Clinical Specialty Areas Research Articles

Training, skills, and leadership experience: The need to expand clinical psychology training as illustrated by psychology leadership stories.

Training for clinical psychologists is grounded in training models emphasizing clinical work, scholarship, and research. Rigorous competencies, varying by clinical specialty area, guide the specifics of training within domains of knowledge, skills, and aptitudes-with the goal of ensuring well-trained clinical psychologists. Research further illuminates the skills, characteristics, and experiences needed to maximize the effectiveness of clinical care provided by trained clinical psychologists. In addition, data indicate that clinical psychologists spend an average of 20% of their work time in management and leadership activities beyond clinical duties of direct care, requiring expanded and additional skills beyond those formally conceptualized and broadly included in graduate training. We utilize descriptions of three clinical psychologists' leadership journeys to illustrate the gap in training filled by these bootstrapping autodidacts when successes led to promotion to higher levels of responsibility and leadership. Our proposed solution is a call to action. We call for consideration of an expansion of clinical psychology training by (a) overtly translating currently taught clinical skills into needed leadership skills to consistently fill the gap rather than relying on individuals to acquire enough experience to adequately perform the translation themselves, and (b) adding both pragmatic and theoretical leadership skills into an expanded training curriculum. We strongly urge this rethinking and expansion of training to adequately support and foster future clinical psychologists in administrative and other leadership roles. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Ambulatory care pharmacy practice: Findings from the 2019 National Pharmacist Workforce Survey.

The purpose of this study was to describe the demographics, training, clinical specialties, and practice activities of ambulatory care pharmacists using data from the 2019 National Pharmacist Workforce Study (NPWS). The 2019 NPWS was conducted using a 3-contact electronic survey sent to a random sample of 94,803 pharmacists using the National Association of Boards of Pharmacy Foundation e-Profile system. The 2019 NPWS had a response rate of 67.3% (5,705/8,466), based on the number of prospective respondents who clicked the survey link. A subset of pharmacists' responses (n = 4,557) was used for this analysis, which included those who selected an employment status of "practicing as a pharmacist." Of the 4,557 actively practicing pharmacists responding, 338 (8.0%) reported working in the ambulatory care setting. Ambulatory care pharmacists were predominately White (71.6%), women (67.5%), and/or between the ages of 31 and 40 years (36.9%). A total of 41.3% had completed PGY1 residency training, 14% had completed PGY2 residency training, and 29.3% had completed one or more board certifications. Their most common clinical specialty areas were anticoagulation (21.7%), endocrinology (19.7%), hematology/oncology (16.2%), and primary care (16.2%). A total of 49.6% reported using a collaborative practice agreement. Ambulatory care pharmacists reported more training and certifications than the overall sample of pharmacists. These pharmacists practiced in a variety of clinical specialty areas and engaged in a range of in-person and telecommunication medication management activities. This study provides a baseline assessment of the ambulatory care pharmacist workforce that can be used to assess changes over time.

Measuring quality and value in genetic counseling: The current landscape and future directions.

Genetic counselors strive to provide high-quality genetic services. To do so, it is essential to define quality in genetic counseling and identify opportunities for improvement. This Professional Issues article provides an overview of the evaluation of healthcare quality in genetic counseling. The National Society of Genetic Counselors' Research, Quality, and Outcomes Committee partnered with Discern Health, a value-based healthcare policy consulting firm, to develop a care continuum model of genetic counseling. Using the proposed model, currently available quality measures relevant to genetic counseling in the US healthcare system were assessed, allowing for the identification of gaps and priority areas for further development. A total of 560 quality measures were identified that can be applied to various aspects of the care continuum model across a range of clinical specialty areas in genetic counseling, although few measures were specific to genetic counseling or genetic conditions. Areas where quality measures were lacking included: attitudes toward genetic testing, family communication, stigma, and issues of justice, equity, diversity, and inclusion. We discuss these findings and other strategies for an evidence-based approach to quality in genetic counseling. Strategic directions for the genetic counseling profession should include a consolidated approach to research on quality and value of genetic counseling, development of quality metrics and patient-experience measures, and engagement with other improvement activities. These strategies will allow for benchmarking, performance improvement, and future implementation in accountability programs which will strengthen genetic counseling as a profession that provides evidence-based high-quality care to all patients.

