Staff Grade Research Articles

Psychiatrists acting as expert witnesses – are they confident?

Purpose – The purpose of this paper is to ascertain the current competencies and training needs for being an expert witness of trainees (CT3, ST4-6) and career grade psychiatrists (consultants and staff grade, associate specialist and specialty doctors) in a UK health and well-being Trust. Design/methodology/approach – This was completed through an online survey, developed by the authors, of all career grade and trainee psychiatrists within the Trust. Findings – Only 9 per cent of respondents reported that they felt they had adequate training to feel competent as an expert witness. Despite low levels of training and confidence, 73 per cent of respondents had written an expert report. As well as shortage of training opportunities for psychiatrics acting as expert witnesses, the findings indicated increasing fear of litigation and lack of direct experience of court proceedings during training. Practical implications – Doctors need to be offered formal training opportunities including simulated training, ideally organised within Trust, Continuing Professional Development (CPD) committees or Education committees. Implementation of the RCPsych report guidance into speciality curricula and CPD opportunities for doctors would ensure a robust curriculum-based delivery of these essential skills. Originality/value – A wealth of guidance is available for expert witnesses, but no previous study had identified the specific training issues and overall confidence in competency to act as an expert witness amongst psychiatrists. It will be valuable to all psychiatrists involved in court work and organisations involved in training psychiatrists, especially in light of recent relevant court cases and removal of expert witness immunity.

Are we following the WHO recommendations for surgical scrubbing?

Surgical site infections have an incidence as high as 10%. To reduce this, the World Health Organisation (WHO) recommends guidelines for surgical scrubbing. We assessed adherence of surgical staff scrub practice before gowning to current WHO recommendations. A prospective study conducted in operation theatres in a university hospital. Participants comprised of consultant surgeons, trainees and scrub nurses. Variables included staff grade, scrub order, length of scrub time and appropriate dress code. Data were collected anonymously and analysed. We assessed 303 surgical scrub-episodes (95 scrub nurses, 123 trainees and 85 consultant surgeons). Mean time for first scrub of the day was 239 s, SD = 99, 95% CI 218, 259 and range = 530 (scrub nurses = 297 s, trainees = 204 s, consultant surgeons = 202 s). Mean time for subsequent scrubs was 161 s, SD = 63, 95% CI 152, 170, range = 312 (scrub nurses = 184 s, trainees = 158 s, consultant surgeons = 143 s). Statistical significance was found between staff grades based on scrub time, with WHO breaches in remaining variables. No written local guidelines on hand scrubbing exist in the hospital and staff were unaware of WHO guidelines. In this study, mean scrub times were less than WHO guidelines with significant variation in practice across grades of staff. Clear written guidelines are needed.

Prevalence, nature and predictors of prescribing errors in mental health hospitals: a prospective multicentre study

ObjectiveTo determine the prevalence, nature and predictors of prescribing errors (PEs) in three mental health hospitals.SettingInpatient units in three National Health Service (NHS) mental health hospitals in the North West...

Listen while you work? The attitude of healthcare professionals to music in the operating theatre.

Although the playing of music is commonplace in the operating theatre, there is nothing in the literature examining whether staff feel this is beneficial. Questionnaires were distributed amongst a random selection of staff in practice at a district general hospital: medical staff from a range of surgical specialities, anaesthetists, and all grades of perioperative staff (nurse/operating department practitioners/healthcare assistants) were encouraged to participate. There were 121 health professionals in total working in the operating theatres. The authors compared the responses to each question amongst the respondents, to check for the tendency to correlate. Out of the 52 health professionals who responded, 36 stated that music is played in their theatre either every day, or two to three times a week. Only five respondents felt that this was too often. Fifteen percent of medical staff were of the opinion that the nursing staff controlled the choice of music. Nursing staff were almost evenly split in thinking that nursing staff, surgical staff and the whole theatre team controlled the choice of music. The majority of both nursing and medical staff felt that they enjoyed their work more and performed better when music was played in theatre. The study concluded that the majority of theatre staff found listening to music while they work a positive experience. The potential for music to have a distracting or detrimental effect on a minority of individuals should always be considered.

BMA should convinceThe BMJnot to advertise non-standard posts, say SAS doctors

The BMA should convince The BMJ not to advertise non-standard grade posts, said delegates at the BMA’s staff, associate specialist, and specialty (SAS) grade doctors’ conference this week. Representatives voted in favour of a motion that “deplored” the creation of non-standard grade posts and “urged” the BMA to “help convince The BMJ not to advertise these …

PWE-052 Bowelscope Screening – The South Of Tyne And Wear Experience

IntroductionThe National Bowel Cancer Screening Programme has been extended to include a one-off flexible sigmoidoscopy (FSIG) to all aged 55, after a large UK study demonstrated reduction in colorectal cancer...

