Client Interactions Research Articles

Self-paced acceptance and commitment training reduces burden transfer, stress, and burnout in veterinary healthcare teams.

An acceptance and commitment training (ACT) educational program targeting reaction to difficult client interactions recently demonstrated efficacy in reducing burden transfer, stress, and burnout in veterinary healthcare teams. The current noninferiority trial compared effectiveness of the original program with a self-paced version. Employees of 2 corporate veterinary groups were randomized to live (n = 128) or self-paced (124) conditions. The workshop and assessments were completed by 137 (55 live and 82 self-paced). Asynchronous modules containing the same content as the original program were placed on in-house veterinary clinic learning systems. Participants of this parallel arms trial completed pretest measures of burden transfer, stress, and burnout. Following assessment, the 3-week ACT program was delivered via videoconferencing (live) or asynchronous modules (self-paced). At post-test and 1-month follow-up, measures were repeated, with added assessment of knowledge, helpfulness ratings, and usage of techniques. A subset (n = 33) of participants repeated measures 9 to 12 months as an extended follow-up. Program helpfulness was rated more highly by live versus self-paced participants. Self-paced showed better program retention. No differences in knowledge or use of program techniques (> 5 times daily) emerged. Relative to pretest, both conditions showed reduced burden transfer, stress, and burnout at post-test and follow-up; no differences by condition emerged. Participants completing extended follow-up maintained improvement from baseline. Findings suggest a learning system-based version of this program can improve occupational distress in veterinary healthcare teams, with gains maintained over time. The flexibility of this format promotes program completion and allows broader dissemination.

Verification of a clinical decision support system for the diagnosis of headache disorders based on patient–computer interactions: a multi-center study

BackgroundAlthough headache disorders are common, the current diagnostic approach is unsatisfactory. Previously, we designed a guideline-based clinical decision support system (CDSS 1.0) for diagnosing headache disorders. However, the system requires doctors to enter electronic information, which may limit widespread use.MethodsIn this study, we developed the updated CDSS 2.0, which handles clinical information acquisition via human–computer conversations conducted on personal mobile devices in an outpatient setting. We tested CDSS 2.0 at headache clinics in 16 hospitals in 14 provinces of China.ResultsOf the 653 patients recruited, 18.68% (122/652) were suspected by specialists to have secondary headaches. According to “red-flag” responses, all these participants were warned of potential secondary risks by CDSS 2.0. For the remaining 531 patients, we compared the diagnostic accuracy of assessments made using only electronic data firstly. In Comparison A, the system correctly recognized 115/129 (89.15%) cases of migraine without aura (MO), 32/32 (100%) cases of migraine with aura (MA), 10/10 (100%) cases of chronic migraine (CM), 77/95 (81.05%) cases of probable migraine (PM), 11/11 (100%) cases of infrequent episodic tension-type headache (iETTH), 36/45 (80.00%) cases of frequent episodic tension-type headache (fETTH), 23/25 (92.00%) cases of chronic tension-type headache (CTTH), 53/60 (88.33%) cases of probable tension-type headache (PTTH), 8/9 (88.89%) cases of cluster headache (CH), 5/5 (100%) cases of new daily persistent headache (NDPH), and 28/29 (96.55%) cases of medication overuse headache (MOH). In Comparison B, after combining outpatient medical records, the correct recognition rates of MO (76.03%), MA (96.15%), CM (90%), PM (75.29%), iETTH (88.89%), fETTH (72.73%), CTTH (95.65%), PTTH (79.66%), CH (77.78%), NDPH (80%), and MOH (84.85%) were still satisfactory. A patient satisfaction survey indicated that the conversational questionnaire was very well accepted, with high levels of satisfaction reported by 852 patients.ConclusionsThe CDSS 2.0 achieved high diagnostic accuracy for most primary and some secondary headaches. Human–computer conversation data were well integrated into the diagnostic process, and the system was well accepted by patients. The follow-up process and doctor–client interactions will be future areas of research for the development of CDSS for headaches.

