Workload Pressures Research Articles

The dual protective role of accountability: Mitigating missed nursing care and nurse moral distress in a nested diary study design.

To examine a novel moderated-mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress. Nested diary study. Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium-sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse-patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated-mediation model. Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses. The study highlights accountability's dual role-safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures. Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff. By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes. The study has adhered to STROBE guidelines. No patient or public contribution.

I balance suffering(s): The politics and moralities of humanitarian caseworkers in Egypt as a refugee transit point

AbstractIn a world where asylum and migration have become major concerns for countries of transit and destination, political neutrality seems to be demanded from humanitarian workers. But under the pressures of workload, limited funds, and complex settings, these actors deviate from expectations and practice extra‐legal authority of a unique political nature. When handling asylum cases, these agents take crucial decisions that decisively impact the lives of asylum seekers. In legally fragile transit points where the rule of law faces challenges and where asylum seekers come seeking further resettlement in European countries, rejected applicants face risky fates of deportation, jail, violence, or death. In turn, humanitarian caseworkers pushed by workloads, purse strings, emotional burnout, and compassion fatigue, flatten the sufferings of their applicants, balance, and rank them. Caseworkers have to rank sufferings and decide who may eventually survive and who may simply be left to a risky unknown. In Agambian terms, this extralegal authority draws the lines, creates a zone of exception and throws rejected applicants into the realm of “Bare Life” where they become “Homo Sacer,” whose life is worthless. Using Lipsky's theorization of street‐level bureaucrats and in‐depth interviews, the paper tackles these crucial issues by interviewing caseworkers from a variety of international organizations operating in the transit point of Egypt. These caseworkers are responsible for conducting different roles in the Refugee Status Determination process.

Exploring Antipsychotic Use for Delirium Management in Adults in Hospital, Sub-Acute Rehabilitation and Aged Care Settings: A Systematic Literature Review.

International guidelines discourage antipsychotic use for delirium; however, concerns persist about their continued use in clinical practice. We aimed to describe the prevalence and patterns of antipsychotic use in delirium management with regard to best-practice recommendations. Primary outcomes investigated were prevalence of use, antipsychotic type, dosage and clinical indication. Eligibility criteria: studies of any design that examined antipsychotic use to manage delirium in adults in critical care, acute care, palliative care, rehabilitation, and aged care were included. Studies of patients in acute psychiatric care, with psychiatric illness or pre-existing antipsychotic use were excluded. we searched five health databases on 16 August, 2023 (PubMed, CINAHL, Embase, APA PsycInfo, ProQuest Health and Medical Collection) using MeSH terms and relevant keywords, including 'delirium' and 'antipsychotic'. Risk of bias: as no included studies were randomised controlled trials, all studies were assessed for methodological quality using the Mixed Methods Appraisal Tool. descriptive data were extracted in Covidence and synthesised in Microsoft Excel. Included studies: 39 studies published between March 2004 and August 2023 from 13 countries (n = 1,359,519 patients). Most study designs were retrospective medical record audits (n = 16). in 18 studies, participants' mean age was ≥65 years (77.79, ±5.20). Palliative care had the highest average proportion of patients with delirium managed with antipsychotics (70.87%, ±33.81%); it was lower and varied little between intensive care unit (53.53%, ±19.73%) and non-intensive care unit settings [medical, surgical and any acute care wards] (56.93%, ±26.44%) and was lowest in in-patient rehabilitation (17.8%). Seventeen different antipsychotics were reported on. In patients aged ≥65 years, haloperidol was the most frequently used and at higher than recommended mean daily doses (2.75 mg, ±2.21 mg). Other antipsychotics commonly administered were olanzapine (mean 11 mg, ±8.54 mg), quetiapine (mean 64.23 mg, ±43.20 mg) and risperidone (mean 0.97 mg, ±0.64 mg). The use of antipsychotics to manage delirium is strongly discouraged in international guidelines. Antipsychotic use in delirium care is a risk for adverse health outcomes and a longer duration of delirium, especially in older people. However, this study has provided evidence that clinicians continue to use antipsychotics for delirium management, the dose, frequency and duration of which are often outside evidence-based guideline recommendations. Clinicians continue to choose antipsychotics to manage delirium symptoms to settle agitation and maintain patient and staff safety, particularly in situations where workload pressures are high. Sustained efforts are needed at the individual, team and organisational levels to educate, train and support clinicians to prioritise non-pharmacological interventions early before deciding to use antipsychotics. This could prevent delirium and avert escalation in behavioural symptoms that often lead to antipsychotic use.

