Clinical Staff Working Research Articles

Supporting staff wellbeing in healthcare settings through multi-levelled creative psychological intervention – a feasibility study

ABSTRACT Background There is growing evidence that the arts and arts-based therapies can support the wellbeing of healthcare workers. However, there are few large trials, limiting the use of such therapies in routine practice. Aim To establish the feasibility of introducing a multi-levelled, evidence-based creative psychological intervention delivered by qualified arts psychotherapists and targeting the wellbeing of NHS clinical staff. Methods This is a feasibility study with pre/post mixed methods design, the first to explore the value of an evidence-based, multi-levelled creative psychological package targeting the diverse needs of clinical staff within different healthcare settings. The intervention wasadapted from a 12-session group therapy titled Arts for the Blues into a three-level package that included: (i) one-off drop-in sessions to release tension, (ii) workshops for staff development, (iii) group sessions for psychological support. It was delivered by qualified arts psychotherapists (i.e., art, drama and dance movement psychotherapists) and used brief evaluation forms, arts-based data and standardised outcome measures to establish acceptability. Results Findings indicate difficulties with recruitment, but the 49 participants placed high value on the different levels offered. All the outcome measures used identified positive change and indicated medium to large effects of the multi-levelled intervention on improvement of wellbeing and resilience, as well as reduction of distress, anxiety, depression and trauma. Conclusions Although the small sample does not allow the generalisation of results, the study suggests that this multi-levelled creative psychological intervention offers acceptable support. Implications for practice/policy/research Further research is needed to establish the effectiveness of this intervention with specific teams of professionals. However, the diverse options proposed in this intervention need to be considered further for routine practice, expanding on current job descriptions for art psychotherapists. Plain-language summary Pressures on healthcare services mean that healthcare workers need support for their wellbeing. It is possible that the arts and arts therapies can offer this support, but we need to conduct more research to be certain. In this study we wanted to see if clinical staff working in health services liked a new creative intervention we developed based on our review of the research literature. We modified this intervention from the Arts for the Blues model, a 12-session group therapy that uses a mixture of different artistic forms. We used this new model to support the wellbeing of clinical staff in a large hospital in the North West of England. We did this in three different ways: Creative activities for the whole organisation to release tension (up to 30 min) Creative psychoeducational workshops with teams for staff development (up to 4 h) Creative psychotherapy sessions with individuals in a group for psychological support (up to 18 h). Arts psychotherapists, including art psychotherapists, designed the content of this work and facilitated their delivery. We collected information from 49 clinical staff before and after each of these activities through questionnaires and a brief evaluation form. Although clinical staff were very busy, they liked the different options of the intervention and their wellbeing scores improved. We need to do further research with a larger number of participants. However, the findings so far show that art psychotherapists can work not only with patients, but also with other healthcare workers to improve their wellbeing.

Primary care and abortion provider perspectives on mail-order medication abortion: a qualitative study

BackgroundThis qualitative study aims to assess perspectives of clinicians and clinic staff on mail-order pharmacy dispensing for medication abortion.MethodsParticipants included clinicians and staff involved in implementing a mail-order dispensing model for medication abortion at eleven clinics in seven states as part of a prospective cohort study, which began in January 2020 (before the FDA removed the in-person dispensing requirement for mifepristone). From June 2021 to July 2022, we invited participants at the participating clinics, including six primary care and five abortion clinics, to complete a semi-structured video interview about their experiences. We then conducted qualitative thematic analysis of interview data, summarizing themes related to perceived benefits and concerns about the mail-order model, perceived patient interest, and potential barriers to larger-scale implementation.ResultsWe conducted 24 interviews in total with clinicians (13 physicians and one nurse practitioner) and clinic staff (n = 10). Participants highlighted perceived benefits of the mail-order model, including its potential to expand abortion services into primary care, increase patient autonomy and privacy, and to normalize abortion services. They also highlighted key logistical, clinical, and feasibility concerns about the mail-order model, and specific challenges related to integrating abortion into primary care.ConclusionClinicians and clinic staff working in primary care and abortion clinics were optimistic that mail-order dispensing of medication abortion can improve the ability of some providers to provide abortion and enable more patients to access services. The feasibility of mail-order pharmacy dispensing of medication abortion following the Supreme Court Dobbs decision is to be determined.Trial registrationRegistry: Clinicaltrials.gov. Trial registration number: NCT03913104. Date of registration: first submitted on April 3, 2019 and first posted on April 12, 2019.

