Staff Survey Research Articles

A01 - AHP An Examination of the Opinions of NHS Stakeholders on the Current and Future Role of Physician Associates

Abstract Background Globally, healthcare systems are experiencing problems recruiting and retaining healthcare workers. Like many developed countries, in the UK, shortages are exacerbated by rising healthcare costs and models have had to be developed utilising shorter training periods and a generalized skillset. One of the consequences is the development of intermediate-level practitioners including Physician Associates (PAs). By 2024 over 4,000 PAs were working in the NHS, but their myriad roles has meant that integration has been challenging. This study examines the opinions of NHS stakeholders on the current and future roles of PAs and explores approaches to improve their integration. Method This cross-sectional study at a single NHS Trust gathered views and experiences regarding PAs through a survey of consultant and junior medical staff (JDs), PAs, and patients. Patients who interacted with a PA within four weeks prior to the period of the survey were randomly selected to avoid recall bias. Surveys, initially generated by doctors and a PA, were tailored, validated by experts, and pilot-tested. Distribution was via Microsoft Forms® and ACCURX® and responses were collected electronically with weekly reminders. Data were analysed using Microsoft Excel® and SPSS®, with qualitative analysis used to identify recurring themes. Results Consultants more frequently recognised positive contributions of PAs (p=0.012) although 68.6% noted PA roles were unclear. The PA role had only been explained to 11% of JDs, just 14% fully understood their role and 75% felt PAs might negatively affect their training. Conversely most PAs felt consultants (87.5%) and JDs (81.3%) were aware of their responsibilities. While 62.5% of PAs anticipated career progression, 87.5% were satisfied with training, 56.3% were considering a career change and 75% felt the healthcare climate adversely affected their work. Only 14% of patients fully understood the PA role, but 86% comfortable being seen by them. Conclusion This study highlights the positive contributions of PAs and recognition by stakeholders. Integration however remains challenging with concerns regarding JD training, PA career progression, and job satisfaction. The main hurdles remain unclear compounded by myriad PA roles and surveys reveal significant gaps in understanding among JDs and patients. PAs overestimate understanding of their role and education of stakeholders regarding their PA roles is crucial and must involve PAs, managers, consultants, GMC, and Royal Colleges. Local trusts and consultants must define PA roles, ensure career progression, and support JD training to enhance interprofessional relationships, trust, and the quality of patient care.

Strengthening social presence and connectedness in 100% online courses through CONNECT

Over recent years, higher education has seen a significant shift toward online courses. Factors driving this change include digital technology ubiquity, diverse student populations, workforce demands, and the increasing need for more flexible learning environments (Serrano et al., 2019). However, while online course enrolments are rising faster than on-campus courses, retention rates remain lower (Australian Government, 2021). Evidence suggests that online education can negatively impact students’ sense of connection, leading to feelings of isolation and disempowerment (Roddy et al., 2017). This is also reflected in the Australian University Mental Health framework (Orygen, 2020) which emphasises creating supportive online learning environments that promote student well-being. The Australian Universities Accord (Australian Government, 2024) calls for universities to embrace TEL. However, given that research has shown the need for more professional development (PD) and support for online educators (Ahern and Biedermann, 2022; 2023), innovative, evidence-based strategies are needed for organisations to build capacity in online teaching. Drawing on a comprehensive review of literature, the authors developed CONNECT: a framework to enhance social presence and connectedness in online learning (Ahern et al., 2024). Grounded in research underpinned by Garrison et al.’s (2000) Community of Inquiry (CoI) framework, the principles of Universal Design for Learning (CAST, 2018) and leveraging TEL, this framework offers educators a roadmap for nurturing a sense of community that positively influences student well-being, engagement, and overall success. Key components of the CONNECT framework are: C - Communication is responsive and supportive O - Optimal online presence N - Nurture educational and professional growth N - Networking opportunities fostered E - Engaging communities of learning C - Contemporary and authentic content T - Timely and effective feedback for learning (Ahern et al., 2024). The study follows a quasi-experimental design to evaluate the effectiveness of CONNECT in guiding teaching staff to use evidence-based strategies to promote belonging and connectedness in online education. In phase one, CONNECT was implemented within a 100% online postgraduate (PG) subject. This presentation will showcase online teaching strategies used to apply all elements of CONNECT as implemented in phase one. Phase two, also showcased, involved creating and releasing an online short course as professional development for teaching staff across two PG online courses at the authors’ university: Master of Nursing (MN) and Graduate Certificate of Diabetes Education (GCDE). After these implementation phases, the third phase will measure the effectiveness of CONNECT across the two PG courses. Data will be collected via (i) a student survey and (ii) a staff survey. Data analysis will compare the experimental group (participants enrolled or teaching in MN or GCDE) against the control group (participants not enrolled or teaching in MN or GCDE). Data will be collected from students and teachers across Australian universities offering 100% online courses. We hypothesise that by implementing CONNECT, the study will (1) Show improved student satisfaction in the experimental group and (2) Add to the body of evidence to inform and support teaching staff to develop strategies that can help build connectedness and social presence in online learning.

