Teamwork in Extreme Environments

Teams are relied upon in extreme and challenging environments in which there are considerable demands and failures can have severe consequences. Despite an increased interest in extreme teams, empirical research remains limited. Moreover, whilst the literature differentiates between extreme and non-extreme teams, it rarely distinguishes between different types of extreme teams. In this thesis, I argue extreme teams can be differentiated into multi-team systems (MTS) and teams in isolated, confined environments (ICE). I draw on contextual challenges present in different types of extreme environments to examine what factors support teamwork in emergency response teams (MTS) and expedition teams (ICE). In doing so, I identify methodological and analytical approaches suitable for researching extreme teams (Chapter II and V). MTS often form quickly in the response to emergencies. This creates challenges in establishing communication channels and managing conflicting objectives across inter-agency partners who may have limited experience working with one another. To address these challenges, I explored how teams communicated and coordinated in crises and if this is influenced by team member familiarity. Data were collected from immersive simulations with commanders in the emergency services and students. Mixed methods analysis showed how team processes changed across time (Chapter III) and how familiarity (Chapter IV) alleviated some of the challenges of working in MTS. In contrast to MTS, teams in ICE co-exist for pro-longed periods in hostile and remote settings. This creates challenges in maintaining team cohesion and balancing the personalities and characteristics of isolated individuals for pro-longed periods. Here, I used a diary methodology to track changes in cohesion over time and explore if fluctuations in cohesion are predicted by day-to-day events and the personality composition of teams (Chapter V). Theoretical implications for the importance of context in shaping team behaviours and practical implications for teams operating in extreme environments are provided

Competências não-instrumentais na prestação de cuidados em saúde

The literature shows that healthcare errors are due to a lack of non-technical skills. Non-technical skills are interpersonal and cognitive skills, whose training in high-fidelity simulation environment, contributes to a safe and effective performance in the solution of diverse and adverse clinical situations. Although the literature reinforces the importance of non-technical skills training in the prevention of errors and consequently in the improvement of patient care delivery, there is not yet an effective and structured curricular integration that allows to develop, in a systematic way, these competences in healthcare education. In order to respond to World Health Organization concerns, particularly those related to patient safety issues, the promotion and implementation of nontechnical skills training programs is paramount. In this sense, the objective of this quasi-experimental investigation is to promote knowledge and training of acting strategies in clinical nursing practice, through the development and implementation of a non-technical skills training course in high-fidelity simulation context with nursing students. In order to evaluate the effectiveness of the developed course, some instruments were constructed, namely the Non-Technical Skills Assessment Scale in Nursing. Thus, according to the results obtained, the present investigation contributes to scientific evidence, reinforcing the importance of non-technical skills training in increasing knowledge, performance and confidence in patient care delivery in the experimental group after the implementation of the course, in comparison with the control group. The main implication for clinical practice is the promotion of patient safety. Based on the present investigation, future work may focus on the implementation of this course not only to nursing students but also to professionals in healthcare teams. On the other hand, it would be important to integrate these competences into structured and specialized curricular modules in nursing education, and in other healthcare areas, as high-quality clinical performance involves not only technical, but mainly non-technical skills.A literatura demonstra que a maioria dos erros em saúde se deve à falta de competências não-instrumentais. Estas, são competências interpessoais e cognitivas que, treinadas em ambiente de simulação de alta-fidelidade, contribuem para potenciar um desempenho seguro e eficaz na resolução de situações clínicas diversas e adversas. Apesar de a literatura reforçar a importância do seu treino na prevenção de erros e consequentemente na melhoria da prestação de cuidados ao doente, não existe ainda uma integração curricular efetiva e estruturada, que permita desenvolver, de forma sistemática, estas competências no ensino em saúde. Procurando dar resposta às normativas e preocupações da Organização Mundial de Saúde, nomeadamente às questões ligadas à segurança do doente, será premente a promoção e implementação de programas de formação em competências não-instrumentais. Neste sentido, o objetivo da presente investigação, do tipo quase-experimental, é o de promover o conhecimento e treino de estratégias de atuação na prática clínica em enfermagem através do desenvolvimento e implementação de uma ação de formação em competências não-instrumentais em contexto de simulação de alta-fidelidade a estudantes de enfermagem. Com o intuito de avaliarmos a sua eficácia foram construídos alguns instrumentos, dos quais destacamos o Questionário de Competências Não-Instrumentais. Desta forma, de acordo com os resultados obtidos, a presente investigação constitui um contributo para a evidência científica, reforçando a importância do treino de competências não-instrumentais no aumento do conhecimento, do desempenho e da confiança na prestação de cuidados, do grupo experimental após a implementação da formação, em comparação com o grupo de controlo, tendo como principal implicação para a prática clínica a promoção da segurança do doente. Com base na presente investigação, futuros trabalhos poderão focar-se na implementação desta formação não só a estudantes como a profissionais de saúde, nomeadamente a equipas de trabalho constituídas. Por outro lado, seria importante a integração desta temática em módulos curriculares estruturados e especializados em competências não-instrumentais no ensino de estudantes de enfermagem, e de outras áreas da saúde, na medida em que o desempenho clínico de alta qualidade envolve não só competências instrumentais, mas sobretudo competências não-instrumentais.Programa Doutoral em Psicologi

