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Heesters V, van Zanten HA, Heijstek V, Te Pas AB, Witlox RSGM. Record, reflect and refine: using video review as an initiative to improve neonatal care. Pediatr Res 2024:10.1038/s41390-024-03083-w. [PMID: 38356026 DOI: 10.1038/s41390-024-03083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/21/2023] [Accepted: 01/27/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The goal of every medical team is to provide optimal care for their patients. We aimed to use video review (VR) sessions to identify and address areas for improvement in neonatal care. METHODS For nine months, neonatal procedures (stabilization at birth, intubations and sterile line insertions) were video recorded and reviewed with the neonatal care providers. Action research was used to identify and address areas for improvement which were categorized as (1) protocol/equipment adjustments, (2) input for research, (3) aspects of variety, or (4) development of educational material or training programs. RESULTS Eighteen VR sessions were organized with a mean(SD) of 17(5) staff members participating. In total, 120 areas for improvement were identified and addressed, of which 84/120 (70%) were categorized as aspects of variety, 20/120 (17%) as development of educational material or training programs, 10/120 (8%) as protocol/equipment adjustments, and 6/120 (5%) as input for research. The areas for improvement were grouped in themes per category, including sterility, technique, equipment, communication, teamwork, parents' perspective and ventilation. CONCLUSION Our study showed that regularly organized VR empowered healthcare providers to identify and address a large variety of areas for improvement, contributing to continuous learning and improvement processes. IMPACT Video review empowered healthcare providers to identify areas for improvement in neonatal care Video review gave providers the opportunity to address identified areas for improvement, either by enhancing the application of external evidence (i.e. guidelines), learning from individual clinical expertise or strengthening resilience and teamwork Embedding regularly organized video review sessions allowed for continuous monitoring of care by providers, which can be beneficial for creating ongoing learning and improvement processes The structured pathways, supporting implementation of changes that were proposed based on the video review sessions, could help other centers make use of the potential video review has to offer.
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Affiliation(s)
- Veerle Heesters
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands.
| | - Henriette A van Zanten
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Veerle Heijstek
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Ruben S G M Witlox
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
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Sinskey JL, Chang JM, Lu AC, Pian-Smith MC. Patient Safety and Clinician Well-Being. Anesthesiol Clin 2023; 41:739-753. [PMID: 37838381 DOI: 10.1016/j.anclin.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Clinician well-being and patient safety are intricately linked. We propose that organizational factors (ie, elements of the perioperative work environment and culture) affect both, as opposed to a bidirectional causal relationship. Threats to patient safety and clinician well-being include clinician mental health issues, negative work environments, poor teamwork and communication, and staffing shortages. Opportunities to mitigate these threats include the normalization of mental health care, peer support, psychological safety, just culture, teamwork and communication training, and creative staffing approaches.
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Affiliation(s)
- Jina L Sinskey
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, 4th Floor, San Francisco, CA, USA.
| | - Joyce M Chang
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, 4th Floor, San Francisco, CA, USA
| | - Amy C Lu
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - May C Pian-Smith
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
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Sihvola S, Nurmeksela A, Mikkonen S, Peltokoski J, Kvist T. Resilience, job satisfaction, intentions to leave nursing and quality of care among nurses during the COVID-19 pandemic - a questionnaire study. BMC Health Serv Res 2023; 23:632. [PMID: 37316918 DOI: 10.1186/s12913-023-09648-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has challenged nurses and healthcare systems globally and raised major concerns for nurses' wellbeing and working conditions. This cross-sectional and correlational study design aims to describe nurses' resilience, job satisfaction, intentions to leave and quality of care, and explain their relationships during the COVID-19 pandemic. METHODS Data were collected from Registered Nurses (N = 437) in Finland through an electronic survey between February 2021 and June 2021. The questionnaire covered background characteristics (seven questions), resilience (four questions), job satisfaction (one question), intention to leave nursing (two questions), quality of care (one question), and requiring factors of the work (eight questions). The background variables and dependent variables were analyzed and presented using descriptive statistics. Structural equation modeling was used to explain dependent variables relationships. The study followed procedures recommended in the STROBE Statement for cross-sectional studies in efforts to maximize the quality of reporting results. RESULTS The surveyed nurses evaluated their resilience by mean score 3.92, more nurses had considered leaving nursing during the pandemic (16%) than before (2%). Nurses´ mean score of requiring factors of the work was 2.56 and overall job satisfaction 5.8. Structural equation modeling revealed that resilience affected their job satisfaction, which also influenced the quality of care, that was rated moderate (7.46 out of 10). Structural equation modeling indices of goodness of fit were NFI = 0.988, RFI = 0.954, IFI = 0.992, TLI = 0.97, CFI = 0.992, and RMSEA = 0.064. No direct relationship was found between resilience and intention to leave nursing. CONCLUSIONS Good resilience promoted delivery of high-quality care by nurses during the pandemic and enhanced their job satisfaction, which reduced their intention to leave nursing. The results indicate that it is important to develop interventions that support nurses' resilience. IMPACT The study highlights the importance of nurses' resilience during the pandemic, while job satisfaction may decrease and requiring factors of the work increase. Given the number of nurses who consider leaving nursing, there are clear needs to develop effective strategies to maintain quality healthcare with resilient, committed nursing staff.