Qualitative assessment of providers’ experiences with a segmentation counseling tool for family planning in Niger

IntroductionThis study examines experiences with a family planning segmentation counseling tool that is used during the provision of family planning services. Based on answers to a series of questions, women are segmented into one of five categories of family planning users and counseled based on their identified segment. This study aimed to qualitatively assess provider perspectives on implementation of the tool.MethodsSemi-structured in-depth interviews took place in the Dosso region of Niger among 16 family planning providers who had been trained in segmentation and were currently using the segmentation tool. The facilities chosen for interviews were part of a larger mixed methods study assessing the impact of using the segmentation approach. Interview questions focused on training, supervision, how segmentation occurs at the health facility, how segmentation changes provider–client interactions, and any difficulties faced with implementation. Interviews were translated and transcribed into French and data were coded and thematically analyzed.ResultsAll providers in the study reported positive outcomes associated with segmentation. While providers acknowledged that the segmentation approach added time to the clinic visit, they did see the benefit of this extra time in providing more meaningful interactions between clients and providers, leaving clients with a deeper understanding of family planning and of the different methods available. The implementation of the tool did not change other aspects of service delivery, except that a segmentation sheet was required to be filled in and kept in each patient’s file. Difficulties reported included translating the segmentation tool questions into local languages, training enough health care providers and avoiding stock outs of the segmentation sheets.ConclusionThe segmentation process is of benefit to family planning clients in Niger and the scale-up of the strategy could bring higher quality services to women. If this approach is brought to scale the implementation challenges uncovered need to be addressed, especially adequate training. Further research is needed to determine if segmentation leads to changes in family planning use outcomes.

Managing emotions in ongoing service relationships: new intrinsic and extrinsic emotion regulation strategies from aged care

Managing emotions at work can be challenging for employees in service roles. Most emotional labor research has been conducted in settings of brief service interactions with strangers. Yet, many traditional family roles, such as aged and child care are now outsourced to personal service roles that have ongoing relationships with clients. The continuing nature of those relationships may result in employees using previously unknown strategies to regulate emotions. To develop an understanding of intrinsic and extrinsic emotion regulation (ER) strategies in service relationships, we interviewed 42 aged care employees in China. Using template analysis we found three new employee-client relationship-based intrinsic ER strategies (i.e. family appreciation, filial reappraisal and deliberate distancing), a self-based strategy (i.e. self-deterioration anticipation) and three client-based strategies (i.e. client deterioration anticipation, vulnerability justification and meaning identification) in managing one’s own emotions in service relationships. When managing others’ emotions in ongoing service settings, a new relationship-based extrinsic ER strategy (i.e. communal bonding) along with situation-based and client-based extrinsic ER strategies were identified. Employees can regulate their own and others’ emotions by crafting their relationships with clients. This study suggests that service relationship is a critical dimension of client interactions and should be considered in workplace ER research.

Assessing the social determinants of mental health in counseling practice

AbstractEvery counselor–client interaction is an opportunity for mutual learning through inquiry, listening, exploring, and understanding about a client's experiences with development and well‐being. Given the convergence of multiple sociopolitical events and systems that impact mental health and well‐being, we issue a call to increase promotion and uptake of preventative mental health strategies by assessing the social determinants of mental health (SDMH) in counseling practice. We contend that counselors are uniquely prepared to assess the SDMH at the intrapersonal, interpersonal, and environmental levels. Therefore, we review the parallels between counseling frameworks and the SDMH with the aim of explaining why and how counselors should assess the SDMH. Specifically, we describe ways that counselors can use their foundational skills and expertise in assessment procedures to identify client needs, as well as potential individual and community interventions. We outline a four‐phased approach for assessing the SDMH in counseling practice and provide implications for improving counseling outcomes.