Physicians’ perceptions of generic drugs in China

BackgroundIn recent years, there has been a significant worldwide increase in the use of generic drugs. China has committed to a consistency evaluation of generic drugs, with the aim to improve the rate of substitution. However, there is little research on physicians’ perceptions of generic drugs in China. ObjectiveThe study aimed to explore the perceptions of physicians in China toward generic drugs. MethodsPerceptions of Chinese physicians towards generic drugs were evaluated by a cross-sectional study from June to July 2020. The online survey tool Sojump was adopted to distribute the questionnaires using convenience sampling. A total of 598 questionnaires were analyzed. ResultsPerceptions of Chinese physicians towards generic drugs are generally positive. However, not all physicians appear to have sufficient knowledge about generic drugs and some of them expressed negative perceptions of generic drugs, such as perceiving generic drugs as less effective and more likely to cause side effects compared to brand-name drugs. There were significant differences in physicians’ opinions about generic drugs according to age group, years in practice, educational background, clinical specialty and residential area. ConclusionIt is imperative to provide physicians with more extensive education about the consistency evaluation of generic drugs to meet the policy goal of reducing overall national medical healthcare costs.

Flipped Clinical Teaching: Battling COVID-19 With Creative and Active Pedagogy.

During the onset of the coronavirus disease 2019 global pandemic, Schools of Nursing transitioned from the traditional clinical teaching and learning experiences to synchronous online learning. As part of the Capstone experience in the second-degree, final semester course, students selected one clinical specialty area. Four full-time clinical faculty and five adjunct clinical instructors collaborated in flipped clinical lesson plans 3 weeks prior to the start of the semester. The lesson plan included three components: preconference, active learning, and postconference. Student evaluation of the experience was another critical component. The student evaluation surveys supported that 95% of the respondents identified that the flipped clinical experience was a successful methodology to reinforce clinical concepts. The flipped clinical learning approach showed promise as an effective way to provide remote clinical instruction for students during public health emergencies, when shortage of clinical sites arise, or as a replacement for missed clinical hours. [J Nurs Educ. 2021;60(9):534-537.].

Elucidating the diagnostic odyssey of 22q11.2 deletion syndrome.

Clinical molecular testing has been available for 22q11.2 deletion syndrome (22q11.2DS) for over two decades yet under-recognition and diagnostic delays are common. To characterize the "diagnostic odyssey" in 22q11.2DS we studied 202 well-characterized unrelated adults, none ascertained through an affected relative. We used a regression model to identify clinical and demographic factors associated with length of time to molecular diagnosis. Kaplan-Meier analysis compared time to diagnosis for the molecular testing era (since 1994) and earlier birth cohorts. The results showed that the median time to molecular diagnosis of the 22q11.2 deletion was 4.7 (range 0-20.7) years. Palatal and cardiac anomalies, but not developmental delay/intellectual disability, were associated with a shorter time to molecular diagnosis. Non-European ethnicity was associated with longer time to diagnosis. Inclusion of a cohort from another 22q11.2DS center increased power to observe a significantly earlier diagnosis for patients born in the molecular testing era. Nonetheless, only a minority were diagnosed in the first year of life. On average, patients were seen in seven (range 2-15) different clinical specialty areas prior to molecular diagnosis. The findings indicate that even for those born in the molecular testing era, individuals with 22q11.2DS and their families face a diagnostic odyssey that is often prolonged, particularly in the absence of typical physical congenital features or for those of non-European ancestry. The results support educational efforts to improve clinical recognition and testing, and ultimately newborn screening as a means of maximizing early detection that would provide the best opportunity to optimize outcomes.

Graduate entry students' early perceptions of their future nursing careers.

Graduate entry nursing programs designed for individuals with prior degrees in other disciplines are becoming increasingly popular internationally. They provide entry into nursing for people with unique skill-sets. Yet, little is known about why these individuals choose career change into nursing and what they expect from their new careers. This component of a larger study sought to explore graduate entry nursing students' short and longer term career intentions on commencement of their courses. A cross-sectional survey was used. Descriptive frequencies were used to analyse demographic data, while summative content analysis was used with the open-ended questions. Participants were drawn from eight cohorts of commencing students from enrolled in one graduate entry masters program in Australia between 2009 and 2015. Content analysis identified three main categories: professional role, work location, and work context. Longer term responses were categorised under four categories: professional role, work location, work context and personal and professional goals. Many students had clear directions about their future nursing careers. On graduation, many envisioned working in advanced roles or in clinical specialty areas, primarily in hospital settings. However, in the longer term, there was diversity among with many envisaging work outside traditional hospital settings, and some in other health disciplines.

