Staff Meetings Research Articles

Primary clinics achieving regular follow-up of patients: Teamwork aspects among healthcare staff

Abstract Backgrounds Studies have shown that more temporally regular primary care visits, or visits more evenly spaced in time, are associated with improved patient outcomes. However, no study has examined what clinic staff can do to encourage greater temporal regularity (TR). We aimed to understand factors related to healthcare staff dynamics that contribute to higher TR for adults with chronic conditions. Methods The study is part of a two-stage mixed methods project. In the first stage, we ranked clinics according to their TR level. In this qualitative stage, we interviewed staff at 6 clinics with extremely high TR (regular follow-up with primary care physician, or PCP), and 6 clinics with extremely low TR. Interviews were conducted with 15 PCPs, 12 nurses, 15 administrative staff, and 4 pharmacists between July 2022- September 2023. Interviews were audiotaped, transcribed, and analyzed using Atlas qualitative analysis software. Findings Themes emerged regarding best ways to promote regular follow-up of patients with chronic conditions. Strategies included having a defined system to reach out to no-show patients, having routine staff meetings to discuss no-shows, adapting workflow to meet the needs of challenging patients, dealing with bureaucracy on patients’ behalf, informal channels of communication with patients, and consulting social workers more often. Relational aspects among staff members at high TR clinics emphasized flat as opposed to hierarchical relationships, as well as high levels of teamwork. Conclusions Teamwork between staff members in primary care settings can contribute to more proactive care delivery, with greater potential to prevent long-term complications. The findings suggest that a high-functioning multidisciplinary care team that focuses on creating the right sorts of interactions and teamwork among staff members, and uses proactive strategies to help engage patients, can contribute to more temporally regular care and thus improved outcomes. Key messages • Stronger teamwork and flat relationships between staff members in primary care settings can result in proactive medicine and developing strategies that improve patients’ regular follow-ups. • Programs focusing on how medical staff utilize their dynamics/relations to improve health outcomes and how doctors’ role align with the staff, can facilitate regular follow-ups of challenging patients.

Readiness of the health system to provide non-communicable disease services in Nepal: a comparison between the 2015 and 2021 comprehensive health facility surveys

BackgroundIn Nepal, despite the escalating burden of non-communicable diseases (NCDs), there is a gap in the continuum of care for prevention, diagnosis, treatment, and care services for NCDs. The study aimed at assessing the changes in availability and readiness scores of health facilities between two consecutive health facility surveys.MethodsWe compared NCD readiness scores between 2015 and 2021, using data from two nationally representative cross-sectional Nepal Health Facility Surveys (NHFS). Both consecutive surveys used globally validated standard tools of Demographic and Health Surveys (DHS)’s service provision assessment. Both surveys were undertaken using World Health Organization’s (WHO) service availability and readiness assessment (SARA) tools. Data were collected using the Census and Survey Processing System on tablets, with validation performed through field check tables. Trained enumerators with a medical background collected data for the surveys, and we analyzed the information from a de-identified dataset downloaded from the DHS website upon request. Both the NHFS protocols were reviewed and approved by the Nepal Health Research Council and the institutional review board of ICF. We calculated the readiness scores based on WHO SARA indicators for diabetes, cardiovascular disease (CVD), and chronic respiratory disease (CRD) using a additive procedure. Multivariate linear regression analysis was undertaken to assess associated factors, with complex sampling design accounting for both surveys.ResultsThe overall availability of all three services has improved between 2015 and 2021 NHFS. Although the availability of diabetes-related services increased significantly between 2015 and 2021, this does not correspond to the increase in the readiness score. The readiness score increased by 10% points for CVDs related services and 9% points for CRDs. Compared to public hospitals, primary healthcare facilities experienced greater increase in readiness scores (11.5% versus 20.9%). Interestingly, those health facilities without quality assurance systems experienced a lower increase or even decrease in readiness scores than those with quality assurance systems. For the factors associated with readiness scores, health facilities charging additional or separate fees to the patients had a higher readiness score than those not charging any user fee for all three services. Compared to 2015, the readiness scores in 2021 improved for diabetes [β = 11.01 (95% CI 9.02 to 12.96)], CVD [β = 10.70 (95% CI 9.61 to 11.80)], and CRD [β = 8.41 (95% CI 7.20 to 9.62)].ConclusionThe improvement in NCD service availability does not correspond to the proportional increase in readiness scores, which is crucial for delivering quality care. Regular staff meetings and feedback systems are crucial for improving all services including NCD-related service readiness and should be prioritized by local and provincial governments.