Creating an inclusive workforce in 2024: Are pharmacy teams across England committed to embedding equality, diversity, and inclusion?

Abstract Introduction The Pharmacy Workforce Race Equality Standard (PWRES) published in 2023 provided evidence of the varied experiences that registered pharmacy professionals in NHS trusts face, particularly in relation to gender and ethnicity.1 Following this, the Inclusive Pharmacy Practice delivery group at NHS England set out to raise awareness of the data and to support regions in developing action plans to drive improvements in equality, diversity and inclusion (EDI) within pharmacy teams. Aim The aim of this study was to identify current initiatives within NHS providers that promote EDI within the pharmacy workforce with a view to enabling the sharing of good practice, and identifying implementation barriers. Methods A questionnaire was created by the Chief Pharmaceutical Officer’s Clinical Fellows and distributed by the 6 regional chief pharmacists within NHS England to their networks. The questionnaire was also promoted in regional pharmacy leadership meetings. Responses were collected between 1st February and 31st May 2024. Data was collected on an Excel spreadsheet. London was excluded from data collection as a similar questionnaire was distributed in 2023. No ethical approval was needed for non-sensitive anonymised data. Results There were 77 responses: 75% (n = 58) from hospital trusts, 13% (n = 10) from integrated care boards and the remaining 9 responses included the Local Pharmaceutical Committee, Hospice and Mental Health Trust. 86% of respondents (n = 66) indicated that their organisation has EDI initiatives in place. These have been summarised into six key themes: 1) EDI network/steering group (n = 44), 2) action plan (n = 14), 3) EDI training/accreditation (n =14), 4) reverse/reciprocal mentoring (n = 11), 5) awareness days (n = 10) and 6) inclusive recruitment practices (n = 10). In contrast, only half of respondents indicated that their team had EDI initiatives. The impact of any initiatives was measured by feedback from staff (e.g. Internal staff survey, NHS staff survey, focus groups, open staff forums) and regular staff demographic data collection. 55% of respondents (n = 36) indicated that recruitment panel members received compulsory EDI training for interviews and 54% of respondents (n = 35) received mandatory recruitment training. Barriers and challenges identified with implementing EDI initiatives included organisational change, workforce capacity, competing priorities and staff apathy. Discussion The survey results highlight a strong commitment to EDI initiatives at an organisational level, with most organisations having established EDI frameworks. However, the lower prevalence of EDI initiatives within individual pharmacy teams suggests a gap in implementation. This discrepancy indicates a need for better dissemination and integration of EDI practices within pharmacy team settings. There is evidence of varied practice in terms of EDI training requirements of interview panellists, and these variations are opportunities where improvements can be made in terms of IPP. The survey was only sent to the managed NHS sector and is not reflective of primary care or community pharmacy. One of the next steps is for regions to use the results of the questionnaire in combination with the PWRES data to develop and implement local action plans to address these issues. Reference 1. NHS England. Pharmacy Workforce Race Equality Standard Report 2023. [Accessed 4th June 2024]. Available from https://www.england.nhs.uk/long-read/pharmacy-workforce-race-equality-standard-report/

Electronic Resources Adoption by Academic Staff in Public Universities in Tanzania Using the Technology Acceptance Model

Abstract This paper analyzes emerging issues on the use of electronic resources (e-resources) by academic staff in public universities in Tanzania. Notable issues include factors influencing adoption of e-resources by academic staff. A quantitative research design based on a cross-sectional survey of academic staff in four public universities was used. The study was informed by the Technology Acceptance Model (TAM) with demographic and institutional factors like awareness on ICT policy and regulations added. A sample of 292 academic staff obtained through a combination of stratified and random sampling was used. Cross-tabulations and Chi-Square statistics were used for analysis of association to establish the influence of the factors on adoption. Through TAM, perceived benefits were measured by eagerness for promotion and increase in income. Perceived ease of use was measured by capacity built on ICT use and perception on ICT infrastructure. Awareness was measured by members’ recognition of ICT policy and regulations. The findings show that experience, age, and awareness have a significant correlation with e-resources adoption. Also, the mostly accessed and used e-resources by academic staff are scholarly search engines such as Google Scholar.

