Staff Comfort Research Articles

Heatwaves, Hospitals, and Health System Resilience in England: A Qualitative Assessment (Summer 2019)

Abstract Background Frequent heatwaves challenge healthcare delivery in England, affecting patient safety and staff welfare. This study addresses the observational gap in how healthcare settings adapt to extreme weather. Methods We utilised a qualitative approach, conducting semi-structured interviews with fourteen NHS staff across England to explore experiences during the 2019 summer heatwave. Participants included clinical and non-clinical personnel, providing broad insights into operational challenges and adaptive strategies. Results The 2019 heatwave significantly disrupted service delivery, with variable staff awareness of the Heatwave Plan for England affecting responses. Key issues included managing infection control versus electric fan usage, impacting patient and staff comfort and safety. These conditions also led to an increase in hospital admissions. Conclusions The findings highlight the need for improved workforce training and strategic planning to enhance resilience to heat-related risks. Further research is essential to develop a comprehensive evidence base on the impacts and costs of heatwaves and to assess the effectiveness of adaptation strategies. This will support national health adaptation planning and emergency response. Key messages • Enhanced planning and training are crucial for health system resilience to heatwaves. • More research is needed to understand heatwave impacts and effective responses.

A "Whole Child Approach": Parent Experiences with Acute Care Hospitalizations for Children with Autism Spectrum Disorder and Behavioral Health Needs.

Children with Autism Spectrum Disorder (ASD) experience increased hospitalizations as compared to the general population, particularly in the context of mental health crises. Given the unique needs of children with ASD and behavioral health needs that can either lead to or emerge during hospitalization, an understanding of hospital experiences is critical. To date, research on caregiver experiences in acute care medical hospital settings is limited. Therefore, the purpose of this qualitative study was to investigate caregiver experiences with inpatient care for children with ASD and behavioral health needs, including factors and practices that impacted or were desirable for care. Two focus groups were conducted with a total of 12 parents of children with ASD admitted to a large pediatric hospital. Data were analyzed using interpretive description. Emerging themes pointed to the child, family, and staff factors and practices that intersect to influence hospitalization experiences. Child factors included the child's communication, sensory, behavioral, medical, and safety needs. Family factors included the family's relationship with the healthcare team, own needs, and advocacy experiences. Staff factors included staff communication practices, comfort, and knowledge when providing care. Overall, this research demonstrates the complexity of factors and practices that impact the behavioral health hospitalization experience for children with ASD and their caregivers. Experiences varied widely and were guided by the unique needs of each child. Findings point to care practices that can be adopted to best meet the needs of all stakeholders during hospitalization and offer implications for future educational initiatives.

The indoor thermal environment performance of various air-conditioning system configurations and airflow modes in a large space museum building

Optimizing air distribution in site museums is crucial for the long-term protection of heritage sites and the thermal comfort of visitors and staff. This study examined a site museum, analyzing the traditional suspended ceiling air-conditioning system and proposing a more rational renovation. Using computational fluid dynamics (CFD) numerical simulations, the study evaluated the effects of both systems on site protection and thermal comfort. The results indicated that the retrofit scheme could significantly reduce the indoor air velocity and temperature with the same air supply parameters, which would improve human thermal comfort and also reduce the negative impact of temperature and wind speed on the site. Additionally, the retrofit scheme cut air-conditioning energy consumption by 40% and reduced initial investment costs for a unit with a rated airflow of 62,000 m³/h. The optimization of the air-conditioning system ends was also carefully considered, resulting in a safer and easier installation and maintenance process, as well as enhancing the visual appeal of the museum’s interior. The proposed retrofit scheme can provide a reference for the design of air-conditioning systems in similar types of buildings.

