Individual Staff Members Research Articles

A Qualitative Evaluation of the Provision of Bereavement Care Accessed by Service Users Living in a Health and Social Care Trust Area in Northern Ireland

Within the health and social care sector in the United Kingdom, the management of death and bereavement has become increasingly challenging. This service evaluation sought to explore the bereavement care offered to individuals living in one Health and Social Care Trust catchment area of Northern Ireland. Qualitative interviews were conducted with key government and voluntary agency staff. The findings indicated that much of the bereavement provision is based on the interest and initiative of individual staff members, with few processes to assess the level of bereavement care needed and those best skilled to provide it. Recommendations are made for a bereavement care strategy that outlines a bereavement needs assessment process, identifying the scope of interventions and protocols for practice.

Legitimising and rationalising in talk about satisfaction with formal healthcare among bereaved family members

While there is a fair amount of knowledge regarding substantive features of end of life care that family members desire and appreciate, we lack full understanding of the process whereby family members formulate care evaluations. In this article we draw on an analysis of interview data from 24 bereaved family members to explicate how they interpret their experiences and formulate evaluations of end of life care services. Most participants wove between expressing and legitimising dissatisfaction, and qualifying or diffusing it. This occurred through processes of comparisons against prior care experiences and expectations, personalising (drawing on personal situations and knowledge), collectivising (drawing on conversations with and observations of others) and attempting to understand causes for their negative care experiences and to attribute responsibility. The findings suggest that dissatisfaction might be diffused even where care is experienced negatively, primarily through the acknowledgement of mitigating circumstances. To a lesser extent, some participants attributed responsibility to the 'system' (policy and decision-makers) and individual staff members. The findings are discussed in relation to the theoretical understanding of satisfaction and evaluation processes and how satisfaction data might inform improvements to care quality.

Schwartz Rounds: reviving compassion in modern healthcare

Schwartz Rounds: reviving compassion in modern healthcare

CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes

BackgroundQuality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occurs within the context of relationships and interactions among individuals. Thus, QI programs will not result in optimal changes in staff behavior unless the context for social learning is present. Accordingly, we developed CONNECT, an intervention to foster systematic use of management practices, which we propose will enhance effectiveness of a nursing home Falls QI program by strengthening the staff-to-staff interactions necessary for clinical problem-solving about complex problems such as falls. The study aims are to compare the impact of the CONNECT intervention, plus a falls reduction QI intervention (CONNECT + FALLS), to the falls reduction QI intervention alone (FALLS), on fall-related process measures, fall rates, and staff interaction measures.Methods/designSixteen nursing homes will be randomized to one of two study arms, CONNECT + FALLS or FALLS alone. Subjects (staff and residents) are clustered within nursing homes because the intervention addresses social processes and thus must be delivered within the social context, rather than to individuals. Nursing homes randomized to CONNECT + FALLS will receive three months of CONNECT first, followed by three months of FALLS. Nursing homes randomized to FALLS alone receive three months of FALLs QI and are offered CONNECT after data collection is completed. Complexity science measures, which reflect staff perceptions of communication, safety climate, and care quality, will be collected from staff at baseline, three months after, and six months after baseline to evaluate immediate and sustained impacts. FALLS measures including quality indicators (process measures) and fall rates will be collected for the six months prior to baseline and the six months after the end of the intervention. Analysis will use a three-level mixed model.DiscussionBy focusing on improving local interactions, CONNECT is expected to maximize staff's ability to implement content learned in a falls QI program and integrate it into knowledge and action. Our previous pilot work shows that CONNECT is feasible, acceptable and appropriate.Trial RegistrationClinicalTrials.gov: NCT00636675

Burden and outcome of HIV infection and other morbidities in health care workers attending an Occupational Health Program at the Provincial Hospital of Tete, Mozambique

To investigate the burden and outcome of HIV infection and other morbidities amongst a Mozambican hospital staff. Within an occupational health service set up in April 2008 in the provincial hospital of Tete, Mozambique, we offered to all staff members an initial clinical, laboratory and radiological screening and followed them up prospectively until April 2010. A total of 47.5% of 423 health workers attended the program. The cohort (female-to-male ratio: 2.2; mean age: 39 years) consisted mostly of auxiliary staff (43%) and nurses (29.8%). At initial screening, 71% were asymptomatic. HIV infection (28.4%) and tuberculosis (TB) (21%) were the main reported antecedent illnesses. Laboratory screening revealed anaemia (haemoglobin level <10 mg/dl) in 9% participants, abnormal liver enzymes in 23.9% and a reactive non-treponemal syphilis test in 5%. Of 145 performed chest X-rays, 13% showed abnormalities. All 113 health workers not recently tested for HIV were screened, and 31 were newly diagnosed with HIV infection (resulting in an overall HIV prevalence of 43.8%). Nine cases of TB were diagnosed at screening/during follow-up. In April 2010, all but one of the participants were alive. All HIV-infected health workers under antiretroviral therapy were actively followed-up. Serious conditions were frequently diagnosed in health workers, in particular HIV infection. Mid-term outcome was favourable within this program. Creation of screening and care services dedicated to caregivers should be of highest priority in similar African settings.