“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises

BackgroundSince the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction services that reduce overdose risk for people who use drugs. In British Columbia, one such treatment is injectable opioid agonist treatment (iOAT), the supervised dispensation of injectable hydromorphone or diacetylmorphine for people with opioid use disorder. While evidence has shown iOAT to be safe and effective, it is intensive and highly regimented, characterized by daily clinic visits and provider–client interaction—treatment components made difficult by the pandemic.MethodsBetween April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software.ResultsQualitative analysis revealed the ways in which the pandemic shaped clients’ lives and the provision of iOAT care. First, client narratives illuminated how the pandemic reinforced existing inequities. For example, socioeconomically marginalized clients expressed concerns around their financial stability and economic impacts on their communities. Second, clients with health comorbidities recognized how the pandemic amplified health risks, through potential COVID-19 exposure or by limiting social connection and mental health supports. Third, clients described how the pandemic changed their engagement with the iOAT clinic and medication. For instance, clients noted that physical distancing guidelines and occupancy limits reduced opportunities for social connection with staff and other iOAT clients. However, pandemic policies also created opportunities to adapt treatment in ways that increased patient trust and autonomy, for example through more flexible medication regimens and take-home oral doses.ConclusionParticipant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment settings, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic.

Homework assignment and compliance review from a behavioural perspective: the verbal sequences between therapist and client

Therapeutic (homework) tasks are a characteristic strategy in behavioral psychology to achieve clinical change. The aim of the present study is to determine how behavioural therapists assign therapeutic tasks and review their compliance. Observational methodology was used to analyse the verbal interaction of therapists and clients in 211 recorded sessions (19 complete successful cases) using a validated coding system (SIST-INTER-INSTR). The values for inter- and intra-judge reliability were from good to excellent. The study shows that behavioural psychologists offer motivating verbalisations when assigning therapeutic tasks. During the review of task compliance, therapists frequently provide positive reinforcement when clients report complete compliance with the assigned task but stop the review of tasks when clients report non-compliance or only partial compliance with the task. These sequences provide information about how behavioural therapists provide instructions for therapeutic tasks and review their compliance. This is a first step to study how these verbal sequences favour the establishment of TC and the effectiveness of treatment.

Indigenous experiences and underutilisation of disability support services in Australia: a qualitative meta-synthesis

Purpose: Aboriginal and Torres Strait Islander People with a disability continue to experience barriers to service engagement such as mistrust of government services, lack of culturally appropriate support, marginalisation and disempowerment. This meta-synthesis reviews current literature regarding these experiences to explain why services are underutilised. Methods: The meta-synthesis was conducted using a meta-ethnographic approach to synthesise existing studies into new interpretive knowledge. The approach was supported by a search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Ten original research papers utilising a qualitative methodology were extracted. Synthesis of the articles revealed four concepts that were developed into a conceptual model. These include:1) History Matters; 2) Cultural Understanding of Disability Care; 3) Limitations to Current Service Provision; and 4) Delivery of Effective Services. Conclusions: Disability services do not adequately consider the cultural needs of Aboriginal and Torres Strait Islander People or communicate in a culturally appropriate manner. There are expectations that Aboriginal and Torres Strait Islander People acknowledge their disability in alignment with western definitions of disability in order to access services. More work is needed to align disability services with culturally appropriate support to provide better health outcomes. Implications for Rehabilitation Aboriginal and Torres Strait Islander people with a disability continue to experience barriers to service engagement which must be addressed. An essential gap that must be filled in providing disability services to Aboriginal and Torres Strait Islander people is the acknowledgment of culture as a resolute influence on all client interactions with providers. A cultural model of disability may better align with the experiences of Aboriginal and Torres Strait Islander people than current medical and social models used in healthcare. Disability services need to align better with culturally appropriate support to provide better health outcomes for Aboriginal and Torres Strait Islander people.

