Can we prepare healthcare professionals and students for involvement in stressful healthcare events? A mixed-methods evaluation of a resilience training intervention

Abstract Background Healthcare professionals are experiencing unprecedented levels of occupational stress and burnout. Higher stress and burnout in health professionals is linked with the delivery of poorer quality, less safe patient care across healthcare settings. In order to understand how we can better support healthcare professionals in the workplace, this study evaluated a tailored resilience coaching intervention comprising a workshop and one-to-one coaching session addressing the intrinsic challenges of healthcare work in health professionals and students. Methods The evaluation used an uncontrolled before-and-after design with four data-collection time points: baseline (T1); after the workshop (T2); after the coaching session (T3) and four-to-six weeks post-baseline (T4). Quantitative outcome measures were Confidence in Coping with Adverse Events (‘Confidence’), a Knowledge assessment (‘Knowledge’) and Resilience. At T4, qualitative interviews were also conducted with a subset of participants exploring participant experiences and perceptions of the intervention. Results We recruited 66 participants, retaining 62 (93.9%) at T2, 47 (71.2%) at T3, and 33 (50%) at T4. Compared with baseline, Confidence was significantly higher post-intervention: T2 (unadj. β = 2.43, 95% CI 2.08–2.79, d = 1.55, p < .001), T3 (unadj. β = 2.81, 95% CI 2.42–3.21, d = 1.71, p < .001) and T4 (unadj. β = 2.75, 95% CI 2.31–3.19, d = 1.52, p < .001). Knowledge increased significantly post-intervention (T2 unadj. β = 1.14, 95% CI 0.82–1.46, d = 0.86, p < .001). Compared with baseline, resilience was also higher post-intervention (T3 unadj. β = 2.77, 95% CI 1.82–3.73, d = 0.90, p < .001 and T4 unadj. β = 2.54, 95% CI 1.45–3.62, d = 0.65, p < .001). The qualitative findings identified four themes. The first addressed the ‘tension between mandatory and voluntary delivery’, suggesting that resilience is a mandatory skillset but it may not be effective to make the training a mandatory requirement. The second, the ‘importance of experience and reference points for learning’, suggested the intervention was more appropriate for qualified staff than students. The third suggested participants valued the ‘peer learning and engagement’ they gained in the interactive group workshop. The fourth, ‘opportunities to tailor learning’, suggested the coaching session was an opportunity to personalise the workshop material. Conclusions We found preliminary evidence that the intervention was well received and effective, but further research using a randomised controlled design will be necessary to confirm this.

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Treating sleep problems in young people at ultra-high-risk of psychosis: study protocol for a single-blind parallel group randomised controlled feasibility trial (SleepWell)

BMJ Open ◽

10.1136/bmjopen-2020-045235 ◽

2020 ◽

Vol 10 (11) ◽

pp. e045235

Author(s):

Felicity Waite ◽

Thomas Kabir ◽

Louise Johns ◽

Jill Mollison ◽

Apostolos Tsiachristas ◽

...

Keyword(s):