Standards-based audit to improve quality of maternal and newborn care-A stepped-wedge cluster randomised trial in Malawi.

Audit is a quality improvement approach used in maternal and newborn health. Our objective was to introduce the practice of standards-based audit at healthcare facility level, and to examine if this would improve quality of care assessed by compliance with standards developed and agreed with healthcare providers. Our focus was on emergency obstetric and newborn care (EmONC). A multidimensional incomplete stepped-wedge cluster randomised trial with 8 steps was conducted in 44 healthcare facilities in Malawi. A total of 25 standards of care were developed. At each healthcare facility one (health centres) or two (hospitals) standards were audited per cycle with two consecutive audit cycles conducted. Each cycle consisted of five steps: (i) select standard to be audited, (ii) measure compliance with standard (measurement 1), (iii) review findings and identify what changes are required to increase compliance (iv) implement changes, (v) re-measure compliance (measurement 2). Each compliance measurement assessed 25 women. Multilevel mixed effects logistic regression models were used to analyse data for all standards. The crude overall compliance rate rose from 45% in the control phase (measurement 1) to 63% in the intervention phase (measurement 2) (from 51.6% to70.6% at Basic and from 34.5% to 50.8% at Comprehensive EmONC healthcare facilities. When adjusted for standard, facility type, month, and healthcare facility by month, the adjusted OR (95% CI) was 2.80 (1.65, 4.76). Actions taken to improve compliance with standards included improving staff performance of clinical duties and general conduct through re-orientation and staff meetings as well as improved supervision, and, ensuring basic equipment and consumables were available on site (thermometers, rapid diagnostic tests, partograph). The introduction of standards-based audit helped healthcare providers identify problems with service provision, which when addressed, resulted in a measurable and significant improvement in quality of care. ISRCTN registration number: 59931298.

STRUCTURAL-FUNCTIONAL MODEL OF PROFESSIONAL COMPETENCE FORMATION OF FUTURE MILITARY INTELLIGENCE OFFICERS IN THE CONDITIONS OF THE INFORMATION AND EDUCATIONAL ENVIRONMENT OF HMEI

This study was conducted to investigate the experience of job satisfaction among academic staff in selected public universities in Tanzania. A cross-sectional survey design with mixed research approaches was employed. Probability and non-probability sampling techniques were used to get a total sample of 74 respondents from public universities in Tanzania. Data were collected by using a four- point scale questionnaires and semi-structured interview techniques. Study findings indicated varying job satisfaction levels among the academic staff in public universities in Tanzania. Despite the contextual differences experiences of academic staff working in public Universities were the same in the facets of work benefits, relationship with their leaders, opportunity for creativity, and communication feedback. On the other hand, the study revealed existing counterproductive behaviors that may impede the attainment of Universities’ core functions of teaching, research, and consultancy. Despite of their severity, counterproductive behaviors ranging from absenteeism and divided loyalty are reported to be among the main threats to public Universities in Tanzania. This study suggests that University leadership needs to consider factors such as improving work benefits, and effective communications among others, to create a friendly organizational culture. It is also recommended that dialogue through regular academic staff meetings, effective communication, and academic freedom can foster a culture of curiosity, autonomy, and trust in public Universities in Tanzania.

Teacher stress and ideal solutions: A qualitative comparison across elementary and middle school teachers.