Nurses’ Perception of Discharging the Medically Complex Pediatric Patient

The purpose of this study is to query the nurses for their perceptions of the barriers and facilitators of discharging medically complex pediatric patients from a freestanding children’s hospital in central California. Using a mixed methods research design via an online survey, 90 nurses identified 3 distinct themes that act as barriers. Those barriers include: 1) knowing the plan of care, 2) time, and 3) disposition of the family. Several implications for improving the discharge process for medically complex patients and overcoming the identified barriers include strategies to improve multidisciplinary communication, implementation of a Family Learning Center, use of video interpreters when in-person interpreters are not available, and respect for discharge readiness. Recognizing and implementing the appropriate interventions based on nurses’ feedback have the potential to improve quality and patient safety

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

Critical Team Composition Issues for Long-Distance and Long-Duration Space Exploration: A Literature Review, an Operational Assessment, and Recommendations for Practice and Research

Prevailing team effectiveness models suggest that teams are best positioned for success when certain enabling conditions are in place (Hackman, 1987; Hackman, 2012; Mathieu, Maynard, Rapp, & Gilson, 2008; Wageman, Hackman, & Lehman, 2005). Team composition, or the configuration of member attributes, is an enabling structure key to fostering competent teamwork (Hackman, 2002; Wageman et al., 2005). A vast body of research supports the importance of team composition in team design (Bell, 2007). For example, team composition is empirically linked to outcomes such as cooperation (Eby & Dobbins, 1997), social integration (Harrison, Price, Gavin, & Florey, 2002), shared cognition (Fisher, Bell, Dierdorff, & Belohlav, 2012), information sharing (Randall, Resick, & DeChurch, 2011), adaptability (LePine, 2005), and team performance (e.g., Bell, 2007). As such, NASA has identified team composition as a potentially powerful means for mitigating the risk of performance decrements due to inadequate crew cooperation, coordination, communication, and psychosocial adaptation in future space exploration missions. Much of what is known about effective team composition is drawn from research conducted in conventional workplaces (e.g., corporate offices, production plants). Quantitative reviews of the team composition literature (e.g., Bell, 2007; Bell, Villado, Lukasik, Belau, & Briggs, 2011) are based primarily on traditional teams. Less is known about how composition affects teams operating in extreme environments such as those that will be experienced by crews of future space exploration missions. For example, long-distance and long-duration space exploration (LDSE) crews are expected to live and work in isolated and confined environments (ICEs) for up to 30 months. Crews will also experience communication time delays from mission control, which will require crews to work more autonomously (see Appendix A for more detailed information regarding the LDSE context). Given the unique context within which LDSE crews will operate, NASA identified both a gap in knowledge related to the effective composition of autonomous, LDSE crews, and the need to identify psychological and psychosocial factors, measures, and combinations thereof that can be used to compose highly effective crews (Team Gap 8). As an initial step to address Team Gap 8, we conducted a focused literature review and operational assessment related to team composition issues for LDSE. The objectives of our research were to: (1) identify critical team composition issues and their effects on team functioning in LDSE-analogous environments with a focus on key composition factors that will most likely have the strongest influence on team performance and well-being, and 1 Astronaut diary entry in regards to group interaction aboard the ISS (p.22; Stuster, 2010) 2 (2) identify and evaluate methods used to compose teams with a focus on methods used in analogous environments. The remainder of the report includes the following components: (a) literature review methodology, (b) review of team composition theory and research, (c) methods for composing teams, (d) operational assessment results, and (e) recommendations