Profiling Nurse Practitioner practice patterns at a major urban acute health service

BackgroundResearch detailing the practice patterns and services provided by nurse practitioners within a large health care facility is currently lacking in the literature. This study fills a gap in the literature by reporting on the practices of nurse practitioners in a variety of clinical specialty areas within the one health care setting. AimTo identify the practices of nurse practitioners in different contexts across one health service. BackgroundAn expanding cohort of nurse practitioners within an Australian health service increasingly delivers services to more complex patients. Understanding this phenomenon assists future workforce planning. MethodsAn exploratory survey of nurse practitioner practice patterns in a metropolitan health service was conducted. Nurse practitioners electronically entered data from patient encounters for two weeks. Descriptive analysis of the quantitative data was conducted. ResultsNine nurse practitioner specialties were identified and 341 encounters were analysed. All specialty groups included counselling and education in patient management. The use of nurse practitioner extensions to practice was dependent on the specialty area including prescribing medicines. ConclusionsNurse practitioner scope of practice differs across specialties and is determined by patient cohorts and associated diagnoses. The results highlighted the diversity and depth of services provided by nurse practitioners. Understanding the scope of practice assist with future nurse practitioner role development andimplementation.

Gender differences in nurse practitioner salaries.

While male nurses have been shown to earn considerably more than female nurses, there is less evidence on gender disparities in salary among nurse practitioners (NPs). This study examines whether the gender gap in NP salaries persists after controlling for differences in work setting and demographic factors. We analyzed the relationship between gender and salary (2011 pretax earnings) among 6591 NPs working as NPs at least 35 h per week, using the 2012 National Sample Survey of Nurse Practitioners. We first conducted bivariate regression analyses examining the relationship between gender and earnings, and then developed a multivariate model that controlled for individual differences in demographic and work characteristics. Male NPs earned $12,859 more than female NPs, after adjusting for individual differences in demographics and work characteristics. The gender gap was $7405 for recent NP graduates, and grew over time. Male NPs earned significantly more than female NPs across all clinical specialty areas. The gender disparities in NP salaries documented here regardless of professional seniority or clinical area should spark healthcare organizations to conduct pay equity assessments of their employees' salaries to identify and ameliorate pay inequality.

JAOA/AACOM. Residency Program Directors’ Interview Methods and Satisfaction With Resident Selection Across Multiple Specialties

Competition for postdoctoral training positions is at an all-time high, and residency program directors continue to have little direction when it comes to structuring an effective interview process. To examine whether a relationship existed between interview methods used and program director satisfaction with resident selection decisions and whether programs that used methods designed to assess candidate personal characteristics were more satisfied with their decisions. Residency directors from the Statewide Campus System at the Michigan State University College of Osteopathic Medicine were invited to complete a 20-item survey regarding their recent interview methods and proportion of resident selections later regretted. Data analyses examined relationships between interview methods used, frequency of personal characteristics evaluated, and subsequent satisfaction with selected residents. Of the 186 program director surveys distributed, 83 (44.6%) were returned, representing 11 clinical specialty areas. In total, 69 responses (83.1%) were from programs accredited by the American Osteopathic Association only, and 14 (16.9%) were from programs accredited dually by the American Osteopathic Association and Accreditation Council for Graduate Medical Education. The most frequent interview method reported was faculty or peer resident interview. No statistically significant correlational relationships were found between type of interview methods used and subsequent satisfaction with selected residents, either within or across clinical specialties. Although program directors rated ethical behavior/honesty as the most highly prioritized characteristic in residents, 27 (32.5%) reported using a specific interview method to assess this trait. Program directors reported later regrets concerning nearly 1 of every 12 resident selection decisions. The perceived success of an osteopathic residency program's interview process does not appear to be related to methods used and is not distinctively different from that of programs dually accredited. The findings suggest that it may not be realistic to aim for standardization of a common set of best interview methods or ideal personal characteristics for all programs. Each residency program's optimal interview process is likely unique, more dependent on analyzing why some resident selections are regretted and developing an interview process designed to assess for specific desirable and unwanted characteristics.