Implementasi Rehabilitasi Medis dan Sosial Terhadap Narapidana Narkotika Pada Lembaga Pemasyarakatan

One of the development activities for inmates is the provision of medical rehabilitation and social rehabilitation for drug offenders. Implementation of medical and social rehabilitation for drug offenders at Class II B Gunung Sugih Prison in accordance with Director General of Prisons Order No. PAS-36.OT.02.02 of 2020 about Correctional Service Standards is the focus of this research. This study examines the adoption of medical and social rehabilitation programs for drug offenders. What obstacles impede the implementation of medical and social rehabilitation programs for drug offenders? This study employs a normative and empirical legal methodology. The findings indicate: The execution of medical and social rehabilitation for drug convicts begins with an assessment of the client's concerns so that medical and social rehabilitation can be applied promptly. Acceptance occurs after determining the nature of the client's problem, as well as his or her physical, psychological, social psychological, and level of expertise, while simultaneously assigning the client to several sorts of programs. The purpose of social and skill mentoring is to improve client interaction patterns, preserve emotional stability, build a sense of responsibility and discipline, and foster the desire to become a better individual. Insufficient medical equipment and infrastructure of buildings and special rooms prevent medical and social rehabilitation from taking place. There are drug users in prison who suffer from serious diseases and a lack of family support.

Consequences of Multigenerational Services Adoption Behavior: Global Client Engagement

This study uses adoption and usage data on the client and firm–client interactions across four technology generations of new-age products/services from 13 developed and emerging markets over an eight-year period to describe how multigenerational service (MGS) adoption behavior influences direct (purchases) and indirect (references and feedback) global client engagement and whether this relationship is moderated by product/service failures and cultural factors. The authors propose metrics to measure the number of generations adopted (MGD), the number of products and features within a generation (MGFs), and the adoption time between generations (MGT). They find that client usage revenue (CUR) is enhanced by greater MGD and higher MGFs combined with lower MGT. However, CUR varies by differences in the needs of clients' own customers, failures, and culture. Greater direct engagement affects reference and feedback behavior, moderated by cultural differences in individualism, power distance, and masculinity. For a typical client in the United States and Canada, a one-unit improvement in MGD and MGFs and a one-year improvement in MGT enhance CUR by $8,150, $5,200, and $2,310 per client, respectively, versus a corresponding enhancement of $4,820, $3,640, and $1,620, respectively, per client in Colombia and Mexico. These findings provide several implications for executives who manage multigenerational innovations across countries regarding client engagement, launching MGS, market entry, and failure recovery.

Clinician perspectives on how digital phenotyping can inform client treatment

This qualitative study explores mental health clinician perspectives on how information extracted from client interactions with digital devices such as smartphones and the Internet (their digital footprint data) can inform client treatment. The process of learning about an individual's behaviours and psychology from their digital footprint, what has been termed ‘digital phenotyping’, has emerged in recent years as a field of research with potential to offer insights of clinical value that could be used to predict/detect mental ill-health and inform treatment. This research agenda has largely consisted of quantitative studies exploring statistical associations between smartphone data and psychometric outcomes among relatively small participant cohorts. We on the other hand focus on how the data gathered from smartphones and other digital sources could be converted to pieces of meaningful information that clinicians could directly access and interpret to augment their practice and inform their treatment of clients. Through a reflexive thematic analysis of interviews involving clinical psychologists, this study presents ideas and a framework for understanding how digital phenotyping can inform, augment, and innovate client treatment. In total, five themes concerning the ethics, praxis, and value of digital phenotyping for client treatment are generated.

Utilising interpersonal skills to manage challenging client behaviour

Widespread pandemic-related disruption has led to increasingly challenging client interactions. The British Veterinary Association (BVA) found that 57% of veterinary staff surveyed in 2021 reported feeling intimidated by client behaviour during the previous year; a 10% increase from 2019. The psychological impact of consistently difficult or abusive interactions can be significant and contribute to the high incidences of stress, burnout, attrition and potentially suicide increasingly noted in the industry. This understanding further highlights the need to focus on developing individual self-care strategies and leaders offering appropriate support to their team. Historically, veterinary education has overlooked the importance of training in interpersonal skills, such as communication, conflict resolution and emotional intelligence. However, human and veterinary medicine is evolving with increasing recognition of the significance of communication skills training to help prevent and manage of challenging client behaviour. This may help to ensure practitioners are better prepared for the challenges that await them.

