Extra Work Research Articles

Root causes behind patient safety incidents in the emergency department and suggestions for improving patient safety - an analysis in a Finnish teaching hospital.

Adverse events occur frequently at emergency departments (ED) because of several risk factors related to varying conditions. It is still unclear, which factors lead to patient safety incident reports. The aim of this study was to explore the root causes behind ED-associated patient safety incidents reported by personnel, and based on the findings, to suggest learning objectives for improving patient safety. The study material included incident reports (n = 340) which concerned the ED of a teaching hospital over one year. We used a mixed method combining quantitative descriptive statistics and qualitative research by inductive content analysis and deductive Ishikawa root cause analysis. Most (76.5%) incidents were reported after patient transfer from the ED. Nurses reported 70% of incidents and physicians 7.4%. Of the reports,40% were related to information flow or management. Incidents were evaluated as no harm (29.4%), mild (46%), moderate (19.7%), and severe (1.2%) harm to the patient. The main consequences for the organization were reputation loss (44.1%) and extra work (38.9%). In the qualitative analysis, nine specific problem groups were found: insufficient introduction, adherence to guidelines and protocols, insufficient human resources, deficient professional skills, medication management deficiencies, incomplete information transfer from the ED, language proficiency, unprofessional behaviour, identification error, and patient-dependent problems. Six organizational themes were identified: medical staff orientation, onboarding and competence requirements; human resources; electronic medical records and information transfer; medication documentation system; interprofessional collaboration; resources for specific patient groups such as geriatric, mental health, and patients with substance abuse disorder. Entirely human factor-related themes could not be defined because their associations with system factors were complex and multifaceted. Individual and organizational learning objectives were addressed, such as adherence to the proper use of instructions and adequate onboarding. System factors caused most of the patient safety incidents reported concerning ED. The introduction and training of ED -processes is elementary, as is multiprofessional collaboration. More research is needed about teamwork skills, patients with special needs and non-critical patients, and the reporting of severe incidents.

I reflect, therefore I am!, Exploring the use of a Voluntary Online Reflective Journal as a learning tool among postgraduate dental students.

Reflection is widely used in all aspects of teaching and learning in dental education and makes a fundamental part of all learning activities for dental students. However, reflective tasks are often used with a clear purpose; for example, in completing e-portfolios or dealing with critical incidences. This study explores the use of optional online journals that Postgraduate (PG) dental students were encouraged to use as part of their own development. To explore how PG dental students perceive the use of optional online journals. Data were collected via an anonymous questionnaire that included a word pool, Likert-scale statements and free text comment sections. Overall, 31 students (93%) responded to the questionnaire with high focus on the usefulness of the journal, with 58% selecting 'connecting with tutors' and 41% selecting 'keeping track' of their own learning and progress. The word 'reflection' was selected by 87% of participants when describing the use of the journal. Some participants, 29%, considered the journal as 'added pressure', and 41% felt it was 'extra work' as the journal, although voluntary, presented an added task to complete. All students made at least one entry in the online journal. The use of an optional online journal can be a useful tool in establishing connection between dental students and their tutors. Some postgraduate dental students valued the benefits of reflective journal without it being linked to assessments. Some concerns were reported around the time constraints as well as the added work related to taking part in such activity.

BMA criticises budget for failing to remove financial barriers to doctors taking on extra work.

BMA criticises budget for failing to remove financial barriers to doctors taking on extra work.

Simulation modelling of cost overruns in building projects: a panel data analysis

Cost overrun is often a challenge in the construction industry due to its complex nature and inefficient project management. Despite extensive research, cost overruns persist in construction. Hence, to minimise these challenges, factors attributing to the cost overrun need to be identified. A country-based assessment is needed since these factors vary from nation to nation. Research conducted almost two decades ago has identified the key cost-related factors influencing cost overrun of Sri Lankan building projects as variation, extra work, fluctuation of price and currency, day works and others. However, given the significant developments and technological advancement in the Sri Lankan construction industry since then, it is crucial to reassess the factors influencing cost overrun in the current context. Therefore, this research intends to re-evaluate the cost-related factors contributing to cost overrun in Sri Lanka. Further, a panel data analysis was conducted to analyse how the influence of the cost-related factors that cause cost overrun has changed over time. This research adopted a survey strategy and used document review on the final BOQ, tender document, and final statement as the data collection technique. Mote-Carlo simulation was adopted to analyse the data collected from twenty random building projects in the western province of Sri Lanka. The findings concluded that work sections measured as ‘item’ in the BOQ and variations and extra work cause overruns in Sri Lankan construction. Hence, clients, contractors, and consultants should give more priority to these factors to minimise the cost overrun by reducing the errors in BOQ, making accurate estimations, and reducing changes over time. However, as the simulation model was derived based on cost-related factors, this study recommends considering other factors influencing the cost overrun of buildings in future research.

