Staff Focus Groups Research Articles

Barriers and enablers to implementing intranasal ketamine for Primary Care Paramedics in Canada – A parallel convergent mixed methods study

Introduction British Columbia Emergency Health Service trialled the use of intranasal (IN) ketamine given by Primary Care Paramedics (PCPs). Prior to this practice change, the PCPs had not performed weight-based drug calculations, given medications intranasally, nor been responsible for controlled and targeted substances. This study aimed to use the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domain Framework (TDF) to identify enablers and barriers to implementing IN paramedic administered ketamine analgesia (iPAKA) for PCPs. Methods This was a parallel convergent mixed methods study with two phases. The quantitative phase consisted of longitudinal staff surveys to assess PCP knowledge and perceptions of ketamine and controlled and targeted substances policies. The qualitative phase involved staff focus groups on programme implementation. Descriptive statistics of survey results were integrated with coded focus group data and analysed using the COM-B model and TDF. Evidence-based behavioural change techniques were mapped to each TDF domain. Findings Our analysis revealed barriers and enablers across several TDF domains. Implementing ketamine was enabled by quality education, strong organisational support and the availability of cognitive aides. Trial success was attributed in part to participant's feelings of optimism and their increased job satisfaction. Key barriers included a knowledge gap involving drug dosage calculations, negative emotions associated with performance anxiety and a lack of field education and supervision to monitor paramedic practice. Conclusion The use of theoretical frameworks and models like COM-B/TDF serves to improve the sustainable implementation of behaviour and clinical practice change in paramedicine. When project teams use theory to guide design and implementation, they can systematically identify and target individual and organisational enablers and barriers to adopting routine practices. The iPAKA study reveals key barriers and facilitators in several TDF domains and presents theory-linked targeted behavioural techniques to support on-going implementation of PCP-administered IN ketamine for analgesia.

(017) Use of Knowledge Translation Methodology to Incorporate Research Results into Clinical Practice: Bringing Mindfulness and Cognitive Behavioural Therapy into a local prostate cancer program

Abstract Introduction There is an unmet need for psychological therapies that address sex-related distress in couples after prostate cancer (PCa) beyond pharmaceuticals and device aids. We recently completed a clinical trial that found both mindfulness and cognitive behavioural therapy (CBT) improved couples’ sexual health after prostate cancer (PCa). Given the benefits of these therapies to patients yet the poor translation of research into routine clinical care, we sought to use evidence-informed methods of knowledge translation to make this transition. Objective This was a knowledge translation (KT) and implementation science project. We aimed to share information about the efficacy of these therapies to PCa patients and their partners in a local prostate cancer program by creating and implementing KT tools in a format that was accessible, affirming, and effective. Methods We utilized two KT frameworks: the Knowledge to Action (KTA) cycle and the Consolidated Framework for Implementation Research (CFIR), and collaborated with knowledge partners (prostate cancer program clinical leader partnerships, patient partner consultations, and a focus group of the program staff analyzed using the CFIR framework) to guide implementation. Results We used the first four stages of the KTA cycle, informed by our knowledge partners, to create our KT tools. The first stage involved clarifying the knowledge gap. We then included the evidence-based mindfulness and CBT approaches to various existing time points of patient education in the local program's context. Next, we conducted our focus group to identify potential barriers and facilitators to implementation, and modified our implementation plan accordingly. We created an information card that explained CBT and mindfulness using terminology appropriate for the patient population. The card contained a link to a patient education video we created that instructed patients on how to practice these skills at home. This link was hosted on a webpage with external CBT and mindfulness resource links. Implementation is currently underway. Eligible patients receive the information card at clinical appointments with a registered sexual health nurse and access the education video, which then guides them on how to practice these therapies at home. A questionnaire has been developed to evaluate patient use of these tools, ease of use of the tools, and whether the tools were helpful with respect to improving sexual intimacy and mental health. Data collection is in progress. Conclusions By creating three KT tools to implement mindfulness and CBT patient education materials, we incorporated research findings into routine clinic flow of a local prostate cancer program. These tools have large implications for the current patient population: we filled a gap of a lack of psychosocial education for sexual intimacy for couples after prostate cancer to practice. To the best of our knowledge, this is the first study to use KTA methodology to apply results from a clinical trial directly into clinical practice. This methodology should be incorporated into research funding mechanisms in order to encourage more widespread adoption of bringing research findings into practice. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast, Sustained Therapeutics, AstraZeneca, Astellas, Genetech, Lantheus Merck, Sharp & Dohme, Myovant, Menarini, Tolmar, Vaccitech, Verity