Interdisciplinary Operating Room Ergonomics Needs and Priorities: A Survey of Operating Room Staff.

To examine perceived OR ergonomics facilitators and barriers, with a focus on the interdisciplinary team. Poor ergonomics causes musculoskeletal injuries affecting all operating room (OR) staff with repercussions on patient care, outcomes, and sustainability. Lack of ergonomic awareness and education are risk factors. We conducted a self-administered web-based survey of OR nurses, surgeons, and anesthesiologists at a single centre (n=238). We developed a questionnaire through items generation and reduction, followed by reliability and validity testing. Response rate was 53.8%. Respondents perceived that on average 80% of nurses, 70% of surgeons, and 40% anesthesiologists experienced MSK injuries, with no difference in professional groups' perceptions. Guideline ergonomics interventions were rarely used (<25%) except for specialized clothing (33%), equipment repositioning (59%), and seating (37%), though perceived beneficial by 80-90%. Reported barriers to optimal ergonomics were organizational/structural (lack of time, space, equipment, funding), whereas solutions were individual. Fear of unfavourable perception from others was a concern for 62%. Teams discussing, prioritizing, monitoring, or helping with ergonomics was indicated by <50%. Individual ergonomic adaptations were perceived as convenience by other staff. While structural/organizational issues are reported as barriers to ergonomics, solutions appeared as individual responsibilities. Team dynamics did not prioritize nor support ergonomics. Education tools leveraging the interdisciplinary team are warranted. This work will be supplemented by interviews and live observations to build tailored educational tools for OR teams.

Using salience and availability to promote sustainable and healthy food choices in hospital cafeterias

Sustainable diets can achieve considerable reductions in greenhouse gas emissions and improvements in human health, but changing dietary behavior remains a challenge. We assessed the impacts of two behavioral insights strategies on bridging the intention-action gap related to sustainable and healthy food choices amongst hospital cafeteria patrons. In a pilot survey of hospital staff (N = 1,165), 56% identified limited awareness and availability of sustainable food as barriers to purchasing, although 46% were extremely willing to try sustainable dishes. We examined increasing salience (Study 1), varying availability (Study 2a), and decreasing availability (Study 2b) on sustainable and healthy dish purchases in three hospital cafeterias. Each study ran for seven weeks from March to April, 2023. In total, 10,616 dishes were purchased. In Study 1, increasing salience was associated with significant uptake of sustainable and healthy dishes, but the effect disappeared once the salience intervention was removed. In Study 2a, increasing availability of sustainable dishes corresponded to a significant increase in purchases of sustainable dishes, while decreasing availability in Study 2b followed a downward trend in purchases, suggesting that availability drove dietary choices. We recommend hospitals consider these choice architecture interventions to support the adoption of sustainable and healthy diets.

Evaluation of a Novel Mechanical Compression Device.

