Staff Team Research Articles

The staff perspectives of facilitators and barriers to implementing virtual reality for people living with dementia in long-term care

IntroductionOne emerging technology in long-term care (LTC) is virtual reality (VR), an innovative tool that uses head-mounted devices to provide the viewer with an immersive experience. It has been shown that VR has a positive impact on the well-being of residents living with dementia, and staff are essential in the implementation and sustainable use of technology. Currently, there is a lack of inclusion and focus on direct staff perspectives on VR implementation in LTC. This paper aims to report staff perspectives on VR adoption in a 2-year study on a virtual reality program at three Canadian LTC homes.MethodsOur interdisciplinary team (clinicians, people living with dementia and family partners, trainees, and researchers) explored the facilitators and barriers to implementing VR in LTC, guided by the Consolidated Framework for Implementation Research (CFIR) and intersectionality supplemented CFIR. Twenty-one participants were recruited, including recreation staff, care aides, nurses, screeners, and leadership team members. The team collected data through staff interviews, focus groups, and ethnographic observation field notes. Reflexive thematic analysis was performed to identify themes reporting the facilitators and barriers for VR implementation in LTC from staff perspectives.ResultsThe data analysis resulted in three facilitators and four barriers. Facilitators are (1) perceived VR benefits, (2) integrate VR into workflow and routines, and (3) partner with skillful VR champions. Barriers include (1) staff concerns about VR use, (2) financial burden and competing priorities, (3) lack of infrastructure and physical spaces, and (4) staff workload and limited leadership support.DiscussionThis study contributes to the field with staff perspectives on facilitators and barriers to VR implementation. It underscores the rarely discussed aspects of VR implementation, such as funding prioritization and implementation timing. We offer practical strategies to inform future practices and research. Future studies should further explore long-term VR implementation, the involvement of family members as VR facilitators, and the use of VR in LTC.

A grounded theory of cognitive analytic reflective practice groups.

Whilst cognitive analytic therapy (CAT) is increasingly used as an indirect intervention, there is little evidence of how the approach can be applied to reflective practice. This study sought to develop a process model of cognitive analytic reflective practice (CARP) groups. Constructivist grounded theory approach supplemented by quantitative measures of helpfulness and group cohesion. Twenty-four participants, working within four staff teams in a secure children's home, attended four CARP groups over a 1-year period. Sessions were audio recorded, transcribed and checked for model fidelity and then analysed using grounded theory. Theoretical sampling was achieved via conducting focus groups with teams informed by the emergent categories, and using sessional measures of group cohesion and helpfulness to confirm theoretical saturation. The model constructed had three interrelated main categories: 'facilitator processes: establishing a reflective space', 'group processes: widening awareness of the self, others, and system' and 'outcomes: changing relational dynamics and finding exits.' The model was validated by evidence from the measures. The model offers an empirical understanding of how CAT informs reflective practice through a better understanding of reciprocity in the dynamics of care systems.

Patient Safety and Medical Error Prevention in General Practice: A Comprehensive Systematic Review

Patient safety and medical error prevention remain critical issues in general practice, where medical errors can lead to adverse patient outcomes and increased healthcare costs. This systematic review synthesizes recent evidence on prevalent types of medical errors, effective prevention strategies, and outcomes of patient safety interventions within general practice settings. Following a comprehensive search across multiple databases, 52 studies published from 2014 to 2024 were included. Findings highlight medication errors, diagnostic inaccuracies, and communication lapses as the most common types of errors. Effective prevention strategies include the adoption of electronic health records (EHR), structured team communication protocols, checklist systems, and staff training programs on safety practices. These interventions have shown significant reductions in error rates and improvements in patient outcomes, though implementation is often hindered by barriers such as limited resources, resistance to change, and lack of training. This review underscores the importance of a multifaceted approach that combines technological, organizational, and educational interventions to enhance patient safety in general practice. Future research should explore long-term impacts of these interventions and address context-specific challenges to foster a culture of safety in healthcare settings.

Interprofessional Team Staffing in U.S. Intensive Care Units.