Access block and overcrowding at the emergency department at Tupua Tamasese Meaole Hospital in Samoa

BackgroundAccess block and overcrowding are known to adversely impact on patient outcomes, service delivery, and patient experiences within emergency departments (ED) worldwide. There are no studies on access block or overcrowding from the Pacific Islands. The aim of the present study is to provide preliminary data on access block and overcrowding in the ED of the national tertiary hospital of Samoa.MethodsMixed methods study design. Data collection was performed in March 2020. The quantitative strand calculated (1) the point prevalence of patients impacted by access block in the ED, and (2) the ED bed occupancy rate to assess for overcrowding. The qualitative strand used thematic analysis of two focus group interviews exploring access block and overcrowding with ED medical and nursing staff members.ResultsOn the day of data collection, a total of 60 patients presented through the ED triage system. Of the 20 patients who were admitted into ED, 80% were triaged as ‘see without delay’ (CAT1), ‘emergency’ (CAT2) or ‘urgent’ (CAT3). For patients requiring admission to hospital wards, 100% waited 4 + h in ED, and 100% waited 8 + h, suggesting the presence of access block. Overcrowding in the ED setting was also evident, with an ED bed occupancy rate of 0.95, and an adjusted bed occupancy rate of 1.43. The major themes emerging from the ED staff focus groups and individual in-depth interviews were (1) the adverse impacts of access block and overcrowding, i.e., violence towards ED staff members, (2) the preventable contributing factors, i.e., lack of physical beds in the ED, and (3) practical recommendations to improve patient flow through the ED, i.e., improved collaboration between ED, outpatient services, and the hospital wards.ConclusionsPreliminary evidence suggested the presence of access block and overcrowding in the ED of the national tertiary hospital of Samoa. ED staff interviews provided insight into the ED frontline challenges and offered practical recommendations for ED health service improvement.

Bubble-PAPR: a phase 1 clinical evaluation of the comfort and perception of a prototype powered air-purifying respirator for use by healthcare workers in an acute hospital setting

ObjectivesWe aimed to design and produce a low-cost, ergonomic, hood-integrated powered air-purifying respirator (Bubble-PAPR) for pandemic healthcare use, offering optimal and equitable protection to all staff. We hypothesised that participants...

Improving measurement-based care implementation in adult ambulatory psychiatry: a virtual focus group interview with multidisciplinary healthcare professionals

