Staff Working Research Articles

External Factors Influencing the Motivation and Performance of Staff in Their Nutritional Work With AdultsWith Intellectual Disabilities.

Staff working in municipal care homes with adults with intellectual disabilities impact their diet significantly. To explore how external factors influence staff's motivation and performance of nutritional work with these residents. Semi-structured qualitative interviews with 11 staff using systematic text condensation for analysis. Five main themes were revealed: Need for the implementation of the official nutritional guidelines, lack of nutritional skills and knowledge, prioritisation of nutritional work tasks, staff's ethical dilemmas with the different legislations and management anchoring and collaboration. Implementing systematic nutritional routines and clarifying nutritional work in practice were emphasised to promote continuity and better cooperation among the staff. This, and the need for increased nutritional competence in the municipality organisation, adequate framework conditions for nutritional work and practical and pedagogical measures for nutritional tasks, were crucial factors for staff's motivation, performance, consistency and equality in nutritional practice.

Authentic Nursing Leadership and Safety Climate Across Hospital Settings During the COVID-19 Pandemic: A Cross-Sectional Study.

To analyse the relationship between authentic nursing leadership and safety climates across hospital settings during the COVID-19 pandemic. Authentic nursing leadership shapes the safety climate by fostering positive perceptions of workplace policies, processes, procedures and practices that influence how safety is prioritised and addressed within an organisation. A cross-sectional study. Our study was conducted from December 2021 to December 2022 in six Brazilian hospitals. Participants were nursing staff working in General Medicine Units, Intensive Care Units (ICU) and Emergency Departments (ED) who provided care to patients with COVID-19. The Authentic Leadership Questionnaire and the Safety Attitudes Questionnaire were used to measure nursing staff perceptions of authentic leadership and safety climates. Data were analysed using descriptive and inferential statistics. 391 nursing staff across six hospitals participated. Self-awareness significantly enhanced perceptions of the safety climates. Additionally, being a Registered Nurse and working in the ICU were positively associated with achieving safe climates in the working environment. In contrast, working in EDs was significantly negatively related to safety climates. The COVID-19 pandemic underscored a lack of authentic nursing leadership and unsafe climates. Therefore, it is critical to implement educational strategies that foster authentic leadership, particularly focusing on self-awareness, to promote more positive safety climates. Ensuring that leadership and safety climates are relationship-focused is critical to enhancing patient outcomes. Nursing staff's perceptions of authentic leadership and safety climates are important in making more informed decisions about patient management. Since self-awareness increases positive perceptions of safety climates, nursing staff should exercise it to guide their actions in facing future health crises. STROBE guidelines. Higher self-awareness in relationships with others is a predictor of safety climates and can lead to enhanced patient outcomes.

The Floor Is (Y)Ours: Auxiliary Staff Voices Their Persona

ABSTRACTThe current study investigated the perspectives of auxiliary staff regarding their profession. This study used a holistic multiple‐case study design and a qualitative research method. The sample consisted of 45 auxiliary staff who worked in various K12 public schools in the central districts of a city in Turkey and voluntarily participated in the study. The study's participants, which was designed using a case study design, consisted of 45 auxiliary staff working in 11 K12 public schools in the central districts of a province in Turkey who voluntarily participated in the study. A maximum variation sampling strategy, a purposeful sampling technique, was employed for sample selection. Semi‐structured interviews were conducted with each participant to gather data for this study. An inductive content analysis method was used to analyze the collected data, and the findings were interpreted accordingly. The results revealed that auxiliary staff perform multiple roles, such as sanitation, kitchen duties, environmental monitoring, administrative tasks, and technical work. Moreover, the auxiliary staff perceived that their various roles contributed to the overall well‐being of the school community in schools.

