Exploring healthcare workers' experiences of a simple intervention to reduce their intrusive memories of psychological trauma: an interpretative phenomenological analysis

ABSTRACTBackground: Many healthcare workers (HCWs) endured psychologically traumatic events at work during the coronavirus disease 2019 (COVID-19) pandemic. For some, these events are re-experienced as unwanted, recurrent, and distressing intrusive memories. Simple psychological support measures are needed to reduce such symptoms of post-traumatic stress in this population. A novel intervention to target intrusive memories, called an imagery-competing task intervention (ICTI), has been developed from the laboratory. The intervention includes a brief memory reminder cue, then a visuospatial task (Tetris® gameplay using mental rotation instructions for approximately 20 min) thought to interfere with the traumatic memory image and reduce its intrusiveness. The intervention has been adapted and evaluated in a randomized controlled trial (RCT) with Swedish HCWs (ClinicalTrials.gov identifier: NCT04460014).Objective: We aimed to explore how HCWs who worked during the COVID-19 pandemic experienced the use of a brief intervention to reduce their intrusive memories of work-related trauma.Method: Interpretative phenomenological analysis was used for in-depth understanding of the lived experiences of HCWs who used the intervention. Seven participants from the RCT were interviewed by an independent researcher without prior knowledge of the intervention. Interviews were conducted via telephone and transcribed verbatim.Results: Four general themes were generated: 'Triggers and troublesome images', 'Five Ws regarding support - what, when, why, by/with who, for whom', 'Receiving it, believing it, and doing it' and 'The intervention - a different kind of help'; the last two included two subthemes each. The results reflect participants' similarities and differences in their lived experiences of intrusive memories, support measures, and intervention impressions and effects.Conclusion: HCWs' experiences of the novel ICTI reflect a promising appraisal of the intervention as a potential help measure for reducing intrusive memories after trauma, and gives us a detailed understanding of HCWs' needs, with suggestions for its adaption for future implementation.Trial registration: ClinicalTrials.gov identifier: NCT04460014.

Corrigendum: Experiences of healthcare staff in forensic care facilities supporting sexual violence survivors, in Tshwane, South Africa

No abstract available.

Development and initial validation of the staff perception of residential care environments (SPORE) instrument

BACKGROUND

The impact of the physical environment on healthcare staff well-being and work performance is well recognised, yet there is a lack of instruments assessing environmental features from the perspective of staff working in residential care facilities (RCFs) for older people.

OBJECTIVES

To develop and provide initial validation of the instrument Staff Perceptions Of Residential care facility Environments (SPORE).

DESIGN

An instrument development and psychometric evaluation study.

METHODS

Based on material from a British project, items were translated and adapted for Swedish residential care facilities as SPORE. Care staff (N = 200), recruited from 20 Swedish RCFs, completed a questionnaire-based survey containing the SPORE instrument and two other instruments selected as suitable for use in the validation. In addition, an environmental assessment instrument was used for further validation. Analyses were performed at individual (staff) level and home (RCF) level.

RESULTS

The SPORE subscales demonstrated good internal consistency reliability and were moderately to strongly correlated at the individual level with the subscales of measures of person-centred care, and strongly correlated with the same measures at the home level. The SPORE subscales were also highly correlated with the total score of the instrument used to assess the quality of the physical environment.

CONCLUSION

The initial validation indicates that the SPORE instrument is promising for measuring care staff perceptions of environmental features in care facilities for older people. SPORE can be a valuable instrument for use in research and in practice to evaluate the environment as part of working towards high-quality care.

IMPLICATIONS FOR PRACTICE

The design of the physical environment within RCFs can affect the staff's health and work performance. The instrument is useful for evaluating the environment and informing decisions about design solutions that support staff in their important work.

Comparison of Mindfulness Practices for Effectiveness of Stress and Burnout Reduction in Healthcare Staff

Purpose: The purpose of this study was to investigate the effectiveness of various mindfulness practices for reducing feelings of stress and burnout among healthcare staff. Study Design: This article contains the quantitative portion of a mixed-methods study. Methods: Healthcare workers (n = 48) were randomly assigned to one of three practices. Data were collected at three-time points (pre-intervention, mid-intervention, and three-weeks-post-intervention). Scores on the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory for Human Services Survey (MBI-HSS) were recorded at each time point. Findings: Scores on the PSS reduced significantly (p < .05) across three time periods. Maslach Burnout Inventory for Human Services Survey EE subscale scores reduced significantly (p < .05) across three time periods. There was no significant difference between the intervention groups on PSS or MBI-HSS scores. Conclusions: All three mindfulness practices were effective in reducing perceived occupational stress and emotional exhaustion. There was no intervention that stood out from the others as the most effective in reducing scores on the PSS and MBI-HSS. This study demonstrated the effectiveness of mindfulness practices that are short in time and simple in implementation for relieving stress and burnout in healthcare staff.

Implementing psychological support for health and social care staff affected by the COVID-19 pandemic: a qualitative exploration of staff well-being hubs ('Resilience Hubs') using normalisation process theory

OBJECTIVES

Evaluate the implementation of Hubs providing access to psychological support for health and social care keyworkers affected by the COVID-19 pandemic.

DESIGN

Qualitative interviews informed by normalisation process theory to understand how the Hub model became embedded into normal practice, and factors that disrupted normalisation of this approach.

SETTING

Three Resilience Hubs in the North of England.

PARTICIPANTS

Hub staff, keyworkers who accessed Hub support (Hub clients), keyworkers who had not accessed a Hub, and wider stakeholders involved in the provision of staff support within the health and care system (N=63).

RESULTS

Hubs were generally seen as an effective way of supporting keyworkers, and Hub clients typically described very positive experiences. Flexibility and adaptability to local needs were strongly valued. Keyworkers accessed support when they understood the offer, valuing a confidential service that was separate from their organisation. Confusion about how Hubs differed from other support prevented some from enrolling. Beliefs about job roles, unsupportive managers, negative workplace cultures and systemic issues prevented keyworkers from valuing mental health support. Lack of support from managers discouraged keyworker engagement with Hubs. Black, Asian and minority ethnic keyworkers impacted by racism felt that the Hubs did not always meet their needs.