Using Implementation Outcomes to Inform Implementation of Suicide Risk Screening with Juvenile Legal-Involved Youth: Considerations for Task-Shifting Suicide Screening to Juvenile Legal Staff

ABSTRACT Youth in the juvenile legal system (JLS) are at increased risk for suicidal thoughts and behaviors. Examine the acceptability, feasibility, and appropriateness of imbedding suicide screening and intervention in the JLS. The current study involved formative semi-structured interviews with key JLS stakeholders (n = 37) from two states, one in the Northeast and one in the Midwest, to determine whether suicide screening and intervention could be integrated into the role of juvenile probation officers. Stakeholders discussed perspectives on the acceptability (perceived JLS staff comfort with suicide screening and a brief intervention), feasibility (improving comfort of staff, youth, and families), and appropriateness (perceived impact on youth and families). Qualitative data suggested acceptability of suicide screening was mitigated by staff comfort and perceived support of available clinical resources. Feasibility of improving staff comfort to conduct suicide screening and a brief intervention revolved around logistical, training, and supervisory support. Barriers to the appropriateness of suicide screening and intervention with youth in the JLS suggest concerns about how youth’s distrust of the JLS and mental health stigma might impact engagement in suicide screening and intervention efforts. We conclude with implementation strategy considerations to enhance successful suicide screening and intervention by JLS staff.

Two-Stage Robust Optimization for Large Logistics Parks to Participate in Grid Peak Shaving

As new energy integration increases, power grid load curves become steeper. Large logistics parks, with their substantial cooling load, show great peak shaving potential. Leveraging this load while maintaining staff comfort, product quality, and operational costs is a major challenge. This paper proposes a two-stage robust optimization method for large logistics parks to participate in grid peak shaving. First, a Cooling Load’s Economic Contribution (CLEC) index is introduced, integrating the Predicted Mean Vote (PMV) and Sales Pressure Index (SPI). Then, an optimization model is established, accounting for renewable energy uncertainties and maximizing large logistics parks’ participation in peak shaving. Results illustrate that the proposed method leads to a reduction in the peak shaving pressure on the distribution network. Specifically, under the scenario tolerating the maximum potential uncertainty in renewable energy output, the absolute peak-to-valley difference and fluctuation variance of the park’s net load are decreased by 45.82% and 54.59%, respectively. Furthermore, the PMV and the SPI indexes are reduced by 39.12% and 26.36%, respectively. In comparison with the determined optimization method, despite a slight cost increase of 20.06%, the proposed method significantly reduces EDR load shedding by 98.1%.

Innovation in the Inland: John Flynn’s Model Hospital in Alice Springs

ABSTRACT In 1920 Rev. John Flynn, Superintendent of the Presbyterian Church’s Australian Inland Mission, planned a model outback hospital for Alice Springs, its most remarkable feature to be an innovative ventilation system. Of the fourteen cottage hospitals established by the AIM before World War II, this was the first to be purpose-built. Flynn had an opportunity to create a building ideally suited to Central Australia’s climate and provide comfort for patients and staff. If successful, it was to become a model for future hospitals. For its design he sought the help of experts, including two architects, John Shedden Adam and Thomas Darling. When opened in 1926, it was not only climatically responsive but equipped with modern amenities, becoming the scene of one of Australia’s first successful outback radio experiments. This paper, based on Flynn’s writings and the AIM’s archives in the National Library of Australia, focuses on the building itself: evolution of its design; design changes during construction; the architects’ contribution; innovative features; place within the AIM’s network; and its success as a model hospital—aspects that have been overlooked previously. Now a museum known as Adelaide House, 1 it stands in central Alice Springs and remains largely intact, demonstrating Flynn’s intentions.

