Additional Staff Research Articles

Making clear and effective communication SOuND BETTeR for patients with communication barriers.

The consequences of ineffective communication between patients and clinicians in the ED range from frustration to significant adverse events. Unfortunately, scenarios where we are unable to understand what our patient is saying to us are common, due to a multitude of factors including acute illness, disability and patient diversity. Current communication aids can be difficult to access and use in the Emergency setting due to lack of physical resources, specific training and time. Our aim was to develop a communication tool which allowed for the rapid identification of urgent patient needs. In order to overcome current challenges, the tool had to be resource-light, quick to use and not reliant on additional staff training or patient education for its effective use. The SOuND BETTeR communication tool is a list of yes/no questions, formatted as a mnemonic, which aims to identify the most common and urgent needs of patients in the ED. As the list of potential needs is not exhaustive, the tool does not purport to replace formal communication aids in the medium and long term, but to bridge the gap often left in the ED where urgent needs must be met and more formal communication aids are not yet available. The tool can effectively and quickly identify important needs in patients with expressive communication barriers such as those with aphasia, facial trauma and on non-invasive ventilation. In addition, the tool can be modified for use in patients with non-English speaking backgrounds. At this stage the tool has not yet been prospectively validated.

A qualitative study on the implementation of a transdiagnostic cognitive behavioral therapy for children in a child welfare residential treatment program

BackgroundYouth with severe emotional or behavioral issues who are involved with child welfare authorities are sometimes placed in intensive care services in a residential treatment program. Evidence-based psychotherapies are often used in residential treatments, but there is very little research on how to adapt psychotherapy for residential treatment. ObjectiveTo describe the implementation of a transdiagnostic cognitive behavioral therapy (the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children) in a residential treatment program for children. Participants and settingStaff (n = 20) at a residential facility in Calgary, Canada. MethodsA combination of qualitative interviews and focus groups were conducted before and after therapy to identify barriers and facilitators to implementation. Data were analyzed and reported using the Consolidated Framework for Implementation Research and the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies. ResultsModifications were made to the program including creating inclusive language, integrating relevant content targeting pediatric irritability, delivering sessions online for caregivers, and using additional staff to support youth to learn and practice the application of the content and behavioral interventions. Key barriers to implementation of the Unified Protocol included staff turnover and the difficulty of sustaining a critical mass of knowledge surrounding the Unified Protocol. The major facilitators to implementation were the perceived quality of the program and advantages of the program to children and their caregivers. ConclusionsThis study supports the feasibility and acceptability of providing transdiagnostic cognitive behavioral therapies for children in residential treatment and provides a template for how to implement evidence-based practice in residential treatment.

Education-related needs for children with cystic fibrosis: Perspectives of US pediatric care teams.

Patients with cystic fibrosis (CF) often bring education-related concerns to their medical teams. Concerns around the ability for CF care teams to identify and address these concerns exist. We sought to describe CF care team perceptions of (1) patient and family education-related needs, (2) how these needs are identified, documented and addressed, and (3) education-related resource gaps. A survey was emailed to pediatric care teams in the CF Foundation Care Center Network in April 2022. Individuals or care teams could complete the survey. Responses were aggregated for descriptive analysis. Sixty-seven programs responded representing 52% of United States pediatric CF centers. Most centers (88%) indicated social workers primarily address school concerns. Care teams often complete school forms (99%), coach families to communicate with schools (96%), communicate with schools directly (90%), and develop educational plans (76%). Formal education risk assessment and support programs are relatively uncommon (19%). Common student-specific needs include carrying medications (75%) and leaving class for gastrointestinal issues (54%). Needs reported are informational materials for families and schools (94%), staff education about school concerns and how to address them (91%), additional staff for education-related issues (65%), and expertise in education plan development (62%). CF care teams often lack comprehensive resources to identify and address education-related concerns. Systematically performing needs assessments, improving training for providers, and evaluating the benefits of education specialists on care teams may better identify and address education-related needs. Supporting educational progression will foster continued independence and well-being in adulthood.

Communicating with Your Department Chair: A Primer on How to Advocate for Your IR Section.