Yemeni Physicians' Attitudes and Perceived Barriers Toward Ward-Based Clinical Pharmacist in Hospital Settings.

Clinical pharmacy services (CPSs) are still in their infancy in Yemen. Furthermore, pharmacists are not members of a multidisciplinary healthcare team, so their responsibilities are limited to drug dispensing and marketing. This study examines physicians' attitudes and perceived obstacles regarding the inclusion of clinical pharmacists in hospital medical wards. A descriptive observational study was carried out using a validated, self-administered bilingual questionnaire. The study's questionnaire was conducted among physicians in three leading hospitals. Those hospitals were at the forefront of establishing clinical pharmacy units and embracing clinical pharmacy services. Data were analyzed using descriptive statistics. Sixty-five responses were included. Our data results indicated that physicians believed the most important contributions for clinical pharmacists to improve patient care were "attending medical rounds", followed by "order review". About 75% of physicians showed positive attitudes toward the clinical pharmacist role. However, more than 70% of physicians believed that clinical pharmacists should leave patient care to other healthcare professionals and focus on drug products. Not enough clinical pharmacist staff working in the health center was considered the top perceived barrier (83.1%), followed by "clinical pharmacist responsibilities were not clearly defined" and "clinical pharmacist recommendations are not properly documented". Strategies to expand clinical pharmacy services in Yemen should focus on several key areas. Protocols must be established to clearly outline the collaboration between clinical pharmacists and physicians. Additionally, fostering inter-professional relationships is crucial to overcoming resistance and increasing awareness and understanding of CPS adoption among healthcare team members.

Healthcare staff’s perspectives on long-acting injectable buprenorphine treatment: a qualitative interview study

BackgroundLong-acting injectable buprenorphine (LAIB) formulations are a novel treatment approach in opioid agonist treatment (OAT), which provide patients with a steady dose administered weekly or monthly and thus reduce the need for frequent clinic visits. Several studies have analyzed patient experiences of LAIB but the perspective of OAT staff is unknown. This study aimed to explore how healthcare staff working in OAT clinics in Sweden perceive and manage treatment with LAIB.MethodsIndividual qualitative interviews were conducted with OAT physicians (n = 10) in tandem with nine focus group sessions with OAT nurses and other staff categories (n = 41). The data was analyzed with thematic text analysis.ResultsFive central themes were identified in the data: (1) advantages and disadvantages of LAIB, (2) patient categories that may or may not need LAIB, (3) patients’ degrees of medication choice, (4) keeping tabs, control and treatment alliance, and (5) LAIB’s impact on risk and enabling environments in OAT. Overall staff found more advantages than disadvantages with LAIB and considered that patients with ongoing substance use and low adherence were most likely to benefit from LAIB. However, less frequent visits were viewed as problematic in terms of developing a treatment alliance and being able to keep tabs on patients’ clinical status. Clinics differed regarding patients' degrees of choice in medication, which varied from limited to extensive. LAIB affected both risk and enabling environments in OAT.ConclusionsLAIB may strengthen the enabling environment in OAT for some patients by reducing clinic visits, exposure to risk environments, and the pressure to divert medication. A continued discussion about the prerequisites and rationale for LAIB implementation is needed in policy and practice.

Reviewing the Awareness of Mental Health Staff of the Possible Visual Side Effects of Antipsychotic Medications

Objective: A staff awareness project was undertaken in order to assess the awareness of clinical staff working in a UK community psychiatry practice of the visual side effects of antipsychotic medications. Study Design: A staff questionnaire was provided to assess baseline knowledge of the visual side effects of antipsychotic medication (the First Questionnaire). Subsequently, a short information sheet was provided regarding the visual side effects of antipsychotic medications. A Second Questionnaire for clinical staff was provided to assess reflections on knowledge gained. Results: 100% of respondents to the Second Questionnaire found the information sheet informative in refreshing or providing knowledge. 100% of the respondents to the Second Questionnaire also found the information sheet had improved their knowledge of the impact of antipsychotic on vision, and how it can be managed. 100% of respondents stated the information provided would influence their care of patients on antipsychotics and how they might approach care. Conclusion: Antipsychotic medications can cause ocular complications and visual side effects. Staff and patient education regarding these potential side effects can help promote patient safety.

