The rate and impact of substance misuse in psychiatric intensive care units (PICUs) in the UK

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Hattie Catherine Ann Moyes ◽  
Lana MacNaboe ◽  
Kate Townsend
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Substance Misuse ◽  
Well Being ◽  
Training Programme ◽  
Content Type ◽  
National Quality ◽  
Improvement Programme ◽  
The Uk ◽  
The Impact

Purpose This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs. Design/methodology/approach The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients. Findings The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed. Research limitations/implications The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs. Practical implications This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes. Originality/value This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

scholarly journals The impact of workplace spirituality on work-based learners

2019 ◽  
Vol 11 (1) ◽  
pp. 63-75 ◽  
Author(s):  
Scott Foster ◽  
Anna Foster
Keyword(s):  
Ethnically Diverse ◽  
Well Being ◽  
Spiritual Needs ◽  
Content Type ◽  
Retail Chain ◽  
Trust Relationships ◽  
Policies And Procedures ◽  
Spiritual Well Being ◽  
The Uk ◽  
The Impact

Purpose The purpose of this paper is to contribute to the emerging spirituality debate with the aim of generating and sustaining tolerance for spirituality in the workplace, with a specific focus upon the impact this can have upon work-based learners. “Spirituality” is gaining impetus worldwide as a growing number of organisations are proactively accommodating their multi-ethnic and multi-faith workforce by adapting their policies to meet employees’ spiritual needs. As yet in the UK, the majority of organisations fail to recognise neither the basic spiritual well-being of their employees nor the impact this can have upon work-based learning processes. Design/methodology/approach This study adopts a quantitative approach with questionnaires distributed to a multi-national retail UK-based organisation with an ethnically diverse national workforce. The study was tested by collecting data from managers and employees of this large, multi-million pound retail chain organisation in the UK, consisting of 55 stores and 1,249 employees, in order to gather employees’ perceptions on spirituality within their place of work regarding policies, communication and perceived source of conflict. Findings The results revealed that the majority of employees deemed spirituality was not something they felt comfortable discussing or appropriate to practice within the workplace and there were no clear policies and procedures in place to support either management or employees. Research limitations/implications This paper highlights areas for further research in the broad professional areas of spirituality in relation to organisational approaches to work-based learning. The research is from one organisation and utilising one method – qualitative research would add depth to the knowledge. Practical implications This paper highlights areas for further research in the broad professional areas of spirituality in relation to organisational approaches to work-based learning. Originality/value Employee spiritual well-being is under-researched and overlooked by organisations. Changing the current spiritual intransigence is long overdue as employees’ spiritual fulfilment leads to high-trust relationships in the workplace and can further support those engaged in work-based learning.

scholarly journals High-Risk International Clones of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Endemic to Indonesian Intensive Care Units: Impact of a Multifaceted Infection Control Intervention Analyzed at the Genomic Level

mBio ◽  
2019 ◽  
Vol 10 (6) ◽  
Author(s):  
Andreu Coello Pelegrin ◽  
Yulia Rosa Saharman ◽  
Aurélien Griffon ◽  
Mattia Palmieri ◽  
Caroline Mirande ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
High Risk ◽  
Infection Control ◽  
Intensive Care Units ◽  
Clinical Data ◽  
Prevention Measures ◽  
Content Type ◽  
Control Intervention ◽  
The Impact

