Healthcare team resilience during COVID-19: a qualitative study.

BACKGROUND: Resilience, in the field of Resilience Engineering, has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the resilience potentials of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a cognizant, singular source of knowledge and defined by its collective identity, purpose, competence, and actions, versus the resilience of an individual or an organization. METHODS: We developed a descriptive model which considered the healthcare team as a unified cognizant entity within a system designed for safe patient care. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework. RESULTS: Five themes were identified from the interviews with acute care professionals across the US (N = 22): teamwork in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants' described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance. CONCLUSION: Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. Our research contributes to a growing understanding of the importance of resilience in the healthcare team. And provides a bridge between individual and organizational resilience.

A systematic concept analysis of healthcare team resilience in times of pandemic disasters.

BACKGROUND: The concept of resilience has been used as a descriptor for individuals and organizations with the dominant themes of bouncing back and moving forward. AIMS: To examine the concept of resilience in providers and healthcare teams during pandemic disasters. RESEARCH DESIGN: Walker and Avant's eight-step concept analysis method. DATA SOURCE: CINAHL, EBSCO Host, PubMed, and SCOPUS were searched using the combined terms "resilience" or "resiliency" or "resilient" and "healthcare professionals," or "healthcare worker" or "healthcare team" or "physician" or "nurse" or "doctor" and "pandemic" or "disaster." METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist was used to review the literature and apply findings using the eight-step Walker and Avant method for concept analysis. RESULTS: Three clusters emerged as attributes of individual resilience that may be applied to healthcare teams in times of pandemic disasters: (1) resilience is a dynamic contextual process, (2) resilience stabilizes the team to maintain a routine level of function, and (3) resilience is a catalyst for the actualization of innate or acquired skills and ability within the healthcare team. CONCLUSION: This analysis suggests that resilience enhances the healthcare team's ability to maintain function during acute changes created by pandemic disasters. Resilience in healthcare teams during pandemics requires future research to explore the phenomenon.

A Qualitative Protocol to Examine Resilience Culture in Healthcare Teams during COVID-19.

Resilience allows teams to function at their optimal capacity and skill level in times of uncertainty. The SARS-CoV-2 (COVID-19) pandemic created a perfect opportunity to study resilience culture during a time of limited healthcare team experience, protocols, and specific personal protective equipment (PPE) needed. Little is known about healthcare team resilience as a phenomenon; existing definitions and empiric referents do not capture the nature of healthcare team resilience, as the traditional focus has been placed on individual resilience. This qualitative research protocol provides the rationale and methodology to examine this phenomenon and builds a bridge between resilience engineering and individual resilience. The sample is composed of healthcare team members from the US. This research may add to the body of knowledge on resilience culture in healthcare teams during the COVID-19 pandemic. This qualitative research protocol paper outlines the rationale, objective, methods, and ethical considerations entailed in this research.

Negative Behavior Among Healthcare Professionals: Integrative Review of Instruments.

BACKGROUND: Behaviors that undermine a culture of safety pose a serious threat to the overall wellbeing of healthcare workers as well as to patient outcomes. PURPOSE: The purpose of this integrative review is to compare reported psychometrics, feasibility, and identify commonalities among available instruments measuring negative behaviors among healthcare professionals. METHODS: Whittemore and Knafl's integrative review methods were used to analyze pertinent instruments designed to measure negative behaviors among healthcare professionals. Multiple computerized databases including CINAHL, MEDLINE, and Scopus databases were searched in the fall of 2017 without date restrictions. RESULTS: Violence, incivility, and bullying are the most frequently measured behaviors in healthcare workers, and a robust number of valid and reliable instruments are available. CONCLUSIONS: To date a comprehensive review of psychometric properties and feasibility of administration is lacking. This review synthesizes the instruments measuring these behaviors, providing a resource for future research focused on mitigation and intervention strategies.

The Negative Behaviors in Healthcare Survey: Instrument Development and Validation.