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Affiliation(s)
- Saija Sihvola
- Faculty of Health Sciences, Department of Nursing Science, University of Eastern Finland, Kuopio Campus, Yliopistonranta 1 C, Canthia, P.O. Box 1627, Kuopio, FI-70211, Finland.
| | - Anu Nurmeksela
- Faculty of Health Sciences, Department of Nursing Science, University of Eastern Finland, Kuopio Campus, Yliopistonranta 1 C, Canthia, P.O. Box 1627, Kuopio, FI-70211, Finland
| | - Santtu Mikkonen
- Faculty of Science and Forestry, Department of Applied Physics, University of Eastern Finland, Kuopio Campus, Yliopistonranta 1 C, Canthia, P.O. Box 1627, Kuopio, FI-70211, Finland
| | - Jaana Peltokoski
- Information Management, Wellbeing Services County of Central Finland, Viitaniementie 1, Jyväskylä, 40720, Finland
| | - Tarja Kvist
- Faculty of Health Sciences, Department of Nursing Science, University of Eastern Finland, Kuopio Campus, Yliopistonranta 1 C, Canthia, P.O. Box 1627, Kuopio, FI-70211, Finland
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Stein J, Madni A, Moody K, Kramer D, Vaughn D, Bhatia S, Sellers J, Snyder A, Lu Z, Baker JN, Levine DR. Decreasing Burnout and Improving Work Environment: The Impact of Firgun on a Pediatric Hematopoietic Cell Transplant Team. JCO Oncol Pract 2023; 19:e365-e376. [PMID: 36538744 DOI: 10.1200/op.22.00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Oncology teams are challenged by BO, which may be alleviated by meaningful recognition. In this study, firgun-altruistic acknowledgment-was implemented on a pediatric hematopoietic cell transplant unit to evaluate its impact on staff and work environment. METHODS In this longitudinal, mixed-methods pilot study, interdisciplinary inpatient hematopoietic cell transplant providers received web-based firgun education. Electronic administration of validated surveys occurred at baseline and 8 weeks, including Perceived Stress Scale, Professional Quality of Life Scale, Maslach Burnout Inventory, Workplace Civility Index, Areas of Work Life Survey, and WHO-5. Weekly e-mails reminded participants to practice and log firgun. Wilcoxon signed test for paired data compared pre/post results. Interviews conducted at project completion were coded using MaxQDA software. RESULTS Forty-two participants enrolled; 25 completed pre/post surveys; eight were interviewed. At study end, participants reported feeling less nervous and stressed (P = .008), and less difficulty coping (P = .01; Perceived Stress Scale), while noting increased acknowledgment of others' work (P = .04) and seeking constructive feedback (P = .04; Workplace Civility Index). Marked BO was not evident overall on the Maslach Burnout Inventory; however, emotional exhaustion subscale mean (SD) scores improved from pre (19.4 [8.6]) to post (16 [6.3; P = .02]) and individual items illustrated decreased fatigue (P = .008), frustration (P = .04), and feeling "at the end of my rope" (P = .001). Postintervention participants noted increased receipt of recognition (P = .02; Areas of Work Life Survey), decreased feeling "bogged down" (P = .02), decreased affective stress (P = .04), and negative pre-occupations (P = .04; Professional Quality of Life Scale). Qualitative analysis revealed themes of improved confidence at work and enhanced feelings of trust and teamwork. CONCLUSION Firgun is a tool that can potentially reduce BO and stress in interdisciplinary providers, facilitate teamwork, and promote positive work environments in clinical oncology and beyond.
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Affiliation(s)
- Jerry Stein
- BMT Unit, Department of Pediatric Hematology Oncology, Schneider Children's Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arshia Madni
- Department of Oncology, Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | - Karen Moody
- Division of Pediatrics, Section of Palliative and Supportive Care, University of Texas, M.D. Anderson Cancer Center, Houston, TX
| | - Deborah Kramer
- School of Nursing, College of Mount Saint Vincent, Riverdale, NY
| | - Dagny Vaughn
- Department of Oncology, Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | - Shalini Bhatia
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Janet Sellers
- Department of Psychosocial Services, Staff Resilience Center, St Jude Children's Research Hospital, Memphis, TN
| | - Angela Snyder
- Department of Oncology, Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | - Zhaohua Lu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Justin N Baker
- Department of Oncology, Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
| | - Deena R Levine
- Department of Oncology, Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, TN
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Bry A, Wigert H. Organizational climate and interpersonal interactions among registered nurses in a neonatal intensive care unit: A qualitative study. J Nurs Manag 2022; 30:2031-2038. [PMID: 35478366 PMCID: PMC9790375 DOI: 10.1111/jonm.13650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/10/2022] [Accepted: 04/25/2022] [Indexed: 12/30/2022]
Abstract
AIM The aim of this work is to describe the organizational climate and interpersonal interactions experienced by registered nurses in a level III neonatal intensive care unit. BACKGROUND Neonatal nurses have a demanding task in caring for a varied, highly vulnerable patient population and supporting patients' families. Nurses' psychosocial work environment affects quality of care as well as nurses' job satisfaction and organizational commitment. METHOD Semistructured interviews with 13 nurses, covering numerous aspects of their psychosocial work environment, were analyzed using thematic analysis. RESULTS High staff turnover and a preponderance of inexperienced nurses were described as stressful and detrimental to group cohesion. Work at the unit was considered overly demanding for newly qualified nurses, while senior nurses expressed frustration at the work of training new nurses who might not stay. While some were very satisfied with the group climate, others complained of a negative climate and incivilities from some experienced nurses toward new recruits. CONCLUSIONS High turnover and variable competence among staff present challenges for maintaining a positive organizational climate. IMPLICATIONS FOR NURSING MANAGEMENT Management should communicate a clear sense of the nature of neonatal intensive care when recruiting, foster group cohesion (e.g., by creating stable work teams) and reward commitment to working at the unit.