Negotiating organisational and professional feeling rules: on digital documentation and emotions in child protection social work

This article explores the emotional challenges of digital documentation practices in child protection social work. Drawing on ethnographic fieldwork in Swedish social services, it explores how social workers negotiate organisational and professional feeling rules when performing child protection investigations using a digital documentation-based structure. Theoretically informed by Arlie Hochschild and other emotion sociologists’ discussions on the origins of feeling rules at work, the study concentrates on how organisational feeling rules challenge professional ideals and force situated negotiations. The documentation structure was introduced and framed as a guarantee that social workers would no longer be guided by emotions but by facts; at the same time, new emotional dilemmas arose when professionals worked according to these ideals. Negotiations between organisational and professional feeling rules were identified regarding traces of emotional work in the documentation, compliance with documentation-based routines in unpredictable client interactions, and professional (dis)satisfaction when documenting activities took time away from meeting with clients. Adding to the existing body of research, the study demonstrates that digital documentation practices deepen the increasingly ambivalent place for emotions in social work and that organisational-administrative emotional regimes are negotiated in situ with other ideals by social workers and frontline managers. By giving examples of social workers’ micro-resistance to organisational feeling rules, the study contributes theoretically with insights into the different origins of feeling rules in professional welfare work and the power (a)symmetry between them. Finally, by situating the tensions between competing ideals in everyday practice, the study adds to the understanding of technostress and emotional fatigue.

The future of accounting: Predictions on automation and AI integration

As we stand on the brink of a transformative era, the future of accounting is intricately linked with the rapid evolution of automation and artificial intelligence (AI). This review delves into predictions regarding the integration of these technologies into the accounting landscape. The impending future is characterized by the increasing reliance on automation to streamline routine tasks, enhance efficiency, and mitigate the risk of errors in accounting processes. Automation is poised to revolutionize traditional bookkeeping, data entry, and reconciliation, allowing accountants to redirect their focus towards higher-value analytical tasks. The integration of robotic process automation (RPA) is anticipated to facilitate seamless collaboration between human expertise and machine precision. In parallel, artificial intelligence is set to become a cornerstone of accounting practices, offering advanced capabilities for data analysis, pattern recognition, and predictive modeling. AI's ability to interpret complex financial data and discern meaningful insights positions it as a valuable tool for decision support. Predictive analytics powered by AI is expected to revolutionize forecasting, enabling accountants to make strategic decisions based on data-driven foresight. Furthermore, the rise of AI-driven chatbots and virtual assistants is predicted to redefine client interactions and support services. These technologies are anticipated to enhance customer experience by providing instant responses to queries, facilitating smoother communication, and offering personalized financial guidance. However, the integration of automation and AI in accounting raises important considerations. Ethical concerns, data security, and the potential displacement of certain job functions are pivotal aspects that demand careful examination. Striking a balance between technological advancements and preserving ethical standards will be a critical challenge in the future accounting landscape. In conclusion, the future of accounting is shaped by the convergence of automation and AI, promising a paradigm shift in how financial information is processed, analyzed, and utilized. While automation and AI bring forth unprecedented opportunities for efficiency and insight, their implementation necessitates a thoughtful approach to ensure ethical conduct and address the evolving role of accountants in this transformative journey.

Availability of Safe Second-Trimester Abortion Services in Health Facilities in Accra, Ghana.