Venous thromboembolism (VTE) is a leading preventable cause of death in hospitalized patients. Current intermittent pneumatic compression (IPC) devices used to provide external mechanical compression for VTE prevention are associated with a multitude of clinical challenges that often result in subtherapeutic use. A comparative study was conducted of the real-world clinical use of a novel mechanical compression device (MCD) and a current IPC device. The purpose of this quality improvement project was to compare use of the novel MCD and the standard IPC device on three clinical inpatient hospital units. Comparisons were based on the following patient outcome measures: evaluation of wear time, adherence to optimal wear time, evaluation of both patient comfort and device satisfaction, and perceived impact on mobility goals. Nurses' satisfaction with the clinical usability for mobility was also measured. This project used a pre-post design. A convenience sample of 89 surgical patients on the three clinical study units and 63 nursing staff members were recruited for the study. Data were collected using electronic health records, MCD data records, patient surveys, and nursing staff surveys. Data were analyzed using descriptive statistics and independent sample t tests. In the preintervention period, data were collected using the current IPC device. Nursing staff were then trained on use of the MCD. In the postintervention period, the MCDs were used in place of the IPC devices. MCD patients had significantly longer (P ≤ 0.001) wear time (mean, 19.3 hours/day) compared with IPC patients (mean, 12.9 hours/day). MCD patients also reported significantly better sleep (P = 0.04), fewer problems with sweaty legs (P ≤ 0.001), and improved assistance with mobility goals (P ≤ 0.001) than IPC patients. Nursing staff reported significantly improved accuracy of mobility documentation (P ≤ 0.001) with the MCD, but no differences in their perception of patient satisfaction with meeting mobility goals. Use of the MCD device for VTE prophylaxis resulted in actual and perceived improvements from the perspective of both patients and nurses. While these results provide initial data in support of a potentially promising system, more research is needed.

Fidelity, acceptability, and feasibility of the revised functional autonomy measurement system for hospitalised people: An implementation study.

The revised functional autonomy measurement system (SMAF-R) is an outcome measure of activity performance and resource needs. This study aimed to measure the implementability of the SMAF-R as a routine outcome measure in acute and subacute inpatients. This was a mixed-methods implementation study. Occupational therapists were asked to complete the SMAF-R in hospitalised people with an anticipated length of stay greater than 48 hours over a 12-month period (n= 13,348). A baseline audit of SMAF-R completion rates was conducted, and behaviour change interventions were delivered over 12 months. The Implementability of Healthcare Interventions conceptual framework was used to evaluate fidelity (completion rates), acceptability (staff survey with quantitative and qualitative responses), and feasibility (change in SMAF-R scores from admission to discharge). Quantitative and qualitative (analysed thematically) data were integrated. Occupational therapists and other staff working to improve outcome measure completion within the electronic medical record and other allied health teams were consulted when developing and delivering behaviour change interventions. Peak completion of the SMAF-R did not meet an 80% fidelity success rate (admission: 32% in acute and 66% in subacute; discharge: 12% in acute and 48% in subacute). Two thirds of occupational therapists reported the SMAF-R was an acceptable measure to use, but only 38% liked using it. Thematic analysis revealed three themes: (1) A greater understanding of the relevance of the SMAF-R influenced acceptability; (2) using the SMAF-R within an electronic medical record may facilitate completion; and (3) it takes more time to complete SMAF. Patients made clinically significant improvements in SMAF-R scores during their hospital stay (median difference 16.5 [6.5-27.0], p< 0.001, n= 764). Although most occupational therapists reported the SMAF-R was acceptable, there were mixed opinions regarding the relevance of the SMAF-R in this setting, which may have impacted fidelity. Additional prompting and training (especially regarding understanding SMAF-R relevance to practice) may assist with improving SMAF-R completion. Further research is required to assess the psychometric properties of the SMAF-R in the hospital environment. The revised functional autonomy measurement system (SMAF-R) is an assessment tool used to measure performance in everyday activities (such as showering) and the resources needed to complete these tasks (e.g., a shower chair or someone's help). Occupational therapists can use it at the start of a patient admission and again at the end in different hospital settings to assess patients' needs and see if they improve. This study aimed to measure (1) how often occupational therapists use the SMAF-R with patients in hospital, (2) how acceptable occupational therapists find the SMAF-R, and (3) whether the SMAF-R shows changes in patients' abilities during their hospital stay. Before the study, usual completion of the SMAF-R was measured, and it was found to be completed in less than 1% of patients. Strategies were introduced to improve SMAF-R completion over 12 months. After this, completion of the SMAF-R improved to between 9% and 38% in different hospital settings. Changes in SMAF-R scores showed that patients improved during their time in hospital. Most occupational therapists reported the SMAF-R was an acceptable measure, but less than half liked using it. The low completion rates suggested that either the SMAF-R was not fit for purpose in this setting or that more support is needed to increase completion.

Clinical Staff Perceptions of Pay-for-Performance Financial Incentives for HPV Vaccine Promotion.