EVALUATION OF ORAL AND DENTAL HEALTH POLYCLINICS IN TERMS OF ERGONOMIC DESIGN FACTORS

The comfort conditions of oral and dental health clinics depend on physical environment factors. The satisfaction of the patient, physician, and staff is directly proportional to the suitability of the ergonomic conditions of the environment. Physical factors affect the health and performance of physicians and personnel working all day long. At the same time, the spatial and technical organization of clinic structures is very important for patient health and comfort. In the literature research, there were no adequate studies on the physical risk factors that the dentist, staff, and patients are exposed to during clinical applications in terms of architectural discipline. This study aims to reveal the ergonomic comfort conditions of dentists, staff, and patients in the oral and dental health outpatient clinic. The research method is fieldwork. An oral and dental health polyclinic in Istanbul was determined as the research area. The research technique is “on-site observation,” “measurement,” “survey” and “interview”. "Luxury Light Meter", "Sound Meter" and "Thermometer" applications were used to measure the light, sound, and temperature values of the space. A questionnaire with the Likert Scaling Model was administered to patients, physicians, and staff. As a result, patients prefer to be treated in the outpatient clinic where they feel comfortable, and dentists and their staff can work more motivated and more efficiently in environments where they feel comfortable and healthy. To provide quality service in an oral and dental health clinic, attention should be paid to physical environmental factors, spatial and technical characteristics, and the comfort of patients, dentists, and staff should be considered.

Simulation Training for Emergency Sternotomy in the Cardiovascular Intensive Care Unit.

Emergency resternotomy in the intensive care unit for a patient who has undergone cardiac surgery can be daunting for surgeons and critical care staff. Clinicians involved are often unfamiliar with the surgical instruments and techniques needed. After an emergency intensive care unit resternotomy resulted in suboptimal performance and outcome, protocols for emergency resternotomy were established and improved. Education and simulation training were used to improve staff comfort and familiarity with the needed techniques and supplies. The training intervention included simulations to provide hands-on experience, improve staff familiarity with resternotomy trays, and streamline emergency sternotomy protocols. Preintervention and postintervention surveys were used to assess participants' familiarity with the implemented plans and algorithms. All 44 participants (100%) completed the preintervention survey, and 41 of 44 participants (93%) returned the postintervention survey. After the intervention, 95% of respondents agreed that they were prepared to be members of the team for an emergency intensive care unit sternotomy, compared with 52% of respondents before the intervention. After the intervention, 95% of respondents strongly agreed or agreed that they could identify patients who might need emergency sternotomy, compared with 50% before the intervention. The results also showed improvement in staff members' understanding of team roles, activation and use of the emergency sternotomy protocol, and differences between guidelines for resuscitating patients who experience cardiac arrest after cardiac surgery and the post-cardiac arrest Advanced Cardiovascular Life Support protocol. Results of this quality improvement project suggest that simulation training improves staff comfort with and understanding of emergency resternotomy.

Is Resectoscopic Hysteroscopy a Dying Art? Creation of an Educational Instructional Video [ID 2683474

INTRODUCTION: Resectoscopic hysteroscopy is a valuable surgical technique for addressing intrauterine pathology. Within our institution, most operative hysteroscopies are performed using newer non-resectoscopic systems, potentially creating a gap in resident surgical education. We developed a novel instructional video demonstrating the components and capabilities of the resectoscopic hysteroscope. Our aim is to assess whether the instructional video increased surgeon comfort using the resectoscopic hysteroscope. METHODS: A pilot cohort study was performed with gynecologic surgery and obstetrics (GS&O) residents and staff physicians at Brooke Army Medical Center. Participants were provided access to the resectoscope surgical set throughout the study, completed a baseline survey assessing surgeon comfort, and then repeated the survey after watching the instructional video. The survey used a 5-point Likert scale with 1) very uncomfortable, 3) neutral, and 5) very comfortable. RESULTS: Of the 20 participants, 85% lacked formal resectoscope training and 45% had no prior resectoscope experience. Prior experience was limited: 55% used it less than five times and 64% had no use in the last year. At baseline, few were comfortable with setup (15%) and troubleshooting (5%). The instructional video significantly increased surgeon comfort with resectoscope setup (P<.001) and troubleshooting (P<.001). Surgeon comfort supervising a resident doubled after the instructional video (33–66%). All participants felt the video was helpful and would recommend it to others (100%; P<.01). Finally, 80% of participants would like more formal training opportunities for other surgical devices. CONCLUSION: This survey demonstrated a gap in surgical experience and comfort using the resectoscope at our institution. The novel instructional resectoscope video improved GS&O resident and staff comfort with setting up and troubleshooting the resectoscope. Staff comfort with supervising a resident using the resectoscope also increased. Future directions include expanding study population to include operating room staff and assessing post-intervention resectoscope utilization rates.