Optimizing Nurse Rostering: A Case Study Using Integer Programming to Enhance Operational Efficiency and Care Quality

Background/Objectives: This study addresses the complex challenge of Nurse Rostering (NR) in oncology departments, a critical component of healthcare management affecting operational efficiency and patient care quality. Given the intricate dynamics of healthcare settings, particularly in oncology clinics, where patient needs are acute and unpredictable, optimizing nurse schedules is paramount for enhancing care delivery and staff satisfaction. Methods: Employing advanced Integer Programming (IP) techniques, this research develops a comprehensive model to optimise NR. The methodology integrates a variety of constraints, including legal work hours, staff qualifications, and personal preferences, to generate equitable and efficient schedules. Through a case study approach, the model’s implementation is explored within a clinical setting, demonstrating its practical application and adaptability to real-world challenges. Results: The implementation of the IP model in a clinical setting revealed significant improvements in scheduling efficiency and staff satisfaction. The model successfully balanced workload distribution among nurses, accommodated individual preferences to a high degree, and ensured compliance with work-hour regulations, leading to optimised shift schedules that support both staff well-being and patient care standards. Conclusions: The findings underscore the effectiveness of IP in addressing the complexities of NR in oncology clinics. By facilitating a strategic allocation of nursing resources, the proposed model contributes to operational excellence in healthcare settings, underscoring the potential of Operations Research in enhancing healthcare delivery and management practices.

Hospital staff's experiences of unsafe staffing levels and employers' responses to their concerns: a survey.

There is a wealth of evidence that demonstrates a link between inadequate nurse staffing levels and suboptimal patient care. Over the last decade, policies and legislation on safe nurse staffing levels have been developed for specific settings and countries in the UK, all of which emphasise employers' responsibility in responding to staff's concerns about unsafe staffing. However, the effectiveness of mechanisms for monitoring and responding to such concerns is unclear. This article provides an overview of some of the results of a union-led pilot survey of acute hospital staff that aimed to explore the prevalence of unsafe staffing levels and employers' responses to concerns raised by staff about staffing levels. Overall, the results demonstrate that hospital staff working in clinical roles often regarded staffing levels as unsafe and that the delivery of nursing interventions was often disrupted on shifts reported as unsafe. In addition, most staff who had raised concerns about staffing levels perceived their employer's response as unsatisfactory. Employers appeared to rely on staff redeployment or temporary staff to address staffing shortfalls, but these are not always effective or viable options. Employers need to explore alternative means of alleviating staffing shortfalls and of supporting their staff.

A multimethods international maPping exercise of Arts Interventions in reNal uniTs: the PAINT project.

Introduction Due to the chronic nature of kidney disease and the challenges of symptom burden, reduced mortality and co-morbidity, individuals living with the condition experience substantial anxiety and depression. Incorporating the arts into clinical practice is encouraged to promote and support mental health and wellbeing. The aim of the PAINT project was to undertake an international mapping exercise to identify the current provision of arts programmes in kidney centres for people living with kidney disease. Methods A multimethods approach was employed, involving a cross-sectional online survey and semi-structured qualitative interviews, which employed Qualitative Description research design. Healthcare staff working in kidney centres or organisations providing arts activities to individuals living with kidney disease were recruited into the study. Results One hundred and nineteen participants from 29 countries responded to the survey, with 39 of the respondents reporting arts activities in their renal unit. There was a wide range of respondents in terms of role, and the types of arts activities included visual art activities, music, literature/creative writing, film, movement/dance and craft. Individuals with chronic kidney disease who had taken part in arts activities were mostly adults (64%) and most were undergoing haemodialysis (82%). Sixteen respondents participated in the semi-structured interviews and encouraged the adoption of arts activities for people living with kidney disease. Three themes were identified: enhanced wellbeing and positive outcomes for individuals living with kidney disease; staff engagement and enthusiasm; and barriers to participation. Conclusions This overview of arts activities being offered globally to people living with kidney disease, and experiences of renal healthcare staff who provide activities in their units, are encouraging in terms of arts in healthcare. Thesepractitioners have observed the benefits of this person-centred arts approach in action, predominantly in terms of the positive impact on the wellbeing of individuals with kidney disease and improved relationships with staff in dialysis units. Further attention and funding should be focused on arts activities within renal centres.