The purpose was to investigate clinical staff perceptions of pay-for-performance human papillomavirus (HPV) vaccination financial incentives. In 2022, the authors conducted a national survey of clinical staff (N = 2527; response rate = 57%). Respondents were (1) certified to practice in the United States; (2) practiced as a physician, physician assistant, nurse practitioner, advanced practice nurse, registered nurse, licensed practical/vocational nurse, medical assistant, or certified nursing assistant; (3) worked in pediatrics, family medicine, or general medicine specialties; and (4) had a role in HPV vaccination for children ages 9 through 12 years. The team used ordered regressions to model whether respondents agreed with (ie, "Strongly agreed" or "Agreed" on a 5-point Likert scale) each of the 9 statements. The statements were mapped to domains based on the theory of planned behavior: attitudes (5 statements), perceived behavioral control (2), and norms (2). Favorable responses to 9 statements ranged from 32% to 85%; 5/9 items had more than 50% favorable responses. The following example odds ratios (ORs) are for "agree" versus "neutral" or "disagree" to change their behavior to obtain the incentive. Clinical staff with prior experience with incentives were more likely to agree with 8/9 positive statements about incentives (eg, OR = 1.32 [95% confidence interval {CI}: 1.12-1.57]). Family medicine clinics were more likely than pediatric clinics to agree with 5/9 statements (eg, OR = 1.42 [95% CI: 1.18-1.70]). Clinical staff with more years of experience were less likely to agree with 6/9 statements (eg, OR = 0.97 [95% CI: 0.97-0.98]). Clinical staff's perceptions of pay-for-performance HPV vaccination financial incentives were generally favorable.

Nutrition Education and Practice in University Dental and Oral Health Programmes and Curricula: A Scoping Review.

Dentists and oral health practitioners have a potential role in supporting the prevention and management of noncommunicable diseases. However, the extent to which university education prepares practitioners to provide nutrition care is unclear. This scoping review identifies and synthesises the evidence related to university-level nutrition education provided to dental and oral health students globally. A scoping review identified relevant literature through search terms "dentistry," "oral health," or "oral hygiene"; "dental students" or "dental education"; "nutrition education" or "nutrition science." Articles were included that examined nutrition education in undergraduate oral health training; or nutrition knowledge, attitudes, confidence, or skills or dietary habits; experts' opinion papers; and position statements. No limitations on the publication years or languages of the articles were applied. A total of 136 articles were included. Half were surveys of students (n = 49) or academic staff (n = 21). The remainder comprised reports of curriculum initiatives (n = 26), opinion papers or narrative reviews (n = 24), position statements (n = 6), curriculum development (n = 6) and curriculum guidelines (n = 9). While dental and oral health students and curriculum experts overwhelmingly recognised the importance of nutrition, most studies that assessed nutrition knowledge of students revealed limited knowledge. Students were not confident in their skills to provide nutrition care. Lack of nutrition experts on teaching teams and unclear expectations about developing nutrition competencies were identified as barriers to greater nutrition education. Nutrition education in university dental and oral health degrees is highly variable. The potential for oral health professionals of the future to promote oral health through nutrition is unrealised.

Optimizing Test Data Management Strategies in Banking Domain Projects

The steady rise in processing power over the past 20 years has resulted in an enormous volume of data. Furthermore, anybody may now easily create and consume material in any format thanks to recent advancements in Web technology. Large volumes of data are regularly gathered by banking systems, including trade finance data, SWIFT and telex communications, client information, details about transactions, risk profiles, credit card details, limit and collateral details, the compliance or Anti Money Laundering (AML)-related data, and limit and collateral details. Every day, thousands of choices are made at banks. These choices pertain to credit, default, beginning a relationship, investments, AML, and illicit funding, among other things. To make these crucial choices, one must rely on a variety of data and drill down capabilities offered by the banking systems. We created a set of specifications for the kinds of data that should be included in a product catalogue. We ascertained what data the departments need by using a survey and questionnaire of the retailer's staff. We ensured that there was no one standard for the information organisation and then put out our own plan. This enormous amount of data may be mined for information and intriguing patterns, which can then be used to the decision-making process. This article examines and summarises a number of data mining methods that have applications in the banking industry. An overview of data mining methods and procedures is given. It also sheds light on how these methods may be applied in the banking industry to facilitate and enhance decision-making.