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Affiliation(s)
- Anna Bry
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Division of NeonatologySahlgrenska University HospitalGothenburgSweden
| | - Helena Wigert
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Division of NeonatologySahlgrenska University HospitalGothenburgSweden
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Palethorpe MK. Improved resilience starts at system level. BMJ 2022; 378:o1832. [PMID: 36028260 DOI: 10.1136/bmj.o1832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Page J, Pearson S, Raghwan S. "A Qualitative Evaluation Of The Hot Debrief/Follow-Up Initiative: Implications Of Readily Identifying Positive Outcomes In An Australian Emergency Department". J Nurs Manag 2022; 30:3589-3598. [PMID: 35970197 PMCID: PMC10087145 DOI: 10.1111/jonm.13767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/18/2022] [Accepted: 08/11/2022] [Indexed: 11/27/2022]
Abstract
AIM To gain insight into how emergency department nurses and doctors perceive the experience of being offered the opportunity to request a patient follow-up as part of a structured debrief initiative. BACKGROUND An increased prevalence of burnout and compassion fatigue amongst emergency clinicians is being recognised globally. A wellbeing initiative has been implemented within a large public hospital emergency department to combat these phenomena. METHOD A qualitative research approach using semi-structured interviews were carried out to explore the participants' views relating to the debrief/follow-up initiative. RESULTS A total of 17 face-to-face semi-structured interviews were conducted. This research highlighted a number of common themes including the participants understanding and perception of the follow up initiative, the barriers and enablers of effective implementation, and the perceived benefits of following up on patient outcomes in the emergency setting. This research identified unanimous support for the initiative. No negative implications relating to the initiative were identified. CONCLUSIONS This study indicates the positive impacts of employing a deliberate and formalised approach to enabling staff to access follow-up information about the patients for whom they provide life-giving care. IMPLICATIONS FOR NURSING MANAGEMENT Nurse Unit Managers should consider the findings of this research and understand the crucial role that nursing leadership can play in fostering the design and implementation of similar initiatives.
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Affiliation(s)
- James Page
- Faculty of Medicine, University of Tasmania, Hobart, Australia
| | - Sue Pearson
- Faculty of Medicine, University of Tasmania, Hobart, Australia
| | - Shantha Raghwan
- Faculty of Medicine, University of Tasmania, Hobart, Australia
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Jepkosgei J, English M, Adam MB, Nzinga J. Understanding intra- and interprofessional team and teamwork processes by exploring facility-based neonatal care in kenyan hospitals. BMC Health Serv Res 2022; 22:636. [PMID: 35562721 PMCID: PMC9103056 DOI: 10.1186/s12913-022-08039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Within intensive care settings such as neonatal intensive care units, effective intra- and interprofessional teamwork has been linked to a significant reduction of errors and overall improvement in the quality of care. In Kenya, previous studies suggest that coordination of care among healthcare teams providing newborn care is poor. Initiatives aimed at improving intra- and interprofessional teamwork in healthcare settings largely draw on studies conducted in high-income countries, with those from resource-constrained low and middle countries, particularly in the context of newborn care lacking. In this study, we explored the nature of intra- and interprofessional teamwork among health care providers in newborn units (NBUs) of three hospitals in Kenya, and the professional and contextual dynamics that shaped their interactions. METHODS This exploratory qualitative study was conducted in three hospitals in Nairobi and Muranga Counties in Kenya. We adopted an ethnographic approach, utilizing both in-depth interviews (17) and non-participant observation of routine care provision in NBUs (250 observation hours). The study participants included: nurses, nursing students, doctors, and trainee doctors. All the data were thematically coded in NVIVO 12. RESULTS The nature of intra- and interprofessional teamwork among healthcare providers in the study newborn units is primarily shaped by broader contextual factors and varying institutional contexts. As a result, several team types emerged, loosely categorized as the 'core' team which involves providers physically present in the unit most times during the work shift; the emergency team and the temporary ad-hoc teams which involved the 'core' team, support staff students and mothers. The emergence of these team types influenced relationships among providers. Overall, institutionalized routines and rituals shaped team relations and overall functioning. CONCLUSIONS Poor coordination and the sub-optimal nature of intra-and interprofessional teamwork in NBUs are attributed to broader contextual challenges that include low staff to patient ratios and institutionalized routines and rituals that influenced team norming, relationships, and team leadership. Therefore, mechanisms to improve coordination and collaboration among healthcare teams in these settings need to consider contextual dynamics including institutional cultures while also targeting improvement of team-level processes including leadership development and widening spaces for more interaction and better communication.
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Affiliation(s)
- Joyline Jepkosgei
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, P. O. Box 43640 - 00100, 197 Lenana Place, Lenana Road, Nairobi, Kenya.
