…” whenever she forgot that junior nurse was very tired because she was hardly working with very critical newly admitted patient at the last night shift”.
Additionally, in some cases, nursing staff were using judgmental words while giving any comment to others. As continuing the previous example, the old staff nurse told the junior one “you came later because you were more committed to the private work than here and you always adjust the private schedule rather than the schedule here” and junior staff responded as there was a traffic problems as she was living in distant place while she had no private shift in that day.
After NTW training program implementation, specially training the nursing staff on one of effective communication tools regarding to provision of constructive nonjudgmental criticism, called Feedback Sandwich, which it enabled them to the staff became more flexible in handling daily work problems and mutually respect each of them in term of respecting their values and contribution while criticizing their mistakes.
Part V: Differences between observed nursing teamwork dimensions by the study participants during different periods of assessment (pre, immediately post-program implementation and three months later).
Concerning the differences between NTW dimensions during (pre, immediately post-program implementation and three months later), the results revealed that there were statistically significant differences among all observed NTW dimensions obviously all dimensions’ total mean scores increased immediately post-program implementation compared to preprogram and relatively gained small decrease three months later.
In addition, the majority of nurses in their study agreed that it was easy for them to ask advice from nurses in their units, find it enjoyable to talk with other nurses in their unit, there was respectful and cordial relationship among nurses, nurses had adequate knowledge about disease process and drugs ordered for the patients on their unit, also, nurse with more experience in the unit help to mentor and teach less experienced nurses.
The results of the study indicated that the implementation of nursing teamwork training program has a positive effect on increasing teamwork effectiveness as compared pre and post-program implementation. Meanwhile, the training program’s effect was relatively decreased within several months after program implementation which in turn resulted in small decrease in the NTW behaviors. In other words, these findings have supported the study hypothesis of NTW scores immediately after NTW training program implementation and haven’t supported the study hypothesis of indifference between the mean scores of the nursing teamwork post program implementation and three months later.
From the investigator’s point of view, this result could be related to that the nursing staff were interested with the subjects of teamwork during the training course as well as the program has presented a newly heard concepts by the majority of them and introduced many interactive scenarios during the sessions made them to be very attentive, interactive and willing to change their traditional behavior in order to enhance any at-stake communication specially at the periods of sever nursing shortage and overload in their units , improve their overall teamwork behavior and improve the quality of nursing care so they were willing to change their altitude as possible as they could. Polis and et al. (2017) mentioned that the strong
It was obviously noticed by investigator that, nursing staff intentionally changed their behavior toward teamwork at the period of provision of NTW training program and immediate after finishing it as they talked loudly to demonstrate their responsiveness to the program and showed some of teamwork behavior (e.g. cross checking patients file, helping each of them, etc.). After several months specifically at the period of program follow up, nursing staff demonstrated less care to the investigator’s presence and showed no more teamwork behavior. Lee and et al. (2017) declared that teamwork training improves short-term teamwork behaviors. However, improvements are often not sustained (Lee & et al., 2017).
The current results illustrated that, the majority of the study participants were observed highly not performing the dimension of “backup behavior” followed by the dimension of “mutual performance monitoring dimension” which increased post program implementation and relatively gained small decrease three months later.