Increased Workload Demands Research Articles

The “Silent Firefighters”: an examination and evaluation of peer support sessions for medical laboratory professionals in Canada

PurposeThe Canadian Society for Medical Laboratory Science (CSMLS) Peer Support Project was a formal and virtual peer support group pilot for medical laboratory professionals in Canada to determine its application for CSMLS members and obtain information regarding the current state of medical laboratory professionals’ mental health, well-being and burnout. CSMLS learned what is contributing to stress at work, coping strategies and barriers to accessing support or help for their mental health among medical laboratory professionals.Design/methodology/approachThe qualitative and exploratory pilot study examined medical laboratory professionals from Canada. Two peer support groups were facilitated in April and May 2022 by a trained mental health clinician. Peer support delivery was virtual and delivered via Zoom. The purposive sample featured medical laboratory technologists, Educators and Supervisors/Directors who were CSMLS members. The qualitative analysis was conducted via analytical memos and incorporated both manual and NVivo software analysis.FindingsOverall themes were identified within the data analysis and included barriers to mental health care; increased stigma for mental health; mixed messaging regarding mental health; feeling invisible; medical laboratory professionals would like to manage stress better but their increasing workload demands and challenges with scheduling and staffing add to their stress. Participants also highlighted their role and its context using metaphors such as “the silent firefighters”, and “the Bass Guitar of the Hospital”. Based on the evaluations, the peer support sessions encouraged participants to address their own mental health, validate their experiences and increase their comfort level in discussing mental health.Social implicationsIt identified a potential resource for medical laboratory professionals and determined that further mental health resources would be beneficial for their field. It also identified their strong commitment to patient care and their role as a medical laboratory professional.Originality/valueTo the best of the authors’ knowledge, this study is one of the first to examine peer support as a mental health resource for medical laboratory professionals. Additionally, its focus was on a Canadian population with virtual delivery.

SHEA position statement on pandemic preparedness for policymakers: building a strong and resilient healthcare workforce.

Throughout the COVID-19 pandemic, many areas in the United States experienced healthcare personnel (HCP) shortages tied to a variety of factors. Infection prevention programs, in particular, faced increasing workload demands with little opportunity to delegate tasks to others without specific infectious diseases or infection control expertise. Shortages of clinicians providing inpatient care to critically ill patients during the early phase of the pandemic were multifactorial, largely attributed to increasing demands on hospitals to provide care to patients hospitalized with COVID-19 and furloughs.1 HCP shortages and challenges during later surges, including the Omicron variant-associated surges, were largely attributed to HCP infections and associated work restrictions during isolation periods and the need to care for family members, particularly children, with COVID-19. Additionally, the detrimental physical and mental health impact of COVID-19 on HCP has led to attrition, which further exacerbates shortages.2 Demands increased in post-acute and long-term care (PALTC) settings, which already faced critical staffing challenges difficulty with recruitment, and high rates of turnover. Although individual healthcare organizations and state and federal governments have taken actions to mitigate recurring shortages, additional work and innovation are needed to develop longer-term solutions to improve healthcare workforce resiliency. The critical role of those with specialized training in infection prevention, including healthcare epidemiologists, was well-demonstrated in pandemic preparedness and response. The COVID-19 pandemic underscored the need to support growth in these fields.3 This commentary outlines the need to develop the US healthcare workforce in preparation for future pandemics.

Millennial Dance Craze for The Well-Being of Teachers: A Multiple Case Study

This study was designed to determine the impact of secondary school teachers' engagement with the millennial dance craze on their teaching and their well-being. Observing teachers' coping mechanisms and factors on fitness, increasing workload demands while having active leisure and social connections, and promoting the importance of teachers' physical and mental well-being motivated the researcher to pursue the investigation on the secondary school teachers' engagement with the millennial dance craze. Qualitative procedures were employed in this case study. Results revealed that secondary teachers' participation in the millennial dance craze is essential since it demonstrates personal explorations and transformation as reflected from their assessment on how their engagement with the millennial dance craze have affected them. As a result, they come to value the millennial dancing craze, which aids teachers' emotional and social development as well as their physical and mental health by allowing them to explore other aspects of life. It is advised that secondary level teachers take part in all types of dances, not just millennial dances, as this will give them the chance to be active, boost their confidence, and learn other important life lessons.