Educators' high levels of stress have been well documented in existing literature, though little research has directly looked at comparisons of stress experiences and needs for support based on school level. The present study included 33 teachers (19 elementary and 14 middle school) from one school district who participated in semistructured interviews. Responses to questions regarding their primary source(s) of stress and their ideal solution(s) to relieve that stress revealed distinctions between elementary and middle school teachers. Elementary teachers described stress related to a sense of responsibility or need to care for students and meet their social, emotional, behavioral, and academic needs. Their ideal solution primarily involved receiving more emotional support and more support staff in the classroom to help meet all students' needs. In contrast, middle school teachers reported the majority of their stress as stemming from external demands or pressures such as test scores, high or unattainable expectations from administrators or parents, and not having enough time. Middle school teachers' ideal solutions largely entailed a shift in the use of their time, specifically to remove tasks (e.g., unnecessary staff meetings) and be able to focus their time on what matters the most (e.g., teaching students). These findings indicate that although almost all of these teachers reported being highly stressed, their sources of stress and perceived needs for support varied based on school level. Efforts to promote teacher well-being must consider school level and teachers' own perspectives on what they need in order to provide the most beneficial supports. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Improving Recess through Collaboration: Exploring the Facilitators and Barriers to Sustaining Positive Playground Behavior.

School recess quality is vital to children's social and emotional skill development. However, there is a research-to-practice gap where academic findings are ineffectively translated back to schools. The aims of this study were to examine how a co-designed intervention would impact negative behaviors observed during recess and to explore the facilitators and barriers to recess implementation over the course of a school year. Utilizing a research-practice partnership, the authors collaborated with staff at an elementary school to design, implement, and assess an intervention focused on improving recess quality. The intervention offered training in research-supported recess practices through professional development training and teaching students transitions and games. The school's recess behavioral report log of negative playground behaviors across the academic year and notes from recess staff meetings were analyzed. Quantitative results pointed to a stable decrease in negative playground behaviors post-intervention compared to pre-intervention. Qualitative analyses suggest school leadership and practitioners should focus on "reculturing" recess prior to making structural changes, and empowering recess staff to sustain change. Prior to considering interventions at recess, there is a need to assess both school and recess culture. In doing so, reculturing around the importance of recess during the school day and the roles of adults in the process is needed to ensure the sustainability of any changes made.

Recruitment Strategies in the Integration of Mobile Health Into Sickle Cell Disease Care to Increase Hydroxyurea Utilization Study (meSH): Multicenter Survey Study.

Hydroxyurea is an evidence-based disease-modifying therapy for sickle cell disease (SCD) but is underutilized. The Integration of Mobile Health into Sickle Cell Disease Care to Increase Hydroxyurea Utilization (meSH) multicenter study leveraged mHealth to deliver targeted interventions to patients and providers. SCD studies often underenroll; and recruitment strategies in the SCD population are not widely studied. Unanticipated events can negatively impact enrollment, making it important to study strategies that ensure adequate study accrual. The goal of this study was to evaluate enrollment barriers and the impact of modified recruitment strategies among patients and providers in the meSH study in response to a global emergency. Recruitment was anticipated to last 2 months for providers and 6 months for patients. The recruitment strategies used with patients and providers, new recruitment strategies, and recruitment rates were captured and compared. To document recruitment adaptations and their reasons, study staff responsible for recruitment completed an open-ended 9-item questionnaire eliciting challenges to recruitment and strategies used. Themes were extrapolated using thematic content analysis. Total enrollment across the 7 sites included 89 providers and 293 patients. The study acceptance rate was 85.5% (382/447) for both patients and providers. The reasons patients declined participation were most frequently a lack of time and interest in research, while providers mostly declined because of self-perceived high levels of SCD expertise, believing they did not need the intervention. Initially, recruitment involved an in-person invitation to participate during clinic visits (patients), staff meetings (providers), or within the office (providers). We identified several important recruitment challenges, including (1) lack of interest in research, (2) lack of human resources, (3) unavailable physical space for recruitment activities, and (4) lack of documentation to verify eligibility. Adaptive strategies were crucial to alleviate enrollment disruptions due to the COVID-19 pandemic. These included remote approaching and consenting (eg, telehealth, email, and telephone) for patients and providers. Additionally, for patients, recruitment was enriched by simplification of enrollment procedures (eg, directly approaching patients without a referral from the provider) and a multitouch method (ie, warm introductions with flyers, texts, and patient portal messages). We found that patient recruitment rates were similar between in-person and adapted (virtual with multitouch) approaches (167/200, 83.5% and 126/143, 88.1%, respectively; P=.23). However, for providers, recruitment was significantly higher for in-person vs remote recruitment (48/50, 96% and 41/54, 76%, respectively, P<.001). We found that timely adaptation in recruitment strategies secured high recruitment rates using an assortment of enriched remote recruitment strategies. Flexibility in approach and reducing the burden of enrollment procedures for participants aided enrollment. It is important to continue identifying effective recruitment strategies in studies involving patients with SCD and their providers and the impact and navigation of recruitment challenges. ClinicalTrials.Gov NCT03380351; https://clinicaltrials.gov/study/NCT03380351. RR2-10.2196/16319.