CONCLUSIONS

Hubs were seen as a valuable, responsive and distinct part of the health and care system. Findings highlight the importance of improving promotion and accessibility of Hubs, and continuation of confidential Hub support. Policy implications for the wider health and care sector include the central importance of genuine promotion of and value placed on mental health support by health and social care management, and the creation of psychologically safe work environments. Diversity and cultural competency training is needed to better reach under-represented communities. Findings are consistent with the international literature, therefore, likely to have applicability outside of the current context.

Recipient-Reported Reactogenicity of Different SARS-CoV-2 Vaccination Regimens among Healthcare Professionals and Police Staff in Germany

The rapid availability of effective vaccines against SARS-CoV-2 was key during the COVID-19 pandemic. However, vaccine hesitancy and relatively low vaccine coverage rates among the general population and particularly vulnerable populations such as healthcare staff reduced the potential benefits of these vaccines. During the early phase of the pandemic, fear of vaccine-related adverse events was common among individuals who refused vaccination. Between March and May 2021, we comparatively assessed the self-reported reactogenicity of different SARS-CoV-2 prime-boost regimens using mRNA-based (BNT162b2 and mRNA-1273) and vector-based vaccines (ChAdOx1 nCoV-19) in (a) healthcare workers (HCW), and (b) police staff from southwest Germany. The majority of participants (71.8%; 1564/2176) received a homologous vaccination. Among HCW, 75.0% were female, whereas 70.0% of police staff were male. The most frequently reported reactions following the first vaccine administration were pain at the injection site (77.94%; 1696/2176), tiredness (51.75%; 1126/2176), and headache (40.44%; 880/2176), which were more commonly reported by HCW as compared to police staff. In homologous, mRNA-based and heterologous vaccination schedules, more reactions were reported after the second vaccine dose. We conclude that the frequency and intensity of self-perceived vaccine reactogenicity may differ between specific population groups and might be mitigated by tailored communication strategies.

Experiences of healthcare staff in forensic care facilities supporting sexual violence survivors, in Tshwane, South Africa

BACKGROUND

 Sexual violence is a persisting global epidemic that is constantly increasing on a large scale. The rate of sexual violence in South Africa is one of the highest in the world; and it has been reported to appear socially normalised and acceptable.

OBJECTIVES

 The study aimed to explore and describe the experiences of healthcare staff working in forensic care centres (FCCs) in Tshwane, South Africa.

METHOD

 A qualitative approach was followed incorporating focus group interviews with a range of healthcare staff based in the two FCCs. Non-probability purposive sampling was done. Data analysis was informed by the Analytic Hierarchy Model which comprised of three steps: data management, descriptive accounts and developing explanatory accounts.

RESULTS

 Three main themes emerged as, (1) help them to do away with the idea of self-blame: everyday work; (2) barriers to the accessibility of care: seeking alternative traditional remedies (muti) from traditional healers and working in an unconducive environment and (3) compassionately sick at times: Emotional impact of forensic care work.

CONCLUSION

 The findings revealed that the healthcare staff are often working in difficult circumstances and that both professional and societal factors mediate against the provision of care and support for survivors. Greater attention is needed both in terms of service development and wider challenges to pervading societal norms surrounding violence against women.Contribution: The study highlighted the need for training, improved management support and debriefing sessions.

Identifying Safety Practices Perceived as Low Value: An Exploratory Survey of Healthcare Staff in the United Kingdom and Australia

OBJECTIVES

Up to 30% of healthcare spending is considered unnecessary and represents systematic waste. While much attention has been given to low-value clinical tests and treatments, much less has focused on identifying low-value safety practices in healthcare settings. With increasing recognition of the problem of "safety clutter" in organizations, it is important to consider deimplementing safety practices that do not benefit patients, to create the time needed to deliver effective, person-centered, and safe care. This study surveyed healthcare staff to identify safety practices perceived to be of low value.

METHODS

Purposive and snowball sampling was used. Data collection was conducted from April 2018 to November 2019 (United Kingdom) and May 2020 to November 2020 (Australia). Participants completed the survey online or in hard copy to identify practices they perceived to not contribute to safe care. Responses were analyzed using content and thematic analysis.

RESULTS

A total of 1394 responses from 1041 participants were analyzed. Six hundred sixty-three responses were collected from 526 UK participants and 515 Australian participants contributed 731 responses. Frequently identified categories of practices identified included "paperwork," "duplication," and "intentional rounding." Five cross-cutting themes (e.g., covering ourselves) offered an underpinning rationale for why staff perceived the practices to be of low value.

CONCLUSIONS

Staff identified safety practices that they perceived to be low value. In healthcare systems under strain, removing existing low-value practices should be a priority. Careful evaluation of these identified safety practices is required to determine whether they are appropriate for deimplementation and, if not, to explore how to better support healthcare workers to perform them.

Assessing the relationship between burnout syndrome and irritable bowel syndrome among medical health providers and medical students in Saudi Arabia

Burnout syndrome, characterized by chronic unmanageable workplace stress, has been linked to lower gastrointestinal disorders, including irritable bowel syndrome. However, the relationship between burnout syndrome and irritable bowel syndrome among medical health providers and medical students in Saudi Arabia has not been fully explored. This cross-sectional correlational study was conducted in Southern Saudi Arabia from 2021 to 2022 and involved 931 medical health providers and medical students who completed an electronic questionnaire. The study assessed the presence and severity of burnout and irritable bowel syndrome and examined their relationship. Burnout syndrome was evaluated using the Maslach Burnout Inventory-Student Survey (MBI-SS), while irritable bowel syndrome criteria and severity were assessed using validated tools. The study found that 85% of medical health providers and medical students experienced high levels of burnout and irritable bowel syndrome severity, with physicians and nurses mainly affected. Occupational exhaustion was high in 44.4% of participants, while depersonalization was high in 53% of participants. Personal accomplishment was low in 73.5% of participants. Mild, moderate, and severe irritable bowel syndrome was reported in 25.6%, 23.8%, and 12% of participants, respectively. The study highlights a significant association between burnout syndrome and irritable bowel syndrome severity among medical health providers and medical students in Saudi Arabia. These findings underscore the importance of developing effective interventions to prevent and manage burnout syndrome and related health issues among healthcare professionals and medical students in the region.

