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van der Veen R, van der Burgt S, Königs M, Oosterlaan J, Peerdeman S. Team functioning in Neurorehabilitation: a mixed methods study. J Interprof Care 2024; 38:621-631. [PMID: 38470835 DOI: 10.1080/13561820.2024.2325694] [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] [Received: 07/14/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
The objective of this study was to enhance understanding of team functioning in a neurorehabilitation team by identifying the factors that impede and facilitate effective interprofessional team collaboration. We focused on team identification, psychological safety, and team learning, and conducted the research at a neurorehabilitation center treating young patients with severe acquired brain injury in the Netherlands. A mixed-methods approach was employed, integrating quantitative data from questionnaires (N = 40) with qualitative insights from a focus group (n = 6) and in-depth interviews (n = 5) to provide a comprehensive perspective on team dynamics. Findings revealed strong team identification among participants, denoting a shared sense of belonging and commitment. However, limited psychological safety was observed, which negatively affected constructive conflict and team learning. Qualitative analysis further identified deficiencies in shared mental models, especially in shared decision-making and integrated care. These results highlight the crucial role of psychological safety in team learning and the development of shared mental models in neurorehabilitation settings. Although specific to neurorehabilitation, the insights gained may be applicable to enhancing team collaboration in various healthcare environments. The study forms a basis for future research to investigate the impact of improvements in team functioning on patient outcomes in similar settings.
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Affiliation(s)
- Ruud van der Veen
- Department of Pediatrics, Emma Children's Hospital, Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Stéphanie van der Burgt
- Teaching and Learning Center (TLC), Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Quality of Care Group, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Marsh Königs
- Department of Pediatrics, Emma Children's Hospital, Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Children's Hospital, Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Saskia Peerdeman
- Teaching and Learning Center (TLC), Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Quality of Care Group, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Neurosurgery, De Boelelaan, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Bourke SL, McKenna L, Cooper S, Lam L. Contextual determinants impacting final year nursing students' emergency team communication during deteriorating patient simulations: A grounded theory study. NURSE EDUCATION TODAY 2024; 138:106183. [PMID: 38554566 DOI: 10.1016/j.nedt.2024.106183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/07/2024] [Accepted: 03/21/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Ability to focus on development of students' team communication and non-technical skills may be reduced in content saturated nursing curricula. Even when communication and simulation-based education is provided, students' utilisation of non-technical skills remains challenging. Although simulation is a recognised means to learn communication skills, little is known about nursing students' team communication in simulated settings. OBJECTIVE To understand the process by which final year undergraduate nursing students communicate in simulated team emergencies. DESIGN Using constructivist grounded theory, data was collected using semi-structured interviews and student observations and analysed using constant comparative analysis. SETTING Simulation laboratories in one university nursing school in Australia. PARTICIPANTS 21 final year nursing students in seven teams. METHODS Data were gathered from interviews and video observations of final year nursing students during simulated team emergencies. RESULTS Interview data and observations of video-recordings revealed contextual determinants that influence communication within teams: the simulation context, the student context and the team context. Team member characteristics, such as cultural and linguistic background, life experiences, gender and age, the ability to shift from leadership to followership as well as environmental factors such as mask wearing and simulation fidelity, contributed to uncertainty in communicating that nursing team effectiveness. CONCLUSIONS Improvement of contextual conditions necessitates implementation of supportive strategies. These include development of educational initiatives, and further research in experiential learning as a modality for learners to experience team communication. Further, simulation context, student context and team context are important considerations. Meeting clinical communication learning needs of students allows better preparation to care for deteriorating patients as graduates.
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Affiliation(s)
- Sharon L Bourke
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Simon Cooper
- The Health Innovation and Transformation Centre (HITC), Institute of Health and Wellbeing, Federation University Australia, Berwick Campus, Clyde Road, Berwick, Victoria, Australia.
| | - Louisa Lam
- School of Nursing, Midwifery and Paramedicine (VIC), Faculty of Health Sciences, Australian Catholic University, Victoria Parade, Fitzroy, VIC 3065, Australia.