Drugs and having babies: An exploration of how a specialist clinic meets the needs of chemically dependent pregnant women

Objectivesto explore the extent to which a specialist clinic meets the needs of chemically dependent women. Designa critical ethnography informed by theorists such as Habermas and feminists' interpretation of Foucault. Settinga specialist antenatal clinic for chemically dependent pregnant women at a major metropolitan women's hospital in Melbourne, Australia. Participantsa purposive sample of twenty (20) chemically dependent pregnant women who attended the clinic.Data collection and analysis included three taped interviews (two preceding the birth and one post birth), observation of the interactions between the women and the clinic staff over a 25-month period and chart audits. Findingssimilar to other studies there were multiple factors influencing development and maintenance of chemical dependency in this group of women, including family instability, family history of drug and alcohol abuse, childhood sexual abuse, having a chemically dependent partner and having a dual diagnosis of both drug addiction and mental illness. Initially there was considerable variation between the women and the clinic staff's expectations with regard to attending for antenatal care and conforming to a set regime as the women struggled with the contradictions inherent in their lifestyle and that of the ‘normal’ expectant mother. Aspects of that struggle included their belief that their opinions and knowledge of their lives was largely ignored, leading to episodes of resistance. Several women alleged the clinics staff's relationship with them was influenced by a belief that the women were ‘hopeless addicts in need of expert medical and midwifery care' and that the clinic staff exercised control in an authoritarian manner. However, as they explored possibilities for collaboration, they realised they could exercise power and work towards a more equal relationship with staff. The quality of relationships in most instances improved over time, and if not always strictly collaborative, was situated at various points along a continuum from minimal to full co-operation, with concomitant varying levels of success in terms of outcomes. It was often the attitude of individual staff members, particularly midwives, that was the key to the way in which the women responded to care. Key conclusions and implications for practicecomprehensive history-taking and engaging women as early as possible in pregnancy; providing continuity of care – particularly midwife care – to assist in developing a collaborative approach to care; provision of an extended period of postnatal support to at least six months for those women able to parent their children was a key recommendation.

Communication, advice exchange and job satisfaction of nursing staff: a social network analyses of 35 long-term care units

BackgroundThe behaviour of individuals is affected by the social networks in which they are embedded. Networks are also important for the diffusion of information and the influence of employees in organisations. Yet, at the moment little is known about the social networks of nursing staff in healthcare settings. This is the first study that investigates informal communication and advice networks of nursing staff in long-term care. We examine the structure of the networks, how they are related to the size of units and characteristics of nursing staff, and their relationship with job satisfaction.MethodsWe collected social network data of 380 nursing staff of 35 units in group projects and psychogeriatric units in nursing homes and residential homes in the Netherlands. Communication and advice networks were analyzed in a social network application (UCINET), focusing on the number of contacts (density) between nursing staff on the units. We then studied the correlation between the density of networks, size of the units and characteristics of nursing staff. We used multilevel analyses to investigate the relationship between social networks and job satisfaction of nursing staff, taking characteristics of units and nursing staff into account.ResultsBoth communication and advice networks were negatively related to the number of residents and the number of nursing staff of the units. Communication and advice networks were more dense when more staff worked part-time. Furthermore, density of communication networks was positively related to the age of nursing staff of the units. Multilevel analyses showed that job satisfaction differed significantly between individual staff members and units and was influenced by the number of nursing staff of the units. However, this relationship disappeared when density of communication networks was added to the model.ConclusionsOverall, communication and advice networks of nursing staff in long-term care are relatively dense. This fits with the high level of cooperation that is needed to provide good care to residents. Social networks are more dense in small units and are also shaped by characteristics of staff members. The results furthermore show that communication networks are important for staff's job satisfaction.