Institutional Trust and Economic Coping Strategies in Response to Sanctions: The Case of Russia and Iran

Sanctions have become an established feature of the economic landscape in Russia and Iran and may lead to economic insecurity and distrust of political bodies among citizens. However, few studies have investigated the way individuals adapt to these sanctions and whether their coping strategies are linked to their trust in institutions. To address this gap, we conducted a comparative study between Russians and Iranians, examining their economic coping strategies (ECS), including traditional ways of storing value, modern investments, cost-cutting measures, extra work, and resorting to social and material resources in response to sanctions and their relationship with institutional trust. Utilizing a cross-sectional research design, we administered surveys and obtained sample sizes of 364 and 311 in Russia and Iran, respectively. Our findings revealed that Russians exhibit higher institutional trust and lower levels of employing ECS compared to Iranians. Furthermore, we observed that lower institutional trust is associated with a greater overall use of ECS among Russians but not Iranians. When analyzing each coping strategy individually, we found that Russians with lower institutional trust tend to rely more on extra work, cost-cutting measures, and social and material resources, while in Iran, we observed this relationship for cost-cutting measures and modern investments. We concluded that in Russia, the financial insecurity induced by sanctions may have impacted institutional trust of those low-income individuals that were pressed to use certain strategies, while in Iran, the link between cutting expenses, modern investments, and institutional trust may be better explained by reduced life satisfaction and cultural factors. Given the role of institutional trust in well-being, it is crucial to protect at-risk segments of society from the adverse effects of financial challenges on their institutional trust.

The hostile environment in primary care: Qualitative analysis of a cross sectional survey of health care professionals in primary care

BackgroundIn 2014 the UK government rolled out the then called hostile environment as a series of punitive policies designed to disenfranchise undocumented migrants from living in Britain. As part of these measures upfront charging was introduced in 2017 which saw patients being denied treatment without prior full payment based on their immigration status. AimAssess the knowledge of the charging regulations in a sample of primary care practitioners. Assess the impact of the regulations on both patients and practitioners in a primary care setting. MethodsBuilding on a previous survey by the RCPCH, a cross sectional survey was circulated through the RCGP faculties and GP training groups within England. Demographic information and likert responses were collected from over 300 responses. Thematic analysis of over 120 white space questions was undertaken to create themes and sub-themes. ResultsResults showed an overall poor knowledge of the regulations. Thematic analysis was split into two main categories, (i) human impact of the policies and (ii) the economic and political impact of the policies. Key points were (i) lack of knowledge and awareness of the regulations, (ii) evidence of patient harm through patients’ being denied care, avoiding care or having care delayed, (iii) evidence of clinician harm through burnout, stress, a loss of faith in practice and concerns over extra work and (iv) concerns over implicit bias and structural racism within primary care and (v) concerns over lack of economic analysis. ConclusionCharging of overseas visitors is poorly understood within primary care despite having an impact on both patients and practitioners within this setting. Recommendations to help tackle this issue and reduce harm include training of staff, systematic reporting of harm, and a system wide economic analysis.

A path-dependent stress-strain model of FRP-confined circular concrete columns derived from an energy balance approach