ABSTRACT Infection control effectiveness evaluations require detailed epidemiological and microbiological data. We analyzed the genomic profiles of carbapenem-nonsusceptible Pseudomonas aeruginosa (CNPA) strains collected from two intensive care units (ICUs) in the national referral hospital in Jakarta, Indonesia, where a multifaceted infection control intervention was applied. We used clinical data combined with whole-genome sequencing (WGS) of systematically collected CNPA to infer the transmission dynamics of CNPA strains and to characterize their resistome. We found that the number of CNPA transmissions and acquisitions by patients was highly variable over time but that, overall, the rates were not significantly reduced by the intervention. Environmental sources were involved in these transmissions and acquisitions. Four high-risk international CNPA clones (ST235, ST823, ST375, and ST446) dominated, but the distribution of these clones changed significantly after the intervention was implemented. Using resistome analysis, carbapenem resistance was explained by the presence of various carbapenemase-encoding genes (blaGES-5, blaVIM-2-8, and blaIMP-1-7-43) and by mutations within the porin OprD. Our results reveal for the first time the dynamics of P. aeruginosa antimicrobial resistance (AMR) profiles in Indonesia and additionally show the utility of WGS in combination with clinical data to evaluate the impact of an infection control intervention. (This study has been registered at www.trialregister.nl under registration no. NTR5541). IMPORTANCE In low-to-middle-income countries such as Indonesia, work in intensive care units (ICUs) can be hampered by lack of resources. Conducting large epidemiological studies in such settings using genomic tools is rather challenging. Still, we were able to systematically study the transmissions of carbapenem-nonsusceptible strains of P. aeruginosa (CNPA) within and between ICUs, before and after an infection control intervention. Our data show the importance of the broad dissemination of the internationally recognized CNPA clones, the relevance of environmental reservoirs, and the mixed effects of the implemented intervention; it led to a profound change in the clonal make-up of CNPA, but it did not reduce the patients’ risk of CNPA acquisitions. Thus, CNPA epidemiology in Indonesian ICUs is part of a global expansion of multiple CNPA clones that remains difficult to control by infection prevention measures.

scholarly journals Culture, consent and confidentiality in workplace autoethnography

2018 ◽  
Vol 7 (3) ◽  
pp. 302-319
Author(s):  
Catherine Lee
Keyword(s):  
Role Models ◽  
Critical Incident ◽  
School Teacher ◽  
Well Being ◽  
Professional Identities ◽  
Content Type ◽  
Ethical Implications ◽  
The Face ◽  
The Uk ◽  
The Impact

Purpose The purpose of this paper is to examine the author’s experiences as a school teacher and a lesbian. It considers the culture and discourses of power in the school and the ethical implications of telling the author’s story. Utilizing autoethnography as a method of inquiry, it draws on a critical incident to explore the incompatibility of the author’s private and professional identities, and reflect on the impact of homophobic and heteronormative discursive practices in the workplace, on health, well-being and identity. Design/methodology/approach This research is grounded in an interpretivist philosophy. It utilizes writing about the self as a method of inquiry. Findings This research examines the incompatibility of the author’s private and professional identities and offers insight into the steps that those in positions of power will take to protect and perpetuate the heteronormative discourse of rural life. Research limitations/implications This research presents the perspective of only one lesbian teacher in a rural context. Consequently, generalizations are inappropriate and recommendations are difficult. Whilst the absence of clear ethical regulation presents an infinite number of possibilities for autoethnographers, the silence that surrounds the prescription of the ethics of autoethnography leaves those of us at the beginnings of our research careers without clear guidance. Originality/value This research specifically addresses a dearth of research examining the experiences of the rural lesbian (or gay) teacher in the UK. Headteachers of rural schools must ensure that their schools are inclusive and welcoming environments for teachers, and their equalities policies are living documents that are not simply cast aside in the face of rural parent power. Young people in the countryside deserve access to the full pool of teaching talent and should have access to the diverse role models that their urban and suburban counterparts are beginning to enjoy.

The subjective experiences of liaison and diversion staff who encounter individuals with autism

2020 ◽  
Vol 6 (2) ◽  
pp. 137-150
Author(s):  
Eleanor Burch ◽  
John Rose
Keyword(s):  
Criminal Justice ◽  
Interpretative Phenomenological Analysis ◽  
Well Being ◽  
Subjective Experiences ◽  
Content Type ◽  
Team Members ◽  
Making A Difference ◽  
The Uk ◽  
The Impact

Purpose Research suggests that individuals with autistic spectrum disorder (ASD) are inconsistently supported throughout the criminal justice system (CJS) in the UK. Bradley (2009) recommended the introduction of criminal justice liaison and diversion (L&D) teams to bridge the gap between the CJS and mental health services and provide a more consistent and improved quality of support for individuals with vulnerabilities, including those with autism. This study aims to explore the experiences of staff working in L&D teams who encounter individuals with ASD. Design/methodology/approach Interviews were conducted with ten L&D team members. Interpretative phenomenological analysis was used to gain insight into their lived experiences of working with autism in the CJS. Findings Interpretation of individual transcripts resulted in three super-ordinate themes: “feeling helpless and helpful in the system”, “transition to knowing” and “impact on self”. Each theme encapsulated a number of sub-themes depicting the limitations of services, difficult environments, making a difference, lack of understanding, developing understanding and the impact of these experiences on staff’s confidence, attitudes and well-being. Practical implications Criminal justice services are limited for people with autism. There is a lack of autism awareness by staff. Lack of awareness impacts staff attitudes and confidence. Training in autism should be provided to criminal justice staff. Originality/value This research highlights the limitations of services available for individuals with autism and the widespread lack of autism awareness. These concerns directly impacted participants’ confidence, attitudes and well-being. Recommendations are proposed to guide future practice and research including increasing availability of access to ASD services, enforcing mandatory autism-specific training for staff and routinely collecting service-user feedback.