There is a paucity of data, and no consensus, about the composition of interdisciplinary teams of healthcare worker (HCW) that provide care in intensive care units (ICU). Delineate the nature and variation of HCW staff composition in US adult ICUs before the COVID-19 pandemic. A national survey of 574 adult ICUs inquired about ICU staffing. Two sets of survey items asked about: (a) "availability to provide care" in ICU for 11 HCW types, collapsed into six groupings, and (b) presence in formal ICU clinical rounds of nine HCW types, collapsed into six groupings; bedside nurses were assumed to be involved in both categories. Analysis was descriptive, seeking to examine the predominant and full range of staffing patterns. Of surveyed ICUs: 94% were in metropolitan areas, 63% in teaching hospitals, 74% had >250 beds, 66% cared for mixed adult patient types (e.g. medical-surgical), median ICU bed count was 20 (interquartile range 12-25), 27% used some form of telemedicine. In addition to bedside nurses, the core staffing group comprised intensivists, respiratory therapists and pharmacists; in 88% of ICUs all were available to provide care. However, there were 28 different combinations of the six groupings (intensivists, respiratory therapists, pharmacists, attending physician support, advanced bedside nurse support, nurse aides), with the most common one, present in 38% of ICUs, including all six. 96% of ICUs had interprofessional rounds at least five days a week; 78% had them on weekends. Among the ICUs with rounds, 61% of weekday rounding teams included all of intensivists, respiratory therapists and pharmacists. Nutrition, rehabilitation and social support practitioners each participated in rounds in 35-80% of ICUs, and altogether in 28% of ICUs. Except for intensivists, all HCW types participated much less commonly in weekend than in weekday rounds. ICU care almost always included a core team of bedside nurses, intensivists, respiratory therapists, and pharmacists. Beyond that core, great variability was seen in the presence of many other HCW types. Almost all ICUs had interprofessional rounds, with three-quarters also having them on weekends.

Am I attached? A patient-partnered approach to creating infographics about attachment to primary care in Ontario, Canada

BackgroundHaving a primary care provider is associated with better care experiences and lower care costs. In 2021, INSPIRE-PHC released Primary Care Data Reports - publicly available summaries of administrative billing data about how populations in each of Ontario’s 60 health teams use primary care services. Given the characterization of Canadian primary care systems as ‘in crisis’, publicly available data about primary care at the regional level presented a significant opportunity for knowledge mobilization. An understandable resource could ground the public conversation about primary care access in data. Recognizing the role that lived experience plays in ensuring the public understands research findings, a partnership between patient advisors, Ontario Health Team representatives, researchers, and trainees was established to co-produce public-facing infographics based on primary care data.MethodsEvidence-based guidelines for public health infographic creation and elements of transformative action research guided a six-meeting process to engage up to 14 patient advisors, three Ontario Health Team staff and two primary care trainees. Patient advisors were affiliated with a provincial patient-oriented primary health care research group or a Hamilton-based Ontario Health Team. Ninety-minute meetings were conducted virtually, and notes were shared with attendees to ensure they accurately reflected the conversation. Two consultations with Ontario Health Team-affiliated primary care providers provided direction and ensured project outputs aligned with local priorities.ResultsProject partners shared feedback on draft infographics, audience identification, priority elements from Primary Care Data Reports to include in the infographics, and aesthetic features (e.g., headings, colour scheme, charts). Project partners felt the most important metrics to convey to the public were those that simultaneously reinforced the benefits of primary care on individual health outcomes and health system costs.ConclusionsPatient engagement in research is becoming widespread, but co-developing knowledge products with patient and health system partners is less common. Our approach to engaging patients prevented both oversimplification and unnecessary complexity in a public-facing visual about attachment to primary care.

TEACHING COMPUTATIONAL THINKING IN LEARNING COMMUNITY: A CASE STUDY OF SOLKAN PRIMARY SCHOOL

Slovene kindergartens and schools have introduced a learning community where teachers learn from and with each other, acquire knowledge, and strengthen students' skills. The success of such connections depends on shared values, attitudes, beliefs, and supportive mutual relationships. Teachers are essential when Slovene school participates in development projects B-RIN, aimed at introducing fundamental computer science and informatics content and computational thinking into kindergarten groups and school classes. When selecting members of the development team, the participants were guided by the criterion that the selected educators and teachers are open to exploring their teaching practices, capable of continuously upgrading and evaluating their pedagogical work, and developing and improving their teaching approaches based on the study of their practice, emphasizing student-centred approaches. The purpose of this contribution is to highlight the implicit theories and attitudes of the development team and school staff regarding the understanding and importance of introducing fundamental B-RIN content and computational thinking into teaching, not only in the STEM field but also in other subject areas, and to present the approaches with which participants have influenced the implicit theories and attitudes of teachers and educators within our VI organization. This is also because training students in computational thinking and fundamental computer science and informatics content significantly impacts the development of metacognitive strategies, such as problem-solving skills, especially for open-ended problems, self-regulation learning skills, perseverance in facing failure, consequently greater resilience, and encouraging creativity. Therefore, it also broadly impacts the mental health of students. Keywords: computational thinking, implicit theories and attitudes, learning community, metacognitive strategies, development team