It is generally believed that the use of fibre-reinforced polymer (FRP) confinement can effectively improve the strength and ductility of concrete. Passive confinement is one of the key features of the behavior of FRP-confined concrete. Analysis-oriented models for passively confined concrete have been established on the base of the active confinement model by many researchers. Among them, a stress path-independent assumption was made for those passively confined concrete. However, in recent years, numerous researchers have found that the influence of stress path on the stress-strain relationship of confined concrete cannot be neglected. Therefore, in order to further understand and simulate the uniaxial behavior of FRP-confined concrete, this paper presents a stress path-dependent model of FRP-confined concrete based on an energy balance approach in which the extra work done by the active confining pressure in the stress path-independent model is considered. Firstly, experimental data comprising 341 sets of FRP jacket confined concrete tests and 28 sets of concrete-filled FRP tube (CFFT) tests were collected. Subsequently, the stress paths of the two types of specimens were identified based on the properties of FRP materials, and then the energy balance assumption was introduced, and finally a new stress path-dependent model was established using the energy balance approach. By comparing the predictions of the proposed model with collected experimental data and those of several existing models, it was observed that the proposed model can more accurately predict the ultimate stress of FRP-confined concrete and exhibit good agreement with the experimental stress-strain curves.

Exploration of Workaholic Characteristics of Married Women in Healthcare sector during Pandemic situations

Women in professional and family life are facing lot of challenges where they are struggling to manage their work pressure and family responsibilities. In healthcare sectors, the employees especially the nurses have to carry out shift work and have to perform morning, evening and night shifts. It is analysed and proved by many analysts that mostly the women from middleclass family life are subject to such work-life challenges in particular the women nurses especially during pandemic situations. This study focuses on Workaholism which is an extreme work force that leads to the disregard of others’ welfare and harmful effects faced by the women nurses especially who are married. In this aspect, the research was conducted to examine the workaholic characteristics of married women especially the nursing professionals during the pandemic period. The study was conducted by collecting data from women nurses from South part of India and the sample size derived for the study is 200. The findings reveal that Continuous thoughts of Work Involvement, Accepts Extra Work Time, Task Oriented, Compensation based on Work Performance and No Botheration about Work life Balance are the major workaholic characteristics of women nurses especially who are married.

‘I’m really glad I did do it and that on balance the extra work was worth it’: A COM-B framework of final year trainees experiences of attaining secondary accreditation in Cognitive Behavioural Therapy on a clinical psychology programme in the UK

Clinical Psychology trainees undertaking the specialised Cognitive Behavioural Therapy (CBT) pathway develop robust CBT competencies and gain secondary accreditation with the British Association for Cognitive and Behavioural Psychotherapy upon qualification from doctoral training. This paper outlines final year trainees’ reflections on their experience of undertaking the pathway. A COM-B model of behaviour change was adopted to consider the process of implementation and avenues for development. Overall, trainees reported being pleased to have left the doctorate with well-honed competencies in CBT. The trainees reported varied opportunities to develop skills, a significant increase in their capability, referred to multiple forms of intrinsic and extrinsic motivations and reported commitment to sustainable behaviour change. Issues relating to working with complexity and across the lifespan were highlighted as areas for further consideration.

Dealing With a Stressful Extra Duty: The Intrapersonal Conflict Experiences of Nurses Caring for Survivors of Suicide Attempts on Medical-Surgical Wards.

Nurses are the frontline professionals caring for patients who have attempted suicide. When clinical nurses learn from medical records or nursing handover, or are proactively informed by patients or family members, that the patients they are caring for have suicidal tendencies, they often experience pressure and face challenges. However, little attention has been given to the experiences of the nurses caring for patients with suicidal intent on medical and surgical wards. We aimed to address this knowledge gap. The purpose of this study was to explore medical and surgical nurses' experiences, especially the internal conflicts they might experience while caring for patients who have a history of attempted suicide. A qualitative descriptive design and semi-structured interviews were used in this study. Twenty-three nurses were recruited and interviewed individually. Data were analysed by qualitative content analysis. The focus of this paper is to examine the emergent theme of intrapersonal conflict experienced by the participants. Nurses' experiences can be clustered into two themes: (1) Pity and annoyance and (2) Hard work does not necessarily pay off. Intrapersonal conflict was identified by participants as considerable fear and anxiety about the possibility of a patient's suicide, as well as a mixture of pity for and annoyance with the patients. Nurses feel sorry for such patients, but they are also annoyed by the extra work required to prevent suicide attempts in the ward. Additionally, having limited time and ability, they see that their hard work does not necessarily pay off and may sometimes lead to punishment. Our findings raise serious concerns about the adequacy of the knowledge of the nurses, their competence and their difficulties in caring for such patients. In addition, there is a need to provide them with appropriate on-the-job education and immediate emotional support relevant to caring for survivors of suicide attempts.