Attitudes and perceptions of nursing staff working in psychiatric clinics and psychosocial rehabilitation structures regarding involuntary hospitalization

Involuntary hospitalization for the treatment of patients with psychiatric disorders is a necessity in modern scientific psychiatric practice. Hospitalization, in general, of the mentally ill is an important and complex issue. The purpose of this study is to investigate the attitudes and perceptions of nurses working in the psychiatric field regarding involuntary hospitalization. In order to achieve this, a questionnaire on "Attitudes and perceptions of nursing staff working in psychiatric clinics and psychosocial rehabilitation structures regarding involuntary hospitalization" was created as a research tool. Results were analyzed with the IBM Statistical Package for Social Sciences (SPSS), version 25.0. The results showed that the opinions of the respondents are consistent with those resulting from surveys, both in Greece and abroad. The majority agree with the process of involuntary hospitalization, while staff in psychiatric units are knowledgeable about the legislation governing this type of hospitalization. In conclusion, it is necessary to investigate the legal framework that governs involuntary hospitalization in Greece, as well as the conditions that prevail in the hospitals that accept such cases.

Experiences of clinical staff who work with patients who self-harm by ligature: An exploratory survey of inpatient mental health service staff.

Self-harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self-harm. Most fatal and non-fatal suicidal behaviours in inpatient settings are a result of ligature use. There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self-harm by ligature. Key issues related to self-harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self-harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self-harm by ligature. Working with self-harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self-harm by ligature, and unsupported after responding to a ligature incident. Training about self-harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self-harm, and acknowledgement of the emotional impact on staff. Support for staff members who respond to ligature incidents should be available for all staff members who respond to self-harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. INTRODUCTION: Self-harm by ligature is a common form of self-harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self-harm. We explored the experiences of clinical staff who work with patients who self-harm by ligature. A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. 275 staff members participated. Challenges most frequently reported about working with self-harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self-harmed by ligature. There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self-harm by ligature.

Prevalence of sexual harassment among female medical staff in four Khartoum State tertiary hospitals.

workplace harassment is hypothesized to cause a psychological impact on the welfare of the individual. The aim of this study is to estimate the prevalence of sexual harassment among female medical staff in Khartoum state tertiary hospitals. this is a cross-sectional hospital-based study in hospitals of Khartoum, Omdurman and North Khartoum. Our study population comprised female medical staff working in the outpatient clinics, emergency clinics, referred clinics and wards. The data was collected by online Google form self-administered questionnaire. The first part includes demographic information. The second part involved information regarding sexual harassment. The third part obtained information about the psychological status (effect) after harassment. The questionnaire was adopted and utilized from previous studies. in this study, 325 participants were recruited. Among the participants, 51.4% were doctors, majority (81.2%) of the study population were single. The mean age was 26.29 and SD 3.865. Forty percent (40%) stated they had been sexually harassed at work. Forty-five percent (45%) reported the harassment occurred more than 3 times and 46.4% reported loss of desire for work. Action taken for investigation was only reported by 5.4%. The logistic regression revealed that female doctors were 1.45 times more prone to sexual harassment. Also, medical staff with low socioeconomic status were 83.2% chance not sexually harassed. the prevalence of sexual harassment among female medical staff was high. Doctors were more vulnerable to sexual harassment. And, the reported incidents were scarce.

Insomnia in cancer patients - A survey of health-care professionals' views and current practice in Romania.

Changes in the quality of sleep are reported often in cancer patients and have a major impact on general health. However, insomnia tends to be insufficiently evaluated and managed. The aim of the study was to analyze the perception of clinical staff working in oncology units regarding patients' sleep disorders. Furthermore, we assessed the prevalence of insomnia in this category of professionals. The study was cross sectional and used a descriptive and correlational design. Clinical personnel working in oncology departments were invited to complete a questionnaire regarding sleep problems in patients, and optionally, the Pittsburgh sleep quality index questionnaire was administered. Correlations between age, profession, experience, and their responses were statistically analyzed. We gathered 101 responses, with 63.4% coming from doctors. With one exception, all professionals observed changes in sleep patterns in patients, but less than a third were actively looking for these problems and only three health professionals used questionnaires. No significant differences in answers were noted based on age, profession, or experience. Regarding professionals, 45.6% of them had impaired sleep based on the Pittsburgh questionnaire results. Oncology staff are aware of the existence and impact of sleep problems, but active assessment for sleep problems is low. There is a relative high prevalence of poor sleep quality among oncology staff. In order to improve the well-being of patients, the quality of sleep should be documented as part of the care plan. The existence of guidelines is desirable.

