Psychological safety between pediatric residents and nurses and the impact of an interdisciplinary simulation curriculum

Courtney Haviland; Janet Green; Kristina Dzara; Wendy O Hardiman; Emil R Petrusa; Yoon Soo Park; Ariel S Frey-Vogel

doi:10.1186/s12909-022-03709-9

Psychological safety between pediatric residents and nurses and the impact of an interdisciplinary simulation curriculum

BMC Med Educ. 2022 Aug 29;22(1):649. doi: 10.1186/s12909-022-03709-9.

Authors

Courtney Haviland¹, Janet Green², Kristina Dzara³, Wendy O Hardiman⁴, Emil R Petrusa⁵, Yoon Soo Park⁶, Ariel S Frey-Vogel⁷

Affiliations

¹ Department of Pediatric Emergency Medicine, Hasbro Children's Hospital, 593 Eddy St., Providence, RI, 02903, USA.
² Department of Nursing, Mass General for Children, 55 Fruit St., Ellison 17, Boston, MA, 02114, USA.
³ Department of Biomedical Informatics and Medical Education and Center for Leadership and Innovation in Medical Education, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98195, USA.
⁴ Mass General for Children, Department of Nursing, 55 Fruit St., Ellison 17, Boston, MA, 02114 , USA.
⁵ Department of Surgery, Harvard Medical School and Massachusetts General Hospital, Bartlett Hall Second Floor, 55 Fruit St., Boston, MA, 02114, USA.
⁶ Department of Emergency Medicine, Harvard Medical School and Massachusetts General Hospital, Bartlett Hall Second Floor, 55 Fruit St., Boston, MA, 02114, USA.
⁷ Harvard Medical School and Mass General for Children, Department of Pediatrics, 175 Cambridge St, Fifth Floor, Room 587, Boston, MA, 02114 , USA. afrey@mgh.harvard.edu.

Abstract

Background: Effective teamwork in interdisciplinary healthcare teams is necessary for patient safety. Psychological safety is a key component of effective teamwork. The baseline psychological safety on pediatric inpatient healthcare teams is unknown. The purpose of this study is to determine the baseline psychological safety between pediatric nurses and residents and examine the impact of an interdisciplinary nighttime simulation curriculum.

Methods: A convergent, multistage mixed methods approach was used. An interprofessional simulation curriculum was implemented fall 2020 to spring 2021. Qualitative focus group data and quantitative survey data on team psychological safety were collected and compared, both pre- and post-intervention and across nurses and residents. Thematic analysis of the qualitative data was conducted, and themes integrated with survey findings.

Results: Data were collected from 30 nurses and 37 residents pre-intervention and 32 and 38 post-intervention, respectively. Residents and nurses negatively rated psychological safety (pre-intervention mean = 3.40 [SD = 0.72]; post-intervention mean = 3.35 [SD = 0.81]). At both times psychological safety was rated significantly lower for residents (pre-intervention mean = 3.11 [SD = 0.76], post-intervention mean = 2.98 [SD = 0.84]) than nurses (pre-intervention mean = 3.76 [SD = 0.45], post-intervention mean = 3.79 [SD = 0.50]), all P < .001. Qualitative analysis identified six integrated themes: (1) influence of existing relationships on future interactions, (2) unsatisfactory manner and frequency of communication, (3) unsatisfactory resolution of disagreements (4) overwhelming resident workload impairs collaboration, (5) interpersonal disrespect disrupts teamwork, and (6) interprofessional simulation was useful but not sufficient for culture improvement.

Conclusion: Resident-nurse team psychological safety ratings were not positive. While interprofessional simulation curriculum shows promise, additional efforts are needed to improve psychological safety among residents and nurses.

Keywords: Interprofessional simulation; Interprofessional teamwork; Nurse/physician relationship; Psychological safety.

MeSH terms

Child
Computer Simulation
Curriculum*
Humans
Interdisciplinary Studies
Interprofessional Relations
Patient Care Team*
Patient Safety