Job description and perception of clinical research personnel working in a network of French intensive care units

BackgroundThere is a lack of information about the organisation and management of clinical research personnel in Europe and of their professional activity in intensive care. We therefore conducted a cross-sectional survey among personnel currently working in a French intensive care research network that involves 41 centres nationwide. The aim of the survey was to describe the personnel’s personal and institutional organisation and management, their job perception in terms of satisfaction and stress, and suggestions for improvement.MethodsOver 3 months in 2023, the research personnel received an electronic questionnaire on their personal and professional profile, past and present training, workplace and functions currently performed, personal knowledge about job skills required, job satisfaction and stress by as measured on a rating scale, and suggested ways of improvement.ResultsNinety seven people replied to the questionnaire (a response rate of 71.3%), of whom 78 (57.3%) were sufficiently involved in intensive care to provide complete answers. This core sample had profiles in line with French recruitment policies and comprised mainly Bachelor/Master graduates, with nurses accounting for only 21.8%. The female to male ratio was 77:23%. Many responders declared to have a shared activity of technician (for investigation) and assistant (for quality control). More than 70% of the responders considered that most of the tasks required of each worker were major. Figures were much lower for project managers, who were few to take part in the survey. On a scale of 10, the median of job satisfaction was 7 for personal work organisation, 6 for training and for institutional organisation, and only 5 for personal career management. The median of job stress was 5 and was inversely correlated with satisfaction with career management. Respect of autonomy, work-sharing activity between investigation and quality control, a better career progression, financial reward for demanding tasks, and participation in unit staff meetings were the main suggestions to improve employee satisfaction.ConclusionThis nationwide survey provides a new insight into the activity of French clinical research personnel and points to ways to improve the quality and efficiency of this workforce.

Department of Forest's new community Forestry Guideline

Department of Forest (DOF) has issued a new version of Community Forestry Guideline in May 2001, replacing the first version that was issued 10 years back. Officials engaged in developing this amendment indicate in their preface statements that a new versionof the guideline was felt necessary in the changing contexts of community forestry policies and practices over thepast several years in general, and in particular, to address the challenges of meeting escalating demand for increasingly diverse services to communities. The guideline was prepared with involvement of, and support from bilateral forestry projects, who deputed their representatives in the guideline review task force constituted by DOF. An outline of the draft guideline was discussed in two national level meetings of government forest officials and forestry project staff.

(In)visibilité dans la clinique de l’AVC du sujet âgé : effets intrapsychiques et intersubjectifs de l’utilisation de l’IRM

ContextThis paper illustrates a psychodynamic analysis of the intrapsychic and intersubjective effects of the use of MRI in a Neurovascular Unit (NVU) for elderly post-stroke patients, in mainland France. The sudden onset of the stroke and the shift from independence to dependence are juxtaposed with the reality of normal and pathological aging in the elderly, making the boundaries around these two issues difficult to determine. ObjectivesThe aim of this paper is to propose a reflection about the intrapsychic and intersubjective effects of the almost automatic use of the MRI results during the hospitalization of elderly post-stroke patients. MethodThis is a theoretical-clinical elaboration based on clinical cases derived from clinical psychotherapeutic sessions with post-stroke hospitalized patients, institutional observations during staff meetings, and transdisciplinary interviews with the patients and their families. ResultsWe can conclude, through the cases studied and the theoretical analysis that a more personalized use of MRI is essential, because it may help the patient to visualize his or her stroke, to organize what has been psychologically and physically disorganized, and to create a link with the healthcare professional. However, an automated and mechanized way of showing these results may lead the patient into a psychological impasse, accentuate the psycho-corporal disorganization, and complexify the relationship with others. InterpretationsMRI is nowadays the main tool for diagnosing strokes, allowing in vivo exploration of the human brain. Despite its relatively recent appearance, MRI seems to be essential in the treatment and monitoring of stroke patients. However, the use of showing the MRI results to the elderly patients in a stroke unit, their families, and the healthcare professionals does not seem to have been thought through, or at the very least, reflected upon consciously.