What Nephrologists Should Know about the Use of Continuous Glucose Monitoring in Type 2 Diabetes Mellitus Patients on Chronic Hemodialysis

Patients with type 2 diabetes (T2D) and end-stage kidney disease (ESKD) on renal replacement therapy represent a specific population with high morbidity and mortality, an increased risk of hypoglycemic episodes and large intra- and interdialysis glycemic variability. Antidiabetic treatment adjustment is therefore challenging, especially in insulin-treated patients. Continuous glucose monitoring (CGM) is increasingly proposed to T2D patients on hemodialysis (HD), although data regarding flash monitoring systems (FMSs) and real-time CGM (rtCGM) in HD patients are limited. Small CGM pilot studies of a short duration demonstrated improvements in glycemic control and decreased hypoglycemic events, despite a lower accuracy of CGM as compared to capillary blood glucose. Moreover, CGM–drug interactions with vitamin C, mannitol and paracetamol can occur in HD diabetic patients and need further study. Despite these shortcomings, professional CGM has the potential to become an integral part of glucose monitoring of HD patients treated with insulin. Personal CGM prescriptions can especially be useful in highly selected, motivated T2D HD patients on multiple daily insulin injections or experiencing frequent hypoglycemia with preserved diabetes self-management abilities or in whom diabetes is fully managed by medical providers. A close collaboration between the clinical staff working on HD units and diabetology teams, and ongoing patient education, are mandatory for optimal use of CGM.

Challenges in managing a remote monitoring device clinic.

BackgroundRecent advances in remote cardiac monitoring technology have created new challenges for clinicians and staff working in device clinics who are left processing large volumes of data. Often, this process is fractured and inefficient, with occurrence of unnecessary alerts that strain staff time and resources.ObjectiveThe purpose of this survey was to identify challenges allied health professional clinicians and staff encounter when managing a remote monitoring device clinic.MethodsA 27-item mixed methods survey was developed using a Qualtrics-encrypted, anonymous Web survey tool. Demographic information and questions rating satisfaction level for remote device clinic issues were obtained using a 5-point Likert scale. Three open-ended questions were included that addressed challenges and successes in managing a remote monitoring clinic and served as a method for identifying common themes.ResultsMajor themes identified were poor connectivity, staffing issues, and large volume of alerts. Approximately 50% of respondents were either satisfied or unsatisfied with issues surrounding managing remote monitoring device clinics. Strategies for success included optimizing alerts, assigning designated staff, and partnering with third-party platforms.ConclusionThis survey confirms these issues as an opportunity for industry and digital health leaders to determine best practices for incorporating these technologies into patient care.

Subjective symptoms of SMFs and RF energy, and risk perception among staff working with MR scanners within two public hospitals in South Africa

ABSTRACT This study assessed subjective symptoms associated with exposure to static magnetic fields (SMFs) and radiofrequency (RF) energy, and perceived safety risk of scanners among magnetic resonance (MR) staff working in the 1.5 and 3 T MRI units. A questionnaire survey was completed by 77 clinical imaging staff working in two hospitals (A and B) in the Mangaung metropolitan region. 50 participants working with the MR scanners were regarded as exposed group and 27 participants from CT scan and X-ray departments were classified as control group. The study comprised 57% females and 43% male participants with an average MRI experience of 5.4 years. Using logistic regression, tinnitus was significantly different between various job titles (p< .034) and it was reported more often (OR 8:00; CI 1.51, 15.17) by those who worked on a 3 T scanner. Increased years of MRI experience was a significant predictor of headache (p< .05), and reporting of nausea was significantly different between various job titles (p < .01). There was an increased risks of reporting vertigo often among female participants (OR: 4.43; CI 0.91, 21.47), those with 5–15 years of MRI experience (OR: 2.09; CI 0.47, 9.34), and those with a light to moderate workload (OR: 2.70; CI 0.49, 14.86). Using linear regression, presence in zone IV during image acquisitioning was the only significant predictor for the sensation of glowing (p < .000). Movement of head/ upper body in the scanner bore was a significant predictor of nausea (p< .026), vertigo (p< .014), instability when standing (p< .014), and a metallic taste (p< .031). There was no correlation between reporting of symptoms and perceived risk of scanners. However, shift duration (rs = 0.576), movement of head/upper body in the scanner bore (rs = 0.424), and strength of the scanners (rs = 0.299) were significantly correlated with perceived risk of scanners. MRI safety training and a comprehensive occupational health and safety program are necessary.