Achieving High Goals: The Impact of Contract Grading on High School Students' Academic Performance, Avoidance Orientation, and Social Comparison

This article examines American high school students’ (N=439) self-worth protection behaviors, maladaptive coping mechanisms, and academic performance under a contract grading system, which has been understudied in contemporary secondary classrooms. The quantitative analysis revealed that under the contract grading system, 97% (n=421) earned a passing grade (i.e., A, B, or C) on the assessment and 90% (n=390) fulfilled the contract by reaching mastery (A) or proficiency (B). Compared to the previous year, students with prior experience were 19% more likely to earn an A and 16% more likely to earn a B under the grading contract despite increased workload demands. The qualitative analysis of 40 semi-structured interviews revealed that performance improved as a result of the contract’s clarity of purpose, which limited task avoidance and facilitated task-oriented effort toward a desirable goal. Students enrolled in regular courses experienced the most significant grade improvement due to clear expectations that helped them place their effort on the right tasks. The findings of this study lead to a call to action for teachers to implement contract grading in high school classrooms to clarify work expectations, improve task-oriented effort, and help students set and achieve high goals.

Family physicians' moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care.

Family physicians (GPs) working with patients experiencing social inequities have witnessed patients' healthcare needs proliferate. Alongside increased workload demands fostered within current remuneration structures, this has generated concerning reports of family physician attrition and possible experiences of moral distress. To explore stories of moral distress shared by family physicians caring for patients experiencing health needs related to social inequities. A critical narrative inquiry, informed by the analytic lens of moral distress, conducted in Ontario, Canada. Twenty family physicians were recruited through purposive and snowball sampling via word of mouth and email mailing lists relevant to addictions and mental health care. Physicians participated in two narrative interviews and had the opportunity to review the interview transcripts. Family physicians' accounts of moral distress were linked to policies governing physician remuneration, scope of practice, and the availability of social welfare programmes. These structural elements left physicians unable to get patients much needed support and resources. This study provides evidence that physicians experience moral distress when unable to offer crucial resources to improve the health of patients with complex social needs resulting from structural features of the Canadian health and social welfare system. Further research is needed to critically interrogate how health and social welfare systems around the world can be reformed to improve the health of patients and increase family physicians' professional quality of life, potentially improving retention.

Ontological (In)security in Early Career Social Work during COVID-19: Experiences in Scotland

Abstract The impact of COVID-19 on the working lives of professionals has been of much interest. Within social work, the pandemic increased workload demands, whilst the way in which work was done shifted significantly. This article uses data gathered from newly qualified social workers (NQSWs) who began their working lives during the pandemic. These first years in practice are viewed as an extension to social workers’ formal education and as a vital stage in their professional development. Survey (n = 124) and interview (n = 12) data were gathered from NQSWs across Scotland. Findings were considered through Giddens’ lens of ontological security, to explore NQSW transitions during a context of pandemic disruption and its impacts on NQSWs’ confidence and competence, as well as their sense of self and identity. Consistent with other studies, respondents were most impacted by home working and the associated isolation and separation from colleagues, particularly when engaged in emotionally charged work. Findings uncovered a trichotomy of experience, with variation in the quality and availability of some formal supports—induction, training and learning and development—and informal support. Implications for practice include a need to focus on how we support and nurture NQSWs at such a critical stage in their professional socialisation.