BackgroundMeasurement-Based Care (MBC) is an evidence-based practice shown to enhance patient care. Despite being efficacious, MBC is not commonly used in practice. While barriers and facilitators of MBC implementation have been described in the literature, the type of clinicians and populations studied vary widely, even within the same practice setting. The current study aims to improve MBC implementation in adult ambulatory psychiatry by conducting focus group interviews while utilizing a novel virtual brainwriting premortem method.MethodsSemi-structured focus group interviews were conducted with clinicians (n = 18) and staff (n = 7) to identify their current attitudes, facilitators, and barriers of MBC implementation in their healthcare setting. Virtual video-conferencing software was used to conduct focus groups, and based on transcribed verbatin, emergent barriers/facilitators and four themes were identified. Mixed methods approach was utilized for this study. Specifically, qualitative data was aggregated and re-coded separately by three doctoral-level coders. Quantitative analyses were conducted from a follow-up questionnaire surveying clinician attitudes and satisfaction with MBC.ResultsThe clinician and staff focus groups resulted in 291 and 91 unique codes, respectively. While clinicians identified a similar number of barriers (40.9%) and facilitators (44.3%), staff identified more barriers (67%) than facilitators (24.7%) for MBC. Four themes emerged from the analysis; (1) a description of current status/neutral opinion on MBC; (2) positive themes that include benefits of MBC, facilitators, enablers, or reasons on why they conduct MBC in their practice, (3) negative themes that include barriers or issues that hinder them from incorporating MBC into their practice, and (4) requests and suggestions for future MBC implementation. Both participant groups raised more negative themes highlighting critical challenges to MBC implementation than positive themes. The follow-up questionnaire regarding MBC attitudes showed the areas that clinicians emphasized the most and the least in their clinical practice.ConclusionThe virtual brainwriting premortem focus groups provided critical information on the shortcomings and strengths of MBC in adult ambulatory psychiatry. Our findings underscore implementation challenges in healthcare settings and provide insight for both research and clinical practice in mental health fields. The barriers and facilitators identified in this study can inform future training to increase sustainability and better integrate MBC with positive downstream outcomes in patient care.

Transitioning off methadone: A qualitative study exploring why patients discontinue methadone treatment for opioid use disorder

IntroductionPatients who discontinue methadone for opioid use disorder are at increased risk of overdose and death. We know little about how patients make the decision to stop treatment. This study explored reasons why patients discontinue methadone treatment. MethodsWe conducted 20 individual semi-structured patient interviews and two staff focus groups, each with five participants, at two opioid treatment programs in Baltimore, MD, in the United States from June 2021 to May 2022. Patient interviews and staff focus groups covered three domains: 1) reasons why patients may want to discontinue methadone; 2) perspectives about the ideal length of methadone treatment; and 3) changes that could improve retention. We used a modified grounded theory approach to code interviews, identify emergent themes, and develop a conceptual model. ResultsWe identified three themes related to patients' internal relationships to methadone: patients (1) viewed methadone as a bridge to opioid-free recovery, (2) believed that long-term methadone damages the body, and (3) felt that methadone increases craving for cocaine; and three themes related to their external relationships with opioid treatment programs and society at large: patients (4) viewed daily dosing as burdensome, (5) feared methadone inaccessibility could trigger relapse, and (6) experienced stigma from friends, family, and peers. Patients with internal reasons planned to stop as soon as possible and asked for education about perceived side effects and treatment for cocaine craving to promote retention. Patients with external reasons were willing to continue for longer and asked for adaptive take-home policies and reduced societal stigma around methadone. ConclusionsPatients want to discontinue methadone either because of their internal relationship to methadone and its real or perceived side effects, or because of their external experiences with opioid treatment programs and societal stigma of methadone. To improve retention, clinical and policy changes should consider responses to both of these categories of reasons.

84 A follow-up evaluation of an expanded good clinical practice online training course: The relevance of community engagement to health research study teams.

OBJECTIVES/GOALS: This study evaluates the impact of an updated and expanded training for social and behavioral health researchers. Participants’ experience with training modules focused on community engagement is a focus of this evaluation as is the application of this training by participants in teams. METHODS/STUDY POPULATION: The Social and Behavioral Research training series for health researchers and team members was first created by faculty and staff of the Michigan Institute for Clinical and Health Research in 2018. This training was updated and expanded in 2021 with support from the National Institutes of Health to include new material regarding community-engaged health research as well as updates concerning technology and new federal regulations. Past participants of the training were invited to retake the training, as were clinical and translational researchers at University of Michigan who were new to the training. Surveys were sent to all participants after completing the training and a focus group of research staff was conducted to identify how they utilized the training in support of their teams. RESULTS/ANTICIPATED RESULTS: It is anticipated that at least 100 individuals will participate in the evaluation of the Social and Behavioral Research training between October 2022 and February 2023. Data extracted from U-M’s learning management platform will demonstrate how well participants performed on key knowledge checks embedded in the modules and how quickly they progressed through the sections of the training. These results will be compared to benchmarks derived from evaluations of the prior course which were conducted in 2018. A focus group of at least 10 individuals will demonstrate how health research staff utilized the training and associated resources to advance the scientific work of their study teams. DISCUSSION/SIGNIFICANCE: Comprehensive training programs for research best practices in social and behavioral health need to have tailored and up-to-date information for this group of researchers and staff. The results of this evaluation will demonstrate how this program contributed to the professional development of the health research workforce.