Value-based leadership in turbulent times: lessons from the Corona crisis and recommendations for post-pandemic management in the health sector

The Corona crisis not only exposed the causes of supply disruptions for system-critical medical products and pharmaceuticals, and made the consequences of the digitalization gap in the health care system transparent, but in particular, revealed the consequences of fundamental leadership deficits in hospital personnel management, professional profiles and ethics, professional policies, and procurement management. However, Corona has also triggered a rethinking of the values, meaning and purpose of work content and behavioral norms. This paper aims to identify and analyse management failures observed and experiences made during the Corona pandemic. Based on these findings recommendations for good leadership practices are given. By literature research reported experiences from physicians and nurses were analysed related to working conditions, motivation-to-work, and satisfaction with incentive systems. Furthermore, interviews with clinical staff working under Corona conditions were realised based on a structured questionnaire. The workload of nursing has increased significantly due to economization: from 2005 to 2017, the number of treatment cases increased by 12%, while at the same time, the number of beds decreased by 9.4% and the length of stay shortened from 8.4 to 7.3 days. The accumulated nursing overtime in German hospitals alone is equivalent to 17,800 full-time employees. During the Corona crisis the working situation especially for nurses facilitating patients ventilated on the intensive care unit has dramatically worsened: additional overtime, high patient mortality, resource-intensive and stressful care requirements lead to prostration and mental exhaustion. As a consequence of this tremendous work burden for nurses and physicians during the Corona pandemic up to 30% of these occupational groups gave voice to inadequate working conditions and utter their intention to quit their jobs. Demotivation and a flight into professions remote from medicine are a reaction of many physicians and nurses to years of leadership failures in hospitals and politics, as well as an increasing economization of medicine. Between 68 and 82% of physicians cite the cost pressure associated with rationing as a source of dissatisfaction with their professional situation. It is up to management to learn from these findings, implement the necessary measures and provide family-friendly working conditions for occupational groups working “at the bed-side”. A “value-based leadership model” that takes into account the specific conditions prevailing in the healthcare industry was developed and serves as a compass in meeting and overcoming this challenge. This paper transfers practical experiences made during the Corona pandemic and pertaining to motivation-to-work under stressful working conditions, the meaning of “purpose”, the try-out of so far unknown working practices and types of inter-occupational co-operation into a leadership model that is unique for the health care sector.

Hematology Patient Explorer - an Informatics Infrastructure and Web Application Empowering Clinicians and Researchers to Use Electronic Health Record Information to Identify Clinical Cohorts of Interest