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, P. O. Box 43640 - 00100, 197 Lenana Place, Lenana Road, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mary B Adam
- AIC Kijabe Mission Hospital, Kijabe, Kenya
- Africa Consortium for Quality Improvement Research in Frontline Healthcare (ACQUIRE), Nairobi, Kenya
| | - Jacinta Nzinga
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, P. O. Box 43640 - 00100, 197 Lenana Place, Lenana Road, Nairobi, Kenya
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The Relationship between Emotional Stability, Psychological Well-Being and Life Satisfaction of Romanian Medical Doctors during COVID-19 Period: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052937. [PMID: 35270629 PMCID: PMC8910741 DOI: 10.3390/ijerph19052937] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 02/01/2023]
Abstract
Due to the COVID-19 pandemic, as well as the fast progression of modern society, occupational stress has recently reached alarming levels with consequences for doctors’ psychological well-being. The aim of this study was to analyze the relationship among emotional stability, psychological well-being, and life satisfaction of medical doctors. We conducted a cross-sectional study on 280 medical doctors from Romania between February 2021 and September 2021, in the period between the third and fourth pandemic waves, who were evaluated by the DECAS, ASSET, and Satisfaction with Life scales. Our results showed that emotional stability is negatively correlated with psychological well-being (r = −0.526, p < 0.000) and positively correlated with life satisfaction (r = 0.319, p < 0.0001). Between psychological well-being and life satisfaction, we found a negative correlation (r = −0.046, p < 0.001). This study shows that there is a correlation among emotional stability, psychological well-being, and life satisfaction, which is why it can be considered that Romanian doctors have generated coping mechanisms during the COVID-19 pandemic.
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Seifart C, Falch M, Wege M, Maier RF, Pedrosa Carrasco AJ. NEO-SPEAK: A conceptual framework that underpins breaking bad news in neonatology. Front Pediatr 2022; 10:1044210. [PMID: 36440326 PMCID: PMC9681898 DOI: 10.3389/fped.2022.1044210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Breaking bad news in neonatology is a frequent and difficult challenge. Although there are guidelines for communicating with parents in pediatrics and neonatology, the specific framework for breaking bad news in neonatology has not been studied in more detail. Therefore, we aimed to identify determinants that are important for successful managing breaking bad news in neonatology from professionals' perspective and to develop a conceptual framework that underpins this challenging task. METHODS We conducted seventeen semi-structured interviews with senior neonatologists of six perinatal centers of the highest level of care in Germany. The transcripts were analyzed according to Mayring's method of qualitative content analysis using inductive and deductive coding. RESULTS Eight determinants of breaking bad news in neonatology could be identified from the interviews. From these, we developed the conceptual framework NEO-SPEAK. The first three determinants, Neonatal prognostic uncertainty, Encounter in (triangular-)partnerships, Organization and teamwork (NEO) are directly related to the specific care situation in neonatology, whereas the others, Situational stress, Processuality, Emotional burden, Attention to individuality, Knowledge and experience, play a role for difficult conversations in general, but are subject to special modifications in neonatology (SPEAK). In addition, the results show that the context in neonatology as well as reciprocal effects on the team and the individual level of the physicians are important influencing factors in breaking bad news. CONCLUSION On the one hand, the constitutional framework NEO-SPEAK shows which special aspects play a role in neonatology for the delivery of bad news, and on the other hand, it can help to identify and consider these aspects in clinical routine and training. Considering or reinforcing each NEO-SPEAK element when planning or delivering bad news may guide healthcare professionals through communication with parents of critically ill or premature newborns and support the resilience of the caring team.
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Affiliation(s)
- Carola Seifart
- Faculty of Medicine, Dean's Office, Research Group Medical Ethics (AGEM), Philipps-University of Marburg, Marburg, Germany
| | - Mirjam Falch
- Faculty of Medicine, Dean's Office, Research Group Medical Ethics (AGEM), Philipps-University of Marburg, Marburg, Germany
| | - Mirjam Wege
- Children's Hospital, University Hospital of Marburg, Marburg, Germany
| | - Rolf F Maier
- Faculty of Medicine, Philipps University of Marburg, Marburg, Germany
| | - Anna J Pedrosa Carrasco
- Faculty of Medicine, Dean's Office, Research Group Medical Ethics (AGEM), Philipps-University of Marburg, Marburg, Germany
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Trinh JQ, Carender CN, An Q, Noiseux NO, Otero JE, Brown TS. Patient Resilience Influences Opioid Consumption in Primary Total Joint Arthroplasty Patients. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:112-117. [PMID: 36601223 PMCID: PMC9769347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Resilience and depression may influence opioid consumption in patients undergoing primary hip and knee arthroplasty (TJA); however, data evaluating these relationships are limited. Methods We retrospectively identified 119 patients undergoing TJA who completed preoperative questionnaires to measure resilience (Brief Resilience Scale) and depression (PHQ-9) from 2017 to 2018 at a single institution. Patients were stratified into high, normal, and low resilience groups as well as no, mild, and major depression groups. Opioid use was recorded in morphine milligram equivalents (MMEs). Nonparametric statistical testing was performed with significance level at P < 0.05. Results Higher levels of resilience correlated with less postoperative inpatient opioid use (P = 0.003). Patients with high resilience were less likely to use preoperative opioids compared to those with low resilience (OR = 6.08, 95% CI [1.230.5]). There was no difference in postoperative outpatient opioid prescriptions between resilience groups. Lower levels of depression correlated with less postoperative inpatient opioid use, though this did not reach statistical significance (P = 0.058). Additionally, there was no significant difference in preoperative opioid use or postoperative outpatient opioid prescriptions between depression groups. Conclusion Patients with higher levels of resilience are less likely to use opioids before TJA and utilize lower amounts of opioids while inpatient following surgery. Depression correlated with higher postoperative inpatient opioid use; however, the present findings regarding this relationship are inconclusive. Resilience is a psychological trait that may impact opioid use in patients undergoing TJA and should be viewed as a modifiable risk factor. Level of Evidence: III.