Many interventional radiologists express concern about communicating their practice needs to their radiology department chairs. As a result, they may have difficulty getting support for hiring of additional physicians and staff, capital investments in equipment, and marketing of IR services. Some perceive that chairs have a preference for diagnostic radiology initiatives over interventional and want to know why. More importantly, they want to know how to approach their chair and succeed in their advocacy for IR. The key to success is understanding the perspective of the chair and the pressures and demands they face. That understanding allows the IR to propose their initiatives in a form that helps address some of the chair's needs and thus eases their path to success.

Impact of Workflow and Educational Interventions on MR Safety in Radiation Oncology.

Magnetic resonance imaging (MRI) is becoming increasingly integrated into radiation oncology (RO) departments with the use of MRI-Linacs and MRI simulation. Due to the number of implants in patients with cancer, adoption of comprehensive patient screening and MR safety workflows in RO is critical. Identifying MR unsafe implants only at the time of MRI simulation leads to same-day cancellations, potentially delaying treatment, and can risk MR safety events (SEs). This quality improvement study evaluated the impact of workflow and educational interventions on MR safety in RO at a single institution. In an effort to decrease same-day cancellations and improve safety surrounding use of a 3 Tesla MRI simulator at an academic center, three plan-see-do-act (PDSA) cycles were implemented from 4/18/22 - 1/19/23. MR safety oversight for the simulator was provided by a multidisciplinary team, with input from both radiology and RO. PDSA cycle 1 implemented a two-screen functional workflow, adapted from radiology at the same institution. The first screen is completed by the practice coordinator (PC) at the time of scheduling to triage high-risk patients into a work queue (WQ) for further evaluation by the MR safety team. The second screen is performed by the MR technologist (MRT) at the point of care. PDSA cycle 2 involved education for PCs. PDSA cycle 3 was a second PC educational intervention including a visual aide to assist with WQ use. Efficacy was determined by the number of same-day cancellations, patients in the WQ (a measure of the number of patients identified at the initial screen as having an implant), and SEs in each PDSA cycle. PDSA cycle 1 spanned 56 workdays during which 91 MR simulations were scheduled with 6 cancellations (6.5%). PDSA cycle 2 spanned 84 days during which 173 MR simulations were scheduled with 18 cancellations (10.4%). PDSA cycle 3 spanned 39 workdays and had 94 MR simulations, with 7 cancellations (7.4%). The cancellation rate during each PDSA cycle was 0.11, 0.21, and 0.17 cancellations/day, respectively. The number of patients in the WQ during each PDSA cycle, representing successfully screened high-risk patients, was 0, 0, and 3, respectively. There were no SEs during the study. In this study, an MR safety workflow from radiology was successfully implemented in RO. There were no SEs during the study, but the number of patients successfully screened as high-risk and placed in the WQ increased after repeat PC education. Further increases in WQ use would decrease the demand for implant assessment at point of care, which could decrease burden on the MRT, same day cancellations, and potentially SEs. This will be especially important if case load increases. Future work could expand educational efforts to additional staff.

CHILDREN WITH A MIGRATION HISTORY IN THE EDUCATIONAL SYSTEM OF ORENBURG REGION

Schools and kindergartens of Orenburg region, as well as many other regions of Russia, from the early 2000s began to accept children from migrant families of Central Asia and Transcaucasia for education. In the 2010s, this trend intensified, and classes began to be filled with already significant groups of children whose families had moved to the region over the past ten years. Orenburg Region is multinational in itself, so the influx of non-ethnic migrants only increased the multicultural nature of children’s and pedagogical collectives.
 
 The purpose of the study is to determine the level of linguistic and socio-cultural adaptation of children with a migration history in the region, the degree of readiness of Orenburg region educational organizations to receive foreign minors and to form ideas about the attitudes of migrant families and students themselves for full socio-cultural integration into the Russian society.
 
 Methods and materials. The source base of the study was made by statistical materials on migration processes, in-depth interviews and conversations with teachers and administration of educational organizations in Orenburg region, diagnostic examination of non-native speaking schoolchildren in three educational organizations of the region using a special technique.
 