Determinants of vaccine acceptance, knowledge, attitude, and prevention practices against COVID-19 among governmental healthcare workers in Addis Ababa and Adama, Ethiopia: A cross-sectional study

Background and Aims

COVID-19 vaccines are vital tools for infection prevention and control of the pandemic. However, coronavirus immunization requires acceptance among healthcare workforces and by the community. In Ethiopia, studies focused on determinants of vaccine acceptance, knowledge, attitude, and prevention practices (KAP) contrary to the novel coronavirus among healthcare staff are limited. Hence, closing this gap requires research.

Methods

A cross-sectional study was conducted on 844 governmental healthcare workers. A stratified, simple random sampling technique was used to select the respondents. Data were collected using a structured questionnaire. Binary and multivariable logistic regression statistical models were used to analyze the data.

Results

This study indicated that only 57.9% of the participants had good COVID-19 vaccine acceptance, meaning they took at least a dose of the vaccine themselves. We found that 65%, 60.9%, and 51.3% of the participants had good knowledge, prevention practices, and attitude against the pandemic. The novel coronavirus vaccine acceptance rate was 2.19 times more likely among females (adjusted odds ratio [AOR] = 2.19 with 95% confidence interval [CI]: 1.54-3.10) than among male participants. Further, respondents who did not report having any chronic diseases were 9.40 times higher to accept COVID-19 vaccines (AOR = 9.40 with 95% CI: 4.77, 18.53) than those who reported having a chronic condition. However, healthcare workers who had a habit of chewing khat at least once per week were 4% less likely to take the vaccine (AOR = 0.04 with 95% CI: 0.01, 0.32) than those who had no habit of chewing khat.

Conclusion

Many core factors influencing COVID-19 vaccine acceptance were identified. A significant number of participants had poor vaccine acceptance, KAP against COVID-19. Therefore, the government should adopt urgent and effective public health measures, including public campaigns to enhance public trust in COVID-19 vaccines. In addition, continuous, timely, and practical training should be provided to healthcare workers.

Redesigning Rural Acute Stroke Care: A Person-Centered Approach

Stroke service delivery in rural areas in Australia lacks evidence-based, best practice care protocols as a result of limited resources and opportunity. Healthcare redesign is an approach to improving health services by understanding barriers and enablers to service provision and work with users to develop solutions for improvement. This research aimed to qualitatively evaluate stroke care in rural Tasmania using a person-centered approach, as part of a larger healthcare redesign initiative to improve acute stroke care. Semi-structured interviews, aimed at gaining insight into experiences of healthcare staff and users, were conducted. Thematic analysis revealed three global themes (communication, holistic care, and resourcing) that demonstrated some consistency between healthcare staff and user experience, highlighting that some needs and expectations were not being met. Results of this experiential study provide important perspectives for delivering needs-based improvements in service provision for acute stroke care. Overall, this study showed that systems of stroke care in rural areas could be improved by utilizing a redesign approach including healthcare staff and users in the development of solutions for health service improvement.

Perceived Organizational Support and Reduced Job Performance During COVID-19

Current research aims to identify a framework to enhance the performance of employees in government sector healthcare during the COVID-19 pandemic. Perceived organizational support was identified to enhance employees' performance through the intervention of a psychological process containing 3 states, that is, psychological safety, felt obligation and organization-based self-esteem. Job performance is considered as planned behavior, and psychological links are developed on the basis of the theory of planned behavior. This study is quantitative and used an empirical survey. Respondents of the study were nursing staff of government hospitals in Pakistan. The data were collected during the first wave of COVID-19 in Pakistan through online distributed questionnaires, and the data were analyzed using Smart PLS. Results show that perceived organizational support positively affects job performance during the COVID-19 crisis, and all the psychological states mediate the relationship. The study results are helpful for decision-makers of public sector organizations dealing with the most common problem of performance reduction during COVID-19. Results are also helpful for policymakers to address reduced performance in most government hospitals. Future research should consider antecedents of the perception of organizational support in the context of government and private hospitals.

Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff

OBJECTIVE

COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake.

DESIGN

Twenty-five semi-structured interviews were conducted (October 2020-January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed.

RESULTS

Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication.

CONCLUSIONS

Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by de-contextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake.

Prevalence, characteristics, and consequences of verbal and physical violence against healthcare staff in Chinese hospitals during 2010-2020

OBJECTIVES

This study investigated the characteristics of workplace violence (WPV) against Chinese healthcare staff and their casualties after severe physical violence (PV).

METHODS

We scrutinized medical WPV incidents reported online and analyzed information on timing, location, violence, criminal incentives, and casualties following severe PV in China from 2010 to 2020.

RESULTS

WPVs were mostly committed by young and middle-aged male family members of the patients, especially in the emergency department (49.1%), and mostly associated with dissatisfaction with treatment effect (28.9%) in general. High medical costs (62.5%) were the leading cause of verbal violence (VV), whereas men predominantly committed PV (OR = 4.217, 95% CI: 1.439-12.359) owing to dissatisfaction with the healthcare staff's attitude (P < 0.001). The victims were security personnel in most cases (81.1%). Nurses were generally more likely to experience PV (P < 0.05), while doctors were more likely to experience lethal PV (OR = 4.732, 95% CI: 1.42-15.772), which mostly happened in oncology (P < 0.05) and committed by visitors (P < 0.001). Slight injuries and mortality were more likely to be inflicted by being rejected for unreasonable demands and disappointed with the treatment effect (P < 0.05).