scholarly journals In the eye of the storm: impact of COVID-19 pandemic on admission patterns to paediatric intensive care units in the UK and Eire

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Hari Krishnan Kanthimathinathan ◽  
Hannah Buckley ◽  
Peter J. Davis ◽  
Richard G. Feltbower ◽  
Caroline Lamming ◽  
...  
Keyword(s):  
Public Health ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Health Interventions ◽  
Paediatric Intensive Care ◽  
Public Health Interventions ◽  
The Uk ◽  
Unplanned Admissions ◽  
The Impact ◽  
Paediatric Intensive Care Units

Abstract Background The coronavirus disease-19 (COVID-19) pandemic had a relatively minimal direct impact on critical illness in children compared to adults. However, children and paediatric intensive care units (PICUs) were affected indirectly. We analysed the impact of the pandemic on PICU admission patterns and patient characteristics in the UK and Ireland. Methods We performed a retrospective cohort study of all admissions to PICUs in children < 18 years during Jan–Dec 2020, using data collected from 32 PICUs via a central database (PICANet). Admission patterns, case-mix, resource use, and outcomes were compared with the four preceding years (2016–2019) based on the date of admission. Results There were 16,941 admissions in 2020 compared to an annual average of 20,643 (range 20,340–20,868) from 2016 to 2019. During 2020, there was a reduction in all PICU admissions (18%), unplanned admissions (20%), planned admissions (15%), and bed days (25%). There was a 41% reduction in respiratory admissions, and a 60% reduction in children admitted with bronchiolitis but an 84% increase in admissions for diabetic ketoacidosis during 2020 compared to the previous years. There were 420 admissions (2.4%) with either PIMS-TS or COVID-19 during 2020. Age and sex adjusted prevalence of unplanned PICU admission reduced from 79.7 (2016–2019) to 63.1 per 100,000 in 2020. Median probability of death [1.2 (0.5–3.4) vs. 1.2 (0.5–3.4) %], length of stay [2.3 (1.0–5.5) vs. 2.4 (1.0–5.7) days] and mortality rates [3.4 vs. 3.6%, (risk-adjusted OR 1.00 [0.91–1.11, p = 0.93])] were similar between 2016–2019 and 2020. There were 106 fewer in-PICU deaths in 2020 (n = 605) compared with 2016–2019 (n = 711). Conclusions The use of a high-quality international database allowed robust comparisons between admission data prior to and during the COVID-19 pandemic. A significant reduction in prevalence of unplanned admissions, respiratory diseases, and fewer child deaths in PICU observed may be related to the targeted COVID-19 public health interventions during the pandemic. However, analysis of wider and longer-term societal impact of the pandemic and public health interventions on physical and mental health of children is required.

scholarly journals Adult safeguarding in Wales: one step in the right direction

2017 ◽  
Vol 19 (4) ◽  
pp. 175-186 ◽  
Author(s):  
John Williams
Keyword(s):  
Social Services ◽  
Well Being ◽  
Lower Threshold ◽  
Future Research ◽  
Content Type ◽  
The Social ◽  
Additional Support ◽  
The Uk ◽  
The Right ◽  
The Impact