BIM Legal: Implementation of a standard for Cadastral Registration of Apartment Complexes in 3D

Abstract. The potential of Building Information Models (BIM) to establish rights and responsibilities for multi-level building complexes in cadastral registrations has been explored in many previous researches. However, the implementation of BIM-based cadastral registrations in practice remains limited due to the complex interplay between technical potentials and legal implications as well as uncertainty about the additional complexity of a BIM model and the extra work that will be required to generate the BIM Legal model. In collaboration with Netherlands Kadaster, we have investigated the data requirements for a BIM Legal model that will support the 3D cadastral registration of apartment complexes and that aligns with BIM creation processes in practice. The BIM Legal model aims to visualise the spatial aspects of apartment complexes and to align the cadastral registration to the 3D data that is generated in the design and construction phase of new buildings. The BIM Legal file will be submitted when an apartment complex is being registered and is based on IFC, the open standard established by BuildingSMART International and used in the BIM domain. To make the implementation of BIM Legal feasible legally, technically, and economically, we apply a 3-phase approach. This paper presents the BIM Legal model as defined in Phase 1, which enables to generate a BIM Legal model compliant with current legislation frameworks with no/minimal manual interaction from BIM models as commonly generated in design processes. The paper describes the 3-phase approach, the context of Phase 1, the data requirement analyses, the defined BIM Legal data model, as well the questions that emerged during the specification process that need to be answered to further improve the implementation of Phase 1 and to further develop BIM Legal for Phases 2 and 3.

Digitalizing Access to Care: How Self-Check-In Kiosks Shape Access to Care and Efficiency of Hospital Services

Responding to labor shortages and rising healthcare expenses, hospitals increasingly turn to self-check-in kiosks to streamline service delivery and improve patients’ experiences. The purpose of this study was to reflect on the implementation of these self-check-in kiosks in a Dutch university hospital, particularly in relation to access to care for more vulnerable patients and intended efficiency goals. We followed a technology-in-practice approach to better understand how new technologies shape care practices in relation to in/exclusion and carried out an ethnographic action study involving desk research, participatory observations, semi-structured interviews, and reflection sessions with developers and hospital staff. Data were analyzed through ethnographic content analysis. Our results show that although self-check-in kiosks work well for some patients, many people experience practical and psychosocial difficulties, especially those who go through a complex care pathway, are low-literate, experience a distance the online world, or have sensory, motor, or cognitive impairments. Kiosks are not yet attuned to these patients and typically leave little flexibility and room for negotiation and personal support in what is, for many, a foreign environment. Therefore, patients frequently seek confirmation and assistance from already downsized or busy staff. In conclusion, we find that digitalization under the banner of efficiency within a healthcare system already under pressure carries risks, as it can unintentionally generate extra (invisible) work for patients and care professionals and threaten access to and quality of care for patients most in need. A more concentrated effort on refining the digitalization of healthcare processes using an inclusive-technology-in-practice approach has the potential to contribute to fairer and more efficient care for all patients.

Assessment of occupational exposure to lead among workers engaged in a city bus garage in Addis Ababa, Ethiopia: a comparative cross-sectional study

BackgroundLead is one of the most nonessential toxic heavy metal agents found in automotive garages. The occupational exposure of garage workers to lead commonly poses acute and chronic health risks that can be prevented. In Ethiopia, there have been limited studies on lead exposure among garage workers, who overemphasize exposure to lead. This study aimed to assess occupational blood lead levels and associated factors in garage workers using a cross-sectional comparative design.MethodsA comparative cross-sectional study design was used to compare the occupational blood lead levels of 36 randomly selected garage workers and 34 office workers who were matched by age and sex. Blood specimens were collected by trained medical laboratory experts. The collected blood samples were tested in a certified laboratory using a microwave plasma atomic emission spectrometry (MP-AES) device at a wavelength of 405.78 nm. Excel and SPSS Version 26 were used for data management and analysis, respectively.ResultsThe mean (SD) age of the exposed group was 39.0 (7.5) years, whereas the mean age of the unexposed group was 38.0 (6.1) years. The occupational mean (SD) blood-lead-level in the exposed groups was 29.7 (12.2) µg/dl, compared to 14.8 (9.9) µg/dl among the unexposed groups. The mean blood-lead level among the exposed workers was significantly different from that among the unexposed workers (P < 0.01). Of all the study participants, only 22.2% of the exposed groups had blood lead levels higher than the World Health Organization’s recommended limit of 40 µg/dl. The main significant predictors of occupational blood-lead-level exposure among workers were extra working hours, service years, and having a previous (prior) employment history in a garage. The occupations of the two groups did not significantly differ in terms of blood-lead levels (p > 0.05).ConclusionsThe BLL of the Garage workers was significantly greater than that of the Non-Garage workers. Hence, it is advised that garage management should encourage workers to use exposure prevention methods, such as washing their hands before eating and taking showers after the completion of work, by providing regular occupational safety training.