Guideline.gov: A Database of Clinical Specialty Guidelines

ABSTRACTThe National Guidelines Clearinghouse (NGC), also known as Guideline.gov, is a database of resources to assist health care providers with a central depository of guidelines for clinical specialty areas in medicine. The database is provided free of charge and is sponsored by the U.S. Department of Health and Human Services and the Agency for Healthcare Research and Quality. The guidelines for treatment are updated regularly, with new guidelines replacing older guidelines every five years. There are hundreds of current guidelines with more added each week. The purpose and goal of NGC is to provide physicians, nurses, and other health care providers, insurance companies, and others in the field of health care with a unified database of the most current, detailed, relevant, and objective clinical practice guidelines.

Multidisciplinary team (MDT) meeting and Radiologist workload, a prospective review in a tertiary care hospital.

Objective:To quantify the increase in workload associated with multidisciplinary team meetings for radiologists in a tertiary care hospital over a period of 15 months.Methods:Data was collected prospectively regarding number of multidisciplinary team meetings, number of clinical cases discussed, number of individual imaging studies reviewed, and preparation time of residents, senior registrar and consultants and the delivery time of meeting.Results:Total 223 meetings were held over 15 months (April 2014 to June 2015) for 12 clinical specialty areas. There were 1120 clinical case discussions and a total of 2759 documented individual imaging studies reviewed. Resident’s preparation time was 74.6 hours/month, senior registrar’s preparation time was 47.93 hours/month, consultant’s preparation time was 18.67 hours/month and the total duration time for meetings was 18 hours/month.Conclusion:Multidisciplinary team meetings now represent a significant workload of radiology and has reduced the time for other academic activities within the department.

The layered learning practice model: Lessons learned from implementation.

Pharmacists' views about the implementation, benefits, and attributes of a layered learning practice model (LLPM) were examined. Eligible and willing attending pharmacists at the same institution that had implemented an LLPM completed an individual, 90-minute, face-to-face interview using a structured interview guide developed by the interdisciplinary study team. Interviews were digitally recorded and transcribed verbatim without personal identifiers. Three researchers independently reviewed preliminary findings to reach consensus on emerging themes. In cases where thematic coding diverged, the researchers discussed their analyses until consensus was reached. Of 25 eligible attending pharmacists, 24 (96%) agreed to participate. The sample was drawn from both acute and ambulatory care practice settings and all clinical specialty areas. Attending pharmacists described several experiences implementing the LLPM and perceived benefits of the model. Attending pharmacists identified seven key attributes for hospital and health-system pharmacy departments that are needed to design and implement effective LLPMs: shared leadership, a systematic approach, good communication, flexibility for attending pharmacists, adequate resources, commitment, and evaluation. Participants also highlighted several potential challenges and obstacles for organizations to consider before implementing an LLPM. According to attending pharmacists involved in an LLPM, successful implementation of an LLPM required shared leadership, a systematic approach, communication, flexibility, resources, commitment, and a process for evaluation.

The impact of contemporary multidisciplinary meetings on workload at a tertiary level hospital.

In recent years, multidisciplinary meetings (MDMs) have become the standard of patient care in oncologic and other speciality care pathways. The number, complexity, and diverse source of imaging studies presented continue to expand rapidly. True multidisciplinary input requires parallel support from other colleagues and diagnostic services. It is now recognised that this is the appropriate forum for key decision making and education in care algorithms, though service plans make little or no accommodation of their expanding role in addition to existing services. We tried to objectively quantify one element of this burgeoning service. Data were retrospectively gathered over a 6month period, and a 5week prospective study was then performed to examine the workload in further detail. Retrospectively, 199 meetings were held with 2253 clinical cases reviewed over 26weeks. Prospectively, 52 meetings were held over 5weeks for 13 clinical specialty areas. There were 1038 clinical case discussions. There were a total of 2122 documented individual imaging studies reviewed. Specialist registrar preparation time was 55h (11 per week). Consultant preparation time was 67.75h (13.55 per week). Delivery time was 57.25h (11.45 per week). The complexity and range of cases at MDMs continue to expand, serving local and national needs, though service plans do not acknowledge their role in the working day. Our study shows just one element that clearly signals a need to take account of the new methods of delivering modern healthcare.

From Expert Clinician to Nurse Educator: Outcomes of a Faculty Academy Initiative.