 The scientific novelty of the research lies in combination of applied ethnographic tools with the study of the current situation in the educational system of the region. The authors answer the problematic question: how to organize the work on linguistic and socio-cultural adaptation of foreign-speaking students, depending on the proportion of children with a migration history at school, the level of teachers’ education and qualification on the example of specific educational institutions in the cities Orenburg and Orsk, a suburban district of Orenburg region.
 
 Study results. The data collected in a number of Russian cities in 2021–2022, including in the region under study, are analyzed, which give the opportunity to assert that the proportion of children from migrant families in school and the native language of foreign-speaking children are not the determining factors in the progress of linguistic and socio-cultural adaptation by means of education. The article gives a description of an approximate distribution of students with a migration history participating in the study in four groups, depending on the recommended model of language adaptation. The factor that significantly complicates the activities on linguistic and socio-cultural adaptation of migrant children in the conditions of the Orenburg region is emphasized: this is a “pendulum” migration, as well as long summer and winter holidays, when parents send their children to their homeland “to grandparents”, not really considering the need to support language practice. The data obtained during the study indicate that the majority of students with a migration history in Orenburg region associate their future with Russia: it is very important to support such children at the initial stage of adaptation and training in a Russian school, because, as a rule, they will be motivated to successfully study and move up the social ladder if the language barrier is overcome.
 
 Conclusions. In general, the experience of many years of positive interethnic interaction accumulated in Orenburg region and reasonably structured national and migration policies create the basis for successful adaptation and integration of migrant families arriving in the region. However, if we talk about the educational system of Orenburg region, then in order to successfully solve the tasks of linguistic and socio-cultural adaptation of children with a migration history, Orenburg region schools need additional staff and financial support.

Applying the R = MC2 implementation science heuristic to assess the impact of readiness on reach and implementation of a population-wide genomic screening program.

Population-wide genomic screening for genes that have high penetrance and clinical actionability enhances the opportunity to identify individuals at risk for developing hereditary conditions. Organizational readiness has been shown to influence the likelihood of successful implementation of complex initiatives such as the integration of population-wide genomic screening in clinical settings. We use the organizational readiness heuristic R = MC2 to better understand three factors that influence readiness for implementation of In Our DNA SC, a population-wide genomic screening program: motivation to implement, general capacity of an organization, and innovation-specific capacities. We then assessed the influence of these readiness factors on implementation outcomes of reach (measured through enrollment rate) and implementation (measured through the number of DNA samples collected). Data were collected pre-implementation and captured during the three-month pilot phase of the In Our DNA SC program. We collected administrative data from the electronic health record and quantitatively captured elements of readiness through surveys distributed to provider champions and clinical administrative champions at the 10 sites implementing the population-wide genomic screening program. We facilitated innovation-specific capacity through training offered at each site, as well as technical assistance through weekly meetings with other implementing sites, and resources available to all staff. Forty percent of provider champions attended training and 80% of administrative champions attended training. An average of 3.7 additional staff were trained at each implementing site. Satisfaction with training positively influenced reach (β = 0.0121, p = 0.0271) but did not impact implementation. Provider engagement (innovation capabilities) was associated with reach (β = 0.0020, p = 0.0251) and clinical administrator engagement was associated with sample collection rate (β = 0.2599, β = 0.038). Readiness to change is considered one of the most important factors in understanding the potential opportunity for implementation. We found that motivation to adopt a population-wide genomic screening program positively impacted the program's reach. The type of champion influenced discrete outcomes, with provider champions positively impacting reach and administrative champions influencing implementation (assessed through sample collection rate). As genomics continues to be integrated into clinical practice, it will be important to understand the contextual factors that influence readiness for implementation and design support throughout the life-course of implementation to ensure the success of large-scale, complex initiatives.