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Affiliation(s)
- Jonathan Q Trinh
- University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
| | - Christopher N Carender
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Qiang An
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Nicolas O Noiseux
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jesse E Otero
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA
| | - Timothy S Brown
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
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12
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Grunberg VA, Vranceanu AM, Lerou PH. Caring for our caretakers: building resiliency in NICU parents and staff. Eur J Pediatr 2022; 181:3545-3548. [PMID: 35804198 PMCID: PMC9395886 DOI: 10.1007/s00431-022-04553-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED The neonatal intensive care unit (NICU) is a high-acuity, stressful unit for both parents and staff. Up to 50% of mothers and partners experience emotional distress (i.e., depression, anxiety, or posttraumatic stress) during NICU hospitalization and 30-60% continue to experience distress after discharge. Similarly, up to 50% of NICU staff report burnout and emotional distress. Although healthcare providers have developed interdisciplinary guidelines to enhance psychosocial resources for parents and staff, standardized psychosocial services are lacking. The purpose of this short communication is to describe: (1) the need for psychosocial interventions for NICU parents and staff; (2) existent psychosocial programs and their gaps and limitations; and (3) future directions for psychosocial care in NICU settings. We reviewed the current literature and propose a new conceptual model to inform psychosocial interventions for the NICU. We argue that brief, evidence-based, resiliency, and relationship-based programs are needed to enhance parent and staff outcomes and, ultimately, child development and the NICU unit culture. CONCLUSION Given the lack of standardized psychosocial care, new interventions for NICU families and staff are needed more than ever. Resiliency, relationship-based interventions that leverage multidisciplinary support may be an innovative way to enhance NICU outcomes and care. WHAT IS KNOWN • 40-50% of parents in the NICU report elevated emotional distress and 30-50% of staff report burnout. • Psychosocial interventions for parents and staff are needed, yet lacking. WHAT IS NEW • Interventions that focus on resiliency and relationships may improve the culture of the NICU. • New multidisciplinary collaborations and approaches are needed to improve implementation.
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Affiliation(s)
- Victoria A. Grunberg
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Harvard Medical School, Boston, MB USA ,Division of Newborn Medicine, MassGeneral for Children, Harvard Medical School, Boston, MA USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Harvard Medical School, Boston, MB USA
| | - Paul H. Lerou
- Division of Newborn Medicine, MassGeneral for Children, Harvard Medical School, Boston, MA USA
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Tabibzadeh M, Patel Z. Reducing unintended retained foreign objects in operating rooms: a proactive risk assessment framework to improve patient safety. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211044608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
According to a study by Johns Hopkins, an average of 251,454 Americans die annually from medical errors. Medical error is the third leading cause of death in the U.S. after heart disease and cancer. Unintended retained foreign objects (URFOs) has been identified as the most common sentinel event by The Joint Commission. This paper proposes a proactive risk assessment framework to enhance patient safety in operating rooms by addressing the URFOs issue. This framework is developed by integrating the 10 traits of a positive safety culture, initially introduced by the nuclear industry and later adopted by other industries, with an accident investigation methodology called AcciMap, originally developed by Rasmussen. The AcciMap is a hierarchical framework consisting of several layers: government and regulatory bodies, company (hospital), (surgery division) management, (operating room) staff, and work. Thirty main categories of socio-technical contributing causes of URFOs were captured across the AcciMap layers. Organizational factors were identified as the root cause of questionable decisions made by staff and management. Financial and budget constraints, inadequate training infrastructure, absence of a risk management infrastructure, and leadership failure are the most influential organizational factors contributed to URFOs. Our mapping of the aforementioned positive safety culture traits on the AcciMap depicted that the four traits of Work Processes, Leadership Safety Values and Actions, Effective Communication, and Continuous Learning had the most influence on the URFOs issue. Associated recommendations to these findings are provided to contribute to reducing risks of URFOs instances.
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Affiliation(s)
- Maryam Tabibzadeh
- Department of Manufacturing Systems Engineering and Management, California State University, Northridge, 18111 Nordho Street, Northridge, CA 91330, USA
| | - Zarna Patel
- Department of Manufacturing Systems Engineering and Management, California State University, Northridge, 18111 Nordho Street, Northridge, CA 91330, USA
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Ravi D, Tawfik DS, Sexton JB, Profit J. Changing safety culture. J Perinatol 2021; 41:2552-2560. [PMID: 33024255 DOI: 10.1038/s41372-020-00839-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/31/2020] [Accepted: 09/18/2020] [Indexed: 02/02/2023]
Abstract
Safety culture, an aspect of organizational culture, that reflects work place norms toward safety, is foundational to high-quality care. Improvements in safety culture are associated with improved operational and clinical outcomes. In the neonatal intensive care unit (NICU), where fragile infants receive complex, coordinated care over prolonged time periods, it is critically important that unit norms reflect the high priority placed on safety. Changing the safety culture of the NICU involves a systematic process of measurement, identifying strengths and weaknesses, deploying targeted interventions, and learning from the results, to set the stage for an iterative process of improvement. Successful change efforts require: effective partnerships with key stakeholders including management, clinicians, staff, and families; using data to make the case for improvement; and leadership actions that motivate change, channel resources, and support active problem- solving. Sustainable change requires buy-in from NICU staff and management, resources, and long-term institutional commitment.