COVID-19 transmission dynamics in close-contacts facilities: Optimizing control strategies

Abstract Close-contact places such as long-term facilities have been found to be high-risk and high-morbidity places in the United States during COVID-19 outbreaks. This could be due to the presence of vulnerable resident population, frequent contacts of residents with visitors, staff working at multiple facilities, and potential contaminated surfaces at these facilities. Here, we model close-contacts places to evaluate the role of different transmission pathways of COVID-19 in the presence of adaptable interventions. The model captures a coupled dynamics between three subpopulations (staff, residents, and visitors) and incorporates infection from infectious individuals and through the environment. By using parameterization of the models via real data from facilities in the United States, we identify and quantify the impact of duration and choice of interventions in real time for subpopulations to mitigate disease burden. We study the trade-off between disease burden and prevention cost using cost-effectiveness analysis. It was found that the specific time interval in which an intervention is included has an important effect when maximizing the effectiveness while minimizing the costs. We find that the presence of super-spreader healthcare workers contribute to a significantly higher peak of the number of infected cases compared to similar situation in the presence of super-spreader residents. Considering two nonpharmaceutical interventions: the use of face masks and cleaning surfaces, we observe that the later is an optimum intervention at the beginning of the system’s evolution, while wearing masks becomes an optimum strategy once the infection is widely established and population behavior changes.

Exploring multidisciplinary team members’ experiences of supporting eating and drinking with acknowledged risk in healthcare and aged care settings

Purpose Dysphagia is a swallowing condition which has significant health and quality of life implications. Speech-language pathologists provide assessment and support shared decision making to optimise swallowing safety. Many people elect to eat and drink with acknowledged risk. This study aimed to explore multidisciplinary team members’ perceptions and experiences supporting eating and drinking at acknowledged risk decision-making and practice, and to determine resources needed to support teams in this area. Method Semi-structured focus groups and one interview were facilitated with multidisciplinary team members (N = 32) from across the continuum of care at a regional health service to explore perceptions and experiences in supporting eating and drinking at acknowledged risk and identify needs to implement best practice. Result Four themes were constructed from the data highlighting the complexity and cyclical nature of supporting eating and drinking at acknowledged risk decision-making and practice. Themes included dynamic shared decision-making, communicating effectively to support and inform eating and drinking at acknowledged risk decision-making, enabling eating and drinking at acknowledged risk in practice, and risks and implications for clinicians and staff. Conclusion Best practice eating and drinking at acknowledged risk decision-making and implementation in healthcare and aged care settings is complex. Effective communication and appropriate support for staff working in this area is crucial, given the clinical, ethical, and moral implications that arise when supporting people who elect to eat and drink at acknowledged risk.

Price Volatility Mitigation and the Securities Market Financial Performance of Listed Insurance Firms at Nairobi Securities Exchange.

The performance of securities market globally plays an important role in both local and international markets. The high rise of such markets has given an increase in the number or risks associated with firms registered at the stock market. This study therefore sought to examine the effect of price volatility mitigation on the securities market financial performance of listed insurance firms in Kenya. The study adopted a descriptive research design and a quantitative research approach. The target population was 548 staff working in finance, investment, risk, actuarial and operations departments in the six insurance firms listed in Nairobi Securities Exchange. The sample size was determined using Yamane's Formula and stratified random sampling was used in the selection of the sample size. The study made use of both primary and secondary data. The study used a data extraction tool to collect secondary data from the annual reports and financial statements of the insurance companies. The study made use of structured questionnaires to collect primary data. The questionnaires generated quantitative data. Descriptive and inferential statistics was used in analyzing quantitative data with the help of the Statistical Package for Social Sciences (SPSS version 24) statistical software. Descriptive statistics included frequency distribution, percentages, mean, and standard deviation. Inferential data analysis was done using Pearson correlation coefficient and linear regression analysis. The study found that price volatility mitigation has a positive and significant effect on securities market financial performance of listed insurance firms in Kenya. The study recommends that insurance firms should focus on implementing strategies to effectively manage supply and demand dynamics within the securities market. This includes closely monitoring market trends, analyzing supply-demand imbalances, and adjusting pricing and stock clearance strategies accordingly. By actively managing supply-demand dynamics, firms can mitigate price volatility risks and enhance securities market financial performance