ЕНЕРГОСПОЖИВАННЯ ШКОЛИ В УМОВАХ НЕПОВНОЇ ЗАЙНЯТОСТІ ДЛЯ РІЗНИХ РЕЖИМІВ ОПАЛЕННЯ ПРИМІЩЕНЬ

The challenges facing the Ukrainian education system, particularly in light of demo-graphic changes and the impact of war, are examined in this research. It highlights the poten-tial for optimizing the operation modes of school buildings under conditions of partial occu-pancy to reduce energy consumption and ensure comfortable conditions for students. Energy modeling analysis using DesignBuilder software shows that the configuration of classrooms significantly impacts the energy efficiency of buildings. The best results for energy efficiency were achieved with rooms stacked on top of each other, outperforming the variant with three rooms on the middle floor by 22.3%, and mixed configurations by 8.5% and 16%. This efficiency is due to minimized contact with unheated premises and maximized solar heat gains. However, without appropriate building upgrades, the use of limited spaces may not provide adequate comfort conditions in colder periods. For the rooms studied (45-48m^2), the required heating device capacity to maintain comfortable conditions varies from 7.5 to 10.5 kW, depending on the level of insulation, which is 3-5 times more than the standard capacity for such spaces. Providing comfortable conditions without upgrading the heating system in cold periods is unfeasible, even with high levels of building insulation and a constant heating schedule. Therefore, implementing partial use of school buildings, despite their high potential for en-ergy savings, cannot satisfy student comfort needs without corresponding improvements. Future research could provide a foundation for developing comprehensive strategies for managing school spaces, considering variable building usage conditions and ensuring an optimal combination of energy efficiency, cost-effectiveness, and comfort for students and staff. The findings can be useful for school administrations, local educational authorities, and policymakers in education and energy efficiency. Further studies are suggested to explore the impact of internal wall insulation, increased heating device capacity, and heating uncondi-tioned rooms to a certain temperature level on energy efficiency and comfort conditions in occupied spaces.

A97 INTERNAL MEDICINE RESIDENT AND STAFF PERCEPTIONS OF GASTROENTEROLOGY ROTATION

Abstract Background The choice of subspecialty by internal medicine residents is partially influenced by their experience with that service. Challenges exist between internal medicine and the high acuity, procedurally-heavy, gastroenterology (GI) service. Negative perceptions may limit the number of residents rotating through a gastroenterology elective, impacting knowledge and comfort managing common GI conditions. Aims To identify misperceptions of the GI service at a tertiary hospital, and evaluate resident and new staff comfort in managing common GI conditions. Methods Twenty-question survey sent to internal medicine residents during 2022-2023 and 13-question survey sent to staff that completed training from 2020-2022; both anonymous, and using Qualtrics software. Results The survey was completed by 18% (30/166) of residents and 20% (13/65) of staff. Most staff (62%) practiced in a community setting. Both cohorts cited overnight cross-coverage consults during (56%) and negative word-of mouth (38%), as reasons they avoided a GI elective. Most participants reported a little (33%) or moderate (47%) amount of GI teaching on medicine service and were unaware of formal lectures (79%) during a GI rotation. Residents and staff were most comfortable managing pancreatitis (98%) and ALF (74%). Staff wished for more experience managing pancreatic and liver masses and outpatient IBD flares; however both groups (86%) were unaware of the ambulatory week during the GI rotation. Conclusions Misperception and unawareness of a GI elective persist amongst internal medicine residents and has implications for new staff managing GI conditions. This study has led to action items that address these concerns. Table 1: Resident & staff awareness, perceptions & knowledge of GI Funding Agencies None

Assessment of indoor environmental quality and seasonal well-being of students in a combined historic technical school building in Slovakia.