Trust, belief and transitions: people’s experiences of multidisciplinary inpatient treatment for persistent physical symptoms. A qualitative study

Purpose People with Persistent Physical Symptoms experience physical symptoms that are not wholly explained by a medical disorder or disease. Multidisciplinary treatment is recommended for people with severe difficulties and is provided in a small number of specialist centres in the UK. Only brief descriptions of this treatment are available, and the experiences of people receiving this treatment as an inpatient have not been explored. This study aimed to explore how people with persistent physical symptoms experience inpatient treatment from a specialist multidisciplinary team, and to identify which factors facilitated their engagement in the rehabilitation. Materials and Methods 18 people who had received inpatient multidisciplinary treatment for persistent physical symptoms participated in semi-structured interviews. The transcripts were analysed using reflexive thematic analysis. Results Participants’ experiences were influenced by whether they felt believed by the healthcare team, and whether they could place their own trust and belief in the staff team and the treatment approach. Their experiences involved a series of transitions; both in environment and understanding. Conclusions Improvements are possible for people receiving inpatient multidisciplinary treatment for severe PPS. Trusting relationships between patients and staff members take time to develop but play a major role in patients’ experiences of treatment.

Integrated Care in a Large Public System Improves Simple Kidney Stone Management.

In the Los Angeles County Department of Health Services-the second largest public health care system in the United States-clinical integration allows specialists and primary care providers to collaboratively provide specialty care. We used time-driven activity-based costing to compare patient burden and cost of kidney stone diagnosis, workup, and management with and without clinical integration. We interviewed and observed teams of physicians and staff to understand workflow practices and personnel, space, material, and device requirements for stone care in the 2 models. We created process maps that outline the entire arc of care and used time-driven activity-based costing to calculate the all-inclusive costs of kidney stone diagnosis, workup, and scheduling for surgical treatment. The total cost of kidney stone treatment per stone episode in the integrated pathway was $499.04, compared with $699.81 in the traditional, nonintegrated pathway, a difference of 29%. The number of steps needed to arrive at operating room scheduling was 11 with integration and 14 without it. Clinical integration resulted in more efficient and cost-effective care from patient, provider, and health system perspectives. Integrated care may improve access to specialty care and increase the value of care and reduce treatment burden on patients.

Very high-speed running (VHSR) profile in elite female football: An update.

The aim of the present study it's a providing an update of the profile of very high-speed running (VHSR) of professional female football players. In this study 23 official matches of the Spanish First Division of Women´s Football were analysed. A total of 15 players participated, who were classified according to their location on the matches played: central-corridor (CCP, n = 7), and lateral-corridor (LCP, n = 8). The variables recorded were: 1) Very High-Speed Running (VHSR), considering the accumulated distance, duration, and frequency, and the individual characteristics of the efforts (distance and duration); 2) Recovery between efforts (VHSRe) and; 3) VMAX. The results show that LCP described higher values in accumulative VHSR and VHSR by distance bands, with greater distances, durations and VMAX of VHSRe, with less recovery between efforts. There seems to be an evolutionary trend in the distribution of the efforts, with a higher % of efforts in the 10-20 m band. The results provide useful information that coaching staff of professional women's football teams could use to design specific very high-speed running training to optimize performance in competition.

Early Health Impacts of a Primary Care Consultation Model for People Served by Assertive Community Treatment teams.