Feasibility and acceptability of a virtual clinical pharmacy service for elective orthopaedic inpatients in an Australian metropolitan hospital

AbstractBackgroundVirtual healthcare services are usually provided from urban centres to outpatient clinics or underserved rural areas. This study utilises virtual pharmacy as an innovative model to provide services to a metropolitan hospital from a rural area.AimThis study assesses the feasibility, and patient and staff acceptability of a Virtual Clinical Pharmacy Service (VCPS) in a tertiary metropolitan hospital ward with limited on‐site clinical pharmacy services.MethodPharmacists from a rural health district provided telepharmacy services for nine weeks. Data on service provision and detection of medication‐related issues were captured in the electronic health record. Service acceptability was assessed through a staff focus group and patient acceptability by a patient‐reported experience measures (PREM) survey. Ethical approval was granted by the Greater Western Human Research Ethics Committee (Reference no: 2021/ETH00097).ResultsThe VCPS demonstrated high utilisation, with 535 clinical and medication reviews provided for 225 patients. Virtual medication reviews identified 151 medication‐related issues or recommendations. PREM surveys (n = 22) were supportive of the VCPS model. Staff valued the service and reported ease of access to specialist medication advice and confidence that patient medications were correct. Staff raised patient confidentiality in open wards and lack of experience using virtual healthcare as barriers to the implementation.ConclusionFeasibility was demonstrated by high service utilisation, detection of medication‐related issues, and measures of acceptability from patients and staff. The VCPS offers a solution to enhance sustainability and service agility by delivery of clinical services when face‐to‐face is not practicable or available. Further research is required to demonstrate efficacy and to confirm patient acceptability.

Facial recognition lock technology for social care settings: A qualitative evaluation of implementation of facial recognition locks at two residential care sites.

There is limited literature on security and access for social care settings despite policy highlighting importance, and no published research exploring facial recognition lock technology (FRLT) for potential improvements. This study explored FRLT device implementation, use, barriers and benefits. One residential care home with 43 older adults and 68 staff members (Site A), and one supported living facility caring for six individuals with mental health issues with 18 staff members (Site B) were provided with FRLT for six months. Nine pre-implementation staff interviews explored existing access and security perceptions. Ten post-implementation staff interviews and one staff focus group were conducted; all were analysed using content analysis to understand, alongside process mapping, the use and impact of the FRLT. Interview participants included site care staff and other visiting healthcare professionals. We additionally report feedback from the technology developers to demonstrate impact of industry-academia collaboration. Pre-implementation interviews highlighted issues with current pin-pad or lock-box systems, including; code sharing; code visibility, ineffective code changes, security issues following high staff turnover, lack of efficiency for visitors including NHS staff and lack of infection control suggesting requirement for innovation and improvement. Pre-implementation interviews showed openness and interest in FRLT, although initial queries were raised around cost effectiveness and staff skills. Following implementation, good levels of adoption were achieved with 72% and 100% (49/68 and 18/18) of staff members uploading their face at the two sites, and 100% of residents at Site B using the system (6/6). Additionally, Site B made a positive procurement decision and continues to discuss wider rollout. Post implementation interviews suggested FRLT was useful and acceptable for improving security and access. Benefits identified included staff/visitor time saving, enhanced security, team ease of access, resident autonomy and fewer shared touch points. Integration was suggested including with fire alarm systems, staff clocking in/out, and Covid monitoring to improve usefulness. The developers have since responded to feedback with design iterations. We identified concerns on security and access in social care settings, which warrant further exploration and research. FRLT could increase resident autonomy and reduce staff burden, particularly considering frequent multi-agency health and care visits.