Implementasi Budaya dan Iklim Organisasi di MIN 1 Medan Sumatera Utara

This research aims to explore: First, explore the organizational culture that occurs at MIN 1 Medan. Second, explore the characteristics of organizational culture that occur at MIN 1 Medan. Third, explore the development of the organizational climate that occurred at MIN 1 Medan. This research method is a qualitative type with a descriptive approach. The instruments used in this research were observation, interviews and documentation studies. The location of this research is MIN 1 Medan, North Sumatra. This research data analysis uses three steps, data reduction, data presentation and conclusion drawing. The results of the research show that: First, the organizational culture that occurs at MIN 1 Medan is the teaching and learning process, both teachers and students understand how it works, namely by helping each other, the leadership, namely the principal, teachers and staff work together in building the MIN School. 1 Medan will be even better in the future and the school management is relatively good between the Principal, Teachers, Staff and Students of MIN 1 Medan as well as the school culture. Second, the characteristics of organizational culture that occur at MIN 1 Medan, namely 1. Norms; Organizational culture in schools is also characterized by the existence of norms that contain standards of behavior for school members, both for students and teachers. 2. Philosophy; namely, the existence of policies relating to the organization's beliefs in treating school members. Organizational culture is characterized by the belief of all members of the organization in seeing things in an essential way. 3. Rules; namely the existence of strict guidelines, linked to the progress of the organization. Third, the development of the organizational climate that occurs at MIN 1 Medan, namely a) First, the implementation of the main character and mission of education as well as the promotion of basic moral values ​​in students. b) Second, the involvement and commitment of the school community (teachers, students and parents) in their work. c) Third, preventing violence and conflict in schools. d) Fourth, prohibition of verbal and psychological violence. e) Fifth, the principal and teachers treat students fairly, equally and with respect.

The central role of housing key workers in supporting healthcare interactions for people experiencing homelessness and implications for palliative care: a qualitative study

BackgroundPeople experiencing homelessness access specialist palliative care late in their illness trajectory, if at all. There is also little evidence they receive generalist palliative care or are given opportunities to engage in Advance Care Planning. This qualitative study describes the central role of key workers in supporting access to healthcare in homeless communities and identifies implications for improving palliative care provision.MethodsQualitative data were collected via focus groups and individual interviews with staff working for a key provider of support and housing/accommodation for people experiencing homelessness in an urban area of Aotearoa New Zealand.ResultsThe ability to provide palliative care for people experiencing homelessness is dependent upon supporting engagement with mainstream health services. It is here that we identified the key worker role as central due to the complex and expert work they undertake to facilitate healthcare access for their clients. As a result of the high burden of chronic conditions this community experiences, most of this work related to support managing serious conditions, as well as death and dying. Key workers often went ‘above and beyond’ to support their clients in engaging with mainstream health services, during outpatient appointments, hospital admissions and in emergency department settings. They felt clinicians in these settings did not recognise the knowledge they held about the person, or their skills in terms of providing trauma informed care. The inflexibility of current care provision, as well as people experiencing homelessness feeling stigmatised, and neither valued nor respected in these settings, also created barriers to receiving care.ConclusionsNew models of palliative care are required which recognise the central role of non-health care key support staff and engage them more actively in supporting people experiencing homelessness when they interact with mainstream health services. Such models will need to be responsive to the nature and complexity of palliative care need in this population and facilitate support for people who typically do not see healthcare spaces as safe. The trusted relationships key workers have developed over time are crucial resources for identifying palliative care need and supporting access to palliative care for people experiencing homelessness.