The cardiometabolic health outcomes and life expectancy of people living with serious mental illness (SMI) continue to significantly flag behind that of the general population. This study explores the possibility of using the evidence-based Assertive Community Treatment (ACT) model and infrastructure to increase access to primary care and improve cardiometabolic outcomes of people with SMI. Four ACT teams in a large urban area received the services of a primary care consultant who was co-located at a Federally Qualified Health Center (FQHC), met regularly with ACT team clinicians to review a cardiometabolic registry of participants, and engaged participants in primary care services. Health screening rates, primary care utilization, and cardiometabolic outcomes-body mass index, blood pressure, hemoglobin A1c, cholesterol, and tobacco smoking status-were monitored over the course of a year. The efficacy of this integrated care model was also explored through focus groups with ACT team staff and participants. Significant improvements in screening rates were found for the ACT teams that received this integrated care intervention; however, only modest improvements in cardiometabolic outcomes were found. Future longitudinal, multi-site studies are needed to fully determine the impact of integrated care models on the physical health outcomes of this vulnerable population.

Impact of a trainee-led initiative to address PCP prophylaxis barriers.

319 Background: In a prior trainee-led QI initiative, we surveyed clinicians about Pneumocystis pneumonia (PCP) and assessed rates of appropriate prophylaxis. Through retrospective chart review, we found that 47% of eligible patients (n=140/297) received PCP prophylaxis between 5/2022 and 5/2023. Clinician-reported barriers included knowledge gaps, systems-related gaps, and unclear corticosteroid durations. In the current initiative, we built an order set to facilitate PCP prophylaxis prescription and created an automated approach to assess prophylaxis rates. We then re-evaluated perceived barriers to prescribing PCP prophylaxis. Methods: A multidisciplinary team of oncology fellows and QI staff was established at Johns Hopkins. A new PCP prophylaxis order set was implemented on 4/15/2023. An automated data query was developed to identify patients with solid malignancies who were eligible for PCP prophylaxis per ASCO/IDSA guidelines (≥20mg prednisone equivalents daily for ≥1 month). Patient data was collected between 4/15/2022 and 4/15/2024. Surveys were conducted in 5/2023 and 5/2024 to assess prescriber knowledge of, and attitudes toward, PCP prophylaxis. The survey was open to prescribers across oncology specialties. Results: 1,404 patients were eligible for PCP prophylaxis over the 2-year study period, with 19% (n=264) receiving prophylaxis. In the year before the order set, 21% (n=138) of eligible patients were prescribed prophylaxis. In the year after the order set, 17% (n=126) of eligible patients were prescribed prophylaxis. A survey conducted post order set implementation included 52 responses from 42% (n= 22) attending physicians, 35% (n=18) advanced practice providers, and 23% (n=12) residents/fellows. While 92% (n=48) of survey participants had prescribed PCP prophylaxis, 31% (n=16) knew the dose/duration of corticosteroids at which society guidelines recommend prophylaxis. Unclear corticosteroid duration, guideline knowledge, and concern about side-effects were the most commonly reported barriers to prescribing prophylaxis. Conclusions: Compared to the prior chart review approach, the automated query identified more than twice as many patients at risk for PCP. Strikingly, <25% of eligible patients were prescribed PCP prophylaxis. Prescription rates did not improve following implementation of the order set. However, the post order set survey found increased rates of guideline knowledge and identified unclear corticosteroid durations as the primary barrier to prophylaxis. Building on these findings, an additional PDSA cycle is ongoing including development of notification system alerting providers when PCP prophylaxis is recommended for their patients. Barriers to PCP prophylaxis. Barrier Number of Respondents (%) Pre Order Set Number of Respondents (%) Post Order Set Unclear Corticosteroid Duration 8 (11%) 10 (19%) Guideline Knowledge 11 (16%) 7 (13%) Lack of EMR Notification 6 (9%) 2 (4%)

Children’s and adolescents’ views of health and mental health concepts - A qualitative group interview study

