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Causer H, Spiers J, Chew-Graham CA, Efstathiou N, Gopfert A, Grayling K, Maben J, van Hove M, Riley R. Filling in the gaps: A grounded theory of the experiences and needs of healthcare staff following a colleague death by suicide in the UK. DEATH STUDIES 2024:1-12. [PMID: 38602818 DOI: 10.1080/07481187.2024.2337202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Health-workers are more likely to die by suicide than their counterparts in other occupational groups. The suicide of a staff member can be widely felt by colleagues, leading to complex emotional and cognitive responses. Exposure to suicide heightens the risk of dying by suicide. We investigated the impact of a colleague suicide on National Health Service (NHS) staff. Twenty-nine staff were interviewed; all participants were white British, and so not representative of the ethnic make-up of the NHS. Data were analyzed using grounded theory methods. A theory, "filling in the gaps" was developed. Staff experiences gave rise to needs that were not always met. Staff endeavored to "fill in the gaps" in support; however, sometimes fell through those gaps. Organizational and professional contexts shaped their experiences and responses. Recommendations include skilled and targeted support and compassion for affected staff. Cultural change is needed to challenge suicide stigma and unhelpful narratives.
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Affiliation(s)
- Hilary Causer
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Johanna Spiers
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Nikolaos Efstathiou
- School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anya Gopfert
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
| | | | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Maria van Hove
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
| | - Ruth Riley
- School of Health Sciences, University of Surrey, Guildford, UK
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Leung KCY, Lele K. A hospital-wide group approach to promote open dialogues of workplace issues and staff wellbeing with Schwartz Rounds. Australas Psychiatry 2024; 32:151-156. [PMID: 38288725 PMCID: PMC10913322 DOI: 10.1177/10398562241229887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVES This study aims to explore the feasibility and impact of Schwartz Rounds® led by psychiatrists/mental health professionals in an urban Australian public hospital setting and to develop strategies for optimising participants' experiences. METHODS Being a mixed-methods study collecting qualitative and quantitative data through post-Rounds evaluation surveys, this study thematically analysed responses from 105 participants attending four consecutive monthly Rounds between February and May 2023 to assess the perceived benefits and challenges of Schwartz Rounds. RESULTS Respondents highly valued the Rounds and felt cared for by the healthcare organisation. Themes related to perceived benefits included (i) Connectedness and shared experience; (ii) Understanding other professionals; (iii) Normalisation of emotional distress, validation and a safe space for vulnerability; and (iv) Fostering authenticity and humanitarian aspects of healthcare. Challenges included (i) Fear of exposure and judgment; (ii) Emotional discomfort; (iii) Unfamiliarity with reflection; and (iv) Safety concerns. CONCLUSIONS This study suggests acceptability and feasibility of implementing Schwartz Rounds within an Australian public health setting, particularly when facilitated by skilled mental health professionals. The outcomes provide preliminary support for the use of group interventions to enhance staff collegiality and culture in healthcare settings, thereby addressing critical needs for health professional wellbeing.
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Affiliation(s)
| | - Kiran Lele
- University of Sydney, Camperdown, NSW, Australia
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Schilling S, Armaou M, Morrison Z, Carding P, Bricknell M, Connelly V. "Trust people you've never worked with" - A social network visualization of teamwork, cohesion, social support, and mental health in NHS Covid personnel. Front Psychol 2024; 15:1293171. [PMID: 38445057 PMCID: PMC10913897 DOI: 10.3389/fpsyg.2024.1293171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
Background The unprecedented rapid re-deployment of healthcare workers from different care pathways into newly created and fluid COVID-19 teams provides a unique opportunity to examine the interaction of many of the established non-technical factors for successful delivery of clinical care and teamwork in healthcare settings. This research paper therefore aims to address these gaps by qualitatively exploring the impact of COVID work throughout the pandemic on permanent and deployed personnel's experiences, their ability to effectively work together, and the effect of social dynamics (e.g., cohesion, social support) on teamwork and mental health. Methods Seventy-five interviews were conducted across the UK between March and December 2021 during wave 2 and 3 of COVID-19 with 75 healthcare workers who were either permanent staff on Intensive Care/High Dependency Units used as COVID wards, had been rapidly deployed to such a ward, or had managed such wards. Work Life Balance was measured using the WLB Scale. Interview transcripts were qualitatively coded and thematic codes were compared using network graph modeling. Results Using thematic network analysis, four overarching thematic clusters were found, (1) teamwork, (2) organizational support and management, (3) cohesion and social support, and (4) psychological strain. The study has three main findings. First, the importance of social factors for teamwork and mental health, whereby team identity may influence perceptions of preparedness, collaboration and communication, and impact on the collective appraisal of stressful events and work stressors. Secondly, it demonstrates the positive and negative impact of professional roles and skills on the development of teamwork and team identity. Lastly the study identifies the more pronounced negative impact of COVID work on deployed personnel's workload, mental health, and career intentions, exacerbated by reduced levels of social support during, and after, their deployment. Conclusion The thematic network analysis was able to highlight that many of the traditional factors associated with the successful delivery of patient care were impeded by pandemic constraints, markedly influencing personnel's ability to work together and cope with pandemic work stressors. In this environment teamwork, delivery of care and staff well-being appear to depend on relational and organizational context, social group membership, and psycho-social skills related to managing team identity. While results hold lessons for personnel selection, training, co-location, and organizational support during and after a pandemic, further research is needed into the differential impact of pandemic deployment on HCWs mental health and teamwork.