Methadone clinic staff perceptions of trauma-informed and patient-centered care: the role of individual staff characteristics

BackgroundU.S. policy intervention to increase methadone treatment accommodations during COVID did not result in national adoption of the new patient-centered treatment practices. Staff-level interventions may facilitate adoption of these treatment practices, but this will depend upon knowledge about staff level characteristics and beliefs. Currently, the role of clinic staff characteristics, beliefs about patient-centeredness, and perceptions about the need for treatment practice change is unknown. This study explored the relationship between opioid treatment program staff characteristics, work roles and staff beliefs to identify opportunities for future staff-level treatment practice change interventions.MethodsStaff of three Arizona opioid treatment programs were surveyed (n = 40) from April 11–22, 2023 using a hybrid online survey method. The 161 survey items required less than 30 min to complete. Pearson point biserial correlation coefficients assessed the covariation between staff beliefs, staff characteristics and staff work roles. Perception of the clinic as person-centered was a potential proxy indicator for staff awareness of discontinuity between the clinic’s person-centeredness and person-centered approaches to methadone treatment.ResultsAmong staff, 47.5% reported lived substance use disorder experience and 27.5% reported lived opioid use disorder experience. Most staff (70%) held at least 1 prior clinic role at the current clinic and 5% had had more than 4 prior roles. Rotation was observed with roles that did not require licensure or degrees. Staff with lived experience with substance use disorder or opioid use disorder treatment reported having more prior roles at the clinic than those without such experience. Abstinence-oriented views were significantly associated with reporting vicarious (work related) trauma symptoms. Those who rated the clinic as significantly more person-centered were staff with lived substance use disorder experience who also held abstinence-oriented views, staff with trauma exposure, and staff with lived opioid use disorder treatment experience who held harm reduction beliefs. In contrast, staff without substance use disorder experience who held harm reduction beliefs perceived the clinic as less person-centered.ConclusionsStaff beliefs, personal and work characteristics are likely factors in the recognition of need for clinic practice change. How these characteristics function in a clinic culture may also be influenced by clinic staffing patterns. A patient-to-provider pipeline with role cycling was observed and this staffing pattern may also influence shared beliefs of trauma-informed care or clinic person-centeredness. Vicarious trauma may also be an important factor. Larger studies should examine these relationships further to understand mechanisms associated with recognition of need for clinic practice change in order to inform staff-level interventions to increase opioid treatment program patient-centeredness.

The Relationship between Work Design and Staff Nurses’ Creativity

The Relationship between Work Design and Staff Nurses’ Creativity

Disaster preparedness for intensive care units: Priorities to inform crisis standards of care

BackgroundThe number of disasters occurring globally is increasing. Natural hazards, changing geopolitical situations, and increasing population densities may lead to an increased likelihood of a surge of patients requiring health care, some of whom might be requiring intensive care–level treatment. There is a dearth of literature on intensive care units’ (ICUs) practitioner priorities regarding disaster preparedness and crisis standards of care. ObjectivesThis study aimed to understand what nurses working in ICUs within Australia prioritise regarding ICU disaster preparedness and the implementation of crisis standards of care. MethodsA modified three-round Delphi design was used for this study. A snowballing recruitment method facilitated the purposive sampling of ICU nurses, starting with members of the Australian College of Critical Care Nurses. Eligible participants were asked to rate statements according to their priorities when addressing disaster preparedness of the Australian ICU in which they work. Statements that achieved the 10 highest scores in the final round were tabulated to indicate the broader areas of disaster preparedness that the respondents considered priorities. ResultsA total of 16 participants completed both round two and round three of this Delphi study. Out of 38 statements across six domains, 33 statements achieved consensus. Healthcare practitioner protection, wellbeing, and the management of space populated the top 10 priorities. These priorities included adequate personal protection equipment, services to support healthcare practitioners, and clear communication and debriefing pathways. Another key priority identified was the need for a clear plan on how the ICU footprint will expand to accommodate a surge of patients. ConclusionHealthcare practitioner wellbeing followed by adequate plans for ICU expansion are key priorities of nursing staff working in ICUs within Australia. Understanding the priorities of those who work in the ICU gives a pragmatic insight into what is required to further develop the disaster preparedness of Australian ICUs.