BackgroundDefinitions and perceptions of health and mental health have not remained static over time. This is also true for statistics over Swedish children’s and adolescents’ health and mental health status. The majority of Swedish school-aged children and adolescents report good physical health and good life satisfaction. However, there are some warning signs when it comes to children’s and adolescents’ health and mental health status, for instance, an increased overweight or obesity in children and adolescents, as well as a higher proportion reporting psychological problems and stress. There is also a need for knowing more about the younger population’s voices in this matter. The aim was therefore to explore children’s and adolescent’s conceptualizations and perceptions of health in general, and mental health in particular.MethodsOpen semistructured group interviews with 44 Swedish children and adolescents (10–14 years old) recruited from four schools were conducted. The interviews were conducted between April 2022 and January 2023. Data were analyzed with qualitative content analysis.ResultsChildren’s and adolescents’ conceptualizations of health included aspects of both the body and the mind, with a focus on the latter. Mental health was expressed as a state of being, illustrated by various lived experiences of emotions, moods, and thoughts. The social world was ever present in their understanding of health, e.g., through the lenses of social and gender norms.ConclusionsThis study revealed children’s and adolescents’ recognition of health terms and their ability to observe nuances between mental health problems and everyday struggles. The participants discussed mental health problems to a greater extent than positive mental health. An implication of this study is the highlighted need to focus more on mental health promotion in future preventive programs. These findings might potentially influence how school staff and student health teams communicate with children and adolescents about these concepts.

Resisting to Exist and the Subtle Invisible Protest: Six Solution Focused Tactics about Challenging Behaviour

According to Young Minds, ‘everyone gets angry sometimes’. Their website offers a number of de-escalating strategies, including staying calm, managing responses, and setting limits to help young people who most deem resistive. Yet, Young Minds are not alone because such logical advice is ubiquitous in the literature about challenging behaviour despite the fact that in our experience when faced with high states of arousal, most young people tend to act first and deal with the consequences later. It is not that they are stupid or non-caring, but they are human, capable of great feats as well as stupidity. The same is true for any claims that solution focused (SF) conversations can put right the several decades of psychological theory suggesting resistance requires logic and better cognition. By giving the correct thinking skills, young people will walk away from risk, avoid physical confrontation, handle challenging situations like logical thinkers, and generally discount that the process of growing up is part of the challenge. It is with this in mind that over recent years in our current SF practice (with staff group supervision), we have examined the concept of ‘resistance’ and how it can be put to use as a process of collaboration. To do this, we have revisited SF theory that preoccupied many of its pioneers during the 1980s and 1990s and attempted to make it useful for the early 2020s for professionals having conversations with young people, who, in traditional models, are labelled challenging. We want to introduce key differences of solution focused practice and how our research started to formulate a 6D-SF model (details, dynamics, dimensions, dispositions, dislocations, descriptions) for contemplating how groups of professionals relate to each other and are triggered by challenging behaviour. We do not claim to have proof, logic, or exactness on our side, but we are happy to suggest how our resistance mirrors what many of the staff teams feel and describe when working through their work.

Strategies to Mitigate the Pandemic Aftermath on Perioperative Professionalism

This retrospective comparative cohort study aimed to evaluate the effects of COVID-19 on professionalism within the perioperative environment of a tertiary cancer center across three periods: pre-pandemic, pandemic, and an interventional endemic phase. A retrospective observational review of a prospectively maintained safety event report (SER) database at MD Anderson Cancer Center, with an intervention during the COVID-19 endemic phase, was conducted. This was performed to compare the incidence of professionalism-related events (PRE), which are included in the SER database, during the COVID-19 pandemic period (March 2020 to May 2022), with a pre-pandemic period (September 2011 to February 2020) and a postintervention endemic phase (June 2022 to March 2023). Study interventions included the application of the Vanderbilt Professionalism Escalation Model with broad staff and surgical team education. During the study period, 17,425 SERs were reviewed. Of these, 11,731 (mean 115.0 SERs/month) were reported in the pre-pandemic period, 4,004 SERs (mean 148.3 SERs/month) in the pandemic period, and 1,690 SERs (mean 169.0 SERs/month) in the endemic phase (p = 0.001). There was a statistically significant increase in the incidence of PRE during the pandemic compared to the pre-pandemic and endemic periods. Specifically, 264 PRE (1.5%) were identified during the study period: 114 PRE (mean 1.1 PRE/month) in the pre-pandemic period, 121 PRE (mean 4.5 PRE/month) in the pandemic period, and 29 PRE (mean 2.9 PRE/month) in the endemic phase (p = 0.001). The increase in PRE during the pandemic period corresponded to a concomitant increase in staff turnover rates (15.5%) compared to the pre-pandemic period (8.3%). However, a time shift of four months into the postintervention endemic phase demonstrated a successful reduction to less than pre-pandemic levels of staff turnover (6.7%, p = 0.001). The COVID-19 pandemic was associated with a significant increase in SERs describing professionalism lapses among health care providers in the perioperative environment. Hospital organizations must recognize the impact of professionalism on morale and turnover and seek to mitigate its effects. Education, promoting individual accountability, confidential reporting, addressing wellness concerns, and providing modes of resilience can enhance workplace culture and potentially cultivate better employee retention rates.