Hybrid-Theory Innovative Clinical Teaching Strategy: A Transformative Approach to Nursing Education.

This article introduces the Hybrid-Theory Innovative Clinical Teaching Strategy (HICTS) as a response to the challenges faced by nurse faculty in clinical education. With a shortage of clinical placements, preceptors, and evolving certification demands, faculty creativity is vital. HICTS integrates several learning theories to provide a transformative educational approach. Through shadowing and reflecting on faculty and peer actions, learners gain confidence and improved clinical reasoning. HICTS benefits faculty by reducing workload pressures and allowing personalized support. Further research is needed to determine the optimal use of HICTS and measure its impact on learner outcomes.

Norwegian general practitioners’ perceptions of their depression care – a national survey

BackgroundThe General Practitioner (GP) is often the first professional contact for patients with depression. Depression care constitutes a substantial part of GPs’ workload.ObjectiveTo assess how GPs experience their patients’ expectations and their own provision of depression care; further, how their depression care was associated with doctor- and practice-characteristics.MethodsA cross-sectional questionnaire study about depression care in general practice among the GPs in the Norwegian Physician Survey of 2021.ResultsOf the 221 responding GPs, 50% were female and 70% agreed to have constant time pressure due to workload. The GPs believed that patients with depression were interested in their professional assessment (87.2%) and saw them as providers of talking therapy (76,9%). Still, 77,8% of the GPs thought the patients expected a referral. Talking therapy was commonly provided (79.6%) along with consultations of more than 30 min (80.4%). The youngest age group and GPs with shorter patient lists spent more time. Most GPs (92.3%) considered their help to be of great benefit for depressed patients. However, one-fourth of the GPs did not feel competent in providing talking therapy, less frequently reported by the GPs aged 40–54 years.ConclusionsTalking therapy is commonly provided by GPs. However, there is a need to investigate what GP talking therapy implies, and to strengthen GP skills in this regard. Overall, the GPs experience their depression care to be useful for their patients, and do not de-prioritize this although they experience workload pressure.

Evaluating video and hybrid group consultations in general practice: mixed-methods, participatory study protocol (TOGETHER 2)

Background General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these challenges, some practices in the UK have been delivering video and hybrid group consultations (VHGCs). Despite positive initial findings and enthusiasm, there are still gaps in our understanding of the influence VHGCs have on patient experience, healthcare utilisation, quality, safety, equity and affordability. Objectives To generate an in-depth understanding of VHGCs for chronic conditions in general practice, surface assumptions and sociotechnical dynamics, inform practice and extend theorisation. Methods Mixed-methods, multi-site research study using co-design and participatory methods, from qualitative, quantitative and cost-related perspectives. WP1 includes a national, cross-sectional survey on VHGC provision across the UK. In WP2 we will engage patients and general practice staff in co-design workshops to develop VHGC models with emphasis on digital inclusion and equity. In WP3 we will carry out a mixed-methods process evaluation in up to 10 GP practices across England (5 sites already running VHGCs and 5 comparison sites). Qualitative methods will include interviews, focus groups and ethnographic observation to examine the experiences of patients, carers, clinical and non-clinical NHS staff, commissioners and policy-makers. Quantitative methods will examine the impact of VHGCs on healthcare utilisation in primary and secondary care, patient satisfaction, engagement and activation. We will also assess value for money of group and individual care models from a health economics perspective. Conclusions We aim to develop transferable learning on sociotechnical change in healthcare delivery, using VHGCs as an exemplar of technology-supported innovation. Findings will also inform the design of a future study.