Introduction: The widespread adoption of electronic health records (EHR) in the US (Adler-Milstein and Jha 2017) presents an opportunity to transform healthcare into rapidly learning health organizations and systems (Etheredge 2007; Abernethy et al. 2010) that use routinely collected clinical data in the course of care to generate evidence, address information disparities in patients underrepresented in clinical trials, such as those who are older, belong to ethnic minorities, or are in medically underserved areas, and continuously improve the quality of care delivered.(Rivera et al. 2019; Penberthy, Rivera, and Ward 2019) Unfortunately, this potential remains largely unrealized due to deficiencies in EHR interoperability (Holmgren, Patel, and Adler-Milstein 2017) and usability.(Dunn Lopez et al. 2021) EHR information remains largely unstructured due to the nature of the patient-clinician interaction and current user interfaces where structured data entry is burdensome.(Khairat et al. 2019) At the University of Utah Huntsman Cancer Institute division of Hematology, clinicians as well as clinical and translational researchers often need detailed information on patients seen at the cancer center to plan and conduct research and evaluate and improve the quality of care delivered. Previous efforts to address these needs relied on a clinical data science and health informatics staff working with clinicians to identify patient cohorts of interest. As part of an effort to improve the efficiency of this service, decrease the latency in information provision, and serve a larger number of clinicians and researchers, we designed and implemented a highly usable, scalable, health information technology solution that allows clinicians and researchers to identify, in near real time, cohorts of interest, based on patient and disease characteristics.Methods: Common information needs at the division were assessed by identifying key stakeholders, including division leadership, clinicians, researchers, and health informatics leadership and staff. A team was formed to include overlapping expertise in Hematology, clinical informatics and data science, and prior experience in extraction of clinical information from EHR data warehouses to generate evidence on patient practices and outcomes. Information sources and architectures were evaluated on their comprehensiveness, validity, extensibility, and ability to integrate multiple data sources. A modern web-based interface was designed to mirror the steps clinicians and clinical researchers frequently used to identify cohorts of interest, provide guidance for these users, and generate population level and patient level information. Usability testing included rounds of initial internal testing, followed by a round of closed beta testing.Results: A data lake architecture was implemented to ingest, harmonize and stage information from various data sources, including the Enterprise Data Warehouse, Tumor Registry, and other data silos. Data cleaning and harmonization was done using Python. A web application using ‘Dash’ was implemented with four steps split into four consecutive panes. The first two focused on cohort identification using diagnosis (first pane), and patient and disease characteristics (pane 2). Users first input keywords that allow them to identify diagnoses of interest based on ICDO-3 codes. Users can select multiple codes at this stage. In the next step, users can filter down their cohort based on patient and disease characteristics, such as sex, age, year of initial diagnosis, grade and stage of disease, and others. Once all desired refinements to the pilot cohort are made, users move on to the third tab, which displays customizable population level information, such as number of diagnoses by year, sex, or age. Finally, the fourth tab presents individual level data such as Patient Medical Record Numbers, age, or ICDO-3 diagnosis descriptions. Based on this output, users can return to the initial selection criteria and adjust them. Users are able to download or export selection criteria and query results for future work.Conclusion: We describe the process, roles, and informatics infrastructure and tools to implement a web interface that allows clinicians and researchers to leverage EHR information to identify cohorts of patients for research and quality improvement. Further research will focus on tool usability and scope. DisclosuresDeininger: Sangamo: Consultancy, Membership on an entity's Board of Directors or advisory committees; Fusion Pharma, Medscape, DisperSol: Consultancy; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Part of a Study Management Committee, Research Funding; SPARC, DisperSol, Leukemia & Lymphoma Society: Research Funding; Novartis: Consultancy, Research Funding; Incyte: Consultancy, Honoraria, Research Funding; Blueprint Medicines Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Part of a Study Management Committee, Research Funding.

Designing and validating a questionnaire on oral health care knowledge, attitude, and practice of dental staff

Objective: This study aimed to design a valid questionnaire to evaluate knowledge, attitude, and practice (KAP) of Mashhad Dental school staff about oral health care and to assess the validity and reliability of this instrument. Methods: The "Dental Staff Awareness of Oral Health Care” (DSAOHC) was divided into three concepts; knowledge, attitude and practice. Ten experts of Mashhad Dental School contributed to design the questionnaire and assessed the face and content validity (I-CVI and S-CVI/AV) in two rounds. The necessity of each item was evaluated according to Lawshe’s Content Validity Ratio (CVR). Construct validity, internal consistency, and reliability were assessed using confirmatory factor analysis, homogeneity coefficients, and test-retest by distributing the instrument among 207 dental staff working in other dental schools and private clinics. &nbsp;&nbsp; Results: Based on the acceptable results of I-CVI, S-CVI/AV (&gt;0.7), and CVR (&gt; 0.62), the final version of DSAOHC was approved with 34 questions, including 10 questions about background information, 8 questions for the knowledge, 5 questions for attitude and 11 questions related to practice. Cronbach's&nbsp;alpha&nbsp;coefficients&nbsp;were&nbsp;acceptable for&nbsp;all&nbsp;domains. The RMSEA criterion was ≤ 0.05 and its upper band confidence interval (CI 90%) was ≤ 0.1. Also, CFI indicated the suitability of the model (the desired value of CFI&gt; 0.9). Inter-Class Correlation/ICC revealed the appropriate measure (ICC=0.998). Conclusion: The measures showed that this instrument is valid and reliable, also culturally adjusted to and acceptable for this community. It may adequately evaluate staffs’ knowledge, attitude, and practice toward oral health.