Perspectives of patients and clinicians on older patient mobility on acute medical wards: a qualitative study

BackgroundLow mobility during an acute care medical hospitalization is frequent and associated with adverse outcomes, particularly among older patients. Better understanding barriers and facilitators to improve mobility during hospitalization could help develop effective interventions. The goal of this study was to assess barriers and facilitators to older medical patients’ hospital mobility, from the point of view of patients and clinicians, to develop a framework applicable in clinical practice.MethodsWe conducted a qualitative study in one university and two non-university hospitals of two different language and cultural regions of Switzerland, including 13 focus groups (FGs; five with patients, eight with clinicians). We included 24 adults aged 60 years or older hospitalized on an acute general internal medicine ward of one of the three participating hospitals during the previous years, and 34 clinicians (15 physicians, nine nurses/nursing assistants, 10 physiotherapists) working on those wards. The FG guides included open-ended questions exploring mobility experiences, expectations, barriers and facilitators to mobility, consequences of low mobility and knowledge on mobility. We applied an inductive thematic analysis.ResultsWe identified four themes of barriers and facilitators to mobility: 1) patient-related factors; 2) clinician-related factors; 3) social interactions; and 4) non-human factors. Clinician-related factors were only mentioned in clinician FGs. Otherwise, subthemes identified from patient and clinician FGs were similar and codes broadly overlapped. Subthemes included motivation, knowledge, expectations, mental and physical state (theme 1); process, knowledge – skills, mental state – motivation (theme 2); interpersonal relationships, support (theme 3); hospital setting – organization (theme 4).ConclusionsFrom patients’ and clinicians’ perspectives, a broad spectrum of human and structural factors influences mobility of older patients hospitalized on an acute general internal medicine ward. New factors included privacy issues and role perception. Many of those factors are potentially actionable without additional staff resources. This study is a first step in participatory research to improve mobility of older medical inpatients.

Prospective Randomized Comparison of Endoscopist-facilitated Endotracheal Intubation and Standard Intubation for ERCP.

Complex endoscopic procedures are increasingly performed with anesthesia support, which substantially impacts endoscopy unit efficiency. ERCP performed under general anesthesia presents unique challenges, as patients are typically first intubated, then transferred to the fluoroscopy table and positioned semi-prone. This requires additional time and staff while increasing the potential for patient/staff injury. We have developed the technique of Endoscopist-facilitated intubation using an endotracheal tube backloaded onto an ultraslim gastroscope as a potential solution to these issues and evaluated its utility prospectively. Sequential patients undergoing ERCP were randomized to Endoscopist-facilitated intubation or to Standard intubation. Demographic data, patient/procedure characteristics, endoscopy efficiency parameters and adverse events were analyzed. During the study period, 45 ERCP patients were randomized to either Endoscopist-facilitated intubation (n=23) or Standard intubation (n=22). Endoscopist-facilitated intubation was successful in all patients, without hypoxic events. Median time from patient arrival in room to procedural start was shorter in patients undergoing Endoscopist-facilitated intubation vs Standard intubation (8.2 min vs. 29 min, p<0.0001). Endoscopist-facilitated intubations were brisker than Standard intubations (0.63 min vs. 2.85 min, p<0.0001). Endoscopist-facilitated intubation patients reported less post-procedure throat discomfort (13% vs. 50%, p<0.01) and fewer myalgias (22% vs. 73%, p<0.01) than Standard intubation patients. Endoscopist-facilitated intubation was technically successful in every patient. Median Endoscopist-facilitated intubation time from patient arrival in room to procedural start was 3.5-fold lower and median Endoscopist-facilitated intubation time was over 4-fold lower than for Standard intubation. Endoscopist-facilitated intubation significantly enhanced endoscopy unit efficiency and minimized staff and patient injury. General adoption of this novel approach may represent a paradigm shift in the approach to safe and efficient intubation of all patients requiring general anesthesia. While the results of this controlled trial are promising, larger studies in a broad population are needed to validate these findings. NCT03879720.