One of the major present challenges in the building sector is to construct sustainable and low-energy buildings with a healthy, safe, and comfortable environment. This study is designed to explore long-term impacts of indoor environmental quality (IEQ) parameters in a historic technical school building on the health and comfort of students. The main objective is to identify environmental problems in schools and to direct public policy towards the enhancement of in-service historic buildings. The collected data on five consecutive days in various seasons from five different classrooms indicate allergy in 45% and asthma in 10% of students. Environmental factors, such as temperature, draught, noise, or light, affected 51% of students' attention. Low temperature, unpleasant air, noise, and draught were found to be the most frequent concerns for students. The lowest temperature was measured during spring at 17.6°C, the lowest humidity of 21.1% in winter, the largest CO2 amount in the air in autumn at 2041ppm level, and the greatest total volatile organic compounds (TVOC) as 514µg/m3. The experimental and statistical analysis results suggest the necessity of a comprehensive restoration of the building with a focus on enhancement of IEQ as well as replacement of old non-standard materials. An effective ventilation system is also necessary. The building requires major renovations to preserve its historic features while safeguarding the well-being and comfort of students and staff. Further research is needed on acoustics, lighting, and energy factors as well as the health effects of old building materials.

Analysis of the air system of the 2-floor electronics industry building PT. CI

For urban areas and Jakarta's industrial sector, air freshener systems and air conditioners are becoming increasingly necessary. At the electronics-focused PT. CI Jakarta, the air conditioner cools the space. The goal of this research is to raise staff comfort levels and productivity levels in order to enhance output. Planning information and a cooling load analysis are needed in order to implement the cooling system in the industrial building. To determine how much AC (Air Conditioner) is required, it is important to analyze the calculation of the design of the AC (Air Conditioner) in the industrial room at PT. CI. The first step in the planning process is to identify the industrial building data, which includes the room's area and wall material as well as its contents. Analyze cooling load to calculate engine power. Choosing a cooling system and cooling. The cooling load analysis at the electronics industry building produced 712 kW of results, including a sensible load of 705.83 kW and a Latent load of 3.03 kW. The machine uses R134a as its refrigerant. 355.5 HP for the compressor. COP 2.77 is of a medium size. The central AC system was chosen as the cooling system

Investigation of thermal comfort and preferred temperatures for healthcare staff in hospitals in Ningbo, China

Appropriate thermal comfort is crucial for healthcare staff to ensure a conducive working environment. Literature review indicates that staff have a much different thermal comfort requirement from patients and visitors, which has not received sufficient attention in current studies. This empirical study was conducted from December 2021 to November 2022 in dental treatment departments of four hospitals in Ningbo, China. A total of 333 questionnaires were collected and analysed to investigate the current thermal environment, the thermal sensation of healthcare staff, and the seasonal variation of the metabolic rate and clothing insulation. The adaptive coefficient of the adaptive predicted mean vote (aPMV) model for healthcare staff was −0.34 in cooler environments and 0.128 in warmer environments. The calculated thermoneutral temperatures, derived from PMV regression, TSV regression, and the Griffiths method, stood at 21.81 °C, 20.99 °C, and 22.54 °C, respectively. Correspondingly, the associated comfort temperature ranges in the case study healthcare buildings were 19.10–24.51 °C, 17.66–24.33 °C, and 22.24–22.84 °C. These parameters play a pivotal role in establishing precise thermal benchmarks and ensure optimal thermal experiences for healthcare staff investigated. The novelty of the research lies in thoroughly investigating the thermal comfort of healthcare staff, with the development of the adaptive models tailored to the climatic conditions of the Ningbo region and the specific characteristics of healthcare staff. Additionally, the research rigorously compares and validates these findings with established standards and previous studies in the field. The research indicated that the resulting comfort temperatures, while lower than established adaptive regulations, closely align with the recommended temperatures in the healthcare building design specifications.

The Role of Transformational Leadership in Increasing Career Commitment in Lecturers at Private Universities: Literature Review

This study aims to determine the transformational leadership role of rectors or academic leaders towards increasing the career commitment of lecturers, especially in private universities. So far, especially on private campuses, career commitment related to academic rank management is very low, even though through this academic rank level can describe the quality of the learning process. To obtain an overview of the role of academic leadership in improving the career of lecturers, this study uses a review of the current literature. This literature review shows several factors influencing career commitment, including career mobility, work commitment, personality, self-esteem, and stigma. So that low career commitment in private universities cannot always be solved only by applying certain leadership patterns. However, on the other hand, this transformational leadership, in some cases, can improve the implementation of better campus governance, create comfort for academic staff, maintain worker motivation and encourage academic service innovation.

