General Medicine ยท Medical Literature
The Association Between Nurses' Perceptions of Teamwork and Nurse and Patient Outcomes in Hospital Settings: A Systematic Review.
Abstract
Teamwork has been recognized as a potentially important organizational factor associated with nurse- and patient-related outcomes. Previous studies have been conducted to examine the association between nurses' perceptions of teamwork and various outcomes in hospital settings. However, no systematic review has yet summarized this evidence. Therefore, this study aimed to summarize the available evidence on the association between nurses' perceptions of teamwork and nurse and patient outcomes in hospital settings. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted using the keywords "teamwork," "group work," and "nurse," along with their synonyms, across PubMed, Scopus, Web of Science, CINAHL, and the Google Scholar search engine. The quality of selected studies was assessed using the Critical Appraisal Skills Programme (CASP) checklists. The narrative synthesis method was used to summarize and classify the results. A total of 33 studies met the inclusion criteria for this systematic review. The analysis identified two overarching themes: nurse-related outcomes and patient outcomes. Twenty-two studies (66.7%) reported that nurses' positive attitudes toward teamwork were associated with more favorable levels in 17 nurse outcomes, which were categorized into four groups: (1) job attitudes and retention; (2) patient safety attitudes and competency; (3) occupational stress, fatigue, and conflict; and (4) ethical values and moral practice. Additionally, fourteen studies (42.4%) reported that such attitudes were linked to more favorable patient-related outcomes, categorized as (1) nursing care processes; (2) adverse events reporting and occurrence; (3) quality and safety of care; and (4) patient-centered and caring behaviors. Teamwork may be considered an important factor associated with more favorable nurse and patient outcomes. To promote collaboration, hospital administrators and nursing educators may consider implementing strategies to support teamwork within clinical settings. Nevertheless, further research employing longitudinal and interventional designs is necessary to clarify causal pathways and better understand the relationship between teamwork and these outcomes.
Clinical relevance
In hospital settings, what is the association between nurses' perceptions of teamwork and nurse-related outcomes (e.g., job satisfaction, burnout, turnover intention) and patient-related outcomes (e.g., patient safety, adverse events, satisfaction)? __SNAPSHOT__ {"studyDesign":"Systematic review with narrative synthesis (PRISMA-compliant; no meta-analysis performed)","setting":"Hospital settings; international scope (specific countries of included studies not reported in available abstract)","sampleSize":"33 primary studies met inclusion criteria; aggregate participant numbers not reported in available abstract","population":"Registered nurses working in hospital settings across included primary studies; specific inclusion/exclusion criteria for individual study populations not reported in available abstract","intervention":"Nurses' perceptions of teamwork (exposure), as measured across included primary studies","comparator":"Not applicable (observational systematic review; no active comparator)","primaryOutcome":"Two overarching thematic categories: (1) nurse-related outcomes and (2) patient outcomes in hospital settings; specific sub-outcomes not fully reported in available abstract (abstract truncated)","followUp":"Not reported (varies by included primary studies)","fundingSource":"Not reported"}
Key findings
The systematic review identified 33 studies meeting inclusion criteria and organized findings into two overarching thematic domains: nurse-related outcomes and patient outcomes. The abstract provided to the reviewer was truncated prior to reporting specific sub-outcomes, findings, directionality of associations, effect sizes, confidence intervals, or p-values for any outcome category. Therefore, no quantitative findings, absolute or relative effect sizes, NNT/NNH, or specific adverse event rates can be summarized from the available abstract. Quality appraisal was performed using the Critical Appraisal Skills Programme (CASP) checklists. Synthesis methodology was narrative rather than statistical meta-analysis. No pooled estimates, heterogeneity statistics, or subgroup analyses are available from the supplied abstract.
Practice implications
IMPORTANT LIMITATION: Only a truncated abstract was available for review; the abstract ends mid-sentence before the specific findings of either thematic domain are described. What can be established from the available text is that: (1) this is the first systematic review to formally synthesize the evidence base linking nurses' perceptions of teamwork to both nurse-related and patient-related outcomes in hospital settings; (2) 33 primary studies satisfied pre-specified inclusion criteria; and (3) a narrative rather than meta-analytic approach was used, suggesting significant heterogeneity among included studies precluded statistical pooling. What cannot be established from the available text includes the directionality, magnitude, or consistency of associations between teamwork perceptions and specific outcomes; which patient populations or hospital types are most affected; whether any subgroup of nurses (e.g., by specialty, experience, or setting) showed differential associations; and whether the findings are sufficient to inform practice change. Clinicians and nurse leaders should await access to the full publication before drawing conclusions about specific outcomes or implementing changes based on this review. __LIMITATIONS__ The following limitations are identifiable from the supplied abstract and inherent study design: (1) Narrative synthesis methodology precludes calculation of pooled effect sizes, limiting the strength of causal inference. (2) Teamwork was assessed via nurses' self-reported perceptions rather than objective behavioral or structural measures, introducing potential social desirability and common method bias. (3) The abstract is truncated, preventing assessment of between-study heterogeneity, risk-of-bias distribution across the 33 included studies, geographic representativeness, publication bias evaluation, or the specific outcomes identified within each thematic domain. (4) Inclusion of studies from varied international settings with differing healthcare systems, team structures, and cultural norms for teamwork may limit the generalizability and coherence of synthesized findings. (5) Restriction to studies measuring nurses' perceptions (rather than observed or objectively measured teamwork) may introduce systematic measurement bias. (6) Funding source is not reported, preventing assessment of potential conflicts of interest. (7) PROSPERO registration status is not confirmed in the available abstract. __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ This is the first systematic review to synthesize evidence on the association between nurses' perceptions of teamwork and both nurse-related and patient-related outcomes in hospital settings, identifying 33 eligible studies and organizing findings into two thematic domains. The abstract provided is truncated before specific findings are reported, making it impossible to determine the direction, magnitude, or clinical importance of any associations at this time. Clinicians and nursing leaders should obtain and review the full publication before applying these findings to organizational decision-making or practice.