Design and Implementation of University Human Resources Management Platform Based on YII

University human resources management is an important part of school management. To summarize, teachers can be managed through a set of scientific and effective method to strengthen the school connotation of the construction of the strategic target. For numerous schools, facing more challenge and competition, in the "survival of the fittest", the "fittest" under the natural law of survival and development, to learn the advanced management experience and management technology, has become urgent and important task of school. In the center of the "people-oriented", "humanistic management" of today, human resource management has become an important factor of success of the school connotation development. Evaluation model is widely used in our common life, which can undertake assessment of a decision and personnel factors, and assessment or evaluation algorithm types are also abundant, including the factor method, fuzzy comprehensive evaluation [, the analytic hierarchy process (ahp), and some algorithm based on artificial intelligence (ai), all these algorithms are effective to solve part of the problem domain. The evaluation of teachers' professional ability involve more factors, including some subjective factors, such as personal moral, lifestyle, ambition, etc., and some objective factors such as working length of service users, specialty, education, scientific research, honors won, etc. If we only use the grade staff to do so, the measurement result of a grade may be affected because of personal emotions, and if we simply evaluate from the objective factors, which may lead to stylized, strengthening the results, lighting the evaluation of the masses .So for teachers' evaluation, we do from these two aspects at the same time, setting subjective and objective factors according to each assessment scheme. For subjective factors, we invite the marker personnel to score by our measurement system based on the subjective factors of scores, and for the objective factors, automatic gradings of staff are done according to the set of weights of objective factors, score, and accumulative number of grading in the scheme of the measurement. We adjust the proportion according to the previous results, as well as the evaluation scheme, to get the sorting and evaluating list of the measured personnel.

Anomalies in drug choice in glaucoma clinics

Sir, We investigated anomalies in drug choice when prescribing new glaucoma drops in glaucoma clinics. A total of 1436 records were assessed for 6 months. Of these, 115 patients had a change in drop. An independent glaucoma consultant ophthalmologist categorised the drug choice into three using clearly defined criteria: no anomaly/error, anomaly, error. An anomaly was defined as the prescription of two new drugs simultaneously, prescription of an additional drug without stopping current ineffective drug,1 prescription of a new drug without considering non-adherence,2 and prescription change to unorthodox drug frequency.3 An error was defined as the prescription of a contraindicated drug or a drug with a clearly documented previous adverse drug reaction. Benefit of doubt was given at all times (e.g., multiple changes in drops were considered to be reasonable practice where a pressure rise was an unacceptable risk). We found that over three quarters of changes in medication had consultant or fellow involvement. Optometrists, registrars, and associate specialists, collectively, were responsible for less than a fifth (n=21) of changes in glaucoma drops. There was a high standard of clinical practice in 92 (80%) cases. In one-fifth, therapeutic management was considered to be anomalous or erroneous: there were 15 anomalies in management (13%, 95% CI 7–19%) and 8 errors (7%, 95% CI 2–12%). Seven of these were prescribed a drug with a clearly documented previous adverse reaction and one patient was prescribed Timolol despite advice from their cardiologist to avoid beta blockers. The following risk factors were examined: day of week, time of clinic, patients per clinician, presence of consultant, and staff grade. There was no correlation between these factors and the numbers of errors or anomalies occurring. Errors are inevitable, however, the magnitude reported here is unacceptably high. The majority may be accounted for by a failure to fully examine hospital records, and changes are needed to assist the clinicians in busy clinics. Electronic records accompanied by decision support reduce errors in prescribing.4 We are currently working towards this. Another important step is to encourage shared decision making with patients. The results of the study are being introduced into the glaucoma service induction training.

Nurses' self‐confidence and attitudes in using the Glasgow Coma Scale: a primary study

The aim of this study was to examine nurses' self-confidence and attitudes towards the Glasgow Coma Scale (GCS). The GCS measures the depth and duration of impaired consciousness. However, there is an increasing evidence that problems are encountered in completing some aspects of the GCS. This descriptive correlational study recruited 114 Registered Nurses (RNs) in one acute care hospital in Singapore. A set of questionnaires were given to the participants. The questionnaire had three parts, which collected data on demographics, attitudes and self-confidence. Data analysis showed the type of clinical discipline (B=0.19), seniority in nursing (Staff Grade) (B=0.28) and higher attitude scores towards the GCS (B=0.41) were significant factors determining a nurse's confidence in using the GCS. A longer length of time working in a Neuroscience setting (B=0.21) and higher self-confidence scores (B=0.41) were significant factors determining a nurse's attitude towards the GCS. To ensure patient safety, the GCS has to be performed accurately. This study has shown there are differences in attitudes and self-confidence in using the GCS between nurses of different demographics, and that there are a variety of factors influencing their attitudes and confidence. Mentoring and educational interventions are suggested in order to reduce safety risks resulting from lower proficiency in using the GCS.