Multi-professional perspectives to reduce moral distress: A qualitative investigation.

Encounters of moral distress have long-term consequences on healthcare workers' physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic medical center. Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine's National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethics approval was obtained from the university and medical center institutional review boards. Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being.

Improving the Timing of Acute Care Insulin Delivery.

Variations in nursing practice were observed across our hospital, a 520-bed acute care teaching facility in the northeast United States, regarding the timing and frequency of insulin administration in adult patients with diabetes. Chart audits noted that RNs administered insulin more than one hour after blood glucose results were obtained 97% of the time. In addition, insulin was given at bedtime only 37% of the time. The purpose of this quality improvement (QI) project was to improve the care of inpatients requiring insulin by implementing protocols and adjusting practice to align with best practice recommendations. The clinical nurse education specialist met with a team of staff nurses, providers, nurse leaders, and patient care technicians (PCTs) to formulate protocols and design interventions to ensure improvements in the quality of care for inpatients with diabetes. A sequence of education sessions and an online learning module were developed and assigned to nurses and PCTs to address knowledge gaps, specifically in the pharmacodynamics and safe administration of insulin, as well as how best to provide care to patients with diabetes. Monthly adherence data were disseminated to nurse leaders and educators and reviewed with clinical staff at daily safety huddles and staff meetings. Additional interventions to enhance nursing practice in caring for patients with diabetes included ensuring both bedtime insulin administration and timely insulin delivery. This project began in May 2017 and ended five years later. Two weeks after initial education sessions began in May and June 2017, the frequency of giving bedtime insulin based on the order set and according to the patient's blood glucose levels rose from 37% to 82%, and adherence to best practice protocols continued until final chart audits were performed in May 2022. The frequency of giving insulin less than one hour after obtaining blood glucose results improved from 3% to 64% between October and December 2019, and increased to a sustained level above the project's 92% goal two years later. Protocol development, targeted education, and audits with feedback led to improved care delivery for patients requiring insulin and increased nursing confidence.

Abstract WP43: Improving Nurse Retention Through Orientation Restructuring, Planned Professional Development, and Leadership-Employee Support: One Unit’s Journey

Introduction: Increasing RN turnover rates are a noteworthy and nuanced problem for many nurse leaders. It is a particular challenge within specialty units, resulting in the loss of specialty nursing knowledge, assessment, and critical thinking skills relevant to specific patient populations. RN turnover rates increased over a two-year period on a stroke unit in a large teaching hospital that provides specialty care as part of a Comprehensive Stroke Center. Many of the RNs leaving the unit pursued critical care roles, and their knowledge was lost with their attrition. This prompted the nurse leadership to re-examine the orientation process, professional development plan, and leadership-employee support methods that were being utilized. Methods: Using the PDSA model, orientation was reorganized allowing new RNs to be trained solely on the stroke unit for 10-12 weeks then working independently on that unit for 6 months prior to training on the epilepsy monitoring unit, as opposed to training and working on both units from the start of their employment. Professional development plans that included one-on-one resource nurse training with the Assistant Nurse Manager and cross-training to the neuroscience stepdown unit after one year of employment were created for each RN. Each staff member was supported with mentorship check-ins by an assigned Clinical Leader and with bi-monthly check-ins with the Nurse Manager. Quarterly staff meetings were held to promote staff engagement and provide staff members with an opportunity to cascade information on their individual projects, councils, or initiatives to their peers. Results: These changes, including the training of 10 RNs to the stepdown unit, resulted in an 82% decrease in the number of RNs who left their job on the stroke unit in the first year. Conclusion: This process improvement plan demonstrated that thoughtful modifications to the orientation process, a structured professional development plan, and an organized leadership-employee support method can decrease RN turnover. It allowed the preservation of specialty stroke knowledge, thus ensuring that stroke patients continue to receive high-quality, specialized care and that specialty knowledge is transmitted to new staff as they start their careers.