Large cells suppress the reproduction of Varroa destructor.

The parasitic mite, Varroa destructor has posed a threat to the health and survival of European honey bees, Apis mellifera worldwide. There is a prevailing belief that small comb cells could provide a management tool against Varroa mites. However, the hypothesis that smaller cells can impede Varroa reproduction has not been fully tested. Here, we tested this hypothesis under laboratory conditions by using two distinct Varroa in vitro rearing systems: one involved gelatin capsules of different sizes, specifically size 00 (0.95 mL) versus size 1 (0.48 mL), and the second consisted of brood comb cells drawn on 3D printed foundations with varying cell sizes, ranging from 5.0 mm to 7.0 mm at 0.5 mm intervals. The results showed that mother mites in size 00 cells had significantly lower fecundity and fertility compared to those in size 1 cells. Interestingly, the reproductive suppression in larger cells could be reversed by adding an extra worker larva. Similarly, gonopore size of mother mites was smaller in size 00 cells, but restored with another host larva. Furthermore, both the fecundity and fertility of mother mites decreased linearly with the size of brood comb cells. Our results suggest that the reproduction of V. destructor is hindered by larger cells, possibly because larger brood cells disperse or weaken host volatile chemical cues that are crucial for Varroa reproduction. The insights derived from this study are expected to hold significant implications for the implementation of Varroa management programs. © 2024 Society of Chemical Industry.

A modeling framework for evaluating proactive and reactive nurse rostering strategies — A case study from a Neonatal Intensive Care Unit

We develop a modeling framework for rostering, absence and demand uncertainty realization, and rerostering to perform detailed quantitative analyses of the robustness of nurse rosters. The framework reflects a real-life problem observed at the Department of Neonatal Intensive Care (DNIC) at St. Olavs Hospital in Trondheim, Norway, but is general and has a high transfer value with respect to using it to analyze roster robustness at other departments. We present multiple proactive strategies to enhance the stability of a roster and a reactive rerostering problem used to improve the flexibility. An extensive case study is performed using historical data from the department. The results show that there is a great potential to improve the stability and flexibility of the rosters using the best combination of strategies. We show that allowing nurses to trade extra weekend work for extra days off, assign surplus work hours evenly over all work shifts, and consider the absence profile of nurses when making the rosters are key strategies to create robust rosters.

Open instrumentation, like open data, is key to reproducible science. Yet, without incentives it won't thrive.

There is far more to open science than simply not shutting away your work. For example, a significant time investment must be made to collate, curate, explain and document precisely how an experiment can be reproduced or data can be reused. This time investment is currently poorly rewarded in our current model of open science where a bare minimum of openness is mandated, but further work is not recognized. As the open science movement looks beyond open access publications and open data towards ongoing detailed work such as open source software and open source hardware, it needs to consider how to properly encourage the extra work that is needed to properly document these projects. Without detailed documentation, the work cannot be replicated, reused and continually improved. If the work cannot be replicated or reused, is it really even open? This article is part of the Theo Murphy meeting issue 'Open, reproducible hardware for microscopy'.

Impact of Sociodemographic Characteristics on the Quality of Life of Frontline Nursing Staff During COVID-19 in Saudi Arabia.