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Lin M, Chen B, Xiao L, Zhang L. Publication Trends of Research on Adverse Event and Patient Safety in Nursing Research: A 8-Year Bibliometric Analysis. J Patient Saf 2024; 20:288-298. [PMID: 38314796 DOI: 10.1097/pts.0000000000001207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Adverse events (AEs), which are associated with medical system instability, poor clinical outcomes, and increasing socioeconomic burden, represent a negative outcome of the healthcare system and profoundly influence patient safety. However, research into AEs remains at a developmental stage according to the existing literature, and no previous studies have systematically reviewed the current state of research in the field of AEs. Therefore, the aims of this study were to interpret the results of published research in the field of AEs through bibliometric analysis and to analyze the trends and patterns in the data, which will be important for subsequent innovations in the field. METHODS A statistical and retrospective visualization bibliometric analysis was performed on July 28, 2022. The research data were extracted from the Web of Science Core Collection, and bibliometric citation analysis was performed using Microsoft Excel, VOSviewer 1.6.18, CiteSpace 6.1.R2, and the Online Analysis Platform of Literature Metrology ( http://bibliometric.com/ ). RESULTS A total of 1035 publications on AEs were included in the analysis. The number of articles increased annually from 2014 to 2022. Among them, the United States (n = 318) made the largest contribution, and Chung-Ang University (n = 20) was the affiliation with the greatest influence in this field. Despite notable international cooperation, a regional concentration of research literature production was observed in economically more developed countries. In terms of authors, Stone ND (n = 9) was the most productive author in the research of AEs. Most of the publications concerning AEs were cited from internationally influential nursing journals, and the Journal of Nursing Management (n = 62) was the most highly published journal. Regarding referencing, the article titled "Medical error-the third leading cause of death in the US" received the greatest attention on this topic (51 citations). CONCLUSIONS After systematically reviewed the current state of research in the field of AEs through bibliometric analysis, and AEs highlighted medication errors, patient safety, according reporting, and quality improvement as essential developments and research hotspots in this field. Furthermore, thematic analysis identified 2 new directions in research, concerned with psychological safety, nurse burnout, and with important research value and broad application prospects in the future.
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Affiliation(s)
| | - Bei Chen
- From the Department of Orthopaedic Surgery, The Affiliated Hospital of Zunyi Medical University
| | - Leyao Xiao
- School of Nursing, ZunyiMedical University
| | - Li Zhang
- The Affiliated Hospital of Zunyi Medical University, Zunyi
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Chau M. Enhancing safety culture in radiology: Key practices and recommendations for sustainable excellence. Radiography (Lond) 2024; 30 Suppl 1:9-16. [PMID: 38797116 DOI: 10.1016/j.radi.2024.04.025] [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: 01/27/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES This review aims to explore and thematically synthesize the existing literature on safety culture within the context of radiology. The primary objective is to identify key practices that effectively strengthen safety culture, highlighting the pivotal roles of leadership, effective teamwork, and interprofessional collaboration in these efforts. The review intends to showcase actionable recommendations that are particularly relevant to the radiology setting. KEY FINDINGS The study highlights that effective leadership is fundamental in establishing and nurturing a safety-first approach within radiology departments. Key practices for promoting a safety culture include safety huddles, leadership walkarounds, quality learning boards, intentional patient rounding (frequent patient-care provider interactions), morbidity and mortality meetings, and multidisciplinary team rounds. These practices have been found to facilitate open communication and transparency, which are crucial elements in creating a sustainable safety culture. Additionally, the study underscores the significant role of radiology managers in driving these safety initiatives and acting as facilitators for a culture of safety, focused on long-term excellence and continuous improvement. CONCLUSION The study concludes that a multifaceted and comprehensive approach is vital for fostering a safety culture in radiology departments, with a focus on sustainable excellence in patient care. The leadership role is critical in this process, with radiology managers being instrumental in implementing and maintaining effective safety practices. IMPLICATIONS FOR PRACTICE This study provides best practices for sustainable safety culture in radiology departments. It advocates for healthcare managers to adopt and integrate these identified practices into their operational strategies. Continuous professional development, focusing on safety and quality in patient care, and fostering a collaborative environment for open discussion and learning from safety incidents are essential for the continued advancement and excellence of healthcare services.
