Table_1_What Is Teamwork? A Mixed Methods Study on the Perception of Teamwork in a Specialized Neonatal Resuscitation Team.DOCX

IntroductionNeonatal resuscitation is a team-based activity involving many decisions and tasks. Non-technical factors, such as teamwork, are increasingly recognized as impacting how well-neonatal resuscitation is performed, and therefore influencing infant outcomes. Prior studies on teamwork in neonatal resuscitation have focused on quantification of teamwork behaviors, or the effects of team training. This study aimed to explore healthcare providers' own perception of teamwork in this specialized environment to identify perceived barriers and facilitators to effective team functioning.
MethodsThis single-center exploratory sequential mixed methods study used two phases. First, semi-structured interviews were conducted, and thematic analysis used to identify themes. Subsequently, interview data informed the development of quantitative surveys to explore selected themes in the wider team.
ResultsFrom ten semi-structured interviews, seven themes were identified including: (1) Team Composition, (2) Effective Communication, (3) Team leadership, (4) Hierarchy, (5) Team Training, (6) Debriefing, and (7) Physical Environment. Perceived teamwork facilitators include role assignment, familiarity, team composition, talking out loud to maintain shared mental models, leadership, and team training. Perceived barriers included time pressures, ad hoc team, ineffective leadership, and space limitations. Selected themes (Communication, Speaking up, Hierarchy, and Leadership) were further explored via electronic surveys distributed via email to all members of the resuscitation team. There were 105 responses; a response rate of ~53%. All respondents agreed or strongly agreed that speaking up is important; however, not all felt comfortable doing so. Neonatal fellows (14%) and nurses (12%) were most likely to report not feeling comfortable speaking up. All respondents agreed that team communication is important to an effective resuscitation. Most respondents (91.5%) agreed that a hierarchy exists within the team; 54.3% believed that hierarchy positively contributes to effective resuscitation. All respondents agreed or strongly agreed that having a clearly defined leader is important in delivery room resuscitations. Ineffective leadership was the most cited reason for poor team communication.
ConclusionsIn this mixed methods study of perceptions of teamwork within a specialized, multi-disciplinary neonatal resuscitation team, communication, hierarchy, and leadership were positively perceived and facilitates teamwork. However, even in this environment, some nurses and trainees expressed discomfort with speaking up.

引言
新生儿复苏（Neonatal Resuscitation）是一项以团队为核心的工作，涵盖多项决策与操作任务。诸如团队合作在内的非技术因素，其对新生儿复苏执行质量的影响正日益受到学界认可，并进而影响新生儿的预后结局。既往针对新生儿复苏中团队合作的研究，多聚焦于团队合作行为的量化分析，或是团队培训的干预效果。本研究旨在探讨医疗从业者在这一专业场景中对团队合作的主观认知，以明确有效团队运作的感知障碍与促进因素。

方法
本研究为单中心探索性序贯混合方法研究（mixed methods study），分为两个阶段：第一阶段开展半结构化访谈（semi-structured interviews），采用主题分析法（thematic analysis）提炼核心主题；随后基于访谈所得数据开发量化调查问卷，以在更大范围的团队中探究选定的主题。

结果
通过10次半结构化访谈，本研究共识别出7项核心主题，分别为：（1）团队构成（Team Composition）、（2）有效沟通（Effective Communication）、（3）团队领导力（Team Leadership）、（4）层级结构（Hierarchy）、（5）团队培训（Team Training）、（6）复盘（Debriefing）、（7）物理环境（Physical Environment）。
研究识别出的团队合作促进因素包括：角色分配、团队成员熟悉度、团队构成、通过口头沟通维持共享心智模型（shared mental models）、领导力以及团队培训。感知到的障碍则包括时间压力、临时组建的团队、领导力低效以及空间限制。
研究通过电子邮件向所有复苏团队成员发放电子调查问卷（electronic surveys），进一步探究选定的主题（沟通、主动发声、层级结构与领导力）。本次调查共回收有效问卷105份，回收率约为53%。所有受访者均认同或非常认同"主动发声至关重要"这一观点，但并非所有人都敢于主动发声。其中，新生儿专科医师（14%）与护士（12%）报告不敢主动发声的比例最高。
所有受访者均认同团队沟通对高效复苏的重要性。绝大多数受访者（91.5%）认同团队内部存在层级结构，其中54.3%认为层级结构对高效复苏具有积极作用。所有受访者均认同或非常认同"在产房复苏中配备明确的团队领导者至关重要"这一观点。领导力低效是被提及最多的团队沟通不畅的诱因。

结论
本项针对多学科专业新生儿复苏团队的混合方法研究显示，受访者对团队沟通、层级结构与领导力均持有积极认知，这些因素可促进团队合作。但即便在这一专业场景中，仍有部分护士与受训人员坦言不敢主动发声。