The Interplay between Workload Pressures, Negative Work Environments, and Employee Motivation

The dynamics between workload pressures, negative work environments, and employee motivation are crucial in understanding workplace productivity and employee well-being. This study explores how these factors interplay within PT. Fouher Popular Internasional. A quantitative approach was employed using a survey method. Data were collected through a questionnaire distributed to a sample of 83 employees at PT. Fouher Popular Internasional. The findings reveal significant correlations between high workload pressures and decreased motivation, as well as between negative work environments and reduced employee engagement. These interactions highlight the need for effective management strategies to mitigate these issues.

Transformation der Arbeit durch die Einführung neuer digitaler Technologien

Abstract Using data from a survey of 3,700 German establishments, this study examines how the adoption of new digital technologies correlates with key labour market indicators: new hires, workload intensification and workforce qualifications. Findings from interviews reveal a mixed impact of digitalisation on job demands and employment dynamics. While some firms experience workforce relief, others face heightened workload pressures. Despite widespread adoption, there is scant evidence of significant job losses attributed to technology integration. Instead, the data suggests a modest trend towards job creation. Notably, investment in workforce training emerges as a crucial factor in managing the digital transition.

The hidden work of general practitioners: An ethnography

High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it. This paper examines non-patient-facing work ethnographically, informed by practice theory, the Listening Guide, and empirical ethics. Ethnographic observations (104 h), in-depth interviews (n = 16; 8 with GPs and 8 with other primary care staff) and reflexive workshops were conducted in two general practices in England. Our analysis shows that ‘hidden work’ was integral to direct patient care, involving diverse clinical practices such as: interpreting test results; crafting referrals; and accepting interruptions from clinical colleagues. We suggest the term ‘hidden care work’ more accurately reflects the care-ful nature of this work, which was laden with ambiguity and clinical uncertainty. Completing hidden care work outside of expected working hours was normalised, creating feelings of inefficiency, and exacerbating workload pressure. Pushing tasks forward into an imagined future (when conditions might allow its completion) commonly led to overspill into GPs' own time. GPs experienced tension between their desire to provide safe, continuous, ‘caring’ care and the desire to work a manageable day, in a context of increasing demand and burgeoning complexity.

Evaluating Success and Challenges of a Primary Care Youth Mental Health Programme Using Complexity, Implementation Science, and Appreciative Inquiry.

Background Using an innovative framework of complexity and implementation science, with underpinning core values of appreciative inquiry (CIS-A), this paper describes the evaluation of a pilot service in New Zealand aiming to deliver integrated psychological therapy services within primary care, to young people (aged 18-24) experiencing mild to moderate mental distress. Method Using mixed quantitative and qualitative methods and multiple data sources,there was a strong focus on local innovation and co-design with service users, young people and multiple care providers. Data is drawn from service users, stakeholders and providers of the service in three areas of the lower North Island of New Zealand. Results The Piki pilot provided a significant and innovative enhancement of mental health care to this population. The service supported 5307 individuals with a range of therapy options, with the majority having between one and three therapy sessions. From 730 service users who completed a survey, 591 (81%) were 'very satisfied' with the service provided. The CIS-A framework was used successfully to provide rapid feedback and encourage adaptation to evolving issues. These included unexpected workload pressures, changes to therapy delivery, the integration of co-design and prioritising the needs of vulnerable groups. There was a successful incorporation of youth/service user input to co-design the programme, introduction of a peer-to-peer support service, and integration of a digital resource platform. The framework was also used to address challenges encountered and to support necessary adaptations in response to the COVID-19 pandemic. Conclusions We describe the use of an embedded evaluation to support and inform the implementation of a novel and innovative youth mental health programme. Complexity and implementation science, underpinned by the core values of appreciative inquiry (CIS-A), were successfully utilised providing potential learning that can be applied locally, nationally and internationally. This study has a focus on youth mental health but the principles and utility of applying a complexity and implementation science approach have application in many different health care settings. The use of a framework such as CIS-A can support complex innovation and implementation and can be used to enable rapid course correction and turn 'hindsight to foresight'.