Evaluating the Productive Ward at an acute NHS trust: experiences and implications of releasing time to care

To demonstrate how a national programme aimed to increase the amount of direct time nurses spend with patients', impacts on both staff and patient experience. The Productive Ward is an improvement programme developed by the NHS Institute for Innovation and Improvement (2007, http://www.institute.nhs.uk/quality_and_value/productivity_series/productive_ward.html) which aims to enable nurses to work more efficiently by reviewing process and practice, thus releasing more time to spend on direct patient care. However, there is little empirical published research around the programme, particularly concerning impact, sustainability and the patient perspective. This manuscript presents the findings from qualitative interviews involving both staff and patients. Semi-structured one-to-one interviews were conducted with patients (n = 8) and staff (n = 5) on five case study wards. Seven focus groups were held according to staff grade (n = 29). Despite initial scepticism, most staff embraced the opportunity and demonstrated genuine enthusiasm and energy for the programme. Patients were generally complimentary about their experience as an inpatient, reporting that staff made them feel safe, comfortable and cared for. Findings showed that the aims of the programme were partially met. The implementation of Productive Ward was associated with significant changes to the ward environment and improvements for staff. The programme equipped staff with skills and knowledge which acted as a primer for subsequent interventions. However, there was a lack of evidence to demonstrate that Productive Ward released time for direct patient care in all areas that implemented the programme. Developing robust performance indicators including a system to capture reinvestment of direct care time would enable frontline staff to demonstrate impact of the programme. Additionally, staff will need to ensure that reorganisation and instability across the NHS do not affect sustainability and viability of the Productive Ward in the long term.

Peer and self assessment in massive online classes

Peer and self-assessment offer an opportunity to scale both assessment and learning to global classrooms. This article reports our experiences with two iterations of the first large online class to use peer and self-assessment. In this class, peer grades correlated highly with staff-assigned grades. The second iteration had 42.9% of students’ grades within 5% of the staff grade, and 65.5% within 10%. On average, students assessed their work 7% higher than staff did. Students also rated peers’ work from their own country 3.6% higher than those from elsewhere. We performed three experiments to improve grading accuracy. We found that giving students feedback about their grading bias increased subsequent accuracy. We introduce short, customizable feedback snippets that cover common issues with assignments, providing students more qualitative peer feedback. Finally, we introduce a data-driven approach that highlights high-variance items for improvement. We find that rubrics that use a parallel sentence structure, unambiguous wording, and well-specified dimensions have lower variance. After revising rubrics, median grading error decreased from 12.4% to 9.9%.

Experiences of staff managing self-harm algorithmically

Purpose – An algorithmic approach to managing self-harm has been introduced within a women's enhanced medium secure. This paper explores the experiences and perspectives of nursing staff using the model. Design/methodology/approach – Purposive sampling was used to gather the experiences of a cross-section of nursing staff of different grades. Semi-structured interviews collected data relating to their experiences using the model as well as their satisfaction with the model in terms of its effectiveness and safety for staff and patients. Findings – Nursing staff described themselves as being confident with the model and were clearly implementing it safely and effectively. They described the model as addressing the challenge of managing self-harm alongside the risk of violence, and also described the importance of effectively marrying individualised assessment and planning with the algorithmic approach. The difficulty for staff new to the ward was also described and this is a useful focus for further development and evaluation. Practical implications – Nursing staff describe the algorithmic approach to managing self-harm in use on this ward as safe and effective and it could usefully be trialled in other areas which manage difficult and potentially high-lethality self-harm. Originality/value – The algorithmic model is a new approach to dealing with the challenging levels of self-harm within the service, and there is a clear need to ensure that the end-users of model are confident that they are using it safely and effectively. This paper describes this work as well as expanding on some of the complexities of managing self-harm day-to-day in this challenging environment.

Nurse-led PICC insertion: is it cost effective?