Background The COVID-19 pandemic imposed unprecedented challenges on healthcare systems worldwide. The pandemic placed frontline nursing staff working in the ICU and ER at the epicenter of this global crisis. This study aimed to assess the multifaceted impact of sociodemographic characteristics on the quality of life (QOL) of nursing staff during the pandemic. Method A cross-sectional survey was conducted to evaluate the impact of sociodemographic characteristics on the QOLof 322 frontline nurses working in the ICU and ER of five Saudi hospitals from May to July 2022. Participants completed the electronic survey questionnaire including demographic characteristics and four domains of QOL from the World Health Organization Quality of Life Questionnaire (WHOQOL-BREFF). The data was evaluated using descriptive and inferential statistics. Results Among 322 nurse participants, the majority were female (84.8%), married (64.4%), and held a bachelor's degree (92.4%). Age (above 40 years), gender (male), and marital status (married) reported a higher individual domain and overall QOL scores which shows that these characteristics have a direct influence on QOL. Years of work experience, extra working hours, and direct contact with COVID-19 patients were additional significant factors. Pearson correlation coefficients among QOL domains ranged from 0.54 to 0.91, indicating a strong interrelation among these domains. The highest transformed score was in the social domain (70.10) while the lowest score was in the psychological domain (59.20). The overall QOL mean score (SD) was 3.49(0.14) and the mean score (SD) of general health was 3.46(0.15). Conclusion The findings of this study suggest that sociodemographic and work-related factors have a complex and multifaceted impact on the QOL of nurses during the COVID-19 pandemic in Saudi Arabia. It also presents an insight into developing specific interventions to enhance nurses' resilience and well-being amidst pandemic challenges and to improve their QOL.

Balancing Act: Investigating the Work-Life Equilibrium of Public Elementary School Teachers

This study aimed to find out the significant relationship between work-related variables and work-life balance of the elementary school teachers of the Division of Lipa City. This study used the descriptive-correlational type of research. This study was conducted with the aid of one hundred twenty (120) public elementary school teachers in the division of Lipa City for the school year 2023-2024. The researcher used the survey questionnaire in gathering responses to find out the effects of work-related variables to teacher’s work-life balance. The study found out that the respondents agree that various work-related factors influence their ability to maintain a healthy work-life balance. The respondents also strongly agree that their work-life balance is significantly impacted by various factors, including their working hours, utilization of vacation and leave, ability to spend quality time, and their overall health and well-being. Overall, work-related variables exhibit significant relationships with various aspects of teachers' professional lives. Based on the findings the following recommendations are set forth: Considering the agreement of the teachers toward the work-related variables, the researcher suggests that time management for teachers should be a priority to avoid stress, anxiety and poor mental health and well-being since in the teaching field, extra work and extended hours of working could not be avoided. Give time for and health and well-being through physical exercise and avoid worries and stress.

Perception of the question tune in Guanzhong Mandarin

This study investigates the perception of the question tune in Guanzhong Mandarin and the interaction between tone and tune using the AX paradigm. Our findings reveal a complex interplay between lexical tones and question tunes, in which when the lexical tone is rising, it is more difficult to perceive question tunes. Furthermore, the research argues that the question tune retrieval requires extra working memory load and cognitive processing, because of the tune information brought by a high register and a high boundary tone.

QCML: Qualified Contrastive Machine Learning methodology for infectious disease diagnosis in CT images

The COVID-19 pandemic has had a terrible effect on human health, and computer-aided diagnostic (CAD) systems for chest computed tomography have emerged as a potential alternative for COVID-19 diagnosis. Yet, since the cost of data annotation may be excessively costly in the medical area, there is a shortage of data that has been annotated. A considerable quantity of labelled data is required in order to train a CAD system to a high level of accuracy. The study aims to describe an automatic and precise COVID-19 diagnostic method that utilizes a restricted amount of labelled CT images to solve this problem. The framework of the system is known as Qualified Contrastive Machine Learning (QCML), and the improvements that we have made may be summed up as follows: 1) In order to make use of all of the image's characteristics, we combine features with a two-dimensional discrete wavelet transform. 2) We employ the COVID-Net encoder with a redesign that focuses on the efficiency of learning and the task specificity of the data. 3) In order to strengthen our capacity to generalize, we have implemented a novel pertaining technique that is based on Qualified Contrastive Machine Learning. 4) In order to get better categorization results, we have included an extra auxiliary work. The application of Qualified Contrastive Machine Learning methodology for infectious disease diagnosis in CT images offers an accuracy of 93.55%, a recall of 91.59%, a precision of 96.92%, and an F1-score of 94.18%, demonstrating the potential for accurate and efficient COVID-19 diagnosis with limited labelled data.