CONCLUSIONS

Medical WPV has numerous reasons, locations, and diverse victims and offenders. Some severe WPVs have serious consequences. Therefore, it is recommended for the concerned authorities to adopt effective steps for appropriate legislative, security, and conflict-resolution measures.

Barriers and enablers to health service access amongst people with diabetes: An exploration of the perceptions of health care staff in regional Australia

Healthcare staff are in a unique position of understanding client experiences, physiological impacts of client behaviour, the local healthcare system and the physical environment in which the services operate. Their perspectives may provide insights into the feasibility and effectiveness of existing models of diabetes care and suggestions for improvements to models of care (MoC). The objective of this qualitative study was to explore the experiences of healthcare staff delivering care for people with diabetes at the request of an existing healthcare service. Semi-structured interviews were conducted with 21 healthcare staff from three community health centres in one region of Victoria, Australia, in 2018. Interviews were audio-recorded and transcribed verbatim. Data were subject to qualitative content analysis and, subsequently, emerging themes were classified at individual, relationship, community and societal levels of the social-ecological model (SEM). Perceived barriers of access to health services using the current MoC included a lack of public transport, low socioeconomic status, job insecurity (resulting in an inability to take time away from work) and inflexible appointment times, all of which negatively impact diabetes management. Perceived enablers included having a co-located, multidisciplinary team, a holistic approach to diabetes management and motivation resulting from improvement in diabetes-related health outcomes. The findings indicate that there is potential to improve the service in this region by adopting a more integrated, team-focused and accessible MoC.

The relationship between polychronicity and job-affective well-being: The moderator role of workplace incivility in healthcare staff

BACKGROUND

Despite the increasing body of research on workplace incivility, the relationship between co-worker/supervisor incivilities and job-affective well-being have received relatively little consideration from the scholars. This study investigates the impact of polychronicity on nurses' psychological well-being in the healthcare sector.

OBJECTIVE

According to COR theory, this study's main objective is to investigate the impact of two aspects of incivilities, co-worker, and supervisor incivilities, as the moderating effect on the relationship between polychronicity and job-affective psychological well-being.

METHODS

The sample data was collected from 260 nurse's staff who were working in hospitals. The proposed model hypothesis was tested through SPSS-Amos-structural equation modeling.

RESULTS

The result shows that polychronic nurses show high job engagement and job performance in a hospital environment. This study's findings revealed that co-workers and supervisors' higher incivility weakens the positive relationship between polychronicity and job-affective well-being.

CONCLUSION

Today, retained the employees are a perilous issue in every organization, especially in hospital sectors, where nurses are working in stressful working environments, facing bullying, harassment, and uncivil behavior from patients' side, co-workers, and supervisor. These types of behaviors are not only affecting employees' well-being, commitment, and job performance but also their mental health and intent to leave. Similarly, the effect on organizational goals, shareholders' value, and progress makes an effective mechanism to control the negative behaviors that would be an apparent advantage for administration and managers to efficiently attain organizational goals.

[CHANGING THE FUNCTIONALITY: HOW DO MEDICAL PROFESSIONALS PERCEIVE INNOVATIONS?]

The article is devoted to the study of the issue of changing the functionality of nurses, analyzing the opinions of nurses and doctors themselves on the implementation of such an innovation, assessing the benefits and consequences associated with expanding the functions and increasing the role of nurses in the medical community. The research is based on CHAID-analysis of data from a questionnaire survey conducted in 2020, which revealed the respondents' attitude to the idea of improving the status of nurses and expanding their functions, expectations of the possible reaction of the medical community and patients to this innovation, and the development of so-called «trees» of classifications for various variables. The collected and systematized data on changes in the functionality of nurses can serve as a starting point for the possible expansion of the functions and powers of nurses in the metropolitan health care, as well as increasing the role and status of nurses in the professional environment. The results of the Moscow study presented in the article confirm the conclusions of other scientists and practitioners from the Russian regions, in which a pilot project has already been implemented to change the functionality of nurses.

Healthcare staff's views on responding to suicide and self-harm: Part II

PURPOSE

To report on healthcare staff's views of the barriers to preventing suicide and self-harm.

DESIGN AND METHODS

Using a qualitative approach, data were collected through "World Café" discussion forums and written submissions, and analyzed using reflexive thematic analysis.

FINDINGS

Healthcare staff, including psychiatric nurses, perceived that a whole of society approach was needed for suicide and self-harm prevention. Support for those at the front line is needed as well as clear referral pathways and interagency working.

PRACTICE IMPLICATIONS

Formalized support for staff working in healthcare should be given with a flexible and inclusive approach to service delivery adopted.

Healthcare staff's views on responding to suicide and self-harm: Part I

PURPOSE

To explore healthcare staff's knowledge and awareness of, and responses to, suicide and self-harm.

DESIGN AND METHODS

A qualitative design was adopted, and data were collected using a "World Café" approach (n = 143 participants), in addition to written submissions (n = 10). Data were analyzed using reflexive thematic analysis.

FINDINGS

There was variation relating to awareness of and responses to suicide and self-harm. Participants highlighted the need for further staff education and training, and a review of standardized assessment tools and referral processes.

PRACTICE IMPLICATIONS

Tailored training and education resources are required for healthcare staff. Clear protocols for assessing, treating, and referring people deemed at risk of suicide and self-harm are needed.