A Low-power wearable acoustic device for accurate invasive arterial pressure monitoring

BackgroundMillions of catheters for invasive arterial pressure monitoring are placed annually in intensive care units, emergency rooms, and operating rooms to guide medical treatment decision-making. Accurate assessment of arterial blood pressure requires an IV pole-attached pressure transducer placed at the same height as a reference point on the patient’s body, typically, the heart. Every time a patient moves, or the bed is adjusted, a nurse or physician must adjust the height of the pressure transducer. There are no alarms to indicate a discrepancy between the patient and transducer height, leading to inaccurate blood pressure measurements.MethodsWe present a low-power wireless wearable tracking device that uses inaudible acoustic signals emitted from a speaker array to automatically compute height changes and correct the mean arterial blood pressure. Performance of this device was tested in 26 patients with arterial lines in place.ResultsOur system calculates the mean arterial pressure with a bias of 0.19, inter-class correlation coefficients of 0.959 and a median difference of 1.6 mmHg when compared to clinical invasive arterial measurements.ConclusionsGiven the increased workload demands on nurses and physicians, our proof-of concept technology may improve accuracy of pressure measurements and reduce the task burden for medical staff by automating a task that previously required manual manipulation and close patient surveillance.

P001 A pharmacist-based flexible approach to workforce enhancement to support implementation of National Institute for Health and Care Excellence Technology Appraisal 715, biologics in moderate rheumatoid arthritis

Abstract Background/Aims The National Institute for Health and Care Excellence Technology Appraisal 715; biologics for treating moderate rheumatoid arthritis was published in July 2021. Previously biologics have only been approved for patients with severe disease. The National Health Service is legally obliged to provide treatments recommended in technology appraisals, yet they do not attract funding for medicines or workforce enhancement. Technology Appraisal 715 is expected to expand the eligible patient cohort posing a significant challenge for the rheumatology team already operating under considerable strain. Without workforce investment clinic capacity would need to be cut for clinicians to manage the additional workload. This would result in greater delays for clinic appointments, already above national targets for new and follow up patients. The specialist pharmacist, an established member of the rheumatology team, is ideally placed to provide further flexible working roles within the team, addressing workforce issues. The aim here was to quantify additional workload associated with technology appraisal 715 and explore potential staffing models for implementation and delivery. Methods An audit of current practice was undertaken. Audit results were used to populate the modelling tool published with the technology appraisal and calculate predicted increase in workload. Three staffing models were developed and critiqued to manage this increase. A business case ranking these models in order of cost effectiveness was submitted to Trust management. Results University Hospitals Sussex rheumatology managed a cohort of around 1500 rheumatoid arthritis patients before publication of appraisal 715 with a growth rate of 14% a year since 2011. A majority of homecare prescribing was undertaken by the current specialist pharmacist and one registrar. Screening and prescribing a prescription took an average of 7 minutes. The team process around 120 prescriptions a week (approximately 14 hours work or two working days). The technology appraisal tool predicted an increase of up to 50% in the eligible patient cohort over 5 years. Increased workload was expected in the following areas; prescribing, pre-biologic and post-biologic clinics, Blueteq management, homecare and general administration workload. The staffing model of one band 8a pharmacist prescriber, one admin band 3 and half an admin band 4 (for Blueteq) was identified as most cost effective. A business case recommending this model was approved by both the Trust and commissioners. Conclusion Rheumatology teams face a growing workload and patient waiting times are increasing. Difficulties in recruitment of clinicians has been highlighted nationally. Pharmacists skilled in managing patients with acute and chronic diseases can acquire specialist competencies allowing them to take on non-traditional roles. Barriers separating professions need to be questioned as pharmacists are ideally placed to help manage increasing workload demands, including that of prescribing and implementation of technology appraisal 715. Disclosure S. Butler: Consultancies; Abbvie, Galapagos, Janssen.

Organizational Factors Associated with Certified Nursing Assistants' Job Satisfaction during COVID-19.

Given the instability of the nursing home (NH) certified nursing assistant (CNA) workforce and the challenging demands during COVID-19, it is important to understand the organizational factors that are correlated with job satisfaction which is a major predictor of CNA turnover. The purpose of this study was to determine the associations between quality of supervisor relationships, organizational supports, COVID-19 work-related stressors, and job satisfaction among CNAs in NHs. The results indicate that CNAs who reported a more optimal relationship with their supervisors, felt appreciated for the job they do and worked in NHs with lower COVID-19 resident infection rates tended to report higher rates of job satisfaction. The COVID-19 work-related stressors of increased workload demands and understaffing were associated with lower rates of job satisfaction. The study has practical implications for employers regarding how to support CNAs to improve job satisfaction especially during a crisis.