Who is supporting who? Re-imagining Graduate Teaching Assistant training and support in a School of Environmental Sciences

Despite the growing use of postgraduate research students as Graduate Teaching Assistants (GTAs) within UK higher education institutes, challenges remain in how to best support these students. This study reports on the GTA experience within a School of Environmental Sciences at a research-intensive UK university. Specifically, the study explores GTA training opportunities and support provision. Findings were drawn from surveys of GTAs and academic staff. Responses revealed that whilst GTAs made a wide range of valuable contributions to teaching, they and academic staff were often unsure or unaware of (i) their individual responsibilities, and/or (ii) development opportunities already available. These barriers have the potential to influence GTAs’ confidence in their ability to teach and can reduce their sense of identity within the school. Based on these findings, suggested areas for action are discussed in a bid to further embed good practice in the use of GTAs within the school. This article was published open access under a CC BY licence: https://creativecommons.org/licences/by/4.0/ .

Insights from an international clinic survey on CIED patient management practices and perceptions

Abstract Background Remote monitoring (RM) is recommended as standard of care to manage patients with cardiac implantable electronic devices (CIEDs). However, implementation within overall follow-up (FU) practice is challenging with many organizational aspects to consider. While the 2023 HRS/EHRA/APHRS/LAHRS consensus on management of remote device clinics provided guidance, data on current patient management practice is lacking to understand existing gaps. Purpose This survey of device clinic staff characterized the state and perceptions of CIED patient management. Methods A Delphi panel of US and EU clinical experts guided the research objectives, structure, and content of the survey. Once consensus was reached, the online survey (Qualtrics) was deployed in partnership with HRS. An available case analysis was performed to handle missing data. Results A total of 471 responses were received between September 2023-January 2024 (66% US, 19% Europe, 15% other). Overall, performing a combination of in-office visits and RM was the most frequent FU practice for all devices. Remote-only management was only commonly reported for insertable cardiac monitors (ICM). Adoption of RM was lower in EU compared to US for therapeutic devices, especially pacemakers for which in-person only FU remained high (Figure 1). Frequency of routine visits and transmissions is reported in Figure 2. While the majority of respondents (48-67%, depending on device type) expressed that less than 20% routine visits are actionable, adopting a practice of FU visits scheduled every 2 years as suggested in the 2023 consensus was rarely reported for therapeutic devices. However, alert-based RM seems to emerge for ICM without routine FU. In the US, frequency of scheduled transmissions appeared aligned with reimbursement rules (monthly for ICMs; quarterly for therapeutic devices), whereas there was more variability in EU where RM often lacks clear funding. Divided opinion was observed regarding staff sufficiency as 43% found staffing levels somewhat/very sufficient, while 42% rated it as somewhat/very insufficient. Managing disconnected patients, initial transmission review, and patient phone calls were identified as most burdensome tasks and were the ones for which there was most willingness to outsource. Although 60% respondents rated their practice as somewhat/very efficient, the majority (45%) did not report monitoring performance. The minority (29%) assessing patient management performance primarily tracked workload volume rather than quality-related metrics. Conclusion This large international survey characterized contemporary CIED patient management practices. While the 2023 HRS/EHRA/APHRS/LAHRS consensus highlighted the potential for alert-based RM, reducing in-person visits, and third-party resources to streamline patient FU, these practices have yet to be fully implemented. As such, there is opportunity to standardize and optimize workflows to drive efficiency and quality of care.Follow-up paradigm by regionFrequency of routine follow-up

Management of Glucocorticoid-Induced Hyperglycemia in Cancer Patients: A Feasibility Study.

Glucocorticoids are commonly used in the management of patients with hematological and solid malignancies. However, their use may be associated with impaired glycemic metabolism and increased treatment-related morbidity and mortality. This study aimed to examine the feasibility and acceptability of a nurse-led model of care (MOC) for screening and managing glucocorticoid-induced hyperglycemia (GIH) in non-diabetic patients requiring high-dose glucocorticoid (HDG) therapies, as well as patients' and health professionals' experiences with the MOC. This study was a single-site feasibility study. Patients with hematological or oncological malignancies who were >18 years of age, receiving a chemotherapy regimen including HDGs, had no prior diagnosis of diabetes or prediabetes, and were not at the end of life were considered eligible for this study. Participants were recruited from a district hospital's Cancer Centre in Australia. All consenting participants were screened for diabetes and were provided with a blood glucose meter to monitor their blood glucose levels (BGLs) four times a day on the days of glucocorticoid therapy (GT) plus one extra day following GT, for the first four cycles of their treatment, to screen for the presence of GIH. Feasibility and acceptability were assessed using rates of consent, study completion, and staff and patient surveys. Forty-eight percent (35/74) of patients approached consented to participate in the study and had screening tests for preexisting diabetes. None were diagnosed with diabetes. Six out of 35 patients withdrew, and 10/29 patients did not complete the recommended BGL monitoring. Thirteen percent (4/29) of patients developed GIH. The most common reasons for non-participation and study withdrawal were related to the self-monitoring of BGLs. While clinical stakeholders found the MOC feasible and acceptable, the results of this study suggest that alternative methods for encouraging self-monitoring of BGL and monitoring the presence of GIH during high-dose chemotherapy need to be explored to address issues associated with adherence and sustainability.