Tell Me Lies

This case explores the impact of being closeted on a gay, male preschool educator and the ways in which homophobic culture is fostered in one early learning center. Although sometimes protective, being challenged to hide one’s sexual orientation most always has negative consequences for the individual and society. Internalized homophobia silences and devalues individuals, and maintains a dominant homophobic culture. The complicated relationships between sexual orientation, race, class, and gender are also illuminated. This case encourages education administration students to consider the impact of homophobia on individual staff members and to imagine possibilities for advocacy and adequate staff support.

MODELO CAPES DE AVALIAÇÃO: QUAIS AS CONSEQUÊNCIAS PARA O TRIÊNIO 2010-2012?

&lt;p&gt;Este artigo tem por objetivo analisar o sistema de avaliação dos programas de pós-graduação na Área de Administração, Ciências Contábeis e Turismo da CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) e propor medidas para aprimorar estas avaliações. Induzidos pelos critérios de avaliação da CAPES, os programas de pós-graduação passaram a supervalorizar a produção científica em detrimento das demais atividades desenvolvidas pelos seus professores. O fator de impacto, medida que indica a qualidade dos periódicos, transformou-se no indicador da qualidade do trabalho do&lt;br /&gt;professor, uma vez que as avaliações individuais dos professores estão fortemente centradas na análise da sua produção científica. Para atingir o objetivo proposto foi realizada uma revisão na literatura sobre avaliação na pós-graduação, que, juntamente com a experiência do autor como professor, pesquisador, gestor de programa de pós-graduação e também membro em 2007 da comissão que avaliou o desempenho dos programas de pós-graduação em Administração subsidiaram a análise aqui apresentada. O artigo apresenta questionamentos e algumas propostas. Questionam-se os atuais critérios de avaliação do desempenho individual dos professores e alerta-se para suas possíveis consequências. Sugere-se que a avaliação considere todas as atividades desenvolvidas pelo professor, construindo o que foi denominado pelo autor de Fator “P”. Este Fator mediria o impacto das atividades do professor no âmbito local, nacional e internacional. Nas considerações finais, é feito um convite para&lt;br /&gt;que os membros da comunidade científica se engajem no debate destas questões.&lt;br /&gt;&lt;br /&gt;&lt;/p&gt;

The Disclosure Dilemma — Large-Scale Adverse Events

To the Editor: Dudzinski et al. (Sept. 2 issue)1 highlight the challenging dilemma that institutions face in disclosing adverse events to their patients and the public at large. Another important dimension of this issue is the effect of these events on patients, families, and caregivers. The uniqueness of medically induced trauma and the broad scope of its impact necessitate the need for supportive services for all persons who are affected by an unexpected medical outcome or error. Institutions should establish critical-incident stress management (CISM) for their staff members.2 CISM centers on helping individual staff members or groups deal with unusually . . .

Supportive leadership in Swedish community night nursing

The aim of the present study was to examine the support night nurses' give to staff in community night nursing. Studies have shown that support given to staff is one of night registered nurses' (RNs') experiences of the meaning of caring. This support, that community RNs display for staff in night-time care, is sparsely described. All community night-duty nurses in a medium-sized municipal in Sweden participated in the present study. Thematic content analysis was used to analyse data from observations. The support given by RNs to staff is described using three themes: (1) a conditional supporting stance, (2) preparing propitious conditions for caring and (3) confidence in the abilities of individual staff members and adaptation to their individual needs. The results reveal that RNs consider support to staff in terms of nursing leadership. Out of 'concern for the staff' the RNs try to be there for them, which corresponds to nursing leadership. Such concern also arises from the RNs' awareness that by giving support to staff this affects the staffs' caring for older people. The current municipal social care organization of community nursing of older people in which RNs have extensive responsibilities with insufficient control, is a working condition with a risk for decreased quality of care and a high risk for work-related stress syndrome.

Impact factor and the Australian Occupational Therapy Journal: A notable achievement