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Affiliation(s)
- Stefan Schilling
- Psychology, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, United Kingdom
| | - Maria Armaou
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Zoe Morrison
- Aberdeen Business School, Robert Gordon University, Aberdeen, United Kingdom
| | - Paul Carding
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom
| | - Martin Bricknell
- King’s College London, School of Security Studies, London, United Kingdom
| | - Vincent Connelly
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, United Kingdom
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Afoko V, Hewison A, Newham R, Neilson S. Moral distress in nurses in developing economies: an integrative literature review. J Res Nurs 2023; 28:609-627. [PMID: 38162718 PMCID: PMC10756174 DOI: 10.1177/17449871231216606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background Moral distress has been extensively studied in developed economies; however, not much in terms of studies has been carried out in developing economies. Objective To review the literature reporting the experience of moral distress in nurses in health care settings in developing economies. Design An integrative literataure review was used. Method Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online Cochrane and Psych INFO were searched to retrieve titles and abstracts of papers on the experience of moral distress in nurses in developing economies. Results Sixteen articles reporting the experience of moral distress in nurses in developing economies published between 1984 and March 2019 were used for the review. Analysis of the findings revealed seven themes, nurses' experience of moral distress, inadequate material and human resources, end-of-life challenges, cultural and religious beliefs as a source of moral distress, perceived inactions of medical and nursing staff, impact of moral distress on nurses in developing economies and coping strategies. Conclusion There is paucity of empirical studies on moral distress in nurses in developing economies. More qualitative studies are needed in various cultural settings to enhance its understanding in nurses working in developing economies.
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Affiliation(s)
- Vivian Afoko
- Lecturer, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Alistair Hewison
- Professor, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Roger Newham
- Associate Professor, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Susan Neilson
- Senior Lecturer, School of Nursing and Midwifery, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Jack FJG, Kotronoulas G. The Perceptions of Healthcare Staff Regarding Moral Injury and the Impact on Staff Life and Work During COVID-19: A Scoping Review of International Evidence. JOURNAL OF RELIGION AND HEALTH 2023:1-25. [PMID: 37027110 PMCID: PMC10080521 DOI: 10.1007/s10943-023-01803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
The COVID-19 response introduced legal restrictions on social distancing globally, affecting healthcare staff personally and professionally. These restrictions suspended routine hospital visiting, which may have left staff feeling they had to compromise on the care they provided. Such conflict may be experienced as moral injury. This scoping review aimed to synthesise international evidence, to answer this question: "Have COVID-19 restrictions affected healthcare staff's experiences of moral injury? If so, how?" Nine studies met the search criteria. Although healthcare staff seemed to be aware of the risks and effects of moral injury, they were still reluctant to "name" it. Healthcare staff's own emotional and spiritual needs were mostly ignored. Although psychological support is often the recommended approach by organisations, a greater focus on spiritual and emotional support is recommended.
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Affiliation(s)
- Fiona J. G. Jack
- NHS Fife–Department of Spiritual Care, Queen Margaret Hospital, Whitefield Road, Dunfermline, Fife, KY12 OSU Scotland, UK
| | - Grigorios Kotronoulas
- School of Medicine Dentistry and Nursing, Nursing and Health Care School, College of Medical, Veterinary and Life Sciences, University of Glasgow, 57-61 Oakfield Avenue, Glasgow, G12 8LL Scotland, UK
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Ng L, Schache K, Young M, Sinclair J. Value of Schwartz Rounds in promoting the emotional well-being of healthcare workers: a qualitative study. BMJ Open 2023; 13:e064144. [PMID: 37019482 PMCID: PMC10083799 DOI: 10.1136/bmjopen-2022-064144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVES Schwartz Rounds are forums that enable healthcare staff to reflect on emotional and social dimensions of their work. In this study, we aimed to explore the experiences of Schwartz Rounds on emotional aspects of care and practice within a clinical environment. DESIGN Using qualitative methods, we interviewed participants individually and in focus groups. Interviews were recorded, transcribed and analysed by thematic analysis. SETTING The study was based at a public health service Te Whatu Ora Counties Manukau in Auckland, New Zealand's largest, most ethnically diverse population. PARTICIPANTS Participants were panellists who took part in successive Schwartz Rounds over a 10-month period. There were 17 participants with a range of experience (1-30 years) and occupations including clinical, allied, technical and administrative staff from medical specialties of plastic surgery, pain services, emergency medicine, intensive care, organ donation services, COVID-19 response and palliative care services. RESULTS Three themes were identified: the need for emotional processing, valuing guided reflection and realising our humanity. The third theme 'realising our humanity' comprised altruism, connection and compassion. Schwartz Rounds provided staff with clear benefits: emotionally resonant experiences within an environment of psychological safety and connection to the wider organisation. The daunting nature of emotional disclosure was mitigated by a supportive audience. CONCLUSION There is an organisational imperative to ensure that staff have opportunities to process intense emotions associated with healthcare work. Schwartz Rounds are one means to attend to the emotional welfare of healthcare staff, enabling them to gain different perspectives in the care of their patients and colleagues within system constraints.