Diving deeper into distress screening implementation in oncology care

Background Responding to calls for additional research that identifies effective distress screening (DS) processes, including referral practices subsequent to screening and receipt of recommended care, we engaged in qualitative research as part of a larger (mixed methods) study of distress screening. This qualitative inquiry of oncology professionals across different facilities in the United States examined routine DS implementation, facilitators and challenges staff encounter with DS processes, and staff members’ perceived value of DS. Participants and Methods We conducted key informant interviews and focus groups with staff in 4 Commission on Cancer (CoC)-accredited oncology facilities (a total of 18 participants) to understand implementation of routine DS within oncology care. We used a rigorous data analysis design, including inductive and deductive approaches. Results Respondents believe DS enhances patient care and described ways to improve DS processes, including administering DS at multiple points throughout oncology care, using patient-administrated DS methods, and enhancing electronic health records infrastructure to better collect, record, and retrieve DS data. Respondents also identified the need for additional psychosocial staff at their facilities to provide timely psychosocial care. Conclusions Results reinforce the value of DS in cancer care, including the importance of follow-up to screening with psychosocial oncology providers. Understanding and resolving the barriers and facilitators to implementing DS are important to ensure appropriate psychosocial care for people with cancer. Insights from oncology staff may be used to enhance the quality of DS and subsequent psychosocial care, which is an essential component of oncology care.

Assessment of the Number of Phlebotomists in a Newly Established Sample Collection Center.

Phlebotomy, i.e., the collection of blood samples, is one of the most commonly performed procedures in almost all hospital settings.The phlebotomy center is the first point of contact for patient samples with the laboratory services. The patient load visiting the phlebotomy center of a rapidly developing hospital is very variable and unpredictable. This leadsto staffing issues related to a number of phlebotomists. The actual phlebotomy procedure requires only a few minutes, but the total time includes thepatient'sarrival to departure from the phlebotomy center.In this study, we have attempted to assess the adequacy of the number of phlebotomists in our sample collection center and to determine how many patients can be attended to comfortably by each phlebotomist. As the sample load increases, the burden on phlebotomists also increases, and they may or may not express the strain of it. We attempted to determine the cut-off patient numbers above which request for additional personnel has to be put into the hospital administration. This was a prospective, hospital-based, observationalstudycarried out in the outpatientsample collection center section at the All India Institute of Medical Sciences, Bibinagar, Telangana, over a period of one month, i.e., December 2022. The movement of 1200 patients was observed for the phlebotomy procedure. Patient details, the time taken for registration, waiting time, and phlebotomy time were noted, along with the hindering factors in the phlebotomy center. There were 680 males and 520 females. The mean time for patient arrival to departure from the phlebotomy center and the mean waiting time was 9.8 minutes and 6.5 minutes, respectively. Various reasons for increased phlebotomy time were pediatric patients, anxious patients, postprandial sample patients, difficulty in finding veins, etc. Though the estimated capacity of the phlebotomy center is apparently satisfactory with four personnel, many hidden causes for time loss were observed. Conclusion: An adequate number of trained and effective phlebotomists is the first step in ensuring the success of any laboratory service, and while deciding on this "adequatenumber," not only the direct effort, but also the indirect effort, operational needs and emergencies have to be kept in mind. Each phlebotomist in a six-hour shift can comfortably attend 30 to 35 outpatients for phlebotomy. When this number exceeds it, additional staff has to be added. Adopting measures to reduce the waiting time for phlebotomy procedures will improve the phlebotomy center's service. The studyprovides a basis for the modification of a number of phlebotomistsin order to ensure optimal patient service.

Inability to work following COVID-19 vaccination–a relevant aspect for future booster vaccinations

ObjectivesCOVID-19 vaccination is a key prevention strategy to reduce the spread and severity of SARS-CoV-2 infections. However, vaccine-related inability to work among healthcare workers (HCWs) could overstrain healthcare systems. Study designThe study presented was conducted as part of the prospective CoVacSer cohort study. MethodsThis study examined sick leave and intake of pro re nata medication after the first, second, and third COVID-19 vaccination in HCWs. Data were collected by using an electronic questionnaire. ResultsAmong 1704 HCWs enrolled, 595 (34.9%) HCWs were on sick leave following at least one COVID-19 vaccination, leading to a total number of 1550 sick days. Both the absolute sick days and the rate of HCWs on sick leave significantly increased with each subsequent vaccination. Comparing BNT162b2mRNA and mRNA-1273, the difference in sick leave was not significant after the second dose, but mRNA-1273 induced a significantly longer and more frequent sick leave after the third. ConclusionIn the light of further COVID-19 infection waves and booster vaccinations, there is a risk of additional staff shortages due to postvaccination inability to work, which could negatively impact the already strained healthcare system and jeopardise patient care. These findings will aid further vaccination campaigns to minimise the impact of staff absences on the healthcare system.