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Affiliation(s)
- Dhurjati Ravi
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA. .,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
| | - Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - J Bryan Sexton
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, USA.,Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, USA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.,California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
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Workforce, Workload, and Burnout in Critical Care Organizations: Survey Results and Research Agenda. Crit Care Med 2021; 48:1565-1571. [PMID: 32796183 DOI: 10.1097/ccm.0000000000004552] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This report provides analyses and perspective of a survey of critical care workforce, workload, and burnout among the intensivists and advanced practice providers of established U.S. and Canadian critical care organizations and provides a research agenda. DESIGN A 97-item electronic survey questionnaire was distributed to the leaders of 27 qualifying organizations. SETTING United States and Canada. PARTICIPANTS Leaders of critical care organizations in the United States and Canada. INTERVENTIONS None. DATA SYNTHESIS AND MAIN RESULTS We received 23 responses (85%). The critical care organization survey recorded substantial variability of most organizational aspects that were not restricted by the critical care organization definition or regulatory mandates. The most common physician staffing model was a combination of full-time and part-time intensivists. Approximately 80% of critical care organizations had dedicated advanced practice providers that staffed some or all their ICUs. Full-time intensivists worked a median of 168 days (range 42-192 d) in the ICU (168 shifts = 24 7-d wk). The median shift duration was 12 hours (range, 7-14 hr), and the median number of consecutive shifts allowed was 7 hours (range 7-14 hr). More than half of critical care organizations reported having burnout prevention programs targeted to ICU physicians, advanced practice providers, and nurses. CONCLUSIONS The variability of current approaches suggests that systematic comparative analyses could identify best organizational practices. The research agenda for the study of critical care organizations should include studies that provide insights regarding the effects of the integrative structure of critical care organizations on outcomes at the levels of our patients, our workforce, our work practices, and sustainability.
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Bruschwein H, Gettle LS. Multipronged intervention for reducing burnout and increasing resiliency in an interdisciplinary care team. BMJ Open Qual 2020; 9:bmjoq-2020-001015. [PMID: 33208306 PMCID: PMC7677337 DOI: 10.1136/bmjoq-2020-001015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Heather Bruschwein
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Lucy S Gettle
- Department of Nutrition Services, University of Virginia Health System, Charlottesville, Virginia, USA
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Blumberg DM, Papazoglou K, Schlosser MD. Organizational Solutions to the Moral Risks of Policing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207461. [PMID: 33066392 PMCID: PMC7602265 DOI: 10.3390/ijerph17207461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/16/2022]
Abstract
In addition to the physical and emotional challenges faced by law enforcement professionals, the job confronts officers with numerous moral risks. The moral risks include moral distress, moral injury, ethical exhaustion, compassion fatigue, and practices that lead to lapses in ethical decision-making. The paper focuses on what police agencies can do to better address the moral risks of policing. These moral risks are central to officer wellness and, thus, a crucial component of officers’ operational readiness. Strategies are presented that will improve prevention efforts, including recruiting and hiring, training, supervision, and promotional practices. Additionally, the paper offers recommendations for effective approaches to intervention with officers who have displayed the effects of these moral risks. Finally, the paper highlights the kind of law enforcement leaders who are best able to implement strategies designed to prevent negative outcomes associated with the moral risks of policing.
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Affiliation(s)
- Daniel M. Blumberg
- California School of Professional Psychology, Alliant International University, San Diego, CA 92129, USA
- Correspondence:
| | | | - Michael D. Schlosser
- Police Training Institute, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA;
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Copeland D. Brief Workplace Interventions Addressing Burnout, Compassion Fatigue, and Teamwork: A Pilot Study. West J Nurs Res 2020; 43:130-137. [PMID: 32646295 DOI: 10.1177/0193945920938048] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Burnout and compassion fatigue are problematic for nurses, patients, and organizations. Identifying brief interventions nurses can engage in while at work to address compassion fatigue, burnout, and teamwork, as burnout and teamwork are inversely related, is important for all stakeholders. This quasi-experimental pilot study sought to examine the feasibility, acceptability, and effectiveness of five-minute interventions on nurses' burnout, compassion fatigue, and perceptions of teamwork. Nurses were randomized into five groups: meditation, journaling, gratitude, outside, and control. Participants engaged in the interventions, the majority of shifts worked, and many expressed a desire to continue after the six-week intervention period. Cohen's d effect sizes were greatest for burnout, range 0.495-0.757, and situation monitoring, range 0.252-1.1. The journaling group had the highest burnout (-11.88%), compassion satisfaction (7.54%), situation monitoring (-21.21%), and communication (-26.47%) Delta scores. Feasibility, acceptability, and effectiveness of these brief workplace interventions were preliminarily established to inform a larger study.
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Affiliation(s)
- Darcy Copeland
- School of Nursing, University of Northern Colorado, Greeley, Colorado, USA.,St Anthony Hospital, Centura Health, Lakewood, Colorado, USA
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Abstract
OBJECTIVE To describe the syndrome of physician burnout within neonatology, its relation to neonatal quality of care, and outline potential solutions. FINDINGS Burnout affects up to half of physicians, including up to one-third of neonatologists, at any given time. It is linked to suicidality, substance abuse, and intent to leave practice, and it is strongly associated with reduced quality of care in the published literature. Resilience and mindfulness interventions rooted in positive psychology may reduce burnout among individual providers. Because burnout is largely driven by organizational factors, system-level attention to leadership, teamwork, and practice efficiency can reduce burnout at the level of the organization. CONCLUSIONS Burnout is common among neonatologists and consistently relates to decreased quality of patient care in a variety of dimensions. Personal resilience training and system-wide organizational interventions are needed to reverse burnout and promote high-quality neonatal care.