Scoping Review on Educational Programs for Medical Professionals on the Management of Acute Agitation.

Agitation is a common reason for psychiatric consultation in the general hospital. The consultation-liaison (CL) psychiatrist is often tasked with teaching the medical team how to manage agitation. The purpose of this scoping review is to explore what resources the CL psychiatrist has for educational tools on teaching about agitation management. Given the frequency with which CL psychiatrists help with on-the-ground management of agitation, we hypothesized that there would be a scarcity of educational resources to teach front-line providers how to manage agitation. Following current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a scoping review was conducted. The literature search focused on the electronic databases MEDLINE (PubMed), Embase (Embase.com), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), PsycInfo (EbscoHost), Cumulated Index to Nursing and Allied Health Literature (CINAHL) (EbscoHost), and Web of Science. Using Covidence software, after screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, we created a predefined set of criteria according to which each article was analyzed. We then grouped the articles in the full-text review according to which patient population a curriculum was designed for. The search yielded a total of 3250 articles. After removing duplicates and reviewing procedures, we included 51 articles. Data extraction captured article type and details; educational program information (staff training, web modules, instructor led seminar); learner population; patient population; and setting. The curricula were further divided based on their target patient population, specifically the acute psychiatric patient (n= 10), the general medical patient (n= 9), and the patient with a major neurocognitive disorder such as dementia or traumatic brain injury (n= 32). Learner outcomes included staff comfort, confidence, skills, and knowledge. Patient outcomes included measurements of agitation or violence using validated scales, PRN medication use, and restraint use. Despite there being numerous agitation curricula in existence, we found that a large majority of these educational programs were done for patients with major neurocognitive disorders in the long-term care setting. This review highlights the gap in education related to agitation management for both patients and providers in the general medical setting, as less than 20% of total studies are focused on this population. The CL psychiatrist plays a critical role in assisting in agitation management in this setting, which often requires collaboration between technicians, nurses, and nonpsychiatric providers. It calls into question whether the lack of educational programs makes the implementation of management interventions more difficult and less effective, even with the assistance of the CL psychiatrist.

Vibration responses of the metro station induced by various train operations under unilateral deep excavation

Field noise tests found that the noise induced by train operation under unilateral excavation is more obvious than that without excavation. Therefore, it is necessary to explore the dynamic response characteristics of metro stations under unilateral deep excavation. Based on the Jincheng Plaza Station in China, this study simulates the impact of train vibration on the structure through a 3-D numerical model and verifies its reliability through field-measured results. Considering various train operations, the analysis is carried out from three perspectives, including time-domain analysis, frequency-domain analysis, and vibration acceleration level (VAL) analysis. The results show that unilateral excavation causes the instability of the station structure, which leads to an 80–140% amplification effect on the peak vibration velocity of the station caused by the train load. Secondly, at the location within the excavation area, the longer the train passes, the more significant the vibration amplification effect is. Thirdly, the station vibration induced by the double-sided train operation is the most significant, which makes the amplitude of frequency domain vibration enlarged by 100–140%. Notably, based on the VAL analysis, it shows that the vibration response of the metro station under excavation is the most significant when the center frequency is 40 Hz. In addition, the VAL under unilateral excavation is 4–7 dB larger than that without excavation, and the increase ratio is about 8–13%. Finally, the maximum VAL under excavation reaches 65.8 dB, which exceeds the specified threshold (52.5 dB). For metro stations with both unilateral excavation and train operation, vibration reduction measures and the lateral structural support in the excavation area should be taken to reduce the vibration response, to improve the comfort of passengers and staff.