Journal quality metrics have been around since the 1960s (Garfield, 2006). Currently the primary journal quality metrics used by universities, research review agencies and research funding bodies are those published by the Thomson Reuters ISI (a private, for-profit company) and reported in the Journal Citation Reports® (JCR). They are based on citation data for journals included in the Science Citation Index/(Expanded) (SCI/(E)) and the Social Science Citation Index (SSCI), which can collectively be searched through the Thomson Reuters ISI Web of Knowledge database. One key journal quality metric that is calculated in the JCR is the Impact Factor (IF), a measure of the frequency with which the average article in a journal has been cited in a particular year. It is calculated by dividing the number of citations in the current year to articles published in the previous two years by the total number of articles published in the previous two years. Another quality metric often reported is the journal ranking of a publication on the JCR database. Three years ago, the AOTJ editorial board with assistance from staff from Wiley-Blackwell prepared an application for submission to Thomson Reuters ISI Web of Knowledge for the AOTJ to be included on the database, to receive an IF and journal ranking. Two years ago, the AOTJ submission was accepted. Now for the first time, the AOTJ has an IF of 0.438, an impressive achievement indeed. Currently there are only three other occupational therapy journals in the JCR Reports for 2009. The 2009 IFs for these three journals were: American Journal of Occupational Therapy (AJOT), 1.419; Occupational Therapy Journal of Research (OTJR), 0.358; and Hong Kong Journal of Occupational Therapy (HKJOT), 0.462. The 2009 SJR journal rankings for AOTJ, HKJOT, AJOT and OTJR were 31/36, 30/36, 17/55 and 50/55, respectively. IFs are increasingly being used in academic, research and grant funding arenas as a quality indicator of individual staff members and as an eligibility criteria for promotion, pay increases, grant funding access eligibility and receiving resources within higher education contexts (Saha, Saint & Christakis, 2003). For example, the Australian Government/Australian Research Council (2010) has initiated a programme referred to as the Excellence in Research for Australia (ERA) initiative which will assess ‘research quality within Australia’s higher education institutions using a combination of indicators and expert review by committees comprising experienced, internationally-recognised experts’ (retrieved on 2 August 2010 from http://www.arc.gov.au/era/default.htm). One of the quantitative indicators that will be used to assess universities’ research quality, including those that have occupational therapy education programs, will be the JCR IF and journal ranking. How universities perform in the ERA exercise will have significant implications for the allocation of scarce research funding resources. The ERA has also developed its own journal ranking system where publications from all fields of study (e.g. psychology, physics, law and engineering) are ranked as A, B or C based on their quality indicators such as prestige, quality and rigor. Currently, no occupational therapy journals have been given the ranking of A by ERA, AOTJ and AJOT are ranked level B and other occupational therapy journals are ranked as a level C (such as CJOT, BJOT, SJOT and OTI). IF and other journal quality metrics are points of reference for occupational therapists (and others) who publish and hopefully this will encourage prospective authors to submit high-calibre manuscripts to AOTJ that are relevant to the discipline. In order for the AOTJ to remain competitive (nationally and internationally) and relevant to its readership and the authors who publish in it, achieving an IF is an outstanding accomplishment. The AOTJ editorial board in collaboration with Wiley-Blackwell will continue to work on constructive ways to improve the journal’s IF and journal ranking when it is next calculated and published. This will assist to ensure that the AOTJ continues to be the high-quality, useful, recognised refereed publication it is.

Staff attitudes and thoughts about the use of coercion in acute psychiatric wards

Previous research has shown considerable differences in how often coercive measures are used in mental health care between groups of patients, institutions and geographical areas. Staff attitudes towards the use of coercion have been put forward as a factor that may influence these differences. This study investigates the attitudes to coercion in 651 staff members within 33 Norwegian acute psychiatric wards. The newly developed Staff Attitude to Coercion Scale was used to measure staff attitudes. Multilevel analysis showed that there was significant variance among wards, estimated to be about 8-11% of the total variance on three scales. Despite substantial differences in attitudes among wards, most of the variance could be attributed to individual staff level factors. Hence, it is likely that staff attitudes are influenced, to a large extent, by each individual staff member's personality and values.

Symposium 4: Practitioner research as experiential learning?

Practitioner research is now long established as a means of professional development for academics in higher education, resulting in well documented benefits for the practitioner researcher and their students. What is less well documented is the process by which individual academic members of staff develop as practitioner researchers and how their engagement with the realities of practice and research influences their learning. This paper is a case study of professional development through practitioner research at the Centre for Open Learning in Mathematics, Science, Computing and Technology (COLMSCT) at the Open University, UK. COLMSCT was established in 2005 to reward teaching excellence and to fund practitioner research into develop ‘effective and engaging’ ways of using new technologies to support students at a distance. A total of 63 two-year projects have been supported through COLMSCT, involving both full-time academics and part-time distance tutors. The effects of the practitioner research projects have been evidenced at the level of student experience, personal transformation, colleagues, the institution and the wider higher education sector and include: changes in individual practice, increased involvement in research, modifications to assessment at module and programme level, and conference presentations and journal publications. The paper uses the theory of experiential learning, and in particular Kolb’s learning cycle, to explore the process of professional development through practitioner research. Kolb’s phases of learning, namely concrete experience, reflective observation, abstract conceptualization and active experimentation, are used as a lens through which to examine the process and effects of practitioner research on the individual, their students and the wider institutional and higher education context. The paper provides examples of how the processes and effects of practitioner research, such as observing practice, engagement with theoretical approaches and implementing change, relate to these phases of learning. It also demonstrates that when these phases interact, so when practitioner researchers bring abstract concepts or theoretical insights into their observations of practice, transformation, or learning, occurs. It examines the factors which influence this learning and concludes that the professional development opportunities provided by practitioner research are, in part, determined by the role that the individual practitioner researcher occupies in the ‘outside world’ of practice.