Mental Health ◽

High Risk ◽

Young People ◽

Sleep Problems ◽

Qualitative Interviews ◽

Feasibility Trial ◽

Psychotic Experiences ◽

Post Intervention ◽

Ultra High Risk ◽

Randomised Controlled

BackgroundEffective interventions, targeting key contributory causal factors, are needed to prevent the emergence of severe mental health problems in young people. Insomnia is a common clinical issue that is problematic in its own right but that also leads to the development and persistence of psychotic experiences. The implication is that treating sleep problems may prevent the onset of psychosis. We collected initial case series data with 12 young people at ultra-high-risk of psychosis. Post-intervention, there were improvements in sleep, depression and psychotic experiences. Now we test the feasibility of a randomised controlled trial, with a clinical aim to treat sleep problems and hence reduce depression, psychotic experiences, and prevent transition to psychosis.Methods and analysisA randomised controlled feasibility trial will be conducted. Forty patients aged 14 to 25 years who are at ultra-high-risk of psychosis and have sleep disturbance will be recruited from National Health Service (NHS) mental health services. Participants will be randomised to receive either a novel, targeted, youth-focussed sleep intervention in addition to usual care or usual care alone. Assessor-blinded assessments will be conducted at baseline, 3 months (post-intervention) and 9 months (follow-up). The eight-session psychological intervention will target the key mechanisms which disrupt sleep: circadian rhythm irregularities, low sleep pressure, and hyperarousal. To gain an in-depth understanding of participants’ views on the acceptability of the intervention and study procedures, 16 participants (n=10 intervention, n=6 control) will take part in qualitative interviews. Analyses will focus on feasibility outcomes (recruitment, retention, and treatment uptake rates) and provide initial CI estimates of intervention effects. Thematic analysis of the qualitative interviews will assess the acceptability of the intervention and trial procedures.Ethics and disseminationThe trial has received ethical approval from the NHS Health Research Authority. Findings will be disseminated through peer-reviewed publications, conference presentations, and lay networks.Trial registration numberISRCTN85601537.

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Developing an intervention to optimise the outcome of cardiac surgery in people with diabetes: the OCTOPuS pilot study

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00887-z ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Richard I. G. Holt ◽

Katharine Barnard-Kelly ◽

Giorgos Dritsakis ◽

Kerensa I. Thorne ◽

Lauren Cohen ◽

...

Keyword(s):

Surgical Outcomes ◽

Healthcare Professionals ◽

Diabetes Management ◽

Controlled Trial ◽

Qualitative Interviews ◽

Cardiothoracic Surgery ◽

University Hospital ◽

Major Surgery ◽

Biomedical Data ◽

Randomised Controlled

Abstract Background Cardiothoracic surgical outcomes are poorer in people with diabetes compared with those without diabetes. There are two important uncertainties in the management of people with diabetes undergoing major surgery: (1) how to improve diabetes management in the weeks leading up to an elective procedure and (2) whether that improved management leads to improved postoperative outcomes. The aim of this study was to develop and pilot a specialist diabetes team-led intervention to improve surgical outcomes in people with diabetes. Design Open pilot feasibility study Setting Diabetes and cardiothoracic surgery departments, University Hospital Southampton NHS Foundation Trust Participants Seventeen people with diabetes undergoing cardiothoracic surgery Intervention Following two rapid literature reviews, a prototype intervention was developed based on a previously used nurse-led outpatient intervention and tested. Primary outcome Feasibility and acceptability of delivering the intervention Secondary outcomes Biomedical data were collected at baseline and prior to surgery. We assessed how the intervention was used. In depth qualitative interviews with participants and healthcare professionals were used to explore perceptions and experiences of the intervention and how it might be improved. Results Thirteen of the 17 people recruited completed the study and underwent cardiothoracic surgery. All components of the OCTOPuS intervention were used, but not all parts were used for all participants. Minor changes were made to the intervention as a result of feedback from the participants and healthcare professionals. Median (IQR) HbA1c was 10 mmol/mol (3, 13) lower prior to surgery than at baseline. Conclusion This study has shown that it is possible to develop a clinical pathway to improve diabetes management prior to admission. The clinical and cost-effectiveness of this intervention will now be tested in a multicentre randomised controlled trial in cardiothoracic centres across the UK. Trial registration ISRCTN; ISRCTN10170306. Registered 10 May 2018.