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Affiliation(s)
- Daniel S. Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA 770 Welch Road, Suite 435, Palo Alto, CA, USA 94304
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA; California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
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Johnson Rolfes J, Christensen K, Gershan LA. Acceptance of Traditional Chinese Medicine in the Neonatal Intensive Care Unit: A Launching Point. Glob Adv Health Med 2020; 9:2164956120924644. [PMID: 32426181 PMCID: PMC7218323 DOI: 10.1177/2164956120924644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/06/2020] [Accepted: 04/07/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Because neonatology is a relatively new medical specialty, it is host to on-going, rapid adaptation and evolution of medical treatments and practices. This process has almost exclusively focused on Western, biomedical treatment modalities, without inclusion of potentially beneficial Traditional Chinese Medicine practices. It is unclear how receptive health-care providers in the neonatal intensive care unit (NICU) and families of NICU patients would be to the introduction of adapted Traditional Chinese Medicine treatments into the NICU environment. OBJECTIVE To assess the potential for engagement of patients, families, and staff in the NICU with Traditional Chinese Medicine therapies and to provide targeted education and low-risk Traditional Chinese Medicine treatments to support the health and well-being of those 3 groups. METHODS A feasibility pilot study including weekly walk-in Traditional Chinese Medicine sessions within the NICU for parents and staff, and neonatal patient consultations, both of which included hands-on therapies and education tailored to each participant's unique needs. Pre- and postsurveys were administered over 3 phases. RESULTS Walk-in sessions were attended by 83 adults and participants reported benefits, with no ill effects. There were 5 neonatal consultations with staff expressing an interest in more. Several obstacles to accessing Traditional Chinese Medicine modalities were identified in pre-surveys and were addressed with education and preemptive modifications to the therapies offered. CONCLUSION Acceptance of Traditional Chinese Medicine modalities in the NICU opens the door to future studies implementing integrative health services into the NICU care model.
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Affiliation(s)
- Julie Johnson Rolfes
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Kimberly Christensen
- Division of Hematology-Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
- Pediatric Integrative Health and Wellbeing, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Lynn A Gershan
- Division of Hematology-Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
- Pediatric Integrative Health and Wellbeing, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
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21
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Fatahi N, Kustrimovic M, Elden H. Non-Medical Radiography Staff Experiences in Inter-Professional Communication: A Swedish Qualitative Focus Group Interview Study. J Multidiscip Healthc 2020; 13:393-401. [PMID: 32431507 PMCID: PMC7201006 DOI: 10.2147/jmdh.s231442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the experiences of non-medical discipline staff of difficulties and possibilities in inter-professional communication within the radiology department and remitting departments. Materials and Methods Three focus group interviews were conducted with 16 non-medical discipline staff in a radiology department at a university hospital in Sweden. Data were analysed using qualitative content analysis. Results The experiences of inter-professional communication by non-medical discipline staff within the radiology department and with remitting departments can be described in three categories, and six sub categories. The informants experienced difficulties in both oral and written inter-professional communication. Inadequate structures, incorrect information and unclear language in the referral forms, lack of feedback from clinicians and radiologists, and reduced face-to-face communication were described as factors that negatively influenced communication. Other difficulties were time shortage, inadequate routines and economy issues. The possibilities described were use of face-to-face communication, interpreters, and clear and well-structured referral forms. Conclusion Non-medical staff experience that quality in inter-professional communication has a significant impact on health outcomes and patient safety. They expressed a number of difficulties in both written and oral inter-professional communication. For example inadequate written and oral communication, as well as practical issues such as routine could negatively influence the quality of the outcome of inter-professional communication. Lack of feedback from clinicians and radiologists and reduced face-to-face communication were also mentioned as factors that influence oral communication. Possibilities described to improve inter-professional communication quality and thus patient safety were professional contact on both professional and personal levels, use of interpreters, and clear and well-structured referral forms. The results of this study add to our knowledge of the difficulties and possibilities in non-medical inter-professional communication, which may enhance both safety and health outcomes for patients if implemented. Future studies in interprofessional communication is needed. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/4xjYNwpYD90
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Affiliation(s)
- Nabi Fatahi
- Department of Learning and Leadership for Health Care Professionals, Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mirjana Kustrimovic
- Department of Radiography, Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helen Elden
- Department of Reproductive and Perinatal Health, Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Franck LS, Waddington C, O'Brien K. Family Integrated Care for Preterm Infants. Crit Care Nurs Clin North Am 2020; 32:149-165. [PMID: 32402313 DOI: 10.1016/j.cnc.2020.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Parent-infant separation is a major source of stress for parents of hospitalized preterm infants and has negative consequences for infant health and development. Family Integrated Care (FICare) uses a strengths-based approach, based on family-centered care principles to promote parental empowerment, learning, shared decision making, and positive parent-infant caregiving experiences. Outcomes of FICare include increased self-efficacy upon discharge and improved parent-infant relationships and infant developmental outcomes. In this article, the authors describe the FICare model and emerging evidence regarding outcomes of FICare for infants and families and discuss challenges and opportunities in implementing and maintaining high-quality FICare.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, Box 0606, San Francisco, CA 94143, USA.
| | - Chandra Waddington
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, British Columbia V6T1Z7, Canada
| | - Karel O'Brien
- Department of Pediatrics, Sinai Health System, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, 19-231A -600 University Avenue, Toronto, Ontario M5G 1X5, Canada
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Abstract
Burnout and mental health issues among residents are associated with adverse health consequences and suboptimal job performance, e.g. increased medical error. Given role models as key to cultivating resilience, we created faculty resilience narrative videos within resilience skill training programs, hypothesizing such videos would provide new perspectives/insights on resiliency and humanize attendings in a useful way. Child and adult neurology residents at two institutions positively rated the impact of these faculty videos. Such videos are an innovative and practical way to: 1) provide exemplar role models for learning about coping with physician challenges and gaining insights on resilience; 2) access stories of triumph over challenge for inspiration; and 3) work to achieve local culture change by reducing stigma and increase empathy/connection during training. Successful implementation of this video innovation provides good rationale for further evaluation of impact on local culture, faculty experience, and resident attitudes and behavior.