Lack of cholinergic features in healthcare workers caring for a patient with organophosphate poisoning

Introduction Controversy exists with regard to risk of secondary exposure of health care workers caring for patients who have ingested an organophosphate insecticide. We aim to report clinical effects of staff members caring for an organophosphate poisoned patient. Incident A 76-year-old male presented to the Emergency Department exhibiting a cholinergic toxidrome requiring atropine, intubation and mechanical ventilation. Methods We undertook a retrospective chart review of any Emergency Department presentations for medical assessment in relation to the incident and conducted telephone interviews of any healthcare workers who did not present but were deemed to be closely involved with patient care. We collected data including age, gender, symptoms reported and plasma cholinesterase activity measurement. Results We collected data from 13 individuals, of whom nine presented for medical assessment, including the patient’s spouse. Five additional staff members were interviewed, having been identified via Emergency Department rostering documentation. The 13 healthcare workers comprised five nurses, four paramedics and four doctors. Dizziness and nausea were reported in two and the patient’s spouse reported one episode of vomiting. Of the nine patients who had plasma cholinesterase activity measured, none were below the laboratory reference range, including those who experienced symptoms. Conclusions We found no clinical nor biochemical evidence of toxicity in healthcare workers caring for a critically ill patient with organophosphate ingestion. These findings are consistent with previously published guidelines advocating standard/Level D personal protective equipment. We believe that emergency departments should not be closed as a safety measure.

Lessons learned from principal investigators on recruitment for community-based health behavior studies during the COVID-19 pandemic.

Little is known about pandemic-related impacts on participant recruitment into community-based health studies during the COVID-19 pandemic. The aim of this report was to summarize lessons learned from principal investigators (PIs) of NIH-funded community-based health behavior studies that were scheduled to recruit during the COVID-19 pandemic. We report on findings from three open-ended questions that were part of a 50-question online survey conducted from December 2022 - January 2023, completed by 52 PIs. Four categories of lessons emerged to optimize recruitment into studies: formalize relationships with community partnerships; focus on study operations; recruitment is a science and an art; and reduce participant burden and increase participant benefit. Taken together, these recommendations will require longer and more complex recruitment plans. To implement these plans, researchers and funders will need to allocate more time, thoughtful attention, and financial resources to support formal community partnerships, additional staff time and training, real-time monitoring and refinement of multiple strategies throughout recruitment, and increased attention to participant benefit.

Remote Evidence-Based Health Promotion Programs During COVID: A National Evaluation of Reach and Implementation for Older Adult Health Equity.

Evidence-based health promotion programs (EBPs) support older adults where they live, work, pray, play, and age. COVID-19 placed a disproportionate burden on this population, especially those with chronic conditions. In-person EBPs shifted to remote delivery via video-conferencing, phone, and mail during the pandemic, creating opportunities and challenges for older adult health equity. In 2021-2022, we conducted a process evaluation of remote EBPs by purposively sampling diverse U.S. organizations and older adults (people of color, rural, and/or with disabilities). The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) + Equity framework was used to understand program reach and implementation, including FRAME to describe adaptations for remote delivery. Analyses include descriptive statistics and thematic analysis of participant and provider surveys and interviews, and joint display tables to compare learnings. Findings from 31 EBPs through 198 managers/leaders and 107 organizations suggest remote delivery increases EBP reach by improving access for older adults who are underserved. For programs requiring new software or hardware, challenges remain reaching those with limited access to-or comfort using-technology. Adaptations were to context (e.g., shorter, smaller classes with longer duration) and for equity (e.g., phone formats, autogenerated captioning); content was unchanged except where safety was concerned. Implementation is facilitated by remote delivery guidelines, distance training, and technology support; and hindered by additional time, staffing, and resources for engagement and delivery. Remote EBP delivery is promising for improving equitable access to quality health promotion. Future policies and practices must support technology access and usability for all older adults.