BACKGROUND AND PURPOSE: Examine the psychometric properties and factor structure of the Negative Behaviors in Healthcare (NBHC) Survey. METHODS: A principal axis factor analysis with varimax rotation was conducted utilizing the 2012 NBHC survey data (n = 1,918) to explore the underlying structure of the NBHC instrument. A confirmatory factor analysis using AMOS 23 (Arbuckle, 2014) was then conducted using the 2014 NBHC survey data (n = 1,479). RESULTS: Internal consistency reliability was supported for four of the five identified factors, while construct validity for a five factor solution was established with acceptable model fit indices (Goodness of Fit Index [GFI] = 0.98; Relative Fit Index [RFI] = 0.98, Normed Fit Index [NFI] = 0.98, Root Mean Square Residual [RMR] = 0.05). CONCLUSIONS: The NBHC instrument is a valid reliable instrument to assess negative behaviors among interprofessional healthcare team members, adding to a select few available instruments measuring negative behavior among interprofessional healthcare workers.

Examining the presence and sources of incivility within nursing.

AIMS: Examine the presence and various sources of incivility among nursing staff working within an academic medical centre utilizing the Nurse Incivility Scale (NIS). BACKGROUND: Evidence suggests various forms of negative behaviour including incivility exist among nurses. Established consequences of these behaviours include increased employee turnover rates, decreased job satisfaction, decreased productivity and increased absenteeism. METHODS: A descriptive survey design was used which included the NIS instrument to measure the presence of incivility within the nursing workforce and specific sources of these behaviours among 414 nurses in an academic medical centre. RESULTS: Hospital nurses working within the intensive and intermediate care unit experienced significantly greater incivility from patients and families than other participants within the study [F (3, 413) 8.62, p = .001]. No other significant differences existed in sources of incivility between various levels of direct care. CONCLUSIONS: Nursing staff working within high-risk areas for incivility such as the intensive care and intermediate care units may require additional interventions to reduce perceptions of incivility from patients/families. IMPLICATIONS FOR NURSING MANAGEMENT: Findings suggest further research is necessary to develop targeted interventions for nurses practicing within intensive care and intermediate units to alleviate the perceived burden of incivility from patients/families.

Negative Behaviors among Healthcare Professionals: Relationship with Patient Safety Culture.

Behaviors that undermine a culture of safety within hospitals threaten overall wellbeing of healthcare workers as well as patient outcomes. Existing evidence suggests negative behaviors adversely influence patient outcomes, employee satisfaction, retention, productivity, absenteeism, and employee engagement. Our objective was to examine the presence of negative behaviors within a healthcare system and the influence of negative behaviors among healthcare workers on perceptions of patient safety culture. Using a cross-sectional design, the negative behaviors in healthcare survey (NBHC) and selected composites of the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS) were combined within an electronic survey which was administered to physicians, clinical and managerial staff. Exposure to contributing factors of negative behaviors was moderately correlated with elements of HSOPS, including perceptions of teamwork within units, management response to error, and overall patient safety grade. Use of aggression and fear of retaliation were moderately correlated with HSOPS management response to error. Reducing healthcare worker exposure to contributing factors of negative behavior may result in increased perceptions of teamwork within a hospital unit, while addressing use of staff aggression and fear of retaliation potentially positively influences management response to error.

Negative behaviours in health care: Prevalence and strategies.

AIM: To evaluate the effectiveness of a professionalism taskforce and the prevalence of negative behaviours across interdisciplinary groups at a south-eastern US academic medical centre. BACKGROUND: Negative behaviours within health care organisations may undermine patient safety. These behaviours are associated with decreased productivity, increased turnover, and poor patient and staff outcomes. METHODS: A pre-post study design using an adapted instrument, the Negative Behaviors in HealthCare (NBHC) survey, assessed perceptions of negative behaviours by physicians, clinical, and managerial staff both before and after a professionalism taskforce was convened in 2012 to identify and promulgate key strategies to improve behaviours. RESULTS: The 1,980 respondents completed the pre-survey in January 2012 and 1,423 completed the post-survey in 2014. Significant reductions in use of lateral aggression (LA) and vertical aggression (VA) (χ2  = 5.65, p < 0.017), observation of LA and VA (χ2  = 4.90, p < 0.027), and experience with contributing factors associated with negative behaviours (χ2  = 9.03, p < 0.003) were identified. CONCLUSIONS: Findings suggest that a professionalism taskforce guiding key strategies to elevate professionalism significantly affected beliefs about lateral and vertical aggression. IMPLICATIONS FOR NURSING MANAGEMENT: Decreasing negative behaviours in health care will require additional strategies and consistent implementation. Additional research addressing fear, retaliation, and job stress, and linking these behaviours to patient safety outcomes, is required.