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Affiliation(s)
- M Chau
- Faculty of Science and Health, Charles Sturt University, Level 5, 250 Boorooma St, NSW 2678, Australia; South Australia Medical Imaging, Flinders Medical Centre, 1 Flinders Drive, Bedford Park, SA 5042, Australia.
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Passariello M, Tarrant C. Psychological safety in an ECMO retrieval team: a qualitative study to inform improvement. BMJ Open Qual 2024; 13:e002706. [PMID: 38782489 PMCID: PMC11116852 DOI: 10.1136/bmjoq-2023-002706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION In healthcare teams, psychological safety is associated with improved performance, communication, collaboration and patient safety. Extracorporeal membrane oxygenation (ECMO) retrieval teams are multidisciplinary teams that initiate ECMO therapy for patients with severe acute respiratory failure in referring hospitals and transfer patients to regional specialised centres for ongoing care. The present study aimed to explore an ECMO team's experience of psychological safety and generate recommendations to strengthen psychological safety. METHODS The study was conducted in the Royal Brompton Hospital (RBH), part of Guy's and St Thomas' NHS Foundation Trust in London. RBH is one of six centres commissioned to provide ECMO therapy in the UK. 10 participants were recruited: 2 consultants, 5 nurses and 3 perfusionists. Semistructured interviews were used to explore the team members' views on teamwork, their perceived ability to discuss concerns within the team and the interaction between speaking up, teamwork and hierarchy. A Reflexive Thematic Analysis approach was used to explore the interview data. RESULTS The analysis of the interview dataset identified structural and team factors shaping psychological safety in the specific context of the ECMO team. The high-risk environment in which the team operates, the clearly defined process and functions and the structured opportunities that provide legitimate moments to reflect together influence how psychological safety is experienced. Furthermore, speaking up is shaped by the familiarity among team members, the interdependent work, which requires boundary spanning across different roles, and leadership behaviour. A hierarchy of expertise is privileged over traditional institutional ranking. CONCLUSION This study surfaced the structural and team factors that influence speaking up in the specific context of an ECMO retrieval team. Such information is used to suggest interventions to improve and strengthen psychological safety.
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Affiliation(s)
- Maurizio Passariello
- Adult Intensive Care Unit, Royal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Carolyn Tarrant
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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de Lisser R, Lauderdale J, Dietrich MS, Ramanujam R, Stolldorf DP. The Social Ecology of Burnout: A framework for research on nurse practitioner burnout. Nurs Outlook 2024; 72:102188. [PMID: 38788272 DOI: 10.1016/j.outlook.2024.102188] [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: 10/06/2023] [Revised: 03/08/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The U.S. health system is burdened by rising costs, workforce shortages, and unremitting burnout. Well-being interventions have emerged in response, yet data suggest that the work environment is the problem. Nurse practitioner (NP) burnout is associated with structural and relational factors in the work environment, practice autonomy, and hierarchical leadership. PURPOSE We explore the unique social, cultural, and political environment in which NPs work through the lens of social ecology and present the Social Ecology of Burnout (SEB) framework. METHODS We review current burnout frameworks in the context of the NP practice environment and discuss the SEB, specifically exploring psychological safety and its influence on burnout. FINDINGS Psychological safety, work environment, and policy are presented within the SEB and solutions which empower NPs are considered. DISCUSSION Our framework can serve as a guide for future nursing research, practice, and policy.
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Affiliation(s)
- Rosalind de Lisser
- School of Nursing, Vanderbilt University, Nashville, TN; Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA.
| | | | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Rangaraj Ramanujam
- Center for Health Care Programs, Owen Graduate School of Management, Vanderbilt University, Nashville, TN
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Nichol H, Turnnidge J, Dalgarno N, Trier J. Navigating the paradox: Exploring resident experiences of vulnerability. MEDICAL EDUCATION 2024. [PMID: 38757457 DOI: 10.1111/medu.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Learning and growth in postgraduate medical education (PGME) often require vulnerability, defined as a state of openness to uncertainty, risk, and emotional exposure. However, vulnerability can threaten a resident's credibility and professional identity. Despite this tension, studies examining vulnerability in PGME are limited. As such, this study aims to explore residents' experiences