Workplace culture for forensic mental health services: a mixed methods descriptive study

BackgroundWorkplace culture is theorized to involve a combination of elements such as assumptions, beliefs, and values. An effective workplace culture is safe and person-centred, which enables staff to flourish. However, there is no empirical evidence describing or informing workplace culture for forensic mental health settings.MethodsThe mixed methods approach is used to describe current indicators of, and perspectives on, workplace culture and understandings of ideal workplace culture for forensic mental health services. Participants responded to a literature informed survey (N = 482) enquiring about workplace psychological health and teamwork, and some (N = 72) participated in follow-up focus group discussions.ResultsPsychological health was less positive for staff working in clinical compared with non-clinical roles (p < 0.01, d = 0.80). Teamwork was positive (M = 27.2, SD = 7.6). Five themes emerged from the focus group data: psychological safety and trust, siloing, passion for the job, service structures (including system issues, resourcing, and support), and staffing. Ideal workplace culture in forensic mental health services could be supported by avoiding a culture of blame, maintaining passion for the job, and supporting good communication.ConclusionsThere is a potential opportunity for forensic mental health services to strengthen workplace culture by improving multi-agency communication methods, improving recognition of employee expertise and achievements, and supporting reasonable risk-taking.

The Role of Leader Support in Person-Job Fit and Employee Creativity

The concept of person-job fit is characterized as the degree of collaboration between both the worker and the work. It is connected to the communication between interaction for further development of job as well as relevant employee organization. Employee creativity is the capacity to come up with concepts or ideas that can result to new services, products, production methods, or modus operandi. This study was aimed to examine the extent person-job fit influence employee creativity and examined how the effect is being moderated by leader support. The study investigated the connections between person-job fit and employee creativity and the moderating effect of leader support. The research examined the relationship between person-job fit (PJF) and employee creativity (EC): the moderating role of leader support (LS) in Ecobank of Oyo State, Nigeria. The study also explains the relationship of the variables, person-job fit (PJF), employee creativity (EC), and the moderating variable, the role of leader support (LS). Using a quantitative research approach, data were gathered from 245 respondents who worked in Nigerian Ecobank at the time of this research. Surveys and questionnaires make up the research design. SPSS was deployed for the statistical analysis. The data was obtained from employees both male and female who are members of staff working in Ecobank of Oyo State, Nigeria during the time of the study. Our results showed that certainty benefits the company in terms of making positive and successful energy that further develops the work effectiveness of workers. The result of analysis supported all the hypotheses (H1 &amp; H2). The findings indicated that all the hypotheses were all supported.

Decision support systems in the diagnosis of urological diseases

The need to process large amounts of data has led to the creation of software that can improve and facilitate the work of medical staff. Decision support systems (DSS) are now used in many branches of medicine both at the outpatient and inpatient stages of medical care, helping clinicians to choose the tactics of treatment and management of each individual patient. These systems to a certain extent can improve treatment results and diagnostic process. The introduction of DSS in clinical practice has shown many advantages in reducing the frequency of misdiagnosis and, consequently, the risk of medical errors. At the same time, DSS can have a number of disadvantages. For example, physicians may view them as a threat to their “clinical autonomy”, and the implementation and subsequent maintenance of DSS can be quite costly. Artificial intelligence, which is increasingly being used not only for diagnosis, but also for treatment and prediction of outcomes in various diseases, should be considered as a prerequisite for the creation of DSS. Active development of artificial intelligence has been noted in almost all branches of medicine. A non-systematic review of the available literature published in the period between 2012 and 2022 has shown that the application of AI in prostate cancer diagnosis has great potential in clinical practice, as it helps both in the choice of treatment method and in planning the course of further surgery.