Evaluation of awake prone positioning effectiveness in moderate to severe COVID-19

Evidence mainly from high income countries suggests that lying in the prone position may be beneficial in patients with COVID-19 even if they are not receiving invasive ventilation. Studies indicate that increased duration of prone position may be associated with improved outcomes, but achieving this requires additional staff time and resources. Our study aims to support prolonged (≥ 8hours/day) awake prone positioning in patients with moderate to severe COVID-19 disease in Vietnam. We use a specialist team to support prone positioning of patients and wearable devices to assist monitoring vital signs and prone position and an electronic data registry to capture routine clinical data.

Debriefing After Critical Events Is Feasible and Associated With Increased Compassion Satisfaction in the Pediatric Intensive Care Unit.

Repeated exposure to death and dying increases health care professionals' risk for burnout and secondary traumatic stress. Pediatric critical care providers are at particularly high risk because the death and dying of children are associated with even greater psychological impact. A charge nurse in the pediatric intensive care unit identified a need for additional staff support after critical patient events. The aim of this quality improvement project was to design and implement a debriefing process, the Rapid Review of Resuscitation, in a 40-bed, high-acuity pediatric intensive care unit at an urban children's hospital in the midwestern United States. A preintervention-postintervention survey used the Professional Quality of Life Scale, version 5, to evaluate staff members' compassion satisfaction, burnout, and secondary traumatic stress before and 1 year after implementation. The debriefing process was designed and implemented on the basis of interview data and literature review. Preimplementation (104 of 222 staff members [47%]) and postimplementation (72 of 184 staff members [39%]) survey responses were compared. Compassion satisfaction scores (mean [SD] T scores: preimplementation, 54.10 [7.52]; postimplementation, 56.71 [6.62]) were significantly higher (P = .02) 1 year after implementation. Burnout (P = .69) and secondary traumatic stress (P = .06) scores were not significantly different. After implementation, 74% of respondents reported that the debriefing process was "very helpful" or "somewhat helpful" after critical patient events. Compassion satisfaction improved and burnout and secondary traumatic stress did not change with implementation of the debriefing process after critical patient events.

Kegiatan preservasi bahan pustaka di Diperpuska Ciamis

Preservation research at the Dinas Perpustakaan dan Kearsipan Kabupaten (Diperpuska) of Ciamis is needed to increase understanding of preservation activities and the methods used. To identify challenges and limitations faced to increase the effectiveness of the preservation process and realize the important role of preservation in maintaining the sustainable use of library collections. This study aims to explore preservation activities carried out by the Diperpuska of Ciamis. Research method used was a qualitative descriptive method which includes interviews, literature studies, and observations. Data analysis using interactive model data analysis techniques. The results showed that the Diperpuska of Ciamis carried out library material preservation activities through preventive activities by conducting collection education, environmental regulations, prohibitions and sanctions, as well as collection control and security. Then curative activities by carrying out periodic cleaning, weeding, maintenance, and fumigation. Finally, restorative activities by binding to library materials that have been damaged. Preservation activities carried out by the Diperpuska of Ciamis are to ensure that library materials can still meet the needs of the community in the Ciamis Regency area. Damage to library materials can be caused by internal and external factors. There are several obstacles in carrying out preservation activities such as the lack of supporting tools, special rooms, and human resources. It was concluded that preservation activities had been carried out by the Diperpuska of Ciamis by carrying out preventive, curative and fumigation activities and required additional facilities and professional staff so that preservation activities could be carried out more optimally.