Healthcare Staff Perceptions Following Inoculation with the BNT162b2 mRNA COVID-19 Vaccine at University Hospitals Coventry & Warwickshire NHS Trust

Background: COVID-19 vaccination programmes offer hope for a potential end to the acute phase of the COVID-19 pandemic. We present perceptions following from a cohort of healthcare staff at the UK NHS hospital, which first initiated the BNT162b2 mRNA COVID-19 (“Pfizer”) vaccination program. Methods: A paper-based survey regarding perceptions on the BNT162b2 mRNA COVID-19 vaccine was distributed to all healthcare workers at the University Hospitals Coventry & Warwickshire NHS Trust following receipt of the first vaccine dose. Results: 535 healthcare workers completed the survey, with a 40.9% response rate. Staff felt privileged to receive a COVID-19 vaccine. Staff reported that they had minimised contact with patients with confirmed or suspected COVID-19. Reported changes to activity following vaccination both at work and outside work were guarded. Statistically significant differences were noted between information sources used by staff groups and between groups of different ethnic backgrounds to inform decisions to receive vaccination. Conclusions: NHS staff felt privileged to receive the COVID-19 vaccine, and felt that their actions would promote uptake in the wider population. Concerns regarding risks and side effects existed, but were minimal. This research can be used to help inform strategies driving wider vaccine uptake amongst healthcare staff and the public.

Assessing the impact of COVID-19 on healthcare staff at a combined elderly care and specialist palliative care facility: A cross-sectional study

BACKGROUND

In the pre-COVID-19 era, healthcare professionals experienced stress and burnout. The international literature confirms that COVID-19 placed significant additional burdens on healthcare workers.

AIM

To describe and characterise the magnitude and variety of ways in which the COVID-19 pandemic affected the personal, social and professional lives of healthcare workers representing several multidisciplinary specialties in a fully-integrated palliative and elderly care service.

DESIGN

All staff were invited to complete an anonymised standardised questionnaire evaluating the impact of COVID-19 across a diverse range of domains. The study was conducted over a 6-week period commencing 11 September 2020.

SETTING

The setting incorporates two distinct but integrated services operating under a single management structure in Ireland: (i) Specialist palliative care across hospice (44 beds), community and hospitals and (ii) Elderly Care Service (long-term and respite care) delivered in a 63-bed inpatient unit.

RESULTS

250 respondents (69.8%) completed the questionnaire. Nurses and healthcare assistants comprised the majority of respondents (60%) and other disciplines were represented proportionately. 230 participants (92%) agreed that their personal workload had changed significantly in response to COVID-19 and 182 (72.8%) agreed that their responsibilities had increased. 196 (78.4%) reported greater work-related stress. Highest-rated sources of stress included fear of contracting COVID-19 or transmitting it to friends/family, interacting with isolated frail/dying patients, changes to workplace protocols and reduced social interaction with colleagues.

CONCLUSIONS

This study demonstrates the profound impact of COVID-19 on personal and professional wellbeing of staff. The greatest burden was carried by those providing prolonged, direct and intimate patient care.

Chances and Barriers of Online Problem-Based Learning (ePBL) for Advanced Training in the Healthcare Sector

An online advanced training for professionals within the healthcare sector was developed including a problem statement to be solved following the steps of problem-based learning (PBL).The findings show that it is feasible to transfer PBL electronically (ePBL) where participants favoured the flexibility and time independency of ePBL. However, the evaluation revealed issues with the learning platform, insufficient technical conditions in the hospitals and a lack of personal exchange. Thus, ePBL offers advantages especially for advanced training in the healthcare sector but requires adaptations and the necessary technical prerequisites.

Providing care to patients with COVID-19 in a reference hospital: health care staff intentional behavior and factors that affect it

Objective

The investigation of intentional behavior of hospital staff to care for COVID-19 patients and the study of the factors that influences it.

Method

This is a cross-sectional study, of 261 physicians and nurses working in a COVID-19 reference hospital. Data were collected by an anonymous questionnaire including demographic and professional characteristics and a scale measuring behavioral intention based on the Theory of Planned Behavior of Ajzen. Statistical analysis was performed by SPSS 21.

Results

Mean age of participants was 40.8 years old, while most of them were nurses (75.7%). Behavioral intention mean score was 18.2 (5-21), which shows high intention to care for COVID-19 patients. Bivariate analysis between independent variables showed that behavioral intention mean score was higher for those that had cared for COVID-19 patients and those that did not (19.0% vs. 16.7%, p < 0.001). Multivariate linear regression analysis identified that increased subjective norms (the perceived social pressure to perform or not the behavior) score was associated with increased behavioral intention score (p < 0.001). Also, participants that provided care for COVID-19 patients had higher behavioral intention score (p < 0.001).

Conclusion

Healthcare staff, that cared for COVID-19 patients had high behavioral intention to continue caring for them. This finding could be used to inform policies and training for staff that will be employed in COVID-19 units.

Job satisfaction and associated factors among health care staff in township health centers--a cross-sectional survey in rural Central China

Township health centers play a cornerstone role in the primary healthcare in China while it's development is largely limited by the brain drain. Job satisfaction is closely related to brain drain, investigating the relevant factors of job satisfaction can provide strategies to reduce brain drain. This research was conducted in Huangpi, China. Convenience sampling methods and self-administereded questionnaires were used. We collected 1370 valid samples, with an effective rate of 97.72%. Descriptive statistics are used to describe sociodemographic information. The Pearson Chi-square statistical was used to test the binary association between job satisfaction and another categorical variable. All the sociodemographic information was applied to the binary logistic regression model using the stepwise selection method. The mean age was 36.98 (SD = 9.84), factors that affect job satisfaction include educational background (x² = 7.99, p< 0.05), marital status (x² = 8.96, p< 0.05, monthly income (x² = 51.43, p< 0.01), hire form (x² = 7.64, p< 0.05), hours worked per week (x² = 33.48, p< 0.01), parent had a stable job (x² = 10.65, p< 0.01). Government and management should consider the impact of current policies on job satisfaction. Increasing the welfare of healthcare staff and promoting equity are potential strategies for improving low levels of job satisfaction.

The Mental Health of Healthcare Staff Working During the COVID-19 Crisis: Their Working Hours as a Boundary Condition

Purpose

Healthcare staff operate at the forefront of the fight against COVID-19 and hence face enormous physical and mental pressures. We aim to investigate healthcare staff's mental health issues and the associated predictors during the COVID-19 pandemic. Specifically, this paper aims to identify some unique predictors of healthcare staff's mental health issues in Iran, the second country after China to experience a major COVID-19 crisis.