Examining the Role of Work-Life Balance Programs in Reducing Burnout among Healthcare Workers: A Case Study of C.B. Dunbar Hospital and the Baptist Clinic in Gbarnga City, Bong County, Liberia

Burnout among healthcare workers is a significant concern globally, particularly in low-resource settings like Liberia. This mixed-methods study aimed to assess burnout levels and identify contributing factors among healthcare workers at C.B. Dunbar Hospital and The Baptist Clinic in Gbarnga City, Bong County, Liberia. Quantitative data on burnout levels and work- life balance perceptions were collected from 50 healthcare workers, supplemented by qualitative insights from interviews. Findings revealed that a majority of participants experienced frequent workload-related stress, highlighting the pervasive nature of burnout in this context. Despite challenges, many healthcare workers reported moderate to positive work-life balance perceptions. Logistic regression analysis identified workload and work-life balance perceptions as significant predictors of burnout. Qualitative analysis further elucidated the complex interplay of factors contributing to burnout, including workload pressures, inadequate support systems, and stigma surrounding mental health issues. The study underscores the importance of implementing targeted interventions to mitigate burnout among healthcare workers in Liberia, including improving workload management, enhancing support systems, and promoting a culture of work-life balance.

Advanced Flame front Detection in Combustion Processes Using Autoencoder Approach

This research explores the detection of flame front evolution in spark-ignition engines using an innovative neural network, the autoencoder. High-speed camera images from an optical access engine were analyzed under different air excess coefficient λ conditions to evaluate the autoencoder’s performance. This study compared this new approach (AE) with an established method used by the same research group (BR) across multiple combustion cycles. Results revealed that the AE method outperformed the BR in accurately identifying flame pixels and significantly reducing overestimations outside the flame boundary. AE exhibited higher sensitivity levels, indicating its superior ability to identify pixels and minimize errors compared to the BR method. Additionally, AE’s accuracy in representing combustion evolution was notably improved, offering a more detailed depiction of the process. AE’s strength lies in its independence from specific threshold searches, a requirement in the BR method. By relying on learned representations within its latent space, AE eliminates laborious threshold exploration, ensuring reliability and reducing workload pressures. Comparative analyses consistently confirmed AE’s superior performance in accurately reproducing and delineating combustion evolution compared to BR. This study highlights AE’s potential as a promising technique for precise flame front detection in combustion processes. Its ability to autonomously extract features, minimize errors, and enhance overall accuracy signifies a significant step forward in analyzing flame fronts. AE’s reliability, reduced need for manual intervention, and adaptability across various conditions suggest a promising future for improving combustion analysis techniques in spark-ignition engines with optical access.

Virtual Classes and EFL Students’ Linguistic Performance; Case Study of Engineering Students at Imam Abdulrahman bin Faisal University

This study identified the perceptions, attitudes, and difficulties that university students encountered to better understand how EFL virtual classrooms affected their language performance. In order to test the study's hypotheses, 124 engineering college students were given a three-section questionnaire comprising 29 statements, and 15 of them were also interviewed. All participants signed up for the English-language online writing composition course. The study's findings indicate that the participants had varying opinions about how virtual EFL classes affected the improvement of their linguistic ability. Additionally, the results showed that students only partially preferred this method of learning because they had to deal with a variety of concerns, including technological difficulties, inadequate instruction and training, financial commitments, workload pressure, and limited access to the internet. In order to properly employ virtual courses in the teaching of EFL, it is strongly advised that the aforementioned issues be fixed. This case study contributes to the body of research by focusing on a situation where there is a dearth of empirical data regarding EFL learners' perceptions of English learning. To understand why this disparity evolved, additional studies in this area are needed.