‘They Might Not Kill You Today but They’re Going to Get You in the End’: The Correctional Subculture and the Schematization of Danger

Abstract Criminology has long investigated criminal justice cultures and their preoccupation with dangerousness. Over a half century ago, correctional scholars called for a richer understanding of how a ‘social reality’ of danger might shape the mental state of staff. More recently, correctional scholarship has demonstrated that correctional culture and perceptions of danger likely play a fundamental role in findings that staff experience conflict across domains. Drawing from 18 focus groups of correctional staff from all adult carceral facilities in one state, this study investigates: 1) how cultural workgroup concerns over danger and values of safety shape staff’s worldview broadly; and, 2) how these worldviews concerning danger shape cultural cognition outside the carceral context. To answer these questions, we draw upon cultural sociology and leverage the mechanism of the schema to understand how values are recalled across domains. Through this analysis, we illustrate how an accumulation of stories concerning danger within prison shapes a worldview that structures compulsive cognition around personal safety. We show how compulsive cognition manifests as an intrinsic knowledge of the dangerous character of others and a personal drive to fortify against underspecified violent threats outside the carceral context.

Examining Efficiency in Open-Bay and Single-Family Room NICU Designs.

There is growing awareness of the relationship between physical work environments and efficiency. Two conflicting factors shape efficiency in the neonatal intensive care unit (NICU) environment: the move to single-family rooms (SFRs) and increased demand for care, requiring growth in unit size. The goal of this research was to understand the impact of SFR NICUs on efficiency factors such as unit design, visibility and proximity, staff time, and workspace usage by various health professionals. A pre-/postoccupancy evaluation assessed a NICU moving from an open-bay to an SFR unit composed of 6 neighborhoods. A NICU patient care manager and researchers in design and communication implemented a multimethodological design using staff surveys, observations, and focus groups. Outcomes revealed SFR NICUs contribute to increased efficiency and overall satisfaction with design. Outside of staff time spent in patient rooms, decentralized nurse stations were the most frequented location for staff work, followed by huddle stations, medication and supply rooms, and corridors. Work at the observed locations was largely performed independently. Survey outcomes reported increased feelings of isolation, but focus groups revealed mixed opinions regarding these concerns. Design solutions found to enhance efficiency include a neighborhood unit design, standardized access to medications and supplies, and proximity of supplies, patient rooms, and nurse workstations. Although feelings of isolation were reported and most staff work was done independently in the patient room, the SFR unit might not be the culprit when considered alongside staff's desire to be closer to the patient room.

Changes to teaching and learning about medication administration within a diploma of nursing course due to the Covid-19 pandemic: A staff and student multi-method evaluation

AimThis project aimed to evaluate student and staff satisfaction with, and perspectives on, changes to delivery and format of the Medication Unit of Competency within a Diploma of Nursing Program. BackgroundMedication safety is an integral component of learning for pre-registration nursing students. The COVID-19 pandemic required rapid changes to be made to the medication competency unit being taught to students within a Diploma of Nursing, pre-registration course. Changes to sequencing of theory, mode of education delivery, class sizes, available resources and learning support were required. DesignA multi-method evaluation process was conducted. The project is reported as per SQUIRE-EDU guidelines. MethodsFocus groups and survey data were obtained from staff and students in December 2020, to evaluate responses to the changes. Student exam results and the number of learning support consultations accessed were also assessed to identify impact of changes. ResultsStaff and student evaluation identified mixed responses but overall, the change in sequence of theory and mode of delivery was positively received. Crude comparisons of final assessment results revealed improved marks compared to the previous cohort. The addition of an online medication resource was utilised by most students. The agility of staff in responding to the challenges was highlighted in the staff focus group and additional, flexible learning support was favourably received by students. ConclusionsDespite the need for rapid changes being made to the course, positive responses were received from both staff and students. Some students preferred the traditional sequencing of learning as they felt it matched their learning style. An added online resource and extra learning support supported student self-efficacy development of medication competency; however further research is needed to ascertain any associations. The online resource is still being utilised within course curriculum.

