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Enhancing Nurse and Physician Collaboration in Clinical Decision Making Through High-fidelity Interdisciplinary Simulation Training


      To determine whether interdisciplinary simulation team training can positively affect registered nurse and/or physician perceptions of collaboration in clinical decision making.


      Between March 1 and April 21, 2009, a convenience sample of volunteer nurses and physicians was recruited to undergo simulation training consisting of a team response to 3 clinical scenarios. Participants completed the Collaboration and Satisfaction About Care Decisions (CSACD) survey before training and at 2 weeks and 2 months after training. Differences in CSACD summary scores between the time points were assessed with paired t tests.


      Twenty-eight health care professionals (19 nurses, 9 physicians) underwent simulation training. Nurses were of similar age to physicians (27.3 vs 34.5 years; p=.82), were more likely to be women (95.0% vs 12.5%; p<.001), and were less likely to have undergone prior simulation training (0% vs 37.5%; p=.02). The pretest showed that physicians were more likely to perceive that open communication exists between nurses and physicians (p=.04) and that both medical and nursing concerns influence the decision-making process (p=.02). Pretest CSACD analysis revealed that most participants were dissatisfied with the decision-making process. The CSACD summary score showed significant improvement from baseline to 2 weeks (4.2 to 5.1; p<.002), a trend that persisted at 2 months (p<.002).


      Team training using high-fidelity simulation scenarios promoted collaboration between nurses and physicians and enhanced the patient care decision-making process.
      AHRQ (Agency for Healthcare Research and Quality), CSACD (Collaboration and Satisfaction About Care Decisions)
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      1. Kohn LT Corrigan JM Donaldson MS To Err Is Human: Building A Safer Health System. National Academy Press, Washington, DC2000: 1-67
        • AHRQ Agency for Healthcare Research and Quality
        Improving Patient Safety Through Simulation Research. US Department of Health and Human Services, Rockville, MD2008 (Accessed October 13, 2010.)
        • Kramer M
        • Schmalenberg C
        Securing “good” nurse/physician relationships.
        Nurs Manage. 2003; 34: 34-38
        • Manojlovich M
        Linking the practice environment to nurses' job satisfaction through nurse-physician communication.
        J Nurs Scholarsh. 2005; 37: 367-373
        • Schmalenberg C
        • Kramer M
        • King CR
        • et al.
        Excellence through evidence: securing collegial/collaborative nurse-physician relationships, part 1.
        J Nurs Adm. 2005; 35: 450-458
        • Thomas EJ
        • Sexton JB
        • Helmreich RL
        Discrepant attitudes about teamwork among critical care nurses and physicians.
        Crit Care Med. 2003; 31: 956-959
        • Buerhaus PI
        • Donelan K
        • Ulrich BT
        • Norman L
        • Williams M
        • Dittus R
        Hospital RNs' and CNOs' perceptions of the impact of the nursing shortage on the quality of care.
        Nurs Econ. 2005; 23: 214-221
        • Rall M
        • Manser T
        • Guggenberger H
        • Gaba DM
        • Unertl K
        Patient safety and errors in medicine: development, prevention and analyses of incidents [in German].
        Anasthesiol Intensivmed Notfallmed Schmerzther. 2001; 36: 321-330
        • Subash F
        • Dunn F
        • McNicholl B
        • Marlow J
        Team triage improves emergency department efficiency.
        Emerg Med J. 2004; 21: 542-544
      2. Wiener EL Kanki BG Helmreich RL Cockpit Resource Management. Elsevier, Oxford, UK1993
        • King HB
        • Battles J
        • Baker DP
        • et al.
        TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety. Agency for Healthcare Research and Quality, Rockville, MD2006
        • Clancy CM
        • Tornberg DN
        TeamSTEPPS: assuring optimal teamwork in clinical settings.
        Am J Med Qual. 2007; 22: 214-217
      3. Mayo Clinic multidisciplinary simulation center receives distinction as an ACS-accredited education institute. Mayo Clinic News. Published September 13, 2007.
        (Accessed October 13. 2010.)
        • Baggs JG
        Development of an instrument to measure collaboration and satisfaction about care decisions.
        J Adv Nurs. 1994; 20: 176-182
        • Bratt MM
        • Broome M
        • Kelber S
        • Lostocco L
        Influence of stress and nursing leadership on job satisfaction of pediatric intensive care unit nurses.
        Am J Crit Care. 2000; 9: 307-317
        • Weiss SJ
        • Davis HP
        Validity and reliability of the Collaborative Practice Scales.
        Nurs Res. 1985; 34: 299-305
        • McConaughey E
        Crew resource management in healthcare: the evolution of teamwork training and MedTeams.
        J Perinat Neonatal Nurs. 2008; 22: 96-104
        • Marshall DA
        • Manus DA
        A team training program using human factors to enhance patient safety.
        AORN J. 2007; 86: 994-1011
        • Miller KK
        • Riley W
        • Davis S
        • Hansen HE
        In situ simulation: a method of experiential learning to promote safety and team behavior.
        J Perinat Neonatal Nurs. 2008; 22: 105-113
        • Fewster-Thuente L
        • Velsor-Friedrich B
        Interdisciplinary collaboration for healthcare professionals.
        Nurs Adm Q. 2008; 32: 40-48
        • Lowry LW
        • Burns CM
        • Smith AA
        • Jacobson H
        Compete or complement? An interdisciplinary approach to training health professionals.
        Nurs Health Care Perspect. 2000; 21: 76-80
        • Rodehorst TK
        • Wilhelm SL
        • Jensen L
        Use of interdisciplinary simulation to understand perceptions of team members' roles.
        J Prof Nurs. 2005; 21: 159-166
        • Ker J
        • Mole L
        • Bradley P
        Early introduction to interprofessional learning: a simulated ward environment.
        Med Educ. 2003; 37: 248-255
        • Messmer PR
        Enhancing nurse-physician collaboration using pediatric simulation.
        J Contin Educ Nurs. 2008; 39: 319-327
        • Burns N
        • Grove SK
        The Practice of Nursing Research: Conduct, Critique, & Utilization. 4th ed. WB Saunders Co, Philadelphia, PA2001: 41
        • Hulley SB
        • Cummings SR
        • Browner WS
        • Grady D
        • Hearst N
        • Newman TB
        Designing Clinical Research: An Epidemiologic Approach. 2nd ed. Lippincott Williams & Wilkins, Philadelphia, PA2001: 168-169
        • Shadish WR
        • Cook TD
        • Campbell DT
        Experimental and Quasi-Experimental Designs for Generalized Causal Inference. Houghton Mifflin Co, Boston, MA2002: 78-79