The Eastern Shore Faculty Academy and Mentorship Initiative, a collaborative program among 3 nursing programs in rural Maryland, was developed to facilitate the transition of expert clinicians from diverse backgrounds in clinical specialty areas with critical shortages to new roles as part-time clinical faculty. Initial outcomes include 32 Academy graduates, with 37.5% representing diverse backgrounds and 37.5% in needed clinical specialties. This initiative represents an innovative approach to meeting the challenges of the nursing faculty shortage through collaborative efforts and creative solutions.

How Health Care Professionals Use Social Media to Create Virtual Communities: An Integrative Review.

BackgroundPrevailing health care structures and cultures restrict intraprofessional communication, inhibiting knowledge dissemination and impacting the translation of research into practice. Virtual communities may facilitate professional networking and knowledge sharing in and between health care disciplines.ObjectivesThis study aimed to review the literature on the use of social media by health care professionals in developing virtual communities that facilitate professional networking, knowledge sharing, and evidence-informed practice.MethodsAn integrative literature review was conducted to identify research published between 1990 and 2015. Search strategies sourced electronic databases (PubMed, CINAHL), snowball references, and tables of contents of 3 journals. Papers that evaluated social media use by health care professionals (unless within an education framework) using any research design (except for research protocols or narrative reviews) were included. Standardized data extraction and quality assessment tools were used.ResultsOverall, 72 studies were included: 44 qualitative (including 2 ethnographies, 26 qualitative descriptive, and 1 Q-sort) and 20 mixed-methods studies, and 8 literature reviews. The most common methods of data collection were Web-based observation (n=39), surveys (n=23), interviews (n=11), focus groups (n=2), and diaries (n=1). Study quality was mixed. Social media studied included Listservs (n=22), Twitter (n=18), general social media (n=17), discussion forums (n=7), Web 2.0 (n=3), virtual community of practice (n=3), wiki (n=1), and Facebook (n=1). A range of health care professionals were sampled in the studies, including physicians (n=24), nurses (n=15), allied health professionals (n=14), followed by health care professionals in general (n=8), a multidisciplinary clinical specialty area (n=9), and midwives (n=2). Of 36 virtual communities, 31 were monodiscipline for a discrete clinical specialty. Population uptake by the target group ranged from 1.6% to 29% (n=4). Evaluation using related theories of “planned behavior” and the “technology acceptance model” (n=3) suggests that social media use is mediated by an individual’s positive attitude toward and accessibility of the media, which is reinforced by credible peers. The most common reason to establish a virtual community was to create a forum where relevant specialty knowledge could be shared and professional issues discussed (n=17). Most members demonstrated low posting behaviors but more frequent reading or accessing behaviors. The most common Web-based activity was request for and supply of specialty-specific clinical information. This knowledge sharing is facilitated by a Web-based culture of collectivism, reciprocity, and a respectful noncompetitive environment. Findings suggest that health care professionals view virtual communities as valuable knowledge portals for sourcing clinically relevant and quality information that enables them to make more informed practice decisions.ConclusionsThere is emerging evidence that health care professionals use social media to develop virtual communities to share domain knowledge. These virtual communities, however, currently reflect tribal behaviors of clinicians that may continue to limit knowledge sharing. Further research is required to evaluate the effects of social media on knowledge distribution in clinical practice and importantly whether patient outcomes are significantly improved.

Preparation of academic nurse educators

Nursing practice is diverse, with nurses serving in both direct and indirect patient care roles. For nurse educators, the realm of nursing practice extends beyond direct patient care to include preparing students for nursing practice. Academic nurse educators must be prepared to serve as educators, researchers, and to have experience in a clinical specialty area. For many nurse educators, advanced academic preparation often relates to a clinical area of practice rather than pedagogical practice. Graduate-level knowledge of evidence-based research and practice, teaching methods, and curriculum design and development form the foundation for academic practice. Because education and nursing are two distinctive disciplines, clinical expertise does not naturally result in teaching expertise. Lack of consensus regarding the educational preparation of nurse educators adds to the complexity of the nursing profession. The purpose of this article is to advocate for pedagogical preparation for academic nurse educators. Additionally, this article contains recommendations for pedagogical competencies indicative of academic nurse educator preparation.

Theory to practice: the humanbecoming leading-following model.