The heuristic divergence between community reporters and child protection agencies: Negotiating risk amidst shifting sands

BackgroundChildren enter the statutory part of ‘notify-investigate’ child protection systems via the reports of others, combined with acceptance by the statutory agency. This key nexus determines entry or deflection from statutory child protection services. ObjectiveTo examine the decision reasoning and processes of community (non-governmental organisation) workers that underpin reports to statutory services. Participants and settingParticipants are non-governmental organisation (NGO) workers in Aotearoa New Zealand. MethodsThe methods are focus groups, interviews and a ‘think – aloud’ vignette-based protocol, used to elicit reporting decision rationales and experiences. Theoretical concepts of heuristics, institutional co-responsibility, and policy change are used to explore the study findings. ResultsMost cases are reported only after NGO workers ‘build a picture’ in the context of relationships with families and efforts to address risks. Reporting is a last resort option and occurs after ‘tipping point’ changes in the balance of protective and risk factors. Participants note a rising threshold and changes to the criteria for report acceptance by Oranga Tamariki (the statutory agency) in recent years, due to changing policy aims, abuse definitions, an ‘add value’ principle, and workload pressures. This heuristic change results in many reports not accepted or acted on, leading to frustration, anxiety, and ethical ambivalence for NGO workers. ConclusionsThe rising threshold and ‘adding value’ principle while aimed at collective responsibility to family issues, is perceived by NGO workers as a deflection heuristic by Oranga Tamariki. In their view, it is applied too broadly, acts as a blunt tool that does not account for differences in role and power, and is used to deflect risk responsibility. Implications for children and whānau, (extended families) the possibilities for ‘co-responsibility’, ethical reasoning, and the data generated by reports are discussed.

PENGARUH INTEGRITAS, BEBAN KERJA, DAN TEKANAN ANGGARAN WAKTU AUDITOR TERHADAP KUALITAS AUDIT (STUDI EMPIRIS PADA KANTOR AKUNTAN PUBLIK DI WILAYAH KOTA BEKASI DAN DKI JAKARTA)

The purpose of this study was to find information and determine the effect of integrity, workload and auditor time budget pressure on audit quality. The data used in this study are primary data. The approach used is quantitative. The sample used in this study were auditors who worked at the Public Accounting Firm in Bekasi City and DKI Jakarta as many as 100 respondents. The sampling technique used in this study was purposive sampling. The data obtained is then processed with a data processing tool, namely the Statistical Program for Social Science (SPSS) Version 25. The conclusion from the results of this study is that integrity has a positive effect on audit quality, workload has no effect on audit quality and auditor time budget pressure has a positive effect on audit quality.

Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation.

Falls are the most common safety incident reported by acute hospitals. The National Institute of Health and Care Excellence recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. To determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute National Health Service hospitals in England. Realist review and multisite case study. (1) Systematic searches to identify stakeholders' theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (n = 50), patient and carer interviews (n = 31) and record review (n = 60). Three Trusts, one orthopaedic and one older person ward in each. Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored. (1) Leadership: wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared responsibility: a key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient participation: nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. (1) Leadership: There should be a clear distinction between senior nurses' roles and falls link practitioners in relation to falls prevention; (2) shared responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) patient participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) mixed method and economic evaluations of patient supervision; (3) evaluation of engagement support workers, volunteers and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. This study is registered as PROSPERO CRD42020184458. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129488) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.

Is it harmful or helpful? Examining the causes and consequences of generative AI usage among university students

