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North J, Murphy K, Beaumont G. Self-regulated trustworthiness: reality or myth? ANZ J Surg 2023; 93:1126-1127. [PMID: 37226666 DOI: 10.1111/ans.18461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/26/2023]
Affiliation(s)
- John North
- Southern Clinical School, University of Queensland, Brisbane, Queensland, Australia
- Telehealth, North-West Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
- Queensland Audit of Surgical Mortality and Northern Territory Audit of Surgical Mortality, Brisbane, Queensland, Australia
| | - Karen Murphy
- Human Factors Training, Clinical Governance Lead, Australian & UK Health Services (NHS), Brisbane, Queensland, Australia
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Veseth M, Ese M, Binder PE, Moltu C. ‘Holding on to regret as a kind of enrichment’ – a qualitative exploration of the role that work-related regrets play in therapists’ clinical practice. COUNSELLING PSYCHOLOGY QUARTERLY 2023. [DOI: 10.1080/09515070.2023.2191310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Affiliation(s)
- Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Mari Ese
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Per-Einar Binder
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
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Naviaux AF, Barbier L, Chopinet S, Janne P, Gourdin M. Ways of preventing surgeon burnout. J Visc Surg 2023; 160:33-38. [PMID: 36257890 DOI: 10.1016/j.jviscsurg.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
In surgical practice, numerous sources of stress (stressors) are unpredictable, two examples being daily workload and postoperative complications. They may help to explain surgeon burnout, of which the prevalence (34 to 53%) has been the subject of many studies. That said, even though assessments are legion, recommended solutions have been few and far between, especially insofar as by nature and training, surgeons are disinclined to interest themselves in burnout, which they are prone to consider as something experienced by "others". The objective of this attempt at clarification is to identify in the literature the strategies put forward in view of avoiding surgeon burnout, and to assess the impact of this phenomenon not only on the surgeon's professional and personal entourage, but also on patient safety. Prevention-based strategies, many of them focused on modifiable stressors, will be detailed.
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Affiliation(s)
- A-F Naviaux
- College of Psychiatrists of Ireland, Health Service Executive (HSE) Summerhill Community Mental Health Service, W35 KC58 Summer Hill, Wexford, Ireland; CHU UCL Namur, Catholic University of Louvain, Yvoir, Belgium
| | - L Barbier
- Liver Transplant and HPB surgery, Auckland City Hospital, University of Auckland, Auckland, New Zealand
| | - S Chopinet
- Liver and Pancreatic Surgery and Liver Transplantation, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - P Janne
- CHU UCL Namur, Catholic University of Louvain, Yvoir, Belgium; Faculty of Psychology, Catholic University of Louvain, place Cardinal Mercier, 10, 1348 Ottignies-Louvain-la-Neuve, Belgium.
| | - M Gourdin
- CHU UCL Namur, Catholic University of Louvain, Yvoir, Belgium; Department of Anesthesiology, CHU UCL Namur, Catholic University of Louvain, B5530 Yvoir, Belgium
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Abdalla I, Robertson AP, Tippett V, Walsh TP, Platt SR. "I'd never have that operation again" - a mixed-methods study on how patients react to adverse outcomes following foot and ankle surgery. J Foot Ankle Res 2022; 15:85. [PMID: 36494742 PMCID: PMC9733247 DOI: 10.1186/s13047-022-00590-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adverse outcomes arising from foot and ankle surgery, including lack of pain relief, increased disability and perioperative complications are infrequent but inevitable. This mixed-methods study aims to explore the impact of adverse outcomes on patients following nonemergent foot and ankle surgery. METHODS Patients who underwent foot and ankle surgery over a two-year period were invited to participate in this study if they reported an adverse outcome. Qualitative assessment consisted of individual semi-structured interviews, designed to explore the decision they made to have surgery and the impact of the outcome after surgery. Quantitative assessment was performed using questionnaires on demographics, current analgesia, foot pain, health-related quality of life, psychological health, and regret. RESULTS Twelve participants (eight women) consented for inclusion in this study. Current foot pain was high in 10 participants, five met the criteria for central sensitisation syndrome and two had clinically significant pain catastrophising. Most participants regretted their decision to have surgery. The three major themes identified were expectations, communication, and alternatives. CONCLUSIONS Self-reported adverse outcomes following foot and ankle surgery were prevalent and participants in this study consistently complained of persistent pain. Regret was common and reasons cited for their adverse outcomes centred around the feelings of inadequate communication and failure to meet expectations.