Where should health system investments be made to protect the mental health of healthcare workers?

Abstract Background This study explores trends and work-related determinants of mental health and wellbeing among health and care workers in Europe since the COVID-19 pandemic. The aim is to determine where investments can best be made to protect and support mental health and wellbeing among health and care workers to improve retention and recruitment. Methods Data are analysed from the National Health Service staff survey in England and the Health Service Executive ‘Your Opinion Counts’ survey in Ireland to explore trends in mental health and wellbeing and burnout. Evidence is then taken from a series of European Observatory policy briefs, based on expert-led literature reviews, to explore determinants of poor mental health and wellbeing and to identify potential areas for investment. Results Rates of burnout and poor mental health and wellbeing have increased in England and Ireland since the start of the pandemic among all professional groups. Workplace-based factors are important determinants of poor mental health and wellbeing, and can be grouped into: macro-level structural factors such as staff shortages, poor working conditions and low pay; meso-level organisational factors including poor leadership, and insufficient education, training and support; micro-level individual factors such as insufficient self-care or not seeking support. However, determinants at the micro-level, especially seeking support from others, are largely shaped by structural or organisational factors. Conclusions Increased financing to address structural and organisational determinants of mental health and wellbeing contributes to improved patient care, better staff experience, lower rates of absenteeism, and enhanced recruitment and retention. It is therefore one of the best health system investments that can be made.

Current oral care practices in an acute aged care setting: An Australian metropolitan hospital perspective

Purpose To evaluate current oral care practices in an acute aged care hospital setting, and staff perceptions of the barriers and enablers to delivery of evidence-based oral care practices. Method A mixed method study comprised of retrospective file audit and cross-sectional survey was conducted within a single acute aged care unit. Medical records of patients aged ≥ 65 years admitted over a 6 month period were retrospectively audited. A clinician survey was used to explore barriers to and enablers of the delivery of oral care practices using the Capability, Opportunity, Motivation, Behaviour (COM-B) questionnaire. Result were analysed using descriptive statistics. Result Patient file audits (n = 206) found 13.6% (n = 28) of patients had oral care completed, despite 23% (n = 47) of patients being recommended by a speech language pathologist to receive oral care. Staff survey respondents (n = 31) reported they do not have the physical or social opportunities to provide oral care (i.e. adequate resources, time, and social support), however, they were motivated and reported they have the required knowledge and skills to provide oral care. Conclusion There is a need for implementation strategies to enable an interprofessional response to improve the delivery of evidence-based oral care practices and optimise patient outcomes.

Business continuity, bureaucratic resilience and the limitations of neoliberal survival logics in international organisations

Abstract This article contends that investigating relationalities between business continuity management (BCM), staff behaviours, and bureaucratic resilience advances understandings of the survival of international organisations (IOs). Drawing on in-depth interviews, a global staff survey, and a discourse analysis of United Nations (UN) reports and applying a post-colonial feminist theoretical approach foregrounding care ethics to the study of IOs, the article examines how the UN Secretary-General’s Alternative Working Arrangements directive to close physical offices and open ‘virtual offices’ was implemented in the first 18 months of the Covid-19 pandemic. It is contended that BCM is necessary for IO survival, since if the IO bureaucracy is unable to be productive and maintain its spheres of influence during a crisis, it risks losing power and authority. Between March 2020 and August 2021, staff facilitated IO survival organically, from the bottom up, in four ways: demonstrating good performance and productivity; being adaptable and resilient; maintaining personal spheres of influence; and building communities of care within the UN. However, the UN’s neoliberal, technocratic approach to business continuity and bureaucratic resilience-building neglected staff care needs. Consequently, IO survival is predicated on staff performing as exploited gendered and racialised ‘neoliberal subjects’, revealing a chronic structural crisis rooted in the UN bureaucracy’s hierarchical composition and unequal employment regime.