A retrospective observational study of labour ward work Intensity: The challenge of maternity staffing

BackgroundThe UK and Ireland are facing significant challenges in the recruitment and retention of midwifery staff. Deficiencies in staffing, training and leadership have been cited as contributory factors to substandard care in both regional and global independent maternity safety reports. Locally, workforce planning is critical to maintaining ‘one to one’ care for all women in labor and to meet the peaks of daily birthing suite activity. ObjectivesAnalyze the variation in work intensity, defined by the mean number and range of births per midwifery working hours. MethodsRetrospective observational study of birthing suite activity between 2017 and 2020. 30,550 singleton births were reported during the study period; however, 6529 elective Cesarean sections were excluded as these were performed during normal working hours by a separate operating theatre team. The times of 24,021 singleton births were organized into five proposed midwifery working rosters lasting eight or 12 h; A (00.00–07.59), B (08.00–15.59), C (16.00–23.59), D (20.00–0.759) and E (0.800–19.59). ResultsThe number of births was comparable between the eight-hour and 12-hour work periods with a mean of five to six babies born per roster (range zero to 15). Work periods D and E lasting 12-hours both recorded a mean of eight births (range zero to 18). Hourly births ranged from a minimum of zero to a maximum of five births per hour (greater than seven times the mean), a number that was achieved 14 times during the study period. ConclusionsThe mean number of births is consistent between normal working hours and unsociable ‘on-call’ periods, however there is an extreme range of activity within each midwifery roster. Prompt escalation plans remain essential for maternity services to manage unexpected increases in demand and complexity. What is already known on this topicShortfalls in staffing and inadequate workforce planning have been frequently cited in recent maternity safety reports as barriers to sustainable and safe maternity care. What this study addsOur study shows that the mean number of births in a large tertiary center are consistent across day and night rosters. However, there are large fluctuations in activity during which births can exceed the number of available midwives. How this study might affect research, practice or policyOur study reflects the sentiments of the Ockenden review and APPG report on safe maternity staffing. Investment in services and the workforce to aid recruitment and reduce attrition is essential to establish robust escalation plans, including the deployment of additional staff in the event of extreme service pressures.

529 Job Sharing: An Innovative Approach to Increasing Research Resources and Improving Staff Satisfaction

Abstract Introduction Pre-pandemic job openings for clinical research staff increased by nearly 10% a month nationwide yet was outpaced by an increase of greater than 12% in clinical trial activity. With the onset of the pandemic, the gulf between supply and demand widened in research. Simultaneously hospitals were stretched to capacity, staff suffered extreme burn-out and there was a dire need for additional bedside nurses. The pandemic shown a bright light on an age-old problem in nursing, whereas for a nurse to grow professionally, it often required leaving the bedside and giving up vital clinical skills, skills that were suddenly in great demand. The purpose of this project was to create a novel new job role, utilizing existing burn nursing staff to job share a research position, while maintaining their clinical expertise. Methods Nurse leaders from both areas worked in concert with the burn center’s director of research, senior hospital administration, human resources and existing staff to develop a new job role. The job description incorporated the scope and standards for nursing practice in both areas into one document. Additionally, a second-level position was created which allowed bedside nurses to trial the new role without a formal commitment to the permanent position. Staff were scheduled to rotate every 2 weeks between the two areas. Two months following implementation, core research staff and job-sharing staff were polled for feedback on benefits and challenges. Results Staff members (n=4) provided feedback independently from each other. A total of 41 comments were received, 27 benefit responses vs 14 challenges responses. Responses were grouped into themes and both benefits and challenges had 6 themes each. Benefit themes included: increased interdepartmental collaboration / trust (26%), professional growth (26%), supported learning (22%), enhanced screening for research patients (11%), unit-based resources (7%) and prevention of burnout (7%). Challenge themes included: scheduling (29%), variability in training opportunities (21%), role transitioning (21%), communication (14%), success personnel driven (7%), compensation (7%). Anecdotally, study investigators have expressed great satisfaction with the new position and there has been an increased interest expressed by other bedside staff in research involvement. Conclusions The response to the new position has been overwhelmingly positive. Staff entered the trial period realizing that it may be “messy” at first but quickly adapted and have worked through many of the challenges. Based on this early success, we are exploring the viability of cross training additional staff. Applicability of Research to Practice Cross training has been demonstrated to increase efficiencies, improve collaboration, trust and job satisfaction.