ORGANIZATIONAL SUPPORTS ASSOCIATED WITH NURSING ASSISTANTS’ JOB SATISFACTION DURING COVID-19

Abstract The COVID-19 pandemic has disproportionately affected nursing home residents and staff, including the nursing assistants who provide critical supports for older adults and people with disabilities. The pandemic has added significant strain to an already vulnerable nursing home workforce, which has historically experienced high levels of turnover, chronic staffing shortages, and high burnout. At the same time, it has generated awareness of the value of the direct care workforce to provide care in places for those most at risk from the disease. Job satisfaction of nursing assistants is as major driver of turnover and intent to leave the job. Research has demonstrated organizational supports and job stresses that are associated with job satisfaction and turnover. However, limited research has investigated the factors associated with job satisfaction in nursing homes during the COVID-19 pandemic. Using data from an employee engagement and management system, we examined organizational supports (e.g., supervision, appreciation, safety) and work-related stresses associated with job satisfaction among nursing assistants in nursing homes (n=402). Higher quality of supervision, feeling appreciated for the job, and feeling safe and comfortable at work were associated with higher levels of job satisfaction. Work-related job stressors –increased workload demands and understaffing – were associated with lower job satisfaction. Our findings provide insights into the importance of employer supports and reducing work-related stressors in nursing assistants’ job satisfaction and practical implications for nursing home leadership regarding how to support workers

Speech-language pathologists’ perspectives of dysphagia following reperfusion therapies: An Australian mixed-methods study

Purpose To investigate speech-language pathologists’ (SLPs) perceptions and clinical experiences of dysphagia management following reperfusion therapies. Method A multi-staged mixed approach involving a two-phase cross-sectional design was used. Data generated during phase 1 (a purpose-built, online survey) guided the development of phase 2 (semi-structured interviews). Sixty-two SLPs participated in phase 1 and six SLPs participated in phase 2. Result SLPs in both phases reported perceived changes in dysphagia presentation according to the success of reperfusion therapy administered and had concerns regarding worsened dysphagia following unsuccessful procedures. Fluctuations in dysphagia were more frequently reported in the acute stage post-stroke. SLPs reported increased workload demands due to increased interhospital transfers between ECR/thrombolysis centres and referring facilities. The optimal timing for swallowing screening and assessment was not identified, with initial SLP involvement ranging from during the administration of thrombolysis to up to 24 hours post-reperfusion therapy. Conclusion Preliminary evidence suggests that SLPs perceive that the presentation of post-stroke dysphagia is changing, with increasing fluctuations and complexities in the acute stage of post-stroke care, within the context of increasing use of reperfusion therapies. There is a critical need for research investigating the trajectory of dysphagia in the acute stage to inform dysphagia management within this patient population.

Thyroid Hormone Receptor Isoforms Alpha and Beta Play Convergent Roles in Muscle Physiology and Metabolic Regulation.

Skeletal muscle is a key energy-regulating organ, skilled in rapidly boosting the rate of energy production and substrate consumption following increased workload demand. The alteration of skeletal muscle metabolism is directly associated with numerous pathologies and disorders. Thyroid hormones (THs) and their receptors (TRs, namely, TRα and TRβ) exert pleiotropic functions in almost all cells and tissues. Skeletal muscle is a major THs-target tissue and alterations of THs levels have multiple influences on the latter. However, the biological role of THs and TRs in orchestrating metabolic pathways in skeletal muscle has only recently started to be addressed. The purpose of this paper is to investigate the muscle metabolic response to TRs abrogation, by using two different mouse models of global TRα- and TRβKO. In line with the clinical features of resistance to THs syndromes in humans, characterized by THRs gene mutations, both animal models of TRs deficiency exhibit developmental delay and mitochondrial dysfunctions. Moreover, using transcriptomic and metabolomic approaches, we found that the TRs–THs complex regulates the Fatty Acids (FAs)-binding protein GOT2, affecting FAs oxidation and transport in skeletal muscle. In conclusion, these results underline a new metabolic role of THs in governing muscle lipids distribution and metabolism.