Exploring A New Path For School Climate & Safety Assessment

The passage of the No Child Left Behind (NCLB) Act in 2001, ushered in a new era of federal oversight in state educational accountability systems. While the act may have succeeded in identifying schools in need of support and creating data systems to help inform parents and assist educators in establishing clear and consistent goals, the state accountability systems created under this law were widely criticized for their narrow academic focus and failure to include the holistic and multifaceted nature of school quality. In response, the federal government replaced NCLB in 2015 with The Every Student Succeeds Act (ESSA). The new law included a provision widely referred to as the “Fifth Indicator” of student success, which was to be non-academic in nature. To address this indicator in state accountability plans, the federal government specifically recommended several strategies, to include measures of school climate and safety. Despite this recommendation and despite decades of research to support its inclusion, only a handful of states have adopted such measures. As a result, schools and districts in most states are left to develop their own systems of school climate assessment and improvement. The primary purpose of this qualitative case study was to explore the efforts of a single Florida school district in their quest to develop such a system. The Sunshine School District (SSD) had begun looking at innovative ways to assess and improve school climate as the ESSA was passed. An instrument had been developed that was loosely based on research and had not been tested in school settings. This instrumental case study provided an in-depth examination of the literature and an analysis of archival data to help refine the instrument and prepare it for a pilot test in nine district schools. Through this study, a follow-up focus group with pilot participants was conducted to determine whether the instrument held promise as a means to assess school climate and safety, as well as drive improvement. Analysis of the data revealed participants found the instrument to be flexible, useful, and effective – particularly as it pertains to the assessment of school climate and safety practices and establishing improvement goals. The analysis additionally revealed the instrument can be lengthy and may not be equally applicable to all schools and grade levels. Although the instrument needs further refinement, pilot participants reported it to still be effective and beneficial as an informal assessment and improvement tool

Applying Gender Action Plan Lessons: A Three-Year Road Map for Gender Mainstreaming (2011- 2013)

This transition plan identifies key lessons from the implementation of the World Bank Group action plan, Gender Equality as Smart Economics (GAP), and sets out a proposal to improve the performance on Gender and Development. It seeks to strengthen the implementation of the Bank?s gender policy and places special emphasis on improving attention to gender in Bank instruments (CASs). It covers World Bank Group (WBG) operations from 2011 to 2013, and was produced on a request by the World Bank Board of Executive Directors. A GAP Three-year Progress Report accompanies this plan

Patient-Centered Care for Underserved Populations: Definition and Best Practices

Defines key components of patient-centered care for diverse, vulnerable populations, and describes how patient-centered philosophies can be incorporated into effective delivery models targeting the underserved. Provides recommendations for policymakers

A Systemic Approach to Building Resilience at Work: Exploring the Resilience of Individuals, Leaders, and Teams

This item is only available electronically.There is growing interest amongst practitioners and managers regarding strategies to increase resilience in the workplace. While the occurrence of resilience programs has been increasing over the past decade, research on measuring and conceptualising resilience is only in its infancy (Bardoel, Pettit, De Cieri & McMillan, 2014). A sound understanding of the current measures used to assess resilience within the workplace domain will help to inform approaches to building resilience with individuals and teams. Accordingly, a narrative review including 25 peer-reviewed articles explored how resilience is currently conceptualised and measured, and identified improvements that could be made to ensure organisations have access to valid and practical resilience tools. A range of issues are discussed and recommendations are made to improve the conceptualisation of resilience, selection of measurement tools, and areas requiring further exploration. Overall, this review serves as a resource to inform practitioners of the best available resilience measures to capture an organisations’ current capacity for resilience, or measure the efficacy of resilience training. Additionally, information on issues requiring further research is provided for scholars who are attempting to advance this line of inquiry.Thesis (M.Psych(Organisational & Human Factors)) -- University of Adelaide, School of Psychology, 201

Funding the Extraordinary: An Evaluation of The Kresge Foundation Arts and Culture Program's Institutional Capitalization Grantmaking

In undertaking an assessment of Kresge's Capitalization Program, NFF applied its own high-level framework to help answer Kresge's primary research questions and assess the progress of each grantee in meeting its stated capital targets. NFF has found that effective capitalization in the nonprofit sector requires attention to three key financial priorities: liquidity, adaptability and durability:1. Liquidity: Does the organization have adequate cash to meet its operating needs?2. Adaptability: Does the organization have flexible funds that allow it to make adjustments as circumstances change?3. Durability: Does the organization have sufficient resources to address the range of needs that it may face in future years?NFF's review of Kresge's grantees sought to assess capitalization by looking for evidence of organizational progress in building liquid funds for immediate operating needs, as well as longer-term balance sheet savings for adaptability and durability. NFF's evaluation of grantees involved a combination of data analysis and interviews