Transdisciplinary allied health assessment for patients with stroke: a pre-/post- mixed methods study protocol

BackgroundTransdisciplinary approaches can streamline processes and build workforce capacity by blurring traditional responsibilities and integrating aspects of care. Emerging evidence shows transdisciplinary approaches can improve time-efficiency, quality of care and cost-effectiveness across various healthcare settings, however no empirical study is based on an acute stroke unit.MethodsThe SPIRIT checklist was used to guide the content of the research protocol. The study is a pragmatic pre−/post- mixed methods four-phase study with a 3-month follow up, based at the Mater Hospital Brisbane. Participants experiencing stroke symptoms will be recruited as they are admitted to the acute stroke unit. Patients presenting with mild stroke symptoms or Transient Ischaemic Attack will be allocated to Phase 1 (baseline) or Phase 2 (implementation), while patients presenting with moderate to severe stroke symptoms will be allocated to Phase 3 (baseline) or Phase 4 (implementation). Participants in baseline Phases 1 and 3 will receive standard allied health assessment, while participants in implementation Phases 2 and 4 will receive the novel transdisciplinary assessment. For the primary aim, allied health professionals will time their assessments to evaluate time taken to administer a novel transdisciplinary assessment, compared to usual discipline-specific assessments. Non-inferiority of the novel transdisciplinary assessment will also be explored in terms of patient safety, compliance to national standards, use of the assessment, and stakeholder perceptions. A retrospective medical record audit, staff focus group, patient/staff surveys, and patient phone interviews at 3-months will be completed. Quantitative results will be estimated using general linear and logistic regression models in Stata 15.1. Qualitative results will be analysed using frequency counts and NVivo software. An economic evaluation will be performed using three scopes including the allied health assessment, hospital admission, and patient outcomes at 3-months.DiscussionWhen designing the study, pragmatic factors related to staff willingness to be involved, patient safety, and existing clinical pathways/processes were considered. To address those factors, a co-design approach was taken, resulting in staff buy-in, clinically relevant outcome measures, and the pre−/post- four-phase study design.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12621000380897. Registered 06 April 2021 - retrospectively registered, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381339&isReview=true

ICRE Top Research Abstracts

ICRE Top Research Abstracts

Feasibility of using health and wellbeing data for school planning: the SHINE pilot in Scotland.

Child and adolescent mental health and wellbeing (MHWB) have received greater attention in recent years due to increases in mental ill health and reports of decreasing subjective wellbeing. The School Health and Wellbeing Improvement Research Network (SHINE) was established to create a national infrastructure to support Scottish schools to collect and use health and wellbeing (HWB) data to inform school improvement action planning. This study aimed to evaluate a pilot of SHINE's provision of school-level HWB data reports from the Health Behaviour in School-aged Children survey and their impact on school action planning. Using a qualitative case study design, we collected data in four local authorities across Scotland via pupil and school staff focus groups (n = 23 groups), and from interviews with senior leaders, school SHINE Leads, other relevant school-level stakeholders, local authority (LA) HWB and data leads (n = 30 interviews). Data analysis was supported using Normalisation Process Theory as a guiding framework. Implementation was at an early stage. Participants indicated that the data reports were an accessible and valuable source of local information to support the improvement agenda. SHINE's expertise supported the lack of research capacity and strengthened HWB data literacy skills in schools. At the point of interview, data reports had not been shared widely within the school community, but there was some limited use of the reports to inform action planning around HWB. Through close working and further engagement with schools, SHINE has the potential to support them to deliver national commitments to improving HWB.