Editorial Volume 13 Issue 1 2022

In 2022 we are still dealing with the impact of COVID-19 across the tertiary education sector and the themes and topics of submissions the Journal has been receiving recently, is indicative of the challenges being faced by staff and students. We recognise the disruption and increased workload demands on academic and professional staff in these times of unprecedented change and we acknowledge and thank all our reviewers for their ongoing dedication to supporting the Journal. Student Success currently has a pool of more than 100 reviewers, some of which have been reviewing for the Journal for more than a decade. All reviewers are experts in their disciplinary fields and importantly, have a profound understanding of the student experience in higher education. Student Success would not be the Journal it is without them. Thank you!

Management of work stress and burnout among community nurses arising from the COVID-19 pandemic.

The COVID-19 pandemic has increased workload demands for many NHS staff including those working in the community. Nurse managers can make a difference by being authentic leaders, nurturing a supportive organisation where the workload is managed participatively and self-kindness is legitimate. Unfortunately some staff may experience burnout and this article presents a personal management plan to address the symptoms of burnout and aid recovery, although it cannot promote a total recovery if the cause of the symptoms remains unaddressed.

Building community during the COVID-19 pandemic: a system level approach to physician well-being

Before the COVID-19 pandemic, physician burnout was identified as reaching crisis proportions, and the pandemic is expected to worsen the already perilous state of physician wellness. It has affected physicians’ emotional health, not only by increasing workload demands, but also by eroding resilience under increasing pressures. The mental health consequences are expected to persist long after the pandemic subsides. With physician wellness increasingly recognized as a shared responsibility between individual physicians and the health care system, system-level approaches have been identified as important interventions for addressing physician well-being. In this article, we describe two evidence-guided initiatives implemented in our hospitalist network during the current pandemic: a trained peer-support team and facilitated physician online group discussions. These initiatives acknowledge the emotional strain of physicians’ work and challenge the “iron doc” culture of medicine. Our efforts build community and shift culture toward improved physician wellness. We suggest that the pandemic might be an opportunity for our profession to strengthen our support networks and for physician leaders to advance physician wellness in their work environments.

Pathology Trainee Redeployment and Education During the COVID-19 Pandemic: An Institutional Experience

Pathology training programs throughout the United States have endured unprecedented challenges dealing with the ongoing coronavirus disease 2019 pandemic. At Houston Methodist Hospital, the Department of Pathology and Genomic Medicine planned and executed a trainee-oriented, stepwise emergency response. The focus was on optimizing workflows among areas of both clinical and anatomic pathology, maintaining an excellent educational experience, and minimizing trainee exposure to coronavirus disease 2019. During the first phase of the response, trainees were divided into 2 groups: one working on-site and the other working remotely. With the progression of the pandemic, all trainees were called back on-site and further redeployed within our department to meet the significantly increased workload demands of our clinical laboratory services. Adjustments to trainee educational activities included, among others, the organization of a daily coronavirus disease 2019 virtual seminar series. This series served to facilitate communication between faculty, laboratory managers, and trainees. Moreover, it became a forum for trainees to provide updates on individual service workflows and volumes, ongoing projects and research, as well as literature reviews on coronavirus disease 2019–related topics. From our program’s experience, redeploying pathology trainees within our department during the coronavirus disease 2019 pandemic resulted in optimization of patient care while ensuring trainee safety, and importantly, helped to maintain continuous high-quality education through active involvement in unique learning opportunities.