Methods

An online survey of 280 healthcare staff in all 31 provinces of Iran assessed staff's mental distress (K6), depression, and anxiety (PHQ-4) during April 5-20, 2020 during the COVID-19 crisis.

Results

Nearly a third of healthcare staff surpassed the cutoff for distress, depression, and anxiety symptoms. Females or more educated healthcare staff were more likely to experience distress. Those who were unsure whether they had COVID-19 were more likely to experience distress and depression symptoms. The number of COVID-19 cases among a healthcare worker's colleagues or friends positively predicted the worker's anxiety symptoms. Amongst healthcare staff, doctors were less likely than radiology technologists to experience distress and anxiety symptoms. Technicians and obstetrics staff experienced fewer anxiety symptoms. The age and the weekly working days of healthcare staff interacted such that age is asignificant predictor of mental health issues among younger but not older healthcare staff.

Conclusion

The identification of the predictors of mental health issues can guide healthcare organizations to screen healthcare workers who are more likely to be mentally vulnerable in the ongoing COVID-19 pandemic.

The challenges of medically complex breastfed children and their families: A systematic review

Exclusive breastfeeding for the first 6 months and then alongside solid food for the first 2 years and beyond is the gold standard in young child nutrition. There is an abundance of literature relating to the preventative nature of breastmilk and breastfeeding against many infectious diseases and chronic conditions. However, despite medically complex infants and children being a group that could benefit most from continued breastfeeding, breastfeeding duration and exclusivity are lower among more complex paediatric populations. The reasons for this are not well known, and there is a paucity of data relating to supporting infants who have acute or chronic illness, disability or congenital anomaly to breastfeed. This systematic review aimed to understand the challenges of breast/chestfeeding the medically complex child and to establish the gaps in healthcare provision that act as barriers to optimal infant and young child feeding. The search was limited to studies published in English, focused on breastfed sick infants in hospital, with no date limits as there is no previous systematic review. Of 786 papers retrieved, 11 studies were included for review, and seven themes identified. Themes included practical and psychological challenges of continuing to breastfeed in a hospital setting, complications of the condition making breastfeeding difficult, lack of specialist breastfeeding support from hospital staff and a lack of availability of specialist equipment to support complex breastfeeding. The findings affirm the lack of consistent high‐quality care for lactation support in paediatric settings and reinforce the need for further focused research in this area.

Developing and Evaluating a Capacity-Building Intervention for Healthcare Providers to Improve Communication Skills and Awareness of Hard of Hearing and D/deaf Populations: Protocol for a Participative Action Research-Based Study

Background: D/deaf and hard of hearing populations are at higher risk for experiencing physical and mental health problems compared to hearing populations. In addition, they commonly encounter barriers to accessing and benefiting from health services, which largely stem from challenges they face in communicating with healthcare providers. Healthcare providers commonly lack tailored communication skills in caring for D/deaf and hard of hearing populations, which lead to difficulties and dissatisfaction for both staff and D/deaf and hard of hearing communities. This research project aims to develop and evaluate a capacity-building intervention for healthcare providers with the goal of increasing their awareness of D/deaf and hard of hearing individuals' experiences with the healthcare system, their distinct needs, and improving their capacity to communicate effectively with this patient population.

Methods: This research project features a participative action research design using qualitative and quantitative methods. Consistent with participative action research, the study will actively involve the target populations, key stakeholders and representative associations. The intervention will be developed and tested through iterative phases. The Integrated Model of Training Evaluation and Effectiveness will guide prospective evaluation of the intervention. The latter will involve qualitative and quantitative assessments in participants before and after the intervention and at 6-months follow-up.

Discussion: Results will contribute to research aimed at decreasing barriers to accessing and benefiting from healthcare services for D/deaf and hard of hearing individuals. Findings will be presented to representative associations and political authorities, as well as disseminated at research conferences and in peer-reviewed journals.

Influence of Nature at the Time of the Pandemic: An Experience-Based Survey at the Time of SARS-CoV-2 to Demonstrate How Even a Short Break in Nature Can Reduce Stress for Healthcare Staff

AIM

The current COVID-19 pandemic has been causing significant upheavals in the daily lives of citizens and consequently also their mood (stress, distraction, anxiety, etc.), especially during the lockdown phase. The aim of the investigation is to evaluate the benefits of 20-30 minutes in contact with nature.

BACKGROUND

The Scientific Community, also through the evidence-based design approach, has already demonstrated the importance of greenery and nature on the psychophysical well-being of people and, in a moment of emergency, contact with the nature can be therapeutic and quite influential on the mental health of staff subject to stress.

METHOD

During the lockdown, an Italian multidisciplinary working group promoted an experience-based survey, based on the Profile of Mood States methodology, for measuring the psychophysical well-being of hospital staff.

RESULTS

The author collected 77 questionnaires. The benefits that users have obtained from the experience in nature have been investigated by comparing the type of stresses they were subjected to and highlighting various peculiarities in the data analysis associated with the type of green in which they carried out the survey, the healthcare areas in which they worked during the pandemic emergency, and the moment in which the survey was conducted.

CONCLUSIONS

The study has highlighted that a short break in green spaces strongly influenced the mental and psychophysical well-being of hospital staff, emphasizing the importance of nearby green spaces in architectures for health. Even a brief break in nature can regenerate users, especially in times of a stressful health emergency.