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Affiliation(s)
- Lillian Ng
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- Mental Health and Addictions, Division of Psychiatry, Te Whatu Ora Health NZ Counties Manukau, Auckland, New Zealand
| | - Kiralee Schache
- Department of Psychological Medicine, Te Whatu Ora Health NZ Counties Manukau, Auckland, New Zealand
- Department of Critical Care, Te Whatu Ora Health NZ Counties Manukau, Auckland, New Zealand
| | - Marie Young
- Department of Psychological Medicine, Te Whatu Ora Health NZ Counties Manukau, Auckland, New Zealand
| | - Joanna Sinclair
- Department of Anaesthesia and Pain Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand
- People and Culture Directorate, Te Whatu Ora Health NZ and Counties Manukau, Auckland, New Zealand
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Wilkinson E. Why medicine must catch up on interprofessional education for a safer NHS. BMJ 2022; 377:o1547. [PMID: 35768125 DOI: 10.1136/bmj.o1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hofmann R, Darnton R. 'This trainee makes me feel angry': It's time to validate the reality and role of trainer emotions. MEDICAL EDUCATION 2022; 56:359-361. [PMID: 34978095 PMCID: PMC9303210 DOI: 10.1111/medu.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Discussing the 'failiure to fail' phenomenon, the authors call for a system‐wide culture shift to better articulate failures as learning opportunities in healthcare.
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Affiliation(s)
| | - Richard Darnton
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
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Ewais T, Hunt G, Munro J, Pun P, Hogan C, William L, Teodorczuk A. Schwartz Rounds for Staff in an Australian Tertiary Hospital: Protocol for a Pilot Uncontrolled Trial (Preprint). JMIR Res Protoc 2021; 11:e35083. [PMID: 35475785 PMCID: PMC9096633 DOI: 10.2196/35083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Schwartz Rounds are a unique, organization-wide interdisciplinary intervention aimed at enhancing staff well-being, compassionate care, teamwork, and organizational culture in health care settings. They provide a safe space wherein both clinical and nonclinical health staff can connect and share their experiences about the social and emotional aspects of health care. Objective Although Schwartz Rounds have been assessed and widely implemented in the United States and United Kingdom, they are yet to be formally evaluated in Australian health care settings. The purpose of this study is to evaluate the feasibility and impact of Schwartz Rounds on staff well-being, compassionate care, and organizational culture, in a tertiary metropolitan hospital in Brisbane, Australia. Methods This mixed methods repeated measures pilot study will recruit 24 participants in 2 groups from 2 departments, the intensive care unit and the gastroenterology department. Participants from each group will take part in 3 unit-based Schwartz Rounds. Primary outcomes will include the study and intervention feasibility measures, while secondary outcomes will include scores on the Maslach Burnout Inventory–Human Services Survey, the Schwartz Centre Compassionate Care Scale, and the Culture of Care Barometer. Primary and secondary outcomes will be collected at baseline, after the Rounds, and 3-month follow-up. Two focus groups will be held approximately 2 months after completion of the Schwartz Rounds. Descriptive statistics, paired t tests, chi-square tests, and analysis of variance will be used to compare quantitative data across time points and groups. Qualitative data from focus groups and free-text survey questions will be analyzed using an inductive thematic analysis approach. Results The study was approved by the Mater Hospital Human Research Ethics Committee (reference number: HREC/MML/71868) and recruitment commenced in July 2021; study completion is anticipated by May 2022. Conclusions The study will contribute to the assessment of feasibility and preliminary efficacy of the Schwartz Rounds in a tertiary Australian hospital during the COVID-19 pandemic. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12621001473853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382769&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/35083
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Affiliation(s)
- Tatjana Ewais
- Mater Young Adult Health Centre, Mater Health, Mater Misericordiae Ltd, South Brisbane, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
- Mater Clinical School, Faculty of Medicine, University of Queensland, South Brisbane, Australia
| | - Georgia Hunt
- Mater Young Adult Health Centre, Mater Health, Mater Misericordiae Ltd, South Brisbane, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Jonathan Munro
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Paul Pun
- Mater in Mind, Mater Health, Mater Misericordiae Ltd, South Brisbane, Australia
| | - Christy Hogan
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Leeroy William
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Andrew Teodorczuk
- Mater Clinical School, Faculty of Medicine, University of Queensland, South Brisbane, Australia
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