Patient and family involvement in designing and evaluating a simulation programme to combat childhood obesity

14.4% enter school reception obese [1]. The Paediatric Emergency Department (PED) offers opportunities for professionals to identify obesity and provide support to children and young people (CYP). Our PED launched an Obesity Toolkit: a medical education project created to help Make Every Contact Count, and to increase opportunistic diagnosis and sensitive communication about obesity (2). This includes teaching resources including communication scenarios and videos. Staff focus groups identified the main barrier for professionals was fear around communicating about obesity in a sensitive way. We aimed to collaborate with CYP to develop our communication simulation programme within the Toolkit. In addition, we aimed to involve families in the evaluation of the project. We developed written patient leaflets, written and filmed communication scenarios incorporating feedback given by focus groups with Youth Empowerment Squad (YES), our local Trust CYP forum. The feedback included preferred language, which was emphasised in the debriefings of simulated sessions. The educational role-play scenario videos, which can be debriefed in teaching sessions, were filmed with a CYP taking on the role of a patient. After the release of the toolkit and accompanying simulation programme, 10 patients diagnosed as overweight or obese were randomly selected 2 to 4 months after attendance, as part of a patient experience survey. This telephone call explored parent opinions about the obesity discussion. Learning from CYP in YES helped us explore their preferred language, such as focussing on healthy living over the concept of obesity and explaining what is meant by body mass index (BMI). We included this in our debriefings. Our role-play videos are used in training to give examples of obesity discussions with CYP. These were semi-scripted to allow the CYP to incorporate their own voice and provide their insight into how they or their peers might react. In the patient experience survey, all parents were positive about the approach, rating the conversation on average 7.6/10 for being helpful (10 most helpful). Notable comments from parents included ‘the approach was sensitive, they spoke about positive change, not negative’. Parents talked positively about conversations that they had about obesity with staff trained using our simulation programme designed following CYP collaboration. It is encouraging that these conversations have been useful for CYP and families. Based on this feedback, we will continue to engage CYP and parents. Feedback from CYP is planned. The Obesity Toolkit is made free and Open Access for any interested departments. 1. NHS Digital. National Child Measurement Programme, England 2020/21 School Year – NHS Digital. NHS Digital. 2022. 2. Health Education England. Making Every Contact Count (MECC). 2022.

A study of caregiver support services: Perspectives of family caregivers of persons with intellectual disabilities in Singapore

AbstractMost people with intellectual disabilities in Singapore live with family and are supported by family caregivers. Many caregivers lack the awareness, skills and resources needed for their caregiving role. A caregiver support service designed to build the capability of family caregivers serving children and adults with intellectual disabilities was evaluated after 2 years of operation to ascertain the level of caregiver coping and resilience, perceived impact of strategies for emotional support, and satisfaction with a range of support services and gaps in service. Family caregivers were surveyed regarding satisfaction with services received using the Client Satisfaction Questionnaire (CSQ‐8) and feedback from activities and events. Their coping and resilience were measured with the Coping Competence Questionnaire (CCQ). Qualitative data from caregiver interviews and staff focus groups were analysed for key themes that were triangulated and converged with other findings. Satisfaction, better coping and resilience were associated with specific support services. Key themes emerged around several effective supports and areas of unmet needs across the lifespan. Limitations and areas for improvement were identified to meet a broader range of caregivers. Targeted family support services can enhance the well‐being of caregivers supporting people with intellectual disabilities (ID) across the lifespan. The results inform policymakers and support agencies that support of the family, not just the person with ID, is an important factor and needs to be incorporated at the heart of the design and development of any inclusive community living in Singapore.