Reaching adolescents with health services: Systematic development of an adolescent health check-ups and wellbeing programme in Ghana (Y-Check, Ghana).

Routine health check-ups may improve adolescent health, but global guidelines are lacking. Phase 1 of the WHO-coordinated Y-Check Research Programme involved three African cities to co-produce a programme of adolescent health check-ups. We describe a systematic approach to developing a routine adolescent health check-ups and wellbeing programme (Y-Check) to contribute evidence on whether adolescent health check-ups should be part of routine health services in Ghana. Y-Check Phase 1 was conducted in four communities in Cape Coast Ghana, over two stages using a variety of methods: (a) needs assessment and landscape analysis on the health of adolescents (existing policies/programmes, school system, adolescent health conditions) was conducted through desk-review and interviews with key informants to identify the potential content, delivery strategy and settings for adolescent health check-ups in this context; (b) co-designing the Y-Check intervention framework through person-centred participatory workshops and a consensus-building workshop with multiple stakeholders, including adolescents (10-19 years) and their parents. The study was conducted between January 2020 and October 2020. The Y-Check intervention consists of two check-ups with content that is tailored to the needs of younger adolescents and older adolescents; delivered at both school and community settings by a team of trained staff in multiple steps involving up to four stations. Y-Check includes a referral system for adolescents with any problems that cannot be investigated or treated on-the-spot. Our systematic approach to co-producing Y-Check has resulted in an intervention whose content and structure is determined by the local context, and which was adjudged by multiple stakeholders to be likely to be both useful and acceptable, and which builds on best practice. As a logical next step, the Y-Check will be subjected to pilot testing and implementation research to rigorously evaluate the feasibility, acceptability, coverage, yield of previously undiagnosed conditions and cost of these health check-ups.

Aphasia and acute care: a qualitative study of healthcare provider perspectives

ABSTRACT Background Poor communication between patients with aphasia and healthcare providers has many adverse consequences. Training healthcare providers to support communication not only improves skill in communicating with people with aphasia, but also potentially avoids adverse incidents. However, families have reported negative communication experiences for their relatives with aphasia during early acute hospitalization and healthcare providers in acute hospitals have reported multiple barriers to managing people with aphasia. Aims To gather information from healthcare providers about their experiences and needs relative to managing people with aphasia in the acute hospital setting as part of a larger implementation project designed to 1) improve acute care staff communication with patients with aphasia, and 2) help staff provide support to families of people with aphasia. Methods Qualitative methods were employed to gather perspectives of stroke team staff regarding the management of aphasia in early acute care. Methods for collecting data from staff in a large metropolitan hospital in Ontario, Canada included open-ended surveys, observations on acute stroke units, interviews, and focus groups. Data were transcribed and analyzed to identify themes that defined staff experiences and needs relative to caring for people with aphasia in the acute setting. Results The overall finding was that staff found communication and caring for people with aphasia and their families in the acute context to be challenging and frustrating. Themes included identification of the following barriers: fast-paced context with competing priorities; limited staff familiarity with communication access or support; priority given to swallowing by speech-language pathologists; and difficulty in addressing the pressing need to provide support and information to family members of patients with aphasia. In addition, a pervasive need for communication with patients with aphasia as part of staff responsibilities was also identified as a theme. Conclusions Findings demonstrate the need for healthcare systems to support acute care staff in their efforts to provide care for people with aphasia. Finding effective ways to influence system change is a priority and is in line with the rationale for the larger implementation project designed to improve staff and patient/family experiences in acute care.