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Development and implementation of a nurse-led allergy clinic model in primary care: feasibility trial protocol

npj Primary Care Respiratory Medicine ◽

10.1038/s41533-019-0155-5 ◽

2019 ◽

Vol 29 (1) ◽

Author(s):

Margaret Kelman ◽

Victoria Hammersley ◽

Marilyn Kendall ◽

Mome Mukherjee ◽

Lynn Morrice ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Healthcare Professionals ◽

Controlled Trial ◽

Qualitative Interviews ◽

Retention Rates ◽

Feasibility Trial ◽

Allergy Clinic ◽

Randomised Controlled

AbstractIn the United Kingdom, there are acknowledged short comings in allergy care provision for patients seen in primary care. There is a lack of allergy training for healthcare professionals and this leads to inappropriate referrals to the limited number of allergy specialists. The primary aims of this study are to assess the feasibility of delivering and evaluating a new nurse-led allergy service in primary care, measured by recruitment, retention and quality of life. This is a single arm feasibility trial in which up to 250 participants referred to the nurse-led allergy clinic will receive the intervention and complete 6–12 weeks follow-up before being referred back to their usual care. Primary outcomes for this study will be establishment of clinics, recruitment and retention rates, and estimates of change in disease-specific quality of life measures. Secondary outcomes will be acceptability of the new service to participants/carers and healthcare professionals. A sample of participants and professional stakeholders will take part in more in-depth semi-structured qualitative interviews. Data from this feasibility trial will be used to inform plans for a pilot randomised controlled trial of nurse-led allergy clinics.

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A Randomised Controlled Trial Comparing the Effect of E-learning, with a Taught Workshop, on the Knowledge and Search Skills of Health Professionals

Evidence Based Library and Information Practice ◽

10.18438/b8h01s ◽

2006 ◽

Vol 1 (3) ◽

pp. 44 ◽

Cited By ~ 2

Author(s):

Nicola Pearce-Smith

Keyword(s):

Randomised Controlled Trial ◽

Sample Size ◽

Health Professionals ◽

Search Strategy ◽

Small Sample Size ◽

Controlled Trial ◽

Small Sample ◽

Post Intervention ◽

E Learning ◽

Randomised Controlled

Objective - The aim of the trial was to establish whether there is a significant difference in terms of knowledge and skills, between self-directed learning using a web-based resource, compared with a classroom based interactive workshop, for teaching health professionals how to search. The outcomes measured were knowledge of databases and study designs, and search skills. Methods - The study design was a randomised controlled trial (RCT). 17 health professionals were randomised into one of two groups – one group (EG) received access to a search-skills web resource, and the other group received a search workshop (WG) taught by a librarian. Participants completed pre- and post-intervention tests involving multiple choice questions and practical searching using clinical scenarios.. Results - 9 WG and 6 EG participants completed both pre-and post-intervention tests. The test results were blindly marked using a score chart developed with two other librarians. For question formulation and devising a search strategy, all participants obtained a score that was the same or better after receiving the intervention (both WG and EG), but statistical analysis showed that the only significant outcomes were for the WG devising a search strategy (p=0.01) and preferring to search using MeSH after receiving the taught workshop (p=0.02). The Mann-Whitney test showed there were no significant differences in any of the outcomes (p>0.05), between the WG and the EG. The statistical analyses must be viewed with caution due to the small sample size. Conclusions - There were no significant differences in knowledge of databases and study design, or search skills, when the WG and the EG were compared. Although many participants obtained a score that was higher post-intervention, only devising a search strategy and preferring to search using MeSH were significant for the WG. The question of whether a taught workshop and an e-learning module are of equal effectiveness in teaching search skills, is an important one for health librarians involved in user education, and was a justifiable topic to propose and conduct research. The fact that the results are mainly inconclusive due to the small sample size is disappointing, but does not diminish the importance of conducting the study.

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Yoga Therapy for Chronic Tension-Type Headache

Global Journal of Health Science ◽

10.5539/gjhs.v11n5p94 ◽

2019 ◽

Vol 11 (5) ◽

pp. 94

Author(s):

Neha Sharma ◽

PJ John ◽

Chandra M Sharma ◽

Ram Vaidya

Keyword(s):