Rapid Changes in the Provision of Rehabilitation Care in Post-Acute and Long-Term Care Settings During the COVID-19 Pandemic

ObjectivesLittle is known about how the COVID-19 pandemic has affected rehabilitation care in post-acute and long-term care. As part of a process to assess research priorities, we surveyed professionals in these settings to assess the impact of the pandemic and related research needs. DesignQualitative analysis of open-ended survey results. Setting and Participants30 clinical and administrative staff working in post-acute and long-term care. MethodsFrom June 24 through July 10, 2020, we used professional connections to disseminate an electronic survey to a convenience sample of clinical and administrative staff. We conducted an inductive thematic analysis of the data. ResultsWe identified 4 themes, related to (1) rapid changes in care delivery, (2) negative impact on patients’ motivation and physical function, (3) new access barriers and increased costs, and (4) uncertainty about sustaining changes in delivery and payment. Rapid changes: Respondents described how infection control policies and practices shifted rehabilitation from group sessions and communal gyms to the bedside and telehealth. Negative impact: Respondents felt that patients’ isolation, particularly in residential care settings, affected their motivation for rehabilitation and their physical function. Access and costs: Respondents expressed concerns about increased costs (eg, for personal protective equipment) and decreased patient volume, as well as access issues. Uncertainty: At the same time, respondents described how telehealth and Medicare waivers enabled new ways to connect with patients and wondered whether waivers would be extended after the public health emergency. Conclusions and ImplicationsSurvey results highlight rapid changes to rehabilitation in post-acute and long-term care during the height of the COVID-19 pandemic. Because staff vaccine coverage remains low and patients vulnerable in residential care settings, changes such as infection precautions are likely to persist. Future research should evaluate the impact on care, outcomes, and costs.

Staff stress and burnout in a community adult mental health service.

Burnout has been associated with medical errors and low levels should be considered an indicator of service quality. This study examined the level of personal, work and client-related burnout in medical, other clinical and non-clinical staff in an adult community mental health service. An anonymous study-specific questionnaire was designed and circulated to all staff with an explanatory document. The Copenhagen Burnout Inventory was used as a validated measure of burnout, with high levels reflecting high rates of stress and burnout. Further questions were added from Maslach Burnout Inventory and effort-reward imbalance index. Information on demographics, job satisfaction, turnover intention, feeling valued and effort/reward balance was gathered and analysed. The overall response rate was 47.4% (63/133), of whom 43 were clinical staff. Overall levels of burnout were low and similar across staff type, with only 30.1% showing moderate levels of burnout, and none in the 'high-burnout' category. All staff displayed positive disposition towards patients, with lower client burnout, as compared to personal and work-related burnout. All medical staff felt valued in their work, with lower rates in the other groups (48.7% of non-medical clinicians and 58.3% of non-clinical staff). Relatively low levels of overall burnout were reported among clinical and non-clinical staff working in our adult mental health service. These rates are similar to the levels identified in a national study of burnout in Irish hospital doctors but lower than the levels found among consultants in Irish child and adolescent mental health services.

Epidemiology Characteristics of COVID-19 Infection Amongst Primary Health Care Workers in Qatar: March-October 2020.