The Interplay of Teachers’ Profile, Workload and Self-Efficacy: A Correlational Study

This study aims to determine the relationships between demographic profile, workload profile, and sense of self-efficacy of teachers in a public senior high school setting. Frequency distribution and percentage calculation were used to describe the demographic profile, and workload profile. Median was used for self-efficacies. Point biserial correlation and Spearman rho correlation were used to determine the relationship between the demographic profile of the teachers and teacher’s self-efficacy. Spearman rho correlation was used to determine the relationship between the workload profile of the teachers to teacher’s self-efficacy. The results show that age and years of teaching experience were significantly related to teachers’ sense of self-efficacy. There were positive and non-significant relationships calculated with sex, education level, subject taught, and teaching to the three constructs of teacher’s sense of self-efficacy. There were positive and non-significant relationships between teachers’ sense of self-efficacy in teaching hours, planning lessons, marking/correcting of students’ work, recording student performance, and student counseling. Negative and non-significant correlations were calculated with staff meetings and general administrative work.

Październik 1956 roku w Wyższej Szkole Ekonomicznej w Sopocie i Wyższej Szkole Pedagogicznej w Gdańsku

The Higher School of Economics in Sopot and the Higher School of Pedagogy in Gdansk were universities established just after World War II and strongly ideologized in the 1950s. The purpose of this article is to reconstruct the events that took place during the October transition at both universities and also to identify the changes these events led to at party meetings. The introduction discusses the history of the WSE in Sopot and the WSE in Gdansk from the time of their establishment until 1956 and outlines the elements of ideological pressure applied to employees and students. An analysis of the minutes of university bodies (staff meetings, Senates) and party bodies at the universities (POP and KU PZPR) and above the universities (KM PZPR in Sopot, KW PZPR in Gdansk), memoirs of students and employees, and newspaper articles were used to achieve the goal. The changes that took place at the universities were primarily concerned with democratization, greater openness in discussion (while remaining faithful to broad Marxist ideology), changes in the conceptual instrumentarium and criticism of both the USSR and national and university authorities. Virtually all groups comprising the WSE and WSP academic community were involved in the 1956 changes, albeit to varying degrees and in different forms. Employees were more involved at meetings of university and party committees, while students were involved at rallies and in the forums of youth organizations.

Measuring Lessons Learned from Durham Community Hub Model during COVID-19: A Support Solution for the Homeless and other Vulnerable Populations

Introduction/background: The COVID-19 pandemic significantly impacted the availability of community support and resources to vulnerable populations, including persons experiencing homeless within the Regional Municipality of Durham, Ontario, Canada. In response, the Region developed pilot community hubs to address escalating unmet housing, healthcare and support needs.&#x0D; Why did you do it? The community hub evaluation project is a community-based research co-created by a research team from Ontario Tech University and community stakeholders to measure the community hubs' effectiveness in addressing service users' unmet needs during the COVID-19 pandemic.&#x0D; Who is it for? The project is relevant to healthcare and social service policymakers and service providers, service users, researchers, and community organizers involved in researching, funding, designing and delivering healthcare and social services for vulnerable populations.&#x0D; Who did you involve and engage with? The project collaborators comprised a research team from Ontario Tech University and an advisory committee of community hub staff members and service users convened by the research team. All aspects of the project’s design and implementation, including creating the data collection tools, participant recruitment, data collection, data analysis and developing the knowledge translation products, were completed in collaboration with the research advisory committee that met monthly. Service users on the advisory committee were compensated for their time and contribution.&#x0D; What did you do? A mixed-methods research design was used to explore the experiences of the community hub service users, staff members and subject matter experts. Service users were recruited from the community hubs. Staff members were recruited through virtual staff meetings. Face-to-face surveys were administered to 75 service users at the community hubs. Staff online surveys were self-administered by 15 direct service staff. Virtual interviews were conducted with five community hub managerial staff and two subject matter experts. Quantitative data were calculated using the SPSS statistical software. Qualitative data were analyzed using thematic analysis.&#x0D; &#x0D; What results did you get? What impact did you have? The integrated service model was described as saving service users’ lives. Adequate, core funding is required for the sustainability of the community hubs. Results from the evaluation provided the regional government with data to help inform its strategic priorities for vulnerable populations.&#x0D; What is the learning for the international audience? The needs of vulnerable populations including persons experiencing homelessness are deep and entrenched. Community hubs integrate a range of healthcare and social support services, including the social determinants of health that respond to service users’ immediate and emerging needs.&#x0D; What are the next steps? Knowledge translation through conferences, symposiums, presentations at regional sector tables and peer-reviewed publications. Collaborating with the community hubs to utilize the research findings to support improvement in future service design and delivery.