We examined providers, methods employed, cost, and other determinants of availability of second-trimester abortion services in health facilities in Accra, Ghana in 2019 to inform policy and program decisions. A two-stage mixed quantitative and qualitative study designs were employed in the conduct of the study. The first stage was a short interaction of the mystery client with a clinical care provider to identify health facilities that provide second trimester induced abortion, the cost, and referral practices, where the facility did not have the service. The second stage was in-depth interviews of second-trimester abortion care providers and non-providers in various health facilities. For internal validity, it also explored the procedure cost, referral, and other practices at the health facilities included in the study, independent of what was captured in the mystery client survey. Second-trimester abortion services in Accra, Ghana are widely unavailable even in most facilities that provided abortion services. Referral policies and practices indicated by the service providers at various facility levels were inadequate. Criminalization of the procedure, social stigma, and fear of complications are the main factors that adversely influence the availability of second-trimester abortion in health facilities in Accra. Albeit increasing demand for second-trimester abortion in health facilities in Accra, services are not readily available due to the ambiguity of the law, its interpretation, and limited flow of accurate information on providers. Policies and programs that limit access to Second-trimester abortions in Ghana are amendable to ensure safe services.

Antibiotic dispensing practices during COVID-19 and implications for antimicrobial resistance (AMR): parallel mystery client studies in Uganda and Tanzania

BackgroundOver-the-counter antibiotic access is common in low-and-middle-income countries and this may accelerate antimicrobial resistance. Our study explores critical aspects of the drug seller–client interaction and antibiotic dispensing patterns for simulated COVID-19 symptoms during the pandemic in two study sites in Tanzania and Uganda, countries with different government responses to the pandemic.MethodsResearch assistants posing as clients approached different types of drug sellers such as pharmacies (Pharms), drug shops (DSs), and accredited drug dispensing outlets (ADDOs) in Mwanza, Tanzania (nPharms = 415, nADDOs = 116) and Mbarara, Uganda (nPharms = 440, nDSs = 67), from June 10 to July 30, 2021. The mystery clients held no prescription and sought advice for simulated COVID-19 symptoms from the drug sellers. They documented the quality of their interaction with sellers and the type of drugs dispensed.ResultsAdherence to COVID-19 preventive measures and vigilance to COVID-19 symptoms was low in both sites but significantly higher in Uganda than in Tanzania. A higher percentage of drug sellers in Mbarara (Pharms = 36%, DSs = 35%, P-value = 0.947) compared to Mwanza (Pharms = 9%, ADDOs = 4%, P-value = 0.112) identified the client’s symptoms as possibly COVID-19. More than three-quarters of drug sellers that sold prescription-only medicines in both Mbarara (Pharms = 86%, DSs = 89%) and Mwanza (Pharms = 93%, ADDOs = 97%) did not ask the MCs for a prescription. A relatively high percentage of drug sellers that sold prescription-only medicines in Mwanza (Pharms = 51%, ADDOs = 67%) compared to Mbarara (Pharms = 31%, DSs = 42%) sold a partial course without any hesitation. Of those who sold antibiotics, a higher proportion of drug sellers in Mbarara (Pharms = 73%, DSs = 78%, P-value = 0.580) compared to Mwanza (Pharms = 40% ADDOs = 46%, P-value = 0.537) sold antibiotics relevant for treating secondary bacterial infections in COVID-19 patients.ConclusionOur study highlights low vigilance towards COVID-19 symptoms, widespread propensity to dispense prescription-only antibiotics without a prescription, and to dispense partial doses of antibiotics. This implies that drug dispensing related to COVID-19 may further drive AMR. Our study also highlights the need for more efforts to improve antibiotic stewardship among drug sellers in response to COVID-19 and to prepare them for future health emergencies.

The effects of COVID-19 on New York State’s Drug User Health Hubs and syringe service programs: a qualitative study