Meeting Power Constraints While Mitigating Contention on Clustered Multiprocessor System

Mobile and embedded devices have adopted the clustered multiprocessing architecture paradigm in order to serve the increasing workload demands and control/reduce their power consumption. Cores of the same type are integrated into clusters and cluster-wide voltage/frequency scaling mechanisms help them operate under specific power constraints. In this letter, we propose a methodology that: 1) enhances performance by addressing contention on shared resources of the cluster and 2) pro-actively predicts the maximum frequency under which the cluster should operate in order to meet a user-defined power threshold. Experimental results on an Odroid-XU3 board show that the proposed methodology meets the power thresholds, achieving at the same time high performance. Particularly for 7-W threshold, it achieved 5% performance gain over Linux which at the same time consumed 8-W approximately.

A Scoping Review: Characteristics and Outcomes of Residents Who Experience Involuntary Relocation.

Relocation to a residential care facility has been described as the most significant relocation affecting older adults, yet subsequent relocations, like in the case of a facility closure, have received minimal attention in the scholarly research literature. This paper reviews the published literature on involuntary relocation, focusing on the experiences of residents, families, and staff and the effects of involuntary relocation on nursing home residents' health. We conducted a scoping review to identify peer-reviewed studies reporting on involuntary relocation of nursing home residents. A total of 28 quantitative, qualitative, and mixed-method articles met inclusion criteria. Researchers mostly relied on longitudinal designs and quantitative indicators of functional health, cognitive status, psychological and emotional well-being, environment, and relocation context to examine residents' mortality risk and health outcomes associated with involuntary relocation. Inclusion of qualitative and mixed-method approaches was infrequent, as were indicators of social engagement and perceptions of relocation. Residents' awareness of and preparation for involuntary relocation positively influenced their health and well-being. Family involvement was frequently hindered by communication challenges with facilities. Staff expressed concern about residents, experienced increased workload demands, and acknowledged challenges with planning and communication. Based on the collective findings, we propose a conceptual model of critical factors at play during relocation for consideration for guiding future research and developing provisions to current policies guiding relocation processes. Facilities and policymakers need to consider procedures that enhance planning efforts and decision-making among this vulnerable population and their families.

Is Load-Induced Ventricular Hypertrophy Ever Compensatory?

When muscle is subjected to increased workload, it grows by means of a cellular process called hypertrophy. When one lifts weights, skeletal muscle hypertrophies in a manner that increases muscle strength and work capacity. When cardiac muscle is exposed to increased workload demand, it, too, hypertrophies. When the increase in workload stems from physiological stress such as exercise, the now hypertrophied myocardium is strengthened. Similarly, when the heart “lifts weights” as a result of increased afterload (eg, hypertension, aortic stenosis), it hypertrophies. However, considerable evidence suggests that this hypertrophied heart is weaker, not stronger. Furthermore, a large body of preclinical evidence points to the fact that this afterload-triggered heart growth is not required to maintain ventricular size and contractile performance even in the face of persistently increased load. This fact, which has yet to be tested in large animals, begs the question of the concept of compensatory hypertrophy, an issue we explore here. It is important to emphasize that we are referring exclusively to disease stress-triggered heart growth, not the unequivocally beneficial myocardial hypertrophy that occurs with exercise. In the 1890s, Woods1 proposed that the left ventricle (LV) could be modeled according to the law of Laplace. Whereas it was apparent from the outset that the LV violates the first principle assumptions of the law, including spherical shape and homogeneous wall characteristics, a simplified model emerged in which wall stress is directly proportional to LV pressure and radius and inversely proportional to wall thickness. Today, this represents the simplest model proposed …

A systemic approach to understanding mental health and services

In the UK mental health and associated NHS services face considerable challenges.This paper aims to form an understanding both of the complexity of context in which services operate and the means by which services have sought to meet these challenges. Systemic principles as have been applied to public service organisations with reference to interpersonal relations, the wider social culture and its manifestation in service provision. The analysis suggests that the wider culture has shaped service demand and the approaches adopted by services resulting in a number of unintended consequences, reinforcing loops, increased workload demands and the limited value of services. The systemic modelling of this situation provides a necessary overview prior to future policy development. The paper concludes that mental health and attendant services requires a systemic understanding and a whole system approach to reform.