Organizational characteristics of highly specialized units for people with dementia and severe challenging behavior

BackgroundPeople with dementia and severe challenging behavior in the Netherlands can be temporarily admitted to highly specialized units when their behavior is not manageable in regular dementia special care units (DSCUs). With scarce evidence available for the treatment of these patients, treatment in these units is in a pioneering phase. To gain more insight into these units, this study investigated organizational characteristics, i.e. admission and discharge characteristics, staffing, the physical environment, and the management of severe challenging behavior.MethodsThree data collection methods were used: 1) a digital questionnaire to be completed by the unit manager, 2) an interview with the physician responsible for medical care and often another practitioner, and 3) an observation of the physical environment for which the OAZIS-dementia questionnaire was used. Descriptive analysis was used for quantitative data and thematic analysis for qualitative data, after which data was interpreted together. Thirteen units participated, with their sizes ranging from 10 to 28 places.ResultsPatients were mainly admitted from regular DSCUs, home or mental health care, and discharged to regular DSCUs. A multidisciplinary team comprising at least an elderly care physician or geriatrician, psychologist, and nursing staff member and other therapists as needed provided the treatment. Nursing staff hours per patient considerably differed among units. Nursing staff played a central role in the treatment. Competences such as reflectiveness on one’s own behavior, and being able to cope with stressful situations were described as relevant for nursing staff. Investing in a stable nursing staff team was described as important. The units varied in whether their work-up was more intuitive or methodological. In the diagnostic phase, observation together with an extensive analysis of the patient’s biography was essential. The units used a broad variety of interventions, and all paid attention to sensory stimuli. In the observation of the physical environment, the safety scored well and domesticity relatively low.ConclusionHighly specialized units show strong heterogeneity in organizational characteristics and management, which can be understood in the light of the pioneering phase. Despite this, similarities were found in nursing staff roles, frequent multidisciplinary evaluation, and attention to sensory stimuli.

The Evolving Nature of Threat and Violence Risk Assessment in College Counseling Centers

ABSTRACT This paper examines the historical and current contexts of threat assessment and violence risk in higher education, highlighting the evolving roles of college counseling centers in the threat assessment process for students displaying signs of concerning behaviors. Given research showing many college mental health professionals feel under-prepared for this work, we build foundational knowledge about the differing purposes of psychological evaluations and threat assessments, and provide recommendations for ways to continue to build and demonstrate understanding, competency and proficiency with threat assessments… Our review shares recent updates in the field regarding high-risk groups and the use of AI in assessment, and highlights the need for more attention to be given to training community members as well as counseling center staff and other members of campus teams involved in decision-making about students who threaten violence. We recommend the deliberate practice model of skill building to better prepare college mental health professionals when needing to respond under stress and pressure.

Exploring staff experiences of remote working in a new community rehabilitation team

Background/Aims Health services required significant adaptation during the COVID-19 pandemic. The remote community enhanced rehabilitation team was created during the pandemic in response to faster discharges. This service evaluation aimed to explore staff experiences of remote working when implementing this new community rehabilitation team. Methods Six members of the community enhanced rehabilitation team, including nursing and psychology staff, completed qualitative semi-structured interviews about staff experiences. The interviews explored experiences of delivering clinical care, providing and receiving team support and personal impacts of remote working. Data were analysed using thematic analysis via a critical-realist approach. Results Thematic analysis from the interview transcripts revealed five main themes: anxiety related to remote working practices during a global pandemic, work–life balance, developing relationships, limits to remote working and working towards a hybrid model. Conclusions Challenges and benefits of remote working were identified along with some mitigations. Moving forward, a hybrid working model would likely benefit both service users and staff.

Intraday Variation of Ankle Dorsiflexion in Short-Track Speed Skaters.

Optimal ankle dorsiflexion range of motion plays a vital role in attaining the essential crouched posture necessary for excelling in speed skating. The purpose of this study was to determine how the ankle dorsiflexion angle evolves throughout a day of training and to identify the factors that influence this angle. Thirty short-track speed skaters, from 2 teams, participated in this study. The maximum ankle dorsiflexion angle was obtained in a lunge position facing a wall, using a digital inclinometer. All measures were obtained 3 times per side, 6 times per day, on 2 training days separated by at least a week. We conducted multiple tests to study the impact of repetition, day, side, team level, sex, and moment on the ankle dorsiflexion angle. The 3 times repeated measures and the 2days of training did not have a significant influence on the results. There was a statistically significant difference between the first time point of the day and the 5 other time points for both ankles. Moreover, the influence of sex and team level was not statistically significant. The results indicate that there are significant changes in ankle dorsiflexion range of motion but only after the first warm-up of the day. Such findings could enable team staff to enhance athletes' precompetition preparation and tailor ankle mobility training regimens more effectively.