BackgroundSyringe service programs (SSPs) deliver critical harm reduction services to people who inject drugs (PWID). Some SSPs in New York State received enhanced funding to provide additional services to combat opioid overdose fatalities. These SSPs, known as Drug User Health Hubs, provide buprenorphine for the treatment of opioid use disorder and other health-related services in addition to their syringe services. While the COVID-19 pandemic posed widespread challenges to the delivery of health services nationwide, the effect of the pandemic on SSPs uniquely impacts PWID. This study examines the impact of COVID-19 on service delivery of Drug User Health Hubs and stand-alone SSPs in New York State.MethodsBetween July 2020 and September 2020, we performed eleven semi-structured virtual interviews with staff from three Health Hub SSPs and three stand-alone SSPs. The interviews explored the effect of the COVID-19 pandemic on SSPs and their clients as well as the changes implemented in response. Interviews were recorded and transcribed. We performed content analysis to identify emerging themes from the data.ResultsDue to the COVID-19 pandemic, some SSPs temporarily shut down while others limited their hours of operation. SSPs modified their service delivery to maintain syringe services and naloxone distribution over other services such as STI and HCV testing. They virtualized components of their services, including telemedicine for the provision of buprenorphine. While SSPs found virtualization to be important for maintaining their services, it negatively impacted the intimate nature of client interactions. Participants also described the impact of the pandemic on the well-being of PWID, including isolation, worsened mental health challenges, and increased drug overdoses.ConclusionsIn response to the COVID-19 pandemic, SSPs demonstrated innovation, adaptability, and togetherness. Despite the challenges posed by the pandemic, SSPs continued to be key players in maintaining access to sterile supplies, buprenorphine, and other services for PWID. In addition to adapting to COVID-19 restrictions, they also responded to the dynamic needs of their clients. Sustainable funding and recognition of the critical role of SSPs in supporting PWID can help to improve outcomes for PWID.

Using interpersonal skills to manage challenging client behaviour

Widespread pandemic-related disruption has led to increasingly challenging client interactions. The British Veterinary Association found that 57% of veterinary staff surveyed in 2021 reported feeling intimidated by client behaviour during the previous year; a 10% increase from 2019. The psychological impact of consistently difficult or abusive interactions can be significant and contribute to the high incidences of stress, burnout, attrition and potentially suicide increasingly noted in the industry. This understanding further highlights the need to focus on developing individual self-care strategies and leaders offering appropriate support to their team. Historically, veterinary education has overlooked the importance of training in interpersonal skills, such as communication, conflict resolution and emotional intelligence. However, human and veterinary medicine is evolving with increasing recognition of the significance of communication skills training to help prevent and manage of challenging client behaviour. This may help to ensure practitioners are better prepared for the challenges that await them.

Auditor-Client Interactions—An Exploration of Power Dynamics during Audit Evidence Collection

SUMMARYAccounting research finds that staff auditors, who increasingly interact with high-level client management, maintain positions of lower power in auditor–client interactions. We conducted semistructured interviews with 22 practicing associate- and senior-level auditors to investigate staff auditor–client interactions and their outcomes. Our results shed light on a deep-rooted power dynamic between staff-level auditors and their clients, whereby clients maintain the upper hand during the evidence-collection process. We also document auditors’ concerns for their clients’ perception of them and the audit team. Finally, we observe that auditors often struggle to fulfill their professional responsibilities while also ingratiating themselves to the client. These forces often lead to audit quality-threatening behaviors such as client avoidance and “ghost ticking.” Our results suggest that ongoing power disparities between staff auditors and their clients may impair staff auditors’ operational independence.

System for Managing Vehicle Services

Abstract: Vehicle owners can prevent unexpected automotive problems by routinely maintaining their vehicles. It's critical to identify car issues as soon as possible to stop them from becoming major problems. Vehicle owners routinely ask auto shops about servicing. Vehicle mechanics inspect important components and address issues to make sure they are in good shape and won't break down unexpectedly. Researchers conducted the study to assess the routine business transactions and activities in vehicle repair shops. Preliminary data collected by the researchers revealed that the majority of vehicle repair companies or garages continue to conduct daily transactions manually. Customer records, client interactions, billing, tracking the progress of auto repairs, and service updates are all still entered by hand. The capstone project, "System for managing vehicle services" will automate the operations and regular transactions of the car repair shop. The system will electronically streamline processes including managing car repair orders, maintaining maintenance logs, monitoring customer and transaction records, servicing updates, and billing. The system's installation will benefit both customers and auto shops. The company's use of the system will enable vehicle garages to grow and enhance operational effectiveness. Customers can easily and comfortably conduct business for vehicle servicing.