Guided by the humanbecoming leading-following model, the author designed a nursing theories course with the intention of creating a meaningful nursing theory to practice link. The author perceived that with the implementation of Situation-Background-Assessment-Recommendations (SBAR) communication, nursing staff had drifted away from using the Kardex™ in shift to shift reporting. Nurse students, faculty, and staff members supported the creation of a theories project which would engage nursing students in the pursuit of clinical excellence. The project chosen was to revise the existing Kardex™ (predominant nursing communication tool). In the project, guided by a nursing theory, nursing students focused on the unique patient's experience, depicting the specific role of nursing knowledge and the contributions of the registered nurse to the patient's healthcare journey. The emphasis of this theoretical learning was the application of a nursing theory to real-life clinical challenges with communication of relevant, timely, and accurate patient information, recognizing that real problems are often complex and require multi-perspective approaches. This project created learning opportunities where a nursing theory would be chosen by the nursing student clinical group and applied in their clinical specialty area. This practice activity served to broaden student understandings of the role of nursing knowledge and nursing theories in their professional practice.

An entrustable professional activity (EPA) for handoffs as a model for EPA assessment development.

Medical education is moving toward assessment of educational outcomes rather than educational processes. The American Board of Internal Medicine and American Board of Pediatrics milestones and the concept of entrustable professional activities (EPA)--skills essential to the practice of medicine that educators progressively entrust learners to perform--provide new approaches to assessing outcomes. Although some defined EPAs exist for internal medicine and pediatrics, the continued development and implementation of EPAs remains challenging. As residency programs are expected to begin reporting milestone-based performance, however, they will need examples of how to overcome these challenges. The authors describe a model for the development and implementation of an EPA using the resident handoff as an example. The model includes nine steps: selecting the EPA, determining where skills are practiced and assessed, addressing barriers to assessment, determining components of the EPA, determining needed assessment tools, developing new assessments if needed, determining criteria for advancement through entrustment levels, mapping milestones to the EPA, and faculty development. Following implementation, 78% of interns at the University of Minnesota Medical School were observed giving handoffs and provided feedback. The authors suggest that this model of EPA development--which includes engaging stakeholders, an iterative process to describing the behavioral characteristics of each domain at each level of entrustment, and the development of specific assessment tools that support both formative feedback and summative decisions about entrustment--can serve as a model for EPA development for other clinical skills and specialty areas.

The impact of a large-scale quality improvement programme on work engagement: Preliminary results from a national cross-sectional-survey of the ‘Productive Ward’

BackgroundQuality improvement (QI) Programmes, like the Productive Ward: Releasing-time-to-care initiative, aim to ‘engage’ and ‘empower’ ward teams to actively participate, innovate and lead quality improvement at the front line. However, little is known about the relationship and impact that QI work has on the ‘engagement’ of the clinical teams who participate and vice-versa. ObjectiveThis paper explores and examines the impact of a large-scale QI programme, the Productive Ward, on the ‘work engagement’ of the nurses and ward teams involved. Design/methodsUsing the Utrecht Work Engagement Scale (UWES), we surveyed, measured and analysed work engagement in a representative test group of hospital-based ward teams who had recently commenced the latest phase of the national ‘Productive Ward’ initiative in Ireland and compared them to a control group of similar size and matched (as far as is possible) on variables such as ward size, employment grade and clinical specialty area. Results338 individual datasets were recorded, n=180 (53.6%) from the Productive Ward group, and n=158 (46.4%) from the control group; the overall response rate was 67%, and did not differ significantly between the Productive Ward and control groups. The work engagement mean score (±standard deviation) in the Productive group was 4.33(±0.88), and 4.07(±1.06) in the control group, representing a modest but statistically significant between-group difference (p=0.013, independent samples t-test). Similarly modest differences were observed in all three dimensions of the work engagement construct. Employment grade and the clinical specialty area were also significantly related to the work engagement score (p<0.001, general linear model) and (for the most part), to its components, with both clerical and nurse manager grades, and the elderly specialist areas, exhibiting substantially higher scores. ConclusionsThe findings demonstrate how QI activities, like those integral to the Productive Ward programme, appear to positively impact on the work engagement (the vigour, absorption and dedication) of ward-based teams. The use and suitability of the UWES as an appropriate measure of ‘engagement’ in QI interventions was confirmed. The engagement of nurses and front-line clinical teams is a major component of creating, developing and sustaining a culture of improvement.