NURS 524 Week 5 The Influence of Teams on Patient Outcomes Paper Example

The Influence of Teams on Patient Outcomes: What a Postpartum Hemorrhage Drill Taught Our Labor and Delivery Unit

Introduction

Kelly and Tazbir (2014) describe a team as a small group of people with complementary skills who share a purpose and hold themselves mutually accountable for results. That definition sounds simple, but I did not understand it fully until I saw the same group of people on my labor and delivery unit respond to two similar emergencies a year apart, once as a collection of skilled individuals and once as a team. This paper describes those two experiences, explains the difference using the course readings, reviews recent evidence on how team training affects patient outcomes, and reflects on what I have learned about my own role in teams.

The First Hemorrhage

Three years ago, a patient on our unit began hemorrhaging about twenty minutes after a vaginal birth. I was her nurse. I recognized the bleeding quickly and called for help, and within two minutes the room filled with people: two other nurses, the charge nurse, a resident, the attending obstetrician and an anesthesiologist. Everyone was competent, and everyone was busy. Two nurses started second IV lines at the same time, nobody was weighing the blood loss, the uterotonic medications were drawn up twice, and the request for blood products was made by the resident and then again by the charge nurse, which confused the blood bank. I kept fundal massage going and could not see who was in charge. The patient recovered after a transfusion of four units, but the debrief afterward was quiet and uncomfortable, because we all knew the response had been slower and more chaotic than it should have been.

The Second Hemorrhage

After that event, our unit manager and the obstetric chief began monthly in-situ drills for postpartum hemorrhage, run on the unit with whoever was working. Each drill assigned roles by position on a laminated card: the primary nurse, a medication nurse, a recorder who quantified blood loss and kept time, a runner for the blood bank, and a single leader who called out the stage of hemorrhage. We practiced closed-loop communication, in which every order is repeated back and confirmed. About a year later, I was the charge nurse when another patient began to bleed heavily after birth. The difference was immediate. The primary nurse announced the hemorrhage and stage, the attending stepped into the leader role, the recorder began weighing pads, and I took the runner role and called the blood bank once. Medications were drawn once and given in sequence with each one confirmed aloud. The people in the room were mostly the same as the year before; what had changed was that they had practiced being a team. The patient's bleeding was controlled with medications and a balloon device without a transfusion.

Explaining the Difference

The course readings help explain what changed. Kelly and Tazbir (2014) emphasize that effective teams need clear roles, open communication and shared goals, and in the first hemorrhage we had the goal but neither the roles nor the communication. Everyone acted on individual expertise, which produced duplication in some tasks and gaps in others. Porter-O'Grady and Malloch (2016) describe team leadership in complex situations as coordinating the contributions of many members rather than directing every action, and the role cards gave us exactly that: a leader who coordinated and members who knew what they owned. Practice also built trust. In the second event, I did not hesitate to say "I have the blood bank," because I knew the team expected me to.

What the Evidence Shows

Research on team training supports what I saw, while also cautioning against overstating it. Brogaard et al. (2022) pooled 21 studies, four randomized trials and 17 cohort studies, comparing obstetric emergency team training with no training in high-resource settings. Annual training may reduce brachial plexus injury in newborns, based on cohort studies, though the reviewers rated their confidence in that finding as low, and its effect on low Apgar scores was not statistically significant. The effects on several other outcomes, including hypoxic ischemic encephalopathy, were unclear. That pattern suggests team training is beneficial for some outcomes but is not a guarantee.

A broader review reached a similar conclusion. Schram et al. (2026) synthesized 18 controlled studies of postgraduate simulation-based team training in acute care and found that many studies reported improvement in at least one outcome domain, but results were inconsistent, overall certainty was low, benefits were more often seen in lower-resource settings, and brief training produced fewer effects. The authors argued that the question is not whether team training works but how it is designed. Our unit's monthly, on-unit drills with defined roles fit the kind of sustained, realistic training their review suggests is more likely to help.

Evidence from emergency departments points the same way. Looking across sixteen emergency department evaluations, Alsabri et al. (2022) judged structured courses in crisis resource management, and TeamSTEPPS in particular, to have done the most for safety culture, although the studies varied widely in design and in how they measured results.

What I Learned About My Role

These experiences changed how I see my own part in teams. In the first hemorrhage, I was a good nurse who did my task well and waited for someone else to organize the room. In the second, I understood that every member, not only the leader, carries responsibility for how the team functions, from claiming a role aloud to repeating back an order. As a future leader, I want to build that kind of preparation into any unit I lead, with regular practice, clear roles and debriefs that focus on the system rather than blame. I also want to remember that drills take time from busy schedules and need visible support from leaders to continue.

Conclusion

The same skilled people produced a chaotic response and a coordinated one a year apart, and the difference was teamwork built through practice. Recent reviews show that team training can improve some patient outcomes, though the evidence is mixed and depends on design. Paul's picture of one body with many parts, each needed and each doing its own work (English Standard Version Bible, 2001/2016, Romans 12:4-5), describes what our unit learned: a team is not a crowd of experts but a body that knows how its parts fit together.

References

Alsabri, M., Boudi, Z., Lauque, D., Dias, R. D., Whelan, J. S., Östlundh, L., Alinier, G., Onyeji, C., Michel, P., Liu, S. W., Jr., Camargo, C. A., Jr., Lindner, T., Slagman, A., Bates, D. W., Tazarourte, K., Singer, S. J., Toussi, A., Grossman, S., & Bellou, A. (2022). Impact of teamwork and communication training interventions on safety culture and patient safety in emergency departments: A systematic review. Journal of Patient Safety, 18(1), e351-e361. https://doi.org/10.1097/PTS.0000000000000782

Brogaard, L., Glerup Lauridsen, K., Løfgren, B., Krogh, K., Paltved, C., Boie, S., & Hvidman, L. (2022). The effects of obstetric emergency team training on patient outcome: A systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica, 101(1), 25-36. https://doi.org/10.1111/aogs.14263

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Kelly, P., & Tazbir, J. (2014). Essentials of nursing leadership and management (3rd ed.). Delmar Cengage Learning.

Porter-O'Grady, T., & Malloch, K. (2016). Leadership in nursing practice (2nd ed.). Jones & Bartlett Learning.

Schram, A., Lauridsen, K. G., Krogh, K., Nielsen, R. P., Brogaard, L., Hvidman, L., Thim, S., & Lindhard, M. S. (2026). Simulation-based team training effects on clinical performance and patient outcomes: Systematic review of controlled studies. Simulation in Healthcare. Advance online publication. https://doi.org/10.1097/SIH.0000000000000965