A Review of Psychological Issues among Patients and Healthcare Staff during Two Major Coronavirus Disease Outbreaks in China: Contributory Factors and Management Strategies

Outbreaks of severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) have affected populations worldwide. Our literature review summarises the studies reporting psychological issues among healthcare staff and infected patients in mainland China, Hong Kong, and Taiwan during these two outbreaks and the potential strategies for addressing these issues. Our review shows that patients and healthcare staff presented similar psychological symptoms, including anxiety, fear, distress, and depression, which may lead to stress-related complications such as insomnia. In patients, these psychological impairments can be contributed to by being quarantined, perceptions of threats to life, and uncertainty about health status. Quarantine is also a factor for distress among healthcare staff, together with their heavy workload, the fear that they and their families would become infected, witnessing their patients' poor and deteriorating conditions, and the requirement to wear protective gear. Strategies that are needed to address these factors include providing counselling services, implementing mindfulness-based therapies and optimism interventions, and providing telecommunication facilities for patients to communicate with their families. Healthcare staff should also be provided with these services, together with appropriate and flexible work shift arrangements and morale boosting. These strategies would improve not only the mental well-being of patients and healthcare staff, but also the self-efficacy and competence of the staff to provide quality healthcare services.

Does team reflexivity impact teamwork and communication in interprofessional hospital-based healthcare teams? A systematic review and narrative synthesis

Background

Teamwork and communication are recognised as key contributors to safe and high-quality patient care. Interventions targeting process and relational aspects of care may therefore provide patient safety solutions that reflect the complex nature of healthcare. Team reflexivity is one such approach with the potential to support improvements in communication and teamwork, where reflexivity is defined as the ability to pay critical attention to individual and team practices with reference to social and contextual information.

Objective

To systematically review articles that describe the use of team reflexivity in interprofessional hospital-based healthcare teams.

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six electronic databases were searched to identify literature investigating the use of team reflexivity in interprofessional hospital-based healthcare teams.

The review includes articles investigating the use of team reflexivity to improve teamwork and communication in any naturally occurring hospital-based healthcare teams. Articles’ eligibility was validated by two second reviewers (5%).

Results

Fifteen empirical articles were included in the review. Simulation training and video-reflexive ethnography (VRE) were the most commonly used forms of team reflexivity. Included articles focused on the use of reflexive interventions to improve teamwork and communication within interprofessional healthcare teams. Communication during interprofessional teamworking was the most prominent focus of improvement methods. The nature of this review only allows assessment of team reflexivity as an activity embedded within specific methods. Poorly defined methodological information relating to reflexivity in the reviewed studies made it difficult to draw conclusive evidence about the impact of reflexivity alone.

Conclusion

The reviewed literature suggests that VRE is well placed to provide more locally appropriate solutions to contributory patient safety factors, ranging from individual and social learning to improvements in practices and systems.

Trial registration number

CRD42017055602.

Healthcare staff digital literacy levels and their attitudes towards information systems

This study aimed to assess the digital literacy levels and attitudes towards information systems of staff in a health service that will be implementing an electronic health record so that barriers towards implementation could be addressed. A survey measuring staff confidence levels and their attitudes towards information systems was developed. Data were collected over a five-week period, with data analysed using frequency analysis and a chi-square analysis. There were 407 respondents to the survey. The majority (70-80%) of which reported high digital literacy levels, expressing confidence in using technology. Respondents also reported positive attitudes towards information systems. However, one-fifth reported anxiety using information systems. Given poor staff engagement with information systems adversely affects the safety and quality of patient care, health services should provide targeted education and training to address staff with low digital literacy levels and/or confidence with using information systems prior to implementation of an electronic health record system.

Determinant factors in applying electronic medical records in healthcare

Background

Electronic Medical Record (EMR) offers remarkable facilities such as reducing medical errors, decreasing healthcare costs and promoting quality of healthcare services by collecting, storing and displaying information at the point of care.

Aims

This study was carried out to identify the determinants of electronic medical record (EMR) adoption by presenting a comprehensive model.

Methods

This was a cross-sectional study in which 330 healthcare personnel working in hospitals affiliated to Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran, were selected as the study sample. A proposed conceptual path model of technology, organization and environment (TOE), and technology acceptance model (TAM) was developed to identify the determinants of EMR adoption. The model was authorized by structural equation modeling (SEM) and represented by Analysis of Moment Structures (AMOS).

Results

The results of the study showed that the integrated model of TOE-TAM explained 68 percent (R² = 0.68) of the variance of EMR adoption. The findings also evidenced that perceived ease of use, perceived usefulness, technological context, organization context and environmental context have significant effect on EMR adoption.

Conclusions

The study findings suggest that the proposed conceptual integrated model of TOE-TAM is a favourable model for identifying the relevant factors of EMR adoption. The present study clearly recognized nine significant determinants that affect end-users' intention when comprehensive implementation of ERMs is considered.

Staff experiences with strategic implementation of clinical health promotion: A nested qualitative study in the WHO-HPH Recognition Process RCT

OBJECTIVES

Health promotion is on the global agenda. The risks targeted include smoking, hazardous alcohol consumption, nutrition and insufficient physical activity. Implementation of clinical health promotion, however, remains a major challenge. While several processes, models and frameworks for strategic implementation exist, very few have been tested in randomized designs. Testing a strategic implementation process for clinical health promotion was only recently attempted via a randomized clinical trial on the World Health Organization Health Promotion Hospitals Recognition Process. The randomized clinical trial showed that the process improved central parts of implementation. To complement these findings, this nested qualitative study aimed to explore experiences and perceptions of staff and managers, who had completed the process, and generate hypotheses for improvements.

METHODS

We interviewed a purposeful sample of 45 key informants from four countries, who worked at clinical departments and had undertaken the World Health Organization Health Promotion Hospitals implementation process. The informants included 14 managers, 14 medical doctors, 13 nurses and 4 other clinical staff. Interview transcripts were analyzed using qualitative content analysis and an inductive approach to coding and categorization supported by QSR NVivo.

RESULTS

The informants' experiences and perceptions centered around four global themes concerning (1) awareness, cultural re-orientation and integration; (2) learnings; (3) normalization and legitimacy and (4) a more evidence-based, structured and systematic approach to clinical health promotion. Informants were positive toward the implementation process, although it was sometimes challenging. The suggested improvements to increase acceptability related to the patient survey, time consumption, translation, tailoring to local circumstances and in-advance training.