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Affiliation(s)
- Hedy S. Wald
- Alpert Medical School of Brown University, Providence, USA & Harvard Medical School, Global Pediatrics Leadership Program, Boston, USA
| | - Brenda Bursch
- David Geffen School of Medicine at UCLA, Los Angeles, USA
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Olson K, Marchalik D, Farley H, Dean SM, Lawrence EC, Hamidi MS, Rowe S, McCool JM, O'Donovan CA, Micek MA, Stewart MT. Organizational strategies to reduce physician burnout and improve professional fulfillment. Curr Probl Pediatr Adolesc Health Care 2019; 49:100664. [PMID: 31588019 DOI: 10.1016/j.cppeds.2019.100664] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Burnout is highly prevalent among physicians and has been associated with negative outcomes for physicians, patients, staff, and health-care organizations. Reducing physician burnout and increasing physician well-being is a priority. Systematic reviews suggest that organization-based interventions are more effective in reducing physician burnout than interventions targeted at individual physicians. This consensus review by leaders in the field across multiple institutions presents emerging trends and exemplary evidence-based strategies to improve professional fulfillment and reduce physician burnout using Stanford's tripartite model of physician professional fulfillment as an organizing framework: practice efficiency, culture, and personal resilience to support physician well-being. These strategies include leadership traits, latitude of control and autonomy, collegiality, diversity, teamwork, top-of-license workflows, electronic health record (EHR) usability, peer support, confidential mental health services, work-life integration and reducing barriers to practicing a healthy lifestyle. The review concludes with evidence-based recommendations on establishing an effective physician wellness program.
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Affiliation(s)
- Kristine Olson
- Yale School of Medicine, Yale New Haven Health, 20 York Street, New Haven, CT 06510, United States.
| | - Daniel Marchalik
- Medstar Health, Georgetown University School of Medicine, Washington, DC, United States
| | - Heather Farley
- Christiana Care Health System, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, United States
| | - Shannon M Dean
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | | | - Maryam S Hamidi
- Department of Psychiatry and Behavioral Sciences, Stanford Medicine WellMD Center, Stanford University, Stanford, CA, United States
| | - Susannah Rowe
- Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Joanne M McCool
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Mark A Micek
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Miriam T Stewart
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Boivin MP, Malo M. La résilience et le bien-être psychologique au travail au service de la thèse du travailleur heureux-productif. PSYCHOLOGIE DU TRAVAIL ET DES ORGANISATIONS 2019. [DOI: 10.1016/j.pto.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Yu Z, Huang KP, Buzney EA. Creating and Managing a Phototherapy Center. Dermatol Clin 2019; 38:137-143. [PMID: 31753186 DOI: 10.1016/j.det.2019.08.014] [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: 11/30/2022]
Abstract
Phototherapy is a safe and effective treatment for many benign and malignant inflammatory cutaneous diseases. Treatment courses require consistent visits over the course of weeks to months, and one barrier for patients in accessing this treatment is the lack of a geographically convenient phototherapy center. To expand access, new phototherapy centers can be created, and this can be done in a series of steps. These include considering the physical space, anticipating the finances, laying the operational groundwork, and establishing a consent and education process.
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Affiliation(s)
- Zizi Yu
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Kathie P Huang
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Elizabeth A Buzney
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA 02115, USA.
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Lilly CM, Cucchi E, Marshall N, Katz A. Battling Intensivist Burnout. Chest 2019; 156:1001-1007. [DOI: 10.1016/j.chest.2019.04.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/03/2019] [Accepted: 04/25/2019] [Indexed: 11/15/2022] Open
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28
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Tawfik DS, Profit J, Webber S, Shanafelt TD. Organizational factors affecting physician well-being. ACTA ACUST UNITED AC 2019; 5:11-25. [PMID: 31632895 DOI: 10.1007/s40746-019-00147-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose of review Symptoms of burnout affect approximately half of pediatricians and pediatric subspecialists at any given time, with similarly concerning prevalence of other aspects of physician distress, including fatigue, depressive symptoms, and suicidal ideation. Physician well-being affects quality of care, patient satisfaction, and physician turnover. Organizational factors influence well-being, stressing the need for organizations to address this epidemic. Recent findings Organizational characteristics, policies, and culture influence physician well-being, and specific strategies may support an environment where physicians thrive. We highlight four organizational opportunities to improve physician well-being: developing leaders, cultivating community and organizational culture, improving practice efficiency, and optimizing administrative policies. Leaders play a key role in aligning organizational and individual values, promoting professional fulfillment, and fostering a culture of collegiality and social support among physicians. Reducing documentation burden and improving practice efficiency may help balance job demands and resources. Finally, reforming administrative policies may reduce work-home conflict, support physician's efforts to attend to their own well-being, and normalize use of supportive resources. Summary Physician well-being is critical to organizational success, sustainment of an adequate workforce, and optimal patient outcomes. Because burnout is primarily influenced by organizational factors, organizational interventions are key to promoting well-being. Developing supportive leadership, fostering a culture of wellness, optimizing practice efficiency, and improving administrative policies are worthy of organizational action and further research.
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Affiliation(s)
- Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.,California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Sarah Webber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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Incorporating resilience competencies in simulation-based education to emergency response training. J Clin Anesth 2018; 53:4. [PMID: 30268881 DOI: 10.1016/j.jclinane.2018.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/19/2018] [Accepted: 09/26/2018] [Indexed: 11/20/2022]
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