Knowledge and Practices Regarding Prevention of Central Venous Catheter Removal-Associated Air Embolism: A Survey of Nonintensive Care Unit Medical and Nursing Staff.

Air embolism is a potentially serious complication of central venous catheter (CVC) use. While CVC insertion is usually performed by a trained specialist, extraction is frequently the responsibility of junior staff members. This complication can be easily prevented by following several simple measures described in common guidelines. We conducted a single-center survey to assess knowledge and practices concerning the prevention of air embolism associated with CVC removal among healthcare workers from nonintensive care units. The correct answers to the questionnaire were determined according to best-practice recommendations for CVC removal. Based on a comparison of the total sum of correct answers between the categories of groups, factors that predicted the level of knowledge were identified using an independent sample t test. Of the 156 respondents, one-third were unfamiliar with air embolism as a complication of CVC extraction. Almost 80% were unaware of the existence of a CVC removal protocol. Almost half of respondents did not follow guidelines regarding patient position when removing a CVC, 72% did not ask the patient to perform the Valsalva maneuver during the procedure, and 54% did not ask the patient to remain supine after the procedure. Adherence to the protocol was correlated with professional experience, with a lower level among those with experience of less than 1 year and, particularly, among interns. Our survey revealed inappropriately low awareness of CVC removal-associated air embolism risk and low familiarity with CVC removal best-practice recommendations among nonintensive care unit healthcare workers. Staff members with experience of less than 1 year, including interns, were found to have a lower level of knowledge. These findings emphasize the importance of development and distribution an internal hospital protocol and the integration of educational intervention into a preliminary internship program.

Staff engagement, co‐workers' complementarity and employee retention: evidence from English NHS hospitals

AbstractRetention of skilled workers is essential for labour‐intensive organizations like hospitals, where an excessive turnover of doctors and nurses can reduce the quality and quantity of services provided to patients. Exploiting a unique and rich panel dataset based on employee‐level payroll and staff survey records from the universe of English NHS hospitals, we investigate empirically the role played by two non‐pecuniary job factors, staff engagement and the retention of complementary co‐workers, in affecting employee retention within the public hospital sector. We estimate dynamic panel data models to deal with reverse causality bias, and validate these estimates through unconditional quantile regressions with hospital‐level fixed effects. Our findings show that a one standard deviation increase in nurse engagement is associated with a 16% standard deviation increase in their retention; and also that a 10% increase in nurse retention is associated with a 1.6% increase in doctor retention, with this co‐workers' complementarity spillover effect driven by the retention of more experienced nurses. Nurse and doctor engagement is positively associated with managers who have effective communication, involve staff in the decision‐making process, and act on staff feedback; in particular, older nurse engagement is responsive to managers caring for staff health and wellbeing.

Medication Counselling on Unlicensed Medicines Should Be Improved - Results from a Finnish Survey for Patients and Pharmacy Staff.

Finnish authorities have published specific instructions for prescribing, handling, and dispensing unlicensed medicines and for the associated communication with patients. However, there is a clear research gap concerning the quality of medication counselling given by doctors and especially pharmacists to patients who are prescribed unlicensed medicines. The success of such counselling was studied with a survey for both pharmacy staff and patients. The survey was conducted in 2022 with two electronic semi-structured questionnaires, one for patients (or caregivers of underaged patients) purchasing medicines with special or fixed-term special permits from community pharmacies in Finland and one for the pharmacy staff dispensing such medication. In all, 49% of the 389 pharmacists did not know if the prescribing doctor had given any counselling to the patient, and 52% of the pharmacists had not given any counselling to the patient themselves. Still, 51% of the pharmacists considered that the patient had received sufficient medication counselling. Almost every one of the 36 patients expressed that they had received medication counselling, 61% of them from the prescribing doctor and 53% from a pharmacist. Medication counselling on unlicensed medicines should be improved to ensure their safe and effective use. This survey revealed that many patients did not receive any such medication counselling as required by the Finnish Medicines Decree.