While the discussion on generative artificial intelligence, such as ChatGPT, is making waves in academia and the popular press, there is a need for more insight into the use of ChatGPT among students and the potential harmful or beneficial consequences associated with its usage. Using samples from two studies, the current research examined the causes and consequences of ChatGPT usage among university students. Study 1 developed and validated an eight-item scale to measure ChatGPT usage by conducting a survey among university students (N = 165). Study 2 used a three-wave time-lagged design to collect data from university students (N = 494) to further validate the scale and test the study’s hypotheses. Study 2 also examined the effects of academic workload, academic time pressure, sensitivity to rewards, and sensitivity to quality on ChatGPT usage. Study 2 further examined the effects of ChatGPT usage on students’ levels of procrastination, memory loss, and academic performance. Study 1 provided evidence for the validity and reliability of the ChatGPT usage scale. Furthermore, study 2 revealed that when students faced higher academic workload and time pressure, they were more likely to use ChatGPT. In contrast, students who were sensitive to rewards were less likely to use ChatGPT. Not surprisingly, use of ChatGPT was likely to develop tendencies for procrastination and memory loss and dampen the students’ academic performance. Finally, academic workload, time pressure, and sensitivity to rewards had indirect effects on students’ outcomes through ChatGPT usage.

Group-based journal review: opportunities for researcher development and enjoyment

ABSTRACT The availability of expert reviewers, essential for academic publishing, is increasingly under threat, due to workload pressures and lack of development pathways. This inquiry, undertaken by the editors of an emergent higher education journal, draws on reviewers’ experiences as articulated in ‘reviewer stories’ and examines key questions around reviewer experiences and development pathways as well as the role of reviewing in the development of research skills and academic identity formation. This article shines a light on the elusive practice of journal reviewing and confirms group-based review as a successful approach for supporting researcher development and bringing enjoyment into academic practice.

Exploring patient safety risk in an emergency ward for substance use through a mixed-method analysis

BackgroundThere is limited knowledge of how psychiatric patient safety measures can detect and understand risk as an emergent property within a healthcare system. Overcrowding poses a risk for patient safety in psychiatric emergency wards and is associated with increased mortality and violence. This paper aims to explore patterns of risk emergence in a psychiatric ward and provide insights into the dynamics of workload pressure.MethodA case study was conducted in a psychiatric emergency ward for patients with substance use disorders. The study employed a four-phased mixed-methods design. Phase one used clinical experts to identify patient safety pressure issues. Phase two used data on patient visits extracted from medical records between 2010 and 2020. In phase three, a quantitative analysis of patient visits and diagnosis was made. Phase four used a focus group of clinical experts for a semi-structured interview, analysing the result from phase three.ResultTrend analysis demonstrated a steady growth of patient visits to the emergency ward over the studied ten-year period. The findings showed a decrease in patients being diagnosed with delirium when visiting the emergency ward and an increase in percentage of patients receiving a psychosis diagnosis. The focus group expressed concerns about delayed treatments, increased violence and underestimating patients’ needs.ConclusionThis study indicated that increased workload pressure can be predicted at a system level by analysing patient visits and diagnostics trends over time. The study advocates for ongoing awareness of patient safety risks by monitoring factors identified by clinical front-end workers as potential sources of risk. Healthcare management could employ supportive tools to detect and address emerging risks, including expected workload, overcrowding, staffing issues or bed shortages.

Aotearoa New Zealand Climate and Environmental Journalists: Profiles, Practices, and Perspectives

This study investigates the profiles, practices, and perspectives of leading climate and environmental journalists from Aotearoa New Zealand. Based upon semi-structured interviews, this study discusses the state of national climate and environmental reportage, as well as possible and desired futures in the round, as responses to the rapidly emerging climate and biodiversity emergency. Within a comparatively small national media ecosystem, the interviews reveal a diversity of backgrounds and degrees of scientific expertise, a collegial relationship amongst the journalists, and a relatively high degree of autonomy in their respective newsrooms. The research notes the journalists believe climate and environmental reportage has increased in Aotearoa New Zealand in recent years although the level of coverage is still insufficient, and there are ongoing struggles to locate climate and environmental journalism within existing news frames. The interview discussion also explores features of reportage such as source relations, workload pressures, and audience engagement. This study explores how journalists negotiate their personal commitments to environmental change within the context of their professional practice. It also discusses the issue of advocacy reportage in climate and environmental journalism and possible critiques of existing journalistic practices and dominant news frames within the contexts of a climate and biodiversity emergency.