Background: COVID-19 transmission was significant among Healthcare workers worldwide. In March 2020, Qatar started reporting numbers of COVID-19 positive cases among workers in Primary Health Care Corporation (PHCC). The study estimates the burden of the aforementioned infections and examines the demographic characteristics associated with the recorded positivity rates.Method: A cross-sectional descriptive study was conducted among Primary healthcare workers between March 1st and October 31st, 2020. The study examined the positivity rate of the different types of Primary healthcare workers and, analyzed the demographic characteristics of the infected persons.Results: 1,048 (87.4%) of the infected Health Care Workers (HCWs) belonged to the age group below 45 years, and 488 (40.7%) HCWs were females. 450 (37.5%) were HCWs clinical staff working in one of the 27 PHCC Health Centers (HCs) Despite the increased patient footfall and risk environment, the COVID dedicated HCs had an attack rate of 10.1%, which is not significantly different from the average attack rate of 8.9% among staff located in other HCs (p = 0.26). Storekeepers, engineering & maintenance staff, housekeeping staff, support staff, and security staff (outsourced non-clinical positions) had the highest positivity rates, 100, 67.2, 47.1, 32.4, and 29.5% respectively.Conclusion: The elevated risk of infection among outsourced non-clinical healthcare workers can be explained by environmental factors such as living conditions. Furthermore, better containment within clinical healthcare workers can be attributed to strict safety training and compliance with preventative measures which is recommended to be implemented across all settings.

Perspectives of Trial Staff on the Barriers to Recruitment in a Digital Intervention for Psychosis and How to Work Around Them: Qualitative Study Within a Trial.

BackgroundRecruitment processes for clinical trials of digital interventions for psychosis are seldom described in detail in the literature. Although trial staff have expertise in describing barriers to and facilitators of recruitment, a specific focus on understanding recruitment from the point of view of trial staff is rare, and because trial staff are responsible for meeting recruitment targets, a lack of research on their point of view is a key limitation.ObjectiveThe primary aim of this study was to understand recruitment from the point of view of trial staff and discover what they consider important.MethodsWe applied pluralistic ethnographic methods, including analysis of trial documents, observation, and focus groups, and explored the recruitment processes of the EMPOWER (Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-being, Engagement, and Recovery) feasibility trial, which is a digital app–based intervention for people diagnosed with schizophrenia.ResultsRecruitment barriers were categorized into 2 main themes: service characteristics (lack of time available for mental health staff to support recruitment, staff turnover, patient turnover [within Australia only], management styles of community mental health teams, and physical environment) and clinician expectations (filtering effects and resistance to research participation). Trial staff negotiated these barriers through strategies such as emotional labor (trial staff managing feelings and expressions to successfully recruit participants) and trying to build relationships with clinical staff working within community mental health teams.ConclusionsResearchers in clinical trials for digital psychosis interventions face numerous recruitment barriers and do their best to work flexibly and to negotiate these barriers and meet recruitment targets. The recruitment process appeared to be enhanced by trial staff supporting each other throughout the recruitment stage of the trial.

A health worker knowledge, attitudes and practices survey of SARS-CoV-2 infection prevention and control in South Africa

BackgroundHealth workers are crucial to the successful implementation of infection prevention and control strategies to limit the transmission of SARS-CoV-2 at healthcare facilities. The aim of our study was to determine SARS-CoV-2 infection prevention and control knowledge and attitudes of frontline health workers in four provinces of South Africa as well as explore some elements of health worker and health facility infection prevention and control practices.MethodsA cross-sectional study design was utilised. The study population comprised both clinical and non-clinical staff working in casualty departments, outpatient departments, and entrance points of health facilities. A structured self-administered questionnaire was developed using the World Health Organization guidance as the basis for the knowledge questions. COVID-19 protocols were observed during data collection.ResultsA total of 286 health workers from 47 health facilities at different levels of care participated in the survey. The mean score on the 10 knowledge items was 6.3 (SD = 1.6). Approximately two-thirds of participants (67.4%) answered six or more questions correctly while less than a quarter of all participants (24.1%) managed to score eight or more. A knowledge score of 8 or more was significantly associated with occupational category (being either a medical doctor or nurse), age (< 40 years) and level of hospital (tertiary level). Only half of participants (50.7%) felt adequately prepared to deal with patients with COVD-19 at the time of the survey. The health workers displaying attitudes that would put themselves or others at risk were in the minority. Only 55.6% of participants had received infection prevention and control training. Some participants indicated they did not have access to medical masks (11.8%) and gloves (9.9%) in their departments.ConclusionsThe attitudes of participants reflected a willingness to engage in appropriate SARS-CoV-2 infection prevention and control practices as well as a commitment to be involved in COVID-19 patient care. Ensuring adequate infection prevention and control training for all staff and universal access to appropriate PPE were identified as key areas that needed to be addressed. Interim and final reports which identified key shortcomings that needed to be addressed were provided to the relevant provincial departments of health.