Controlled Trial ◽

Preliminary Evidence ◽

Tension Type Headache ◽

Post Intervention ◽

Headache Attack ◽

Yoga Therapy ◽

Chronic Tension Type Headache ◽

Therapy Program ◽

Type Headache ◽

Randomised Controlled

OBJECTIVE: To evaluate the clinical efficacy of yoga therapy for Chronic Tension-Type Headache. METHOD: 68 patients diagnosed with chronic tension-type headache were included in 12- week yoga therapy program. All patients completed baseline assessments before starting the intervention and at 4, 8 and 12 weeks completing the yoga therapy. Headache frequency, duration, intensity and analgesics use were recorded through headache diaries. RESULT: Compared with baseline values, mean headache days reduced 51% after 4-week of intervention which continued to reduce by 78% by end of 12 weeks. Comparing from baseline, at 12-week, duration of each headache attack also significantly (P < 0.0001) shortened as well as headache intensity (p < 0.0001). Days with medication per four weeks at post intervention were lower than those at the baseline. CONCLUSION: The study provided preliminary evidence that yoga therapy can be clinically useful for chronic tension-type headache. Further randomised controlled trial is needed.

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Facilitating trial recruitment: A qualitative study of patient and staff experiences of an orthopaedic trauma trial

10.21203/rs.2.124/v1 ◽

2018 ◽

Author(s):

Emma Phelps ◽

Elizabeth Tutton ◽

Xavier Griffin ◽

Janis Baird

Keyword(s):

Healthcare Professionals ◽

Qualitative Interviews ◽

Feasibility Trial ◽

Orthopaedic Trauma ◽

Trial Recruitment ◽

Research Culture ◽

Structured Interviews ◽

Randomised Controlled ◽

The Right ◽

The Impact

Abstract Background: Qualitative research has been used to explore patients’ and healthcare professionals’ experiences of surgical randomised controlled trials (RCTs). From this research, reasons why patients accept or decline participation and barriers to engaging clinicians in trials have been identified. In a trauma setting, recruitment to surgical trials can be particularly difficult as patients may require urgent treatment and their ability to consider their options, ask questions and reach a decision may be hindered by the impact of their injury. Little research however, has explored patients’ and healthcare professionals’ experiences of surgical RCTs in a trauma setting. This study aimed to understand participants’ and staffs’ experiences of an orthopaedic trauma trial. Methods: We carried out semi-structured interviews with 11 participants and 24 staff (10 surgeons and 14 research associates) participating in a UK multi-centre feasibility trial comparing intramedullary nails versus distal locking plates for fractures of the distal femur (TrAFFix). Interviews explored patients’ experience of TrAFFix and their reason for participating and staffs’ experience of recruiting to TrAFFix and trauma trials more generally. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed using thematic analysis. Results: Three themes were identified. These were i) navigating research with patients after orthopaedic trauma, ii) knowing that it is the right decision and iii) making it work. These themes reflect: i) how research associates supported and guided patients through the consent process enabling them to participate, ii) the difficulty in engaging surgeons in a trial when individual equipoise and experience of the interventions is low despite the presence of community equipoise and iii) the way in which research teams worked together and encouraged the development of a research culture within the clinical teams in order to facilitate recruitment. Conclusions: Our findings highlight the pivotal role of research associates (RAs) in facilitating trial recruitment. RAs supported patients to enable them to make a decision about participation and assisted in developing a research culture within the team by promoting studies and communicating research to clinical staff. Our findings also reinforce surgeons’ difficulty with equipoise and suggest that accepting community equipoise could facilitate recruitment. Keywords: Qualitative, Interviews, experience, recruitment, trials,

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Interdisciplinary Promises and Hierarchical Ambiguities in a Danish Hospital Context

Professions and Professionalism ◽

10.7577/pp.2862 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Anette Lykke Hindhede ◽

Vibeke Andersen

Keyword(s):