A qualitative evaluation of staff experience in the delivery of a co-produced consultation service for personality disorder

PurposeConsultation services are recommended to support mental health staff working with service users diagnosable with personality disorder. However, there is scarce literature examining the impact of delivering and receiving consultation services. This study aims to investigate the impact of a pilot co-produced consultation service aiding clinical teams in the engagement of service users diagnosable with personality disorder.Design/methodology/approachThis is a qualitative evaluation using a focus group and five semi-structured interviews to explore the experience of delivering and receiving the consultation service. Data were analysed using thematic analysis. Clinical and demographic characteristics were obtained on service users referred.FindingsThe consultation staff focus group produced two overarching themes: “Disrupting the system” and “Mirroring the service and the service users consulted”. The staff consultee semi-structured interviews produced two overarching themes: “Experience of working with personality disorder” and “Experience of the consultation service”. Staff described working with personality disorder as challenging. The consultation process was experienced as a helpful and reassuring space to gain a new perspective on the work. However, the service was felt to be limited; in that, it lacked follow-on treatment.Originality/valueThis study adds to the body of literature on consultation for service users diagnosable with personality disorder and demonstrates its function in service provision. It sheds light on staff experience of delivering and receiving a consultation service, including the use of a co-production model.

Evaluating the implementation of the Birmingham Symptom-specific Obstetric Triage System (BSOTS) in Australia

BackgroundObstetric triage is usually undertaken by a midwife and involves conducting a physical assessment to identify a woman’s presenting problem. The Birmingham Symptom-specific Obstetric Triage System (BSOTS) was developed in the United Kingdom (UK) to overcome challenges associated with triaging women by standardising the maternity triage process. The Australian study site is the first hospital outside the UK to implement this approach. AimTo evaluate the implementation of the BSOTS in an Australian tertiary maternity service. MethodsA multi-method approach including pre-implementation BSOTS education evaluations (n = 26), post-implementation clinical data audit (n = 660), and staff focus groups (n = 9) was undertaken. Participants included midwives who worked in the Maternity Assessment Centre. Data of women who had attended the service during BSOTS implementation was analysed in the audit component. FindingsStaff valued the BSOTS standardised approach to maternity triage, particularly for midwives new to the role. The retrospective audit showed that time to triage and time to care outcomes for women improved from pre-implementation audits and were mostly adhering to auditable standards. Lack of knowledge amongst staff (especially medical staff) regarding the BSOTS was considered a barrier to the effective flow of care of women through the centre. DiscussionThe BSOTS is a useful approach for prioritising women’s care. Ensuring that all staff are aware of the system and its benefits is likely to enhance implementation and improve triage outcomes. ConclusionThe BSOTS is an innovative midwife led practice change that is applicable to the Australian context, and benefits women, midwives, and the maternity service.

Career Mentoring Surgical Trainees in a Competitive Marketplace

Resident trainees in Canadian Otolaryngology–Head & Neck Surgery (OHNS) programs have cited job prospects as the biggest stressor they face. Increased numbers of residency training positions combined with decreased employment opportunities have worsened competition for surgical positions. The purpose of this inquiry was to explore gaps in resident career planning and examine how leadership can prepare graduating residents to optimize employability. This mixed-methods prospective study was completed in two phases. A combination of online surveys and two focus group sessions were used to gather information from academic and clinical staff surgeons, resident trainees, and administrative leadership. Eleven of the potential 12 resident participants responded to the initial survey, seven of the 13 staff surgeons, and one administrative leader. Each of the resident and staff focus groups had five participants. This comprehensive inquiry led to the development of a conceptual framework describing domains of concern important to OHNS residents. Themes included lack of career mentoring, complex systemic limitations, inadequacy of exposure to community-based surgical practice, and a potentially stifling organizational culture. OHNS residents face significant stress regarding potential employability following residency. Solutions to address concerns must be collaborative in nature and begin with the existing leadership structure.