Four-Hour Teamwork Workshop Boosts Nursing Students’ Safety Communication Skills

Communication failures remain one of the most persistent and preventable threats to patient safety in modern healthcare. More than two decades after the landmark Institute of Medicine report To Err Is Human drew global attention to avoidable harm, unsafe care continues to be driven in large part by breakdowns in how clinical teams share information, escalate concerns and coordinate under pressure. Speaking up about a deteriorating patient, handing over critical details at shift change and redistributing workload during a crisis all depend on teamwork behaviours that are rarely taught explicitly. Now, new research from China suggests that even a single, carefully structured afternoon of training can begin to change how nursing students think about teamwork and how much they know about structured communication.

The study, published in the open-access journal Nursing Open, evaluated a four-hour TeamSTEPPS-based patient safety workshop delivered to third-year undergraduate nursing students at Chongqing Medical University. TeamSTEPPS, which stands for Team Strategies and Tools to Enhance Performance and Patient Safety, is an evidence-based teamwork system developed jointly by the United States Department of Defense and the Agency for Healthcare Research and Quality. It translates decades of research on team performance into teachable, observable behaviours organised around four core skills: communication, leadership, situation monitoring and mutual support. In its current version, TeamSTEPPS 3.0 operationalises these skills through practical tools such as SBAR for structured handovers, call-out and check-back for closed-loop communication, brief, huddle and debrief for leadership processes, and techniques such as the two-challenge rule and CUS for asserting concerns assertively.

Previous research involving nursing students has generally required far more extensive interventions. Some studies combined TeamSTEPPS training with simulation across multiple sessions, others embedded the material longitudinally throughout an entire baccalaureate curriculum, and one integrated ten hours of simulation-based training at designated points across a programme. In China specifically, undergraduate nursing education has tended to focus on individual communication strategies rather than comprehensive teamwork systems, with one notable study improving interprofessional communication knowledge through an ISBARR intervention. This left an important gap in the evidence: could a compact, stand-alone workshop produce measurable immediate gains, particularly when assessed with both a validated teamwork perception instrument and a content-specific knowledge test?

To answer that question, researchers designed a single-group pretest-posttest quasi-experimental study. Fifty-three third-year students were recruited, all of whom had completed foundational nursing courses and a one-month clinical observation placement in the university-affiliated hospital, and fifty-one provided matched pre- and post-intervention data for the paired analyses, a response rate of 96.2 percent. The cohort was predominantly female, with a mean age of 20.15 years. The workshop took place in October 2024 at the clinical teaching and simulation centre of the First Affiliated Hospital of Chongqing Medical University and was led by an associate professor of nursing with extensive clinical experience, supported by two postgraduate teaching assistants, all formally trained in TeamSTEPPS.

The pedagogical design was tightly sequenced around experiential learning and deliberate practice principles. Students were randomly allocated to five small groups and began with a collaborative icebreaker that surfaced existing teamwork habits. Each of the four TeamSTEPPS modules then followed the same rhythm: participants first responded to an acute or critical care crisis case using their intuitive approach, then received focused instruction through short lectures, video examples and discussion of positive and negative exemplars, practised the relevant structured tools in a second deliberate simulation of the same case, and closed with self-reflection and facilitator feedback. Group points encouraged active participation throughout. This structure meant students could directly compare an unstructured response with a structured team response and apply feedback immediately, rather than merely learning terminology in a passive lecture format.

Teamwork perceptions were measured with the Chinese version of the TeamSTEPPS Teamwork Perceptions Questionnaire, a 35-item instrument spanning team structure, leadership, situation monitoring, mutual support and communication, rated on a five-point scale. Knowledge was assessed with a researcher-developed 30-item test covering TeamSTEPPS concepts and workshop case content, scored out of 100. Both measures were completed within two weeks before and within two weeks after the workshop, with anonymous codes used to pair individual responses. The researchers are careful to note that this locally developed test should be interpreted as a proximal learning measure rather than an established competence instrument.