Pharmacy provision of emergency contraception to men: A survey of pharmacist attitudes in Rhode Island

ObjectiveTo describe pharmacy staff members's attitudes and practices related to male emergency contraception (EC) requests, as well as the occurrence of male purchases in Rhode Island. DesignCross-sectional study. SettingPharmacies throughout Rhode Island during April to August 2008. Participants226 pharmacists and pharmacy technicians. InterventionParticipants were mailed a 21-item closed-ended questionnaire. Main outcome measuresDemographics, EC provision practices, recall of male EC purchases, and attitudes toward male EC access. ResultsOf 151 pharmacies surveyed, 91 responded, providing 226 individual pharmacy staff member surveys. Among this population, 95.6% sold EC. Although 59.7% believed male EC purchases occurred rarely, 63.3% sold EC to a man in the previous year. Ten (4.4%) respondents refused sale of EC to a man. Respondents were less likely to agree that men should always have access if they also believed that access would decrease regular contraceptive use (P = 0.008) and if they could not verify the female recipient'ss consent (P < 0.001). ConclusionPharmacists and technicians commonly believed that male EC purchases did not occur or occurred rarely; however, more than one-half of this population sold EC to men. Although the majority expressed personal reservations against providing EC to men, they still agreed that men should have access to EC. These findings suggest that pharmacies are an acceptable setting for male EC access and that although refusal exists, it may not be a barrier to access.

Philanthropy, Evaluation, Accountability, and Social Change

All foundations know the accountability checklist. Avoid self-dealing. File your 990 on time. Pay the excise tax. Be transparent about your grant processes. Avoid excessive compensation. Avoid luxury perks for board members. Commit to board development. Do not bully nonprofits. Keep administrative costs low. Have HR establish annual performance reviews for individual staff members. Benchmark internal processes against those of other foundations. Seek cause-and-effect attribution regarding quantitative outcome targets for grants.

Using Affect to Understand Employee Turnover: A Context-Specific Application of a Theory of Social Exchange

Employee turnover is of broad interest, and we focus on turnover in an occupational group that is appropriate for our theoretical approach: Nursing home staff. Using a large and representative sample, we apply conceptual work in the area of social exchange by Lawler and colleagues to examine the role of affect toward the organization on employee turnover as well as antecedents of that affect. We use previous research and survey data to demonstrate that nursing home staff work in the conditions under which Lawler's theories of social exchange apply. We use longitudinal survey data to test whether nursing home staff turnover can be predicted by the level of affective attachment of the individual staff members to the nursing home, controlling for factors related to nursing home turnover. We find that lower nursing home staff turnover at Time 2 is predicted by affective attachment to the nursing home at Time 1.

There are three basic steps to motivating nurses.

Further to 'The right incentive' (career development September 30), there is no need for managers to ask individual staff members what motivates us.

Training excellence in the independent sector

Train to Gain is a national skills service to support employers of all sizes and in all sectors, to improve services and the skills of their employees as a way of improving overall performance and enhancing customer care. Train to Gain is a joint investment-employers and the Government working together to boost business by improving the skills of individual staff members.

United Front: Blame Management and Scandal Response Tactics of the United Nations

In this paper we conduct a systematic study of the United Nations (UN) responses to allegations of transgression. We examine the patterns in the UN reaction to scandals, the types of accounts, the institutional providers of the responses, and the implications of scandals for the UN and its' official(s). We conduct a content analysis of the UN scandal and account coverage in international (print) media in the last 25 years, and find a scandal‐responsive UN, particularly in the case of institutional scandals. Concessions issued by the office of the Secretary General is dominant UN account to allegations of misconduct. Individual staff members implicated in the scandals offer a greater variety of accounts and often suffer resignations and severe punishments.