Implementasi Metode Network Development Life Cycle Pada Rancang Bangun Jaringan Wireless Berbasis Mikrotik

As a non-departmental government agency (LPND) the Zainuddin Abdul Madjid Meteorological Station located at Lombok International Airport Zainuddin Abdul Madjid is one of the government agencies that is engaged in meteorology, namely conducting research related to climate change, early warning especially for the West Nusa Tenggara region. West Nusa Tenggara). In this study using data collection methods namely methods of observation, interviews, literature study and using the Network Development Life Cycle (NDLC) as a method of network design/development. There are several problems encountered within the internal scope, namely in increasing the comfort of staff using the internet network which has an unstable signal for the process of exchanging data resulting in one path of using the internet network there is one username and password that is used simultaneously by all staff and guests so that it makes the internet connection less stable. So this study aims to improve the system by resetting the existing proxy at the Zainuddin Abdul Madjid Meteorological Station office and creating usernames and passwords for staff and guests who have their own bandwidth.

Comfort levels in discussing tobacco smoking among hospital staff in a children's hospital.

Hospital staff discussing smoking with children and their families can impact tobacco control, which is crucial in reducing the harmful effects of tobacco smoke exposure. Our study aims to assess staff comfort level in discussing smoking with patients or their families, and coworkers, after the implementation of a hospital-wide tobacco control policy. This cross-sectional study included 2340 staff members who completed an anonymous online survey in a large urban children's hospital in 2019. The main outcomes of interest were the comfort level in discussing smoking with patients or their families, and co-workers. We used multivariable logistic regression to identify whether the comfort level varied by sex, age, job type, and smoking status. Most of the respondents (83.8%) were female, 41.2% were aged 18-35 years, 57.6% worked as clinical staff, and 15.5% were ever smokers. Compared to males, females were less likely to feel very comfortable in asking patients or their families about their smoking tobacco (adjusted odds ratio, AOR=0.72; 95% CI: 0.56-0.92) or talking to co-workers about the health risks associated with their smoking (AOR=0.71; 95% CI: 0.54-0.93). Staff who were non-smokers were less likely to feel very comfortable in talking to co-workers about the health risks associated with their smoking (AOR=0.60; 95% CI: 0.45-0.78). The odds of feeling very comfortable in discussing smoking were consistently lower among those aged 18-35 years than their older counterparts. Clinical staff were more likely than non-clinical staff to feel very comfortable in discussing with patients and their parents about smoking, but there was no difference when talking to co-workers. We found differences in staff comfort level in discussing smoking with patients or their families, and coworkers, by sex, age, job type, and smoking status. These results can guide training and identify potential barriers and improve tailored tobacco control training programs and policies for hospital staff.

Palliative Care Communication Among Home Health Interprofessional Staff: A Randomized Controlled Trial of Feasibility, Acceptability, and Preliminary Effectiveness.

Skilled home health care (HH) is the largest and fastest growing long-term care setting in the United States. Patients in HH are served by an interprofessional team, and may have little direct contact with physicians, when discussing their progress, prognosis, and goals of care. Such conversations are part of primary palliative care communication. Evidence on primary palliative care communication training in the non-physician HH interprofessional team is lacking. The objectives of this study were to assess the feasibility, acceptability, and preliminary effectiveness of using a palliative care communication model known as COMFORT© to provide palliative care communication training to HH staff. A randomized controlled trial was conducted at a regional health system in the southeastern U.S. to test online training modules (n = 10) (Group 1) and online training modules plus face-to-face training (n = 8) (Group 2). Measures included training completion rates, staff acceptability ratings, comfort with palliative and end-of-life communication (C-COPE) and moral distress (MMD-HP). Results showed that COMFORT© training was feasible (92%), highly acceptable (>4 on a 6-point scale), and positively correlated with improved C-COPE scores (P = .037). There was no significant difference in moral distress scores pre- and post-intervention or in effectiveness between the groups. However, acceptability of COMFORT© was positively correlated with history of leaving or considering leaving a job due to moral distress ( = 7.6, P = .02). Preliminary findings from this pilot study suggest that administration of COMFORT© training was feasible, and it was correlated with increased HH staff comfort with palliative care communication.