Purpose The purpose of this paper is to consider the background to the recent changes to adult safeguarding in Wales as a result of the new measures introduced by the Social Services and Well-being (Wales) Act 2014 and discuss their potential impact. Design/methodology/approach The paper relies on a range of material including reports published by the Law Commission, the National Assembly for Wales and other public bodies. It also refers to academic and practitioner material in journals and government guidance. Findings Although the Social Services and Well-being (Wales) Act 2014 introduced many changes in adult safeguarding in Wales, not least the duty to make enquiries, it does not take the opportunity to include statutory powers of barring and removal. The introduction of Adult Protection and Support Orders (APSOs) is a cautious step forward – perhaps it is too cautious. More research in needed on the different approaches across the UK. Research limitations/implications At the time of publication, the full effect of the new legislation has not been seen. Local authorities and others are coming to terms with the new provisions. No data on the impact of the new legislation are yet available. The paper identifies future research evaluating the working of the different approaches to safeguarding within the UK. Practical implications For practitioners, the new legislation provides opportunities to rethink the approach to safeguarding. The lower threshold for referrals will mean an increase in caseloads and the need to react to both low- and high-risk cases. For authorised officers, the practical issues identified relate to the circumstances in which an APSO may be sought and what can be put in place to protect the adult at risk once the order has been used. Social implications For those who experience abuse or neglect, the new legislation provides additional support when compared to the POVA process. The duty to make enquiries and the duty to report will hopefully strengthen protection and, with a lower threshold for referral, enable more preventative work to be done at an earlier stage. Whether the new APSO will make a difference remains to be seen. Originality/value As this is new legislation, there is very little analysis of the implications of the Social Services and Well-being (Wales) Act 2014 in relation to safeguarding. This paper presents an overview and, in places, a critical analysis of the new safeguarding duties.

scholarly journals Comparing the impact of authentic leadership on Italian and UK police officers' discretionary power, well-being and commitment

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Benjamin Farr-Wharton ◽  
Yvonne Brunetto ◽  
Paresh Wankhade ◽  
Chiara Saccon ◽  
Matthew Xerri
Keyword(s):  
Organizational Commitment ◽  
Police Officers ◽  
Authentic Leadership ◽  
Affective Commitment ◽  
Well Being ◽  
Discretionary Power ◽  
Police Leadership ◽  
Content Type ◽  
The Uk ◽  
The Impact

PurposeThis paper compares the impact of leadership behaviours on the discretionary power, and well-being, and affective commitment of police officers from Italy and the United Kingdom (UK). In contrast to Italy, UK is an example of a core-New Public Management (NPM) country that has implemented reforms, in turn, changing the management and administration of public organizations. Consequently, it is expected that there will be significant differences in the behaviour of police officers. In particular, the paper examines the antecedents and outcomes of police officers' well-being.Design/methodology/approachThe study involves collecting and analysing survey data using Structural Equation Modelling from 220 Italian and 238 UK police officers.FindingsThere was a significant path from Leadership to Discretionary Power to Employee Well-being to Affective Commitment – at least for the Italian sample. The UK sample does not have a significant link between leadership and discretionary power. Discretionary power was similarly low for both groups as was affective commitment. Authentic leadership and discretionary power explained approximately a third of their well-being, particularly discretionary power. Together, directly and indirectly (mediated by well-being), they explained at least a third of police officers' commitment to their organization. Well-being appears to be the key to ensuring effective police officers.Research limitations/implicationsThe limitation of this paper includes the use of cross-sectional data (Podsakoff et al., 2003). However, a common latent factor (CLF) was included, and several items that were explained by common method variance were controlled, as per George and Pandey's recommendations (2017). Additionally, a Harmon's single factor test was applied to the data.Practical implicationsThe UK police officers have significantly lower commitment compared with the Italian police officers (non-commitment), and both Italian and UK police officers have less discretionary power and well-being compared with police from the United States of America (USA) police officers and other street-level bureaucrats (SLBs). The findings suggest that the present police leadership behaviours erode rather than supports police officers' discretionary power and well-being, leading to a low organizational commitment. Leadership training will better prepare managers to ensure the well-being of police officers working under conditions of work intensification.Originality/valueThe UK police officers have significantly lower commitment compared with the Italian police officers (non-commitment), and both Italian and UK police officers have less discretionary power and well-being compared with US police officers and other SLBs. The findings show that the police leadership erodes rather than supports police officers' discretionary power and well-being, leading to low organizational commitment. Leadership models that enhance employee well-being rather than efficiency targets must be a priority if police are to be prepared to cope effectively with emergencies and pandemics.