Health Professionals ◽

Middle Managers ◽

Healthcare Professionals ◽

Qualitative Interviews ◽

Health Sector ◽

Welfare States ◽

The Public ◽

Jurisdictional Control ◽

Knowledge Claims ◽

Danish Hospital

The public health sector in welfare states is increasingly subject to organisational changes, particularly in hospitals, as organisations comprise coali-tions of various (healthcare) professionals. In this context, due to interprofessional competition, knowledge claims play an important role in achieving jurisdictional control. In this paper, we investigate the manifestations of and health professionals’ reactions to competing institutional discourses. Through qualitative interviews with hospital management, middle managers, and staff employees at three hospitals in Denmark, we demonstrate how managerial attempts to control tenacious profes-sional bureaucracies are exercised through both bureaucratic forms of control and cultural-ideological modes of control with an introduction of new discourses of in-terprofessional teamwork. The findings suggest that hospitals seek not only to con-tain ambiguity through bureaucratic features of control, but also to cultivate it when seeking to strengthen cooperation between professions. Thereby, ambiguity itself becomes a mechanism for management.

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The Effect of Real-Time Feedback Using a Smartwatch on the Clinical Behavior of Novice Student Clinicians

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp2.sig11.79 ◽

2017 ◽

Vol 2 (11) ◽

pp. 79-90

Author(s):

Courtney G. Scott ◽

Trina M. Becker ◽

Kenneth O. Simpson

Keyword(s):

Real Time ◽

Rating Scales ◽

Qualitative Interviews ◽

Communication Disorders ◽

Preliminary Evidence ◽

Single Subject ◽

Clinical Behavior ◽

Stimulus Response ◽

Treatment Data ◽

Computer Monitors

The use of computer monitors to provide technology-based written feedback during clinical sessions, referred to as “bug-in-the-eye” (BITi) feedback, recently emerged in the literature with preliminary evidence to support its effectiveness (Carmel, Villatte, Rosenthal, Chalker & Comtois, 2015; Weck et al., 2016). This investigation employed a single-subject, sequential A-B design with two participants to observe the effects of implementing BITi feedback using a smartwatch on the clinical behavior of student clinicians (SCs). Baseline and treatment data on the stimulus-response-consequence (S-R-C) contingency completion rates of SCs were collected using 10 minute segments of recorded therapy sessions. All participants were students enrolled in a clinical practicum experience in a communication disorders and sciences (CDS) program. A celeration line, descriptive statistics, and stability band were used to analyze the data by slope, trend, and variability. Results demonstrated a significant correlative relationship between BITi feedback with a smartwatch and an increase in positive clinical behaviors. Based on qualitative interviews and exit rating scales, SCs reported BITi feedback was noninvasive and minimally distracting. Preliminary evidence suggests BITi feedback with a smartwatch may be an effective tool for providing real-time clinical feedback.

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Recomendações de equipamentos de proteção individual no combate ao COVID-19

Revista Recien - Revista Científica de Enfermagem ◽

10.24276/rrecien2020.10.31.87-95 ◽

2020 ◽

Vol 10 (31) ◽

pp. 87-95

Author(s):

Nicole Maria Miyamoto Bettini ◽

Fabiana Tomé Ramos ◽

Priscila Masquetto Vieira de Almeida

Keyword(s):