'It's that camaraderie': Experiences of a Long-COVID peer support group for staff working in health, social care and emergency services.

Health, social care and emergency services staff, continue to feel the impact of Long-COVID. Using quantitative and qualitative methods, this study aims to evaluate the experience of UK health and social care staff who participated in a virtual Long-COVID peer support group between May 2021 and May 2023. The outcome measures (SWEMWBS and PHQ9) show an improvement in post-group scores, suggesting participation in the peer support group is linked to improved wellbeing. Thematic analysis identified five key themes: finding connectedness, reciprocity, effective facilitation, filling the gaps and virtual format. This evaluation shows how peer support groups provided space for reciprocity and the positive outcomes associated with this. This evaluation highlights the importance of co-produced, needs-based services providing Long-COVID peer support.

Frontline clinic perspectives on climate change, human health, and resilience: a national cross-sectional survey

BackgroundFrontline clinics - primary care clinics that predominantly serve low-income and socially disadvantaged communities - are facing increasing impacts from climate-related extreme events. This study evaluated staff perspectives at frontline clinics on the health risks of climate change, the impacts of extreme events on their clinics and patients, and their motivators to improve climate resiliency.MethodsA national, cross-sectional survey was conducted of staff working at frontline clinics including administrators, case workers, and providers across the United States. Survey questions assessed clinic and respondent attributes, knowledge of health risks of climate change, preferences for climate change educational and operational resources, and clinic and patient climate impacts and resilience. The survey was distributed electronically to a convenience sample of primary care clinics and to the National Association of Community Health Centers (NACHC) and National Association of Free and Charitable Clinics (NAFC) listservs. Data was collected from September to November of 2021. Respondents were current staff who consented to the survey. Responses were collected via Qualtrics, and the statistical analysis was completed using Stata.ResultsA total of 430 surveys were completed representing clinics in 43 states. Most (82.0%) respondents reported human activities were causing climate change. Over half (52.8%) of respondents reported an operational disruption to their clinic from extreme events in the past 3 years, and another 54.4% had plans in place to address risks from extreme events. The most useful resources identified to improve operational resilience were checklists and planning guidance. Over half (52.0%) of respondents reported they were motivated to use these resources to improve clinic preparedness. Most (84.4%) providers and case workers reported that climate change impacted patient health, however only 36.2% discussed health risks with patients, with barriers including more pressing topics and time available. Another 55.7% of respondents reported they were motivated to learn ways to help patients prepare for extreme events.ConclusionsClimate-related extreme events were reported to impact patient health and disrupt frontline clinic operations. Overcoming gaps in knowledge about climate change impacts on health and providing climate educational resources can engender motivation to improve clinic and patient resilience to climate change.

Exploring physiotherapy staff's perceptions of physiotherapy delivery in acute stroke rehabilitation.

To explore physiotherapists' perspectives on current and alternative models of physiotherapy delivery in acute stroke rehabilitation. Qualitative service evaluation. An acute stroke rehabilitation unit within a London teaching hospital in the UK. A purposive sample of 17 physiotherapy staff (qualified physiotherapists and physiotherapy support staff) working in the acute stroke rehabilitation unit at the time of, or in the previous 3 months of the study were recruited to participate. Three themes were identified: barriers to effective physiotherapy delivery, enablers of effective physiotherapy delivery, and alternative models of physiotherapy delivery. Themes were framed by the concept of providing effective and efficient physiotherapy guided by reflection. Main barriers included patients not being ready for and underutilisation of time within physiotherapy sessions. Use of timetabling and access to senior therapy support enabled more effective and efficient physiotherapy delivery. Alternative models to optimise physiotherapy delivery included different staff to patient ratios, group therapy, opportunistic physiotherapy delivery and self-management. Several enablers of and barriers to providing effective and efficient physiotherapy post-stroke exist. Physiotherapists should consider implementing alternative models of physiotherapy delivery to increase the amount of physiotherapy provided to patients' post-stroke, thereby facilitating post-stroke functional recovery.