EVALUATION OF DEMENTIA EDUCATION TRAINING IN GEORGIA NURSING HOMES

Abstract The increased use and misuse of antipsychotics and psychotropics in nursing homes have been well documented. Person-centered dementia care training that addresses skill development and practice change around communication strategies and non-pharmacologic approaches has the potential to impact the misuse of these drugs as chemical restraints. The goal of this study is to implement and evaluate an online team-based dementia education (Dementia Beyond Drugs: Changing the Culture of Care) program aimed at skill development and practice change. The program was delivered online over six weeks to teams of nursing home staff for a total of 12 hours of synchronous interactive learning. Teams were also assigned application exercises between meetings. Topics included “dementia, dementia beyond drugs, interpersonal approaches, and understanding personal expressions.” This study implemented the training with staff teams from 22 nursing homes in Georgia (N=97). Pre-post data analysis reveals a significant improvement in the nursing home environment and relationships as measured by the Kansas Culture Change Instrument, and increased attention to the use of antipsychotic drugs in staff meetings. This study indicates that team-based online learning has the potential to improve person-centered dementia care practices and attention to the use of non-pharmacological approaches to address behavioral expressions of residents living with dementia. Future research is needed to expand person-centered dementia care education programs to more nursing homes and evaluate their short and long-term effectiveness.

Take Inspiration From Staff Meetings

Take Inspiration From Staff Meetings

It's the little THANGS: Recording frequently unreported errors for dosimetry quality improvement

The reporting of errors resulting in dose deviations are well-studied. Less studied is the amount of inconsequential errors that will not harm the patient but could lead to inefficiency. This paper reports an institutional effort to quantify and reduce these less significant errors. Dosimetry items discovered during physicist plan/record and verify (R&V) check prior to treatment were recorded in a shared document and called Therapy Anomaly Gathering System (THANGS) and individual items were called a “thang.” Items were categorized to 1 of 4 types: Treatment Plan, Plan Document, R&V, and Secondary MU. The aggregate numbers were presented to the dosimetry staff at regular staff meetings. It was emphasized to the staff that this was a Quality Improvement (QI) study and would not be used punitively. Thangs were tracked over a 4-year period. In Q1 of year 1 of the study, the average number of errors identified was 179/month. This was reduced to 114/month by Q4 of year 1 and 68/month by the end of year 4, a 62% reduction. The number of errors/plan in Q1 Year 1 was 1.25, and that was reduced by Q4 Year 4 to 0.4, a 68% reduction. The percentage of errors by type did not vary much over the 4 years. By far, R&V errors were the most common, and QI efforts were primarily aimed at them. We have developed a simple method to identify areas in dosimetric work that are vulnerable to minor errors and, through consistent reminders, drastically reduce them. This leads to a seamless throughput for a given plan ultimately resulting in improved physics, therapist, and most importantly patient satisfaction.

Inclusion and exclusion of teaching assistants as members of the teaching team. Enhancing school cohesion

ABSTRACT This article explores how teaching assistants (TA) are included and excluded in English primary schools; at times integrated fully whilst at others functioning on the periphery. Through interviews and observations TAs provided examples of their inclusion and exclusion from staff meetings, training, planning and time to talk. TAs across four schools were approached and completed questionnaires. A sample of TAs was observed and interviewed, alongside interviews with line managers. Findings suggest that TA inclusion as part of the pedagogical team is improving, driven at times by TA agency, but also inhibited by the power interplay that exists in schools. It concludes that TAs should be fully involved in pedagogical process if they are expected to lead learning.