Publication Date




Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Nursing (Nursing)

Date of Defense


First Committee Member

Doris Ugarriza

Second Committee Member

David Birnbach

Third Committee Member

Joseph De Santis

Fourth Committee Member

Karina Gattamorta


Teamwork and communication failures contribute substantially to healthcare associated errors which are cited to cost over $17 billion dollars a year in the U.S alone. Teams are being used more often to delivery care because they are thought to improve the effectiveness, efficiency of care, as well as decrease costs. Teamwork and communication are critical to patient safety however, the benefits of a team-based approach to deliver healthcare has not been fully realized. Improving the understanding of the factors that affect team successes and failures is needed to advance team functioning and decrease teamwork and communication associated errors. The influence of team cohesion on performance is well established outside healthcare; however, research on the impacts of these variables in healthcare is lacking. A convenience sample of nursing and medical students participating in an inter-professional simulation-based patient safety course was used for this study. A time series design was employed to explore relationships between time and cohesion, performance and cohesion and differences in cohesion by gender and intended profession. Mid-week cohesion was found to predict post course cohesion (p < .001) and team performance (p = .010). No differences in cohesion by gender or intended profession were found. Healthcare research, including findings of this study, point toward cohesion as an element necessary for successful team functioning. Cohesion promotes higher levels of quality care, better patient satisfaction, and reduces staff stress and turnover. Cohesion plays an essential role in strengthening effective team qualities (communication, situation monitoring, conflict resolution, and shared goals) that directly contribute to the formation of a strong culture of safety. Healthcare leaders and educators should recognize cohesion as a critical group factor and put effort toward developing practices that encourage team cohesion in order to reduce healthcare associated errors.


Interprofessional; cohesion; teams; simulation; patient safety