The results were statistically significant and, in places, striking. The overall T-TPQ score rose from 149.06 to 159.45, a mean gain of 10.39 points, with a paired-samples effect size of 0.66, a moderate and educationally meaningful change. Every one of the five domains improved. The largest standardised gains appeared in mutual support, communication and situation monitoring, each with effect sizes between 0.59 and 0.65, while leadership improved by 0.53 and team structure by a smaller but still significant 0.33. Knowledge scores also increased significantly, from an average of 80.14 to 87.33 points, a gain of 7.20 points with an effect size of 0.39. The knowledge effect was smaller, which the authors attribute partly to high baseline performance and the sensitivity limits of a locally developed test.

The domain-specific pattern offers a genuinely interesting insight into what brief training can and cannot change. Communication, mutual support and situation monitoring are built from explicit, rehearsable behaviours such as call-outs, check-backs, cross-monitoring and the CUS assertiveness script, which can be demonstrated, practised and corrected within a single session. Team structure, by contrast, encompasses broader understandings of roles, responsibilities, hierarchy and accountability that are shaped by the wider curriculum and clinical culture, and its comparatively high baseline score may also have limited observable change. In effect, the workshop appeared particularly well suited to introducing a shared, concrete vocabulary for escalation, information verification, workload redistribution and speaking up, rather than transforming system-level role perceptions after one exposure.

The authors are appropriately cautious about interpretation. Because the study used a single-group design without a control condition, testing effects, maturation, concurrent learning and observer effects cannot be excluded, and the short-term follow-up window says nothing about whether gains persist. The outcomes were self-reported perceptions and knowledge rather than observed behaviour, so no claims can be made about clinical performance or patient outcomes; in training-evaluation terms, the evidence sits at the level of short-term learning rather than behavioural transfer. The cohort was also drawn from a single institution and was almost entirely female, limiting generalisability. Within those constraints, the study’s central contribution is to demonstrate that a brief, nursing-focused, scenario-based format can produce measurable immediate changes across both a validated teamwork measure and a content-specific knowledge assessment, something the prior literature had not clearly established.

The practical implications for nursing education are considerable. A four-hour workshop can function as an entry module within an existing curriculum without requiring a new semester-long course, and the authors sketch a plausible integration pathway: introducing briefs, huddles and speaking-up strategies in patient safety and management courses, embedding SBAR and check-backs into deterioration recognition and handover exercises, writing TeamSTEPPS behaviours explicitly into simulation objectives and debriefing prompts, and running a refresher before clinical placements. They emphasise, however, that the workshop should be treated as initial structured exposure rather than a complete teamwork curriculum, and that longitudinal reinforcement through progressively complex simulations and clinical placement prompts is likely to be essential for durable transfer, a view consistent with studies showing that curriculum-wide and reinforced TeamSTEPPS programmes yield stronger and more sustained outcomes. Future research, they argue, should move to controlled multi-centre designs with active comparison groups, follow-up assessments extending to twelve months, blinded behavioural observation using the TeamSTEPPS Team Performance Observation Tool, and interprofessional adaptations involving medical and other health-profession students. If those trials confirm and extend these findings, a single afternoon of structured teamwork training could become a standard, low-cost first step in preparing the next generation of nurses to communicate clearly when patients’ lives depend on it.

Subject of Research: Effects of a brief TeamSTEPPS-based patient safety workshop on nursing students' teamwork perceptions and communication knowledge

Article Title: Effects of a TeamSTEPPS‐Based Patient Safety Workshop on Undergraduate Nursing Students' Teamwork Perceptions and Communication‐Related Knowledge

Article References: Yin, Y., Tang, W., Li, Y., Ye, H., Zhang, Y., Wu, X., Wan, L., & Huang, E. (2026). Effects of a TeamSTEPPS ‐Based Patient Safety Workshop on Undergraduate Nursing Students' Teamwork Perceptions and Communication‐Related Knowledge. Nursing Open, 13(9), Article e70825. https://doi.org/10.1002/nop2.70825

Image Credits: AI Generated

DOI: 10.1002/nop2.70825

Keywords: TeamSTEPPS, patient safety, nursing education, teamwork, communication, undergraduate nursing students, simulation training, closed-loop communication, SBAR, teamwork perceptions, quasi-experimental study, Chongqing Medical University