CONCLUSIONS

Managers and staff were positive toward the World Health Organization Health Promotion Hospitals process, which was perceived to bring about positive changes and learnings. The findings also suggest that the implementation process may be improved by minor adjustments to process elements and design. It is our recommendation to use the process in clinical departments to further implementation of clinical health promotion.

Organ donation and transplantation: Awareness and roles of healthcare professionals-A systematic literature review

AIMS AND OBJECTIVES

To examine the role of healthcare professionals in the organ donation and transplantation process.

BACKGROUND

Globally, there remains a perennial disequilibrium between organ donation and organ transplantation. Several factors account for this disequilibrium; however, as healthcare professionals are not only strategically positioned as the primary intermediaries between organ donors and transplant recipients, but also professionally situated as the implementers of organ donation and transplantation processes, they are often blamed for the global organ shortage.

DESIGN

Mixed-method systematic review using the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 checklist.

METHODS

Databases were searched including CINAHL, MEDLINE, Web of Science and EMBASE using the search terms "organ donation," "healthcare professionals," "awareness" and "roles" to retrieve relevant publications.

RESULTS

Thirteen publications met the inclusion criteria. The global organ shortage is neither contingent upon unavailability of suitable organs nor exclusively dependent upon healthcare professionals. Instead, the existence of disequilibrium between organ donation and transplantation is necessitated by a web of factors. These include the following: healthcare professionals' attitudes towards, and experience of, the organ donation and transplantation process, underpinned by professional education, specialist clinical area and duration of professional practice; conflicts of interests; ethical dilemmas; altruistic values towards organ donation; and varied organ donation legislations in different legal jurisdictions.

CONCLUSION

This review maintains that if this web of factors is to be adequately addressed by healthcare systems in different global and legal jurisdictions, there should be sufficient organs voluntarily donated to meet all transplantation needs.

RELEVANCE TO CLINICAL PRACTICE

There is a suggestion that healthcare professionals partly account for the global shortage in organ donation, but there is a need to examine how healthcare professionals' roles, knowledge, awareness, skills and competencies might impact upon the organ donation and transplantation process.

Health Facility Staff Training for Improving Breastfeeding Outcome: A Systematic Review for Step 2 of the Baby-Friendly Hospital Initiative

The Baby-Friendly Hospital Initiative (BFHI) implemented through the "Ten Steps to Successful Breastfeeding" has been widely promoted as an intervention that improves breastfeeding rates. Step 2 requires the training of all healthcare staff in skills that are necessary to implement the policy. This systematic review provides evidence about the effect of training healthcare staff in hospitals and birth centers on breastfeeding outcomes. Randomized controlled trials (RCT), quasi-RCT, and controlled before and after (CBA) studies comparing training of healthcare staff on breastfeeding and supportive feeding practices with no training were included in this review. We searched CENTRAL PubMed, EMBASE, CINAHL, Web of Science, and the British Nursing Index for studies. Studies were screened against predetermined criteria, and risk of bias of included studies was assessed using the Risk of Bias Assessment tool for Non-Randomized Studies for non-RCT studies and the Cochrane Handbook for Systematic Reviews of Interventions for RCT studies. Of the six studies included in this review, three were RCT whereas three were CBA studies. The studies were conducted in 5 countries and involved 390 healthcare staff. Provision of educational interventions aimed at increasing knowledge and practice of BFHI and support was found to improve health worker's knowledge, attitude, and compliance with the BFHI practices. In one study, the rate of exclusive breastfeeding increased at the intervention site but no differences were found for breastfeeding initiation rates. All included studies had methodological limitations, and study designs and methodologies lacked comparability.

Assaulted and Unheard: Violence Against Healthcare Staff

Healthcare workers regularly face the risk of violent physical, sexual, and verbal assault from their patients. To explore this phenomenon, a collaborative descriptive qualitative study was undertaken by university-affiliated researchers and a union council representing registered practical nurses, personal support workers, and other healthcare staff in Ontario, Canada. A total of fifty-four healthcare workers from diverse communities were consulted about their experiences and ideas. They described violence-related physical, psychological, interpersonal, and financial effects. They put forward such ideas for prevention strategies as increased staffing, enhanced security, personal alarms, building design changes, "zero tolerance" policies, simplified reporting, using the criminal justice system, better training, and flagging. They reported such barriers to eliminating risks as the normalization of violence; underreporting; lack of respect from patients, visitors, higher status professionals, and supervisors; poor communication; and the threat of reprisal for speaking publicly. Inadequate postincident psychological and financial support compounded their distress.

Profiling bacterial community in upper respiratory tracts

BACKGROUND

Infection by pathogenic viruses results in rapid epithelial damage and significantly impacts on the condition of the upper respiratory tract, thus the effects of viral infection may induce changes in microbiota. Thus, we aimed to define the healthy microbiota and the viral pathogen-affected microbiota in the upper respiratory tract. In addition, any association between the type of viral agent and the resultant microbiota profile was assessed.

METHODS

We analyzed the upper respiratory tract bacterial content of 57 healthy asymptomatic people (17 health-care workers and 40 community people) and 59 patients acutely infected with influenza, parainfluenza, rhino, respiratory syncytial, corona, adeno, or metapneumo viruses using culture-independent pyrosequencing.

RESULTS

The healthy subjects harbored primarily Streptococcus, whereas the patients showed an enrichment of Haemophilus or Moraxella. Quantifying the similarities between bacterial populations by using Fast UniFrac analysis indicated that bacterial profiles were apparently divisible into 6 oropharyngeal types in the tested subjects. The oropharyngeal types were not associated with the type of viruses, but were rather linked to the age of the subjects. Moraxella nonliquefaciens exhibited unprecedentedly high abundance in young subjects aged <6 years. The genome of M. nonliquefaciens was found to encode various proteins that may play roles in pathogenesis.

CONCLUSIONS

This study identified 6 oropharyngeal microbiome types. No virus-specific bacterial profile was discovered, but comparative analysis of healthy adults and patients identified a bacterium specific to young patients, M. nonliquefaciens.