Repeated attempts to cannulate small veins can cause considerable distress for patients and expend substantial staff time.For longer term venous access, a peripherally inserted central catheter(PICC) may be used instead of a peripheral cannula. Previous studies indicate that insertion of a PICC costs three times more than a cannula but the lifespan is substantially longer. This study aimed to compare insertion cost, patient satisfaction, and infection rates of PICCs for the two main staff groups (trained nurses and radiologists) inserting these devices in a district general hospital. The study took place over 4 months in 2012-13.A questionnaire was attached to all identified PICCs in stock at Raigmore Hospital to collect details of the date of insertion, patient involved, time taken, attendant staff grade and experience level,consumables used and insertion success. The lead author's personal observation of PICC insertion by different staff groups allowed estimation of staff time, costs and success rates. Patient experience and satisfaction was assessed before and after insertion using a patient questionnaire. PICC longevity, infection rates and failures were assessed by review of patient notes. The radiologist group had a statistically significant (p< 0.01) increased cost (42%) over the nurse group. Patient satisfaction regarding explanation of treatment before insertion was higher in the nurse group. Insertion success and infection rates were higher in the radiologist group. The authors conclude that the majority of PICCs can be safely performed without x-ray screening in a ward-based environment. This is likely to be the most cost-effective solution for large volume services.

Incidence of complications following mandibular third molar extraction under day case general anaesthesia

Incidence of complications following mandibular third molar extraction under day case general anaesthesia

Leadership Soft Skills of Deans in Three Malaysian Public Universities

Abstract This study aims to examine the leadership soft skills of deans in three public universities of Malaysia from the views of their support staff. For decades, the focus of management and leadership was on technical skills, i.e., the so-called ‘hard skills’. Technical skills are critical as to perform effectively within an organization. Nowadays, employees also need leaders with critical soft skills. These soft skills are more generic in nature and are the keys towards effective performance across job categories. The main purpose of this study is to explain and interpret the implementation of the eight components of leadership soft skills, namely collaboration/teamwork, communication skills, initiative, leadership ability, people development/coaching, personal effectiveness/personal mastery, planning and organizing, and presentation skills. This study employed qualitative method using face-to-face interview to collect data from 12 support staff (Grade 17-36). Among the 12 respondents, six respondents are working under deans with reportedly high leadership soft skills and the other six respondents are working under deans with reportedly low leadership soft skills. Findings showed that there are some similarities and differences between the deans with high and low leadership soft skills. This study attempts to advocates about the importance and value of leadership soft skills in higher educational institutions. Additionally, researchers hope that the findings can provide information to assist administrators in developing high-quality interpersonal relationships with their associates and support staffs.

P87 May I?: Audit of documentation of consent for care

AimsConsent to valid treatment and care is central in all forms of healthcare: patients have a fundamental, legal and ethical right to determine what happens to them. Hospice at Home...

An evaluation of the referral process in the emergency department

IntroductionMaking an effective telephone referral is an important skill for an emergency department (ED) clinician. It is essential for patient safety that the information is conveyed in a succinct manner...

Charter aims to improve careers of staff grade doctors

The Royal College of Physicians of Edinburgh is urging NHS employers to adopt a UK-wide charter that recognises and supports staff, specialty, and associate specialist (SAS) doctors. The college said that Britain’s hospitals were in danger of losing talented doctors who were essential in keeping services running, because of the lack of importance being attached to their role. …

PTH-173 Introduction of the Team Brief and who Safety Checklist in Endoscopy

IntroductionThe World Health Organization (WHO) launched the Global Patient Safety Challenge, ‘Safe Surgery Saves Lives’1, in 2008 with the aim of reducing the number of deaths and adverse events resulting...

Failing to fail: clinicians’ experience of assessing underperforming dental students

Anecdotal evidence within a UK dental school indicated that staff's grading did not always match their evaluation of students' clinical proficiency. The invalid assessment of underperforming students, which has considerable ramifications, has been reported internationally for students of nursing and medicine, but a database search revealed no accounts for dental education. To develop an understanding of clinicians' approaches to assessing underperforming dental students. Seventeen clinical staff were interviewed (eleven females, six males). Interviews were recorded and transcribed verbatim. A grounded theory methodology was used, with simultaneous data collection and analysis. The main analytical technique was constant comparison. Participants' shared basic problem was Assessing undergraduate students, expressed as how they evaluated and used the assessment system or perceived others to do so. The core category, which explains what clinical staff do to manage their difficulties with assessment, was identified as Failing to Fail and has three subcategories: Evaluating the Assessment System, Shielding the Student and Protecting Myself. This study has substantiated the complexity of failing to fail and confirmed that some causes are shared across healthcare professions, although insufficient staff discussion, the avoidance of confrontation and the impact of negative student attitude are not reported elsewhere or are minor findings. It is recommended that clinical staff receive additional training in assessment and that they are made more aware of their learning needs, their attitudes and beliefs. Increased discussion between staff about assessment and about students known to be in difficulty is essential.