World Health Organization ◽

Personal Protective Equipment ◽

Health Professionals ◽

Health Personnel ◽

Healthcare Professionals ◽

World Health ◽

Protective Equipment ◽

Effective Strategy ◽

The World ◽

Health Organization

A Organização Mundial da Saúde - OMS confirmou a circulação internacional do novo Coronavírus em janeiro de 2020, nomeando-o como COVID-19 e, declarando uma pandemia. É de extrema importância que durante a pandemia, os profissionais de saúde tenham acesso e conhecimento sobre o uso correto dos Equipamentos de Proteção Individual (EPIs) e suas indicações, tomando assim, as devidas precauções na prevenção de infecções. O presente estudo buscou identificar a padronização mundial quanto ao uso dos EPIs utilizados no atendimento a pacientes suspeitos e/ou confirmados de COVID-19 no Brasil, EUA, China, Espanha, Itália e demais países europeus. Os guidelines apresentam a padronização quanto ao uso dos EPIs utilizados no atendimento a suspeitos e/ou confirmados de COVID-19, indo ao encontro das recomendações fornecidas pela OMS. Até o momento, o uso de EPIs é sem dúvida a estratégia mais importante e eficaz para proteger os profissionais de saúde durante a assistência ao paciente com COVID-19.Descritores: Infecções por Coronavírus, Equipamento de Proteção Individual, Pessoal de Saúde, Enfermagem. Recommendations for personal protective equipment to combat COVID-19Abstract: The World Health Organization - WHO confirmed the international circulation of the new Coronavirus in January 2020, naming it as COVID-19 and declaring a pandemic. It is extremely important that during the pandemic, health professionals have access and knowledge about the correct use of Personal Protective Equipment (PPE) and its indications, thus taking appropriate precautions to prevent infections. The present study sought to identify the worldwide standardization regarding the use of PPE utilized to take care of suspected and confirmed patients with COVID-19 in Brazil, USA, China, Spain, Italy and other European countries. The guidelines present a standardization regarding the use of PPE utilized to take care of suspected and confirmed with COVID-19, in line with the recommendations provided by WHO. To date, the use of PPE is undoubtedly the most important and effective strategy to protect healthcare professionals during care for patients with COVID-19.Descriptors: Coronavirus Infections, Personal Protective Equipment, Health Personnel, Nursing. Recomendaciones para el equipo de protección personal para combatir COVID-19Resumen: La Organización Mundial de la Salud - La OMS confirmó la circulación internacional del nuevo Coronavirus en enero de 2020, nombrándolo COVID-19 y declarando una pandemia. Es extremadamente importante que durante la pandemia, los profesionales de la salud tengan acceso y conocimiento sobre el uso correcto del Equipo de Protección Personal (EPP) y sus indicaciones, tomando así las precauciones adecuadas para prevenir infecciones. El presente estudio buscó identificar la estandarización mundial con respecto al uso de EPP utilizado para atender a pacientes sospechosos y/o confirmados con COVID-19 en Brasil, Estados Unidos, China, España, Italia y otros países europeos. Las pautas presentan la estandarización con respecto al uso de EPP utilizado para cuidar COVID-19 sospechoso y/o confirmado, de acuerdo con las recomendaciones proporcionadas por la OMS. Hasta la fecha, el uso de EPP es, sin duda, la estrategia más importante y efectiva para proteger a los profesionales de la salud durante la atención de pacientes con COVID-19.Descriptores: Infecciones por Coronavirus, Equipo de Protección Personal, Personal de Salud, Enfermería.

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Experiences in physical activity promotion in health care settings for primary prevention in the UK

Swiss Sports & Exercise Medicine ◽

10.34045/ssem/2014/11 ◽

2014 ◽

Vol 62 (2) ◽

Keyword(s):

Physical Activity ◽

Primary Care ◽

Health Professionals ◽

Controlled Trial ◽

Full Range ◽

Tertiary Care ◽

Physical Activity Promotion ◽

Community Based ◽

Activity Promotion ◽

Randomised Controlled

In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial. With notable exceptions where individuals have a personal interest or commitment, the majority of health professionals tend to limit themselves to peremptory non-specific advice at best, or frequently don’t broach the subject at all. There are a number of reasons for this including increasing time pressures, a general lack of knowledge, limited evidence and concerns about litigation in the event of an adverse exercise induced event. However in the 1990s there was a surge of interest in the emerging “Exercise on Prescription” model where patients could be referred to community based exercise instructors for a structured “prescription” of exercise in community leisure centres. Despite the continuing popularity of the model there remain problems particularly in getting the active support of health professionals who generally cite the same barriers as previously identified. In an attempt to overcome some of these problems Wales established a national exercise referral scheme with an associated randomised controlled trial. The scheme evaluated well and had subsequently evolved with new developments including integration with secondary and tertiary care pathways, accredited training for exercise instructors and exit routes into alternative community based exercise opportunities.

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