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Affiliation(s)
- Israa Abdalla
- grid.1024.70000000089150953Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059 Australia
| | - Aaron P. Robertson
- grid.1024.70000000089150953Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059 Australia
| | - Vivienne Tippett
- grid.1024.70000000089150953Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059 Australia
| | - Tom P. Walsh
- grid.1024.70000000089150953Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059 Australia ,grid.413154.60000 0004 0625 9072Department of Orthopaedics, Gold Coast Hospital and Health Service, Southport, Queensland 4215 Australia
| | - Simon R. Platt
- grid.413154.60000 0004 0625 9072Department of Orthopaedics, Gold Coast Hospital and Health Service, Southport, Queensland 4215 Australia
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McQueen SA, Hammond Mobilio M, Moulton CA. Pulling our lens backwards to move forward: an integrated approach to physician distress. MEDICAL HUMANITIES 2022; 48:404-410. [PMID: 34417324 DOI: 10.1136/medhum-2020-012100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 06/13/2023]
Abstract
The medical community has recently acknowledged physician stress as a leading issue for individual wellness and healthcare system functioning. Unprecedented levels of stress contribute to physician burnout, leaves of absence and early retirement. Although recommendations have been made, we continue to struggle with addressing stress. One challenge is a lack of a shared definition for what we mean by 'stress', which is a complex and idiosyncratic phenomenon that may be examined from a myriad of angles. As such, research on stress has traditionally taken a reductionist approach, parsing out one aspect to investigate, such as stress physiology. In the medical domain, we have traditionally underappreciated other dimensions of stress, including emotion and the role of the environmental and sociocultural context in which providers are embedded. Taking a complementary, holistic approach to stress and focusing on the composite, subjective individual experience may provide a deeper understanding of the phenomenon and help to illuminate paths towards wellness. In this review article, we first examine contributions from unidimensional approaches to stress, and then outline a complementary, integrated approach. We describe how complex phenomena have been tackled in other domains and discuss how holistic theory and the humanities may help in studying and addressing physician stress, with the ultimate goal of improving physician well-being and consequently patient care.
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Affiliation(s)
| | - Melanie Hammond Mobilio
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Unexpected operative death from hemorrhage: a review of six cases and recommendations. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Kuo TH, Tien HK. Role of regret in transfer of training: do negative emotions enhance training transfer effects? KNOWLEDGE MANAGEMENT RESEARCH & PRACTICE 2022. [DOI: 10.1080/14778238.2022.2141148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tsung-Hsien Kuo
- Department of Banking and Finance, Tamkang University College of Business, Taipei, Taiwan
| | - Han-Kuang Tien
- School of Business, Department of International Trade, Chinese Culture University, Taipei, Taiwan
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Serou N, Husband AK, Forrest SP, Slight RD, Slight SP. Support for Healthcare Professionals After Surgical Patient Safety Incidents: A Qualitative Descriptive Study in 5 Teaching Hospitals. J Patient Saf 2021; 17:335-340. [PMID: 33881807 DOI: 10.1097/pts.0000000000000844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Patient safety incidents can have a profound effect on healthcare professionals, with some experiencing emotional and psychological distress. This study explored the support medical and nonmedical operating room staff received after being involved in a surgical patient safety incident(s) in 5 UK teaching hospitals. METHODS An invitation letter and information sheet were e-mailed to all medical and nonmedical operating room staff (N = 927) across the 5 sites. Semistructured interviews were arranged with a range of different healthcare professionals working in operating rooms across a wide variety of surgical specialities. Interviews were audio recorded, transcribed verbatim, and analyzed using an inductive thematic approach. RESULTS We conducted 45 interviews with medical and nonmedical operating room staff, who emphasized the importance of receiving personalized support soon after the incident. Operating room staff described how the first "go to" people were their peers and reported feeling comforted when their peers empathized with their own experience(s). Other participants found it very difficult to seek support, perceiving it as a sign of weakness. Although family members played an important role in supporting second victims, some participants felt unable to discuss the incident with them, fearing that they might not understand. CONCLUSIONS There should be clear support structures in place for operating room staff who have been involved in surgical incidents. Health organizations need to offer timely support to frontline staff after these incidents. Senior clinicians should be proactive in offering support to junior colleagues and empathize with their own experiences, thus shifting the competitive culture to one of openness and support.
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Affiliation(s)
| | - Andy K Husband
- From the School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
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Saposnik G, Bueno-Gil G, Sempere ÁP, Rodríguez-Antigüedad A, Del Río B, Baz M, Terzaghi M, Ballesteros J, Maurino J. Regret and Therapeutic Decisions in Multiple Sclerosis Care: Literature Review and Research Protocol. Front Neurol 2021; 12:675520. [PMID: 34234734 PMCID: PMC8256155 DOI: 10.3389/fneur.2021.675520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Decisions based on erroneous assessments may result in unrealistic patient and family expectations, suboptimal advice, incorrect treatment, or costly medical errors. Regret is a common emotion in daily life that involves counterfactual thinking when considering alternative choices. Limited information is available on care-related regret affecting healthcare professionals managing patients with multiple sclerosis (MS). Methods: We reviewed identified gaps in the literature by searching for the combination of the following keywords in Pubmed: "regret and decision," "regret and physicians," and "regret and nurses." An expert panel of neurologists, a nurse, a psychiatrist, a pharmacist, and a psychometrics specialist participated in the study design. Care-related regret will be assessed by a behavioral battery including the standardized questionnaire Regret Intensity Scale (RIS-10) and 15 new specific items. Six items will evaluate regret in the most common social domains affecting individuals (financial, driving, sports-recreation, work, own health, and confidence in people). Another nine items will explore past and recent regret experiences in common situations experienced by healthcare professionals caring for patients with MS. We will also assess concomitant behavioral characteristics of healthcare professionals that could be associated with regret: coping strategies, life satisfaction, mood, positive social behaviors, occupational burnout, and tolerance to uncertainty. Planned Outcomes: This is the first comprehensive and standardized protocol to assess care-related regret and associated behavioral factors among healthcare professionals managing MS. These results will allow to understand and ameliorate regret in healthcare professionals. Spanish National Register (SL42129-20/598-E).