Think outside: positive risk-taking with people living with dementia

2017 ◽  
Vol 21 (3) ◽  
pp. 157-166 ◽  
Author(s):  
Neil Mapes
Keyword(s):  
Risk Taking ◽  
Well Being ◽  
Social Emotional ◽  
Content Type ◽  
Outdoor Activities ◽  
People With Dementia ◽  
Wide Range ◽  
The Uk ◽  
The University ◽  
The Impact

Purpose The purpose of this paper is to share findings from the evaluation of dementia adventure (DA) holidays provided in 2016 and drawing on these data, to share reflections on positive risk-taking, which are inherent in outdoor activities, and consider the implications for research and practice with people with dementia. Design/methodology/approach Data are drawn from the 2016 internal evaluation report, using mixed methods design, of DA holidays independently reviewed by Dr Ruth Bartlett at the University of Southampton. Findings DA holidays are leading to a range of social, emotional and physical well-being outcomes, as well as wider benefits for the community of people with dementia, their family and carers. Practical implications Drawing on what positive risk-taking means for individuals, families and organisations, top ten considerations for positive risk taking outdoor activities are presented. Originality/value The number of organisations providing adventure experiences and holidays for people with dementia in the UK remains very low with just a handful of organisations. The impact and evaluation of these holidays is just emerging and whilst compelling needs replication, with larger sample sizes supported by clinical and scientific expertise to deepen our understanding of the impact of positive risk-taking outdoor activities. Additionally, there is a need for thinking and acting differently summarised by the phrase “THINK OUTSIDE” in developing a wide range of nature based positive risk-taking activities with people with dementia.

ICU admissions: Consequences after discharge

2020 ◽  
Vol 13 (9) ◽  
pp. 550-556
Author(s):  
Minal Karavadra ◽  
Ricky Bell
Keyword(s):  
Intensive Care ◽  
Cognitive Decline ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Psychiatric Disturbance ◽  
Intensive Care Department ◽  
Previous Level ◽  
The Uk

The intensive care department may seem a long way from the GP's consulting room, but every year tens of thousands of critically ill patients are admitted to intensive care units (ICUs) across the UK. Patients are often left with long term sequelae that may require GP input. Physical weakness, psychiatric disturbance and cognitive decline are not uncommon after an illness that requires a stay in an ICU. These hinder a patient’s return to their previous level of function and impact caregivers after discharge. This article aims to highlight the chronic symptoms patients can acquire during ICU admission that may come to the attention of GPs for their advice and treatment.

scholarly journals Three models for the regulation of polygenic scores in reproduction

2021 ◽  
pp. medethics-2020-106588
Author(s):  
Sarah Munday ◽  
Julian Savulescu
Keyword(s):  
Human Genetics ◽  
Ethical Issues ◽  
Well Being ◽  
Embryo Selection ◽  
Risk Scores ◽  
Regulatory Regime ◽  
Polygenic Scores ◽  
The Usa ◽  
The Uk ◽  
The Impact

The past few years have brought significant breakthroughs in understanding human genetics. This knowledge has been used to develop ‘polygenic scores’ (or ‘polygenic risk scores’) which provide probabilistic information about the development of polygenic conditions such as diabetes or schizophrenia. They are already being used in reproduction to select for embryos at lower risk of developing disease. Currently, the use of polygenic scores for embryo selection is subject to existing regulations concerning embryo testing and selection. Existing regulatory approaches include ‘disease-based' models which limit embryo selection to avoiding disease characteristics (employed in various formats in Australia, the UK, Italy, Switzerland and France, among others), and 'laissez-faire' or 'libertarian' models, under which embryo testing and selection remain unregulated (as in the USA). We introduce a novel 'Welfarist Model' which limits embryo selection according to the impact of the predicted trait on well-being. We compare the strengths and weaknesses of each model as a way of regulating polygenic scores. Polygenic scores create the potential for existing embryo selection technologies to be used to select for a wider range of predicted genetically influenced characteristics including continuous traits. Indeed, polygenic scores exist to predict future intelligence, and there have been suggestions that they will be used to make predictions within the normal range in the USA in embryo selection. We examine how these three models would apply to the prediction of non-disease traits such as intelligence. The genetics of intelligence remains controversial both scientifically and ethically. This paper does not attempt to resolve these issues. However, as with many biomedical advances, an effective regulatory regime must be in place as soon as the technology is available. If there is no regulation in place, then the market effectively decides ethical issues.

Sign in / Sign up

Export Citation Format

Share Document