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Affiliation(s)
- Gustavo Saposnik
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.,Clinical Outcomes & Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Ángel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Beatriz Del Río
- Department of Neurology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mar Baz
- Department of Psychiatry, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - María Terzaghi
- Clinical Outcomes & Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, ON, Canada
| | - Javier Ballesteros
- Department of Neurosciences and CIBERSAM, University of the Basque Country (UPV/EHU), Leioa, Spain
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Lai PBS. Temptation of becoming the evil queen ‐ metric fixation. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fleury AM, McGowan B, Burstow MJ, Mudge AM. Sharing the helm: medical co‐management for the older surgical patient. ANZ J Surg 2020; 90:2357-2361. [DOI: 10.1111/ans.16347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Aisling M. Fleury
- Perioperative Medicine Unit, Division of Surgery Logan Hospital Logan Queensland Australia
- Centre for Health Services Research PA Southside Clinical School, The University of Queensland Brisbane Queensland Australia
| | - Brian McGowan
- Department of Surgery Logan Hospital Logan Queensland Australia
| | - Matthew J. Burstow
- Department of Surgery Logan Hospital Logan Queensland Australia
- Department of Surgery Griffith University School of Medicine – Logan Campus Logan Queensland Australia
| | - Alison M. Mudge
- School of Clinical Medicine The University of Queensland Faculty of Medicine Brisbane Queensland Australia
- Internal Medicine and Aged Care Royal Brisbane and Women's Hospital Brisbane Queensland Australia
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Selwood A, Blakely B, Senthuran S, Lane P, North J, Clay-Williams R. Variability in clinicians' understanding and reported methods of identifying high-risk surgical patients: a qualitative study. BMC Health Serv Res 2020; 20:427. [PMID: 32414412 PMCID: PMC7227052 DOI: 10.1186/s12913-020-05316-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background High-risk patients presenting for surgery require complex decision-making and perioperative management. However, given there is no gold standard for identifying high-risk patients, doing so may be challenging for clinicians in practice. Before a gold standard can be established, the state of current practice must be determined. This study aimed to understand how working clinicians define and identify high-risk surgical patients. Methods Clinicians involved in the care of high-risk surgical patients at a public hospital in regional Australia were interviewed as part of an ongoing study evaluating a new shared decision-making process for high-risk patients. The new process, Patient-Centred Advanced Care Planning (PC-ACP) engages patients, families, and clinicians from all relevant specialties in shared decision-making in line with the patient’s goals and values. The semi-structured interviews were conducted before the implementation of the new process and were coded using a modified form of the ‘constant comparative method’ to reveal key themes. Themes concerning patient risk, clinician’s understanding of high risk, and methods for identifying high-risk surgical patients were extricated for close examination. Results Thirteen staff involved in high-risk surgery at the hospital at which PC-ACP was to be implemented were interviewed. Analysis revealed six sub-themes within the major theme of factors related to patient risk: (1) increase in high-risk patients, (2) recognising frailty, (3) risk-benefit balance, (4) suitability and readiness for surgery, (5) avoiding negative outcomes, and (6) methods in use for identifying high-risk patients. There was considerable variability in clinicians’ methods of identifying high-risk patients and regarding their definition of high risk. This variability occurred even among clinicians within the same disciplines and specialties. Conclusions Although clinicians were confident in their own ability to identify high-risk patients, they acknowledged limitations in recognising frail, high-risk patients and predicting and articulating possible outcomes when consenting these patients. Importantly, little consistency in clinicians’ reported methods for identifying high-risk patients was found. Consensus regarding the definition of high-risk surgical patients is necessary to ensure rigorous decision-making.
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Affiliation(s)
- Amanda Selwood
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia.
| | - Brette Blakely
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia
| | - Siva Senthuran
- Townsville Hospital and Health Service, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia.,College of Medicine & Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Paul Lane
- Townsville Hospital and Health Service, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - John North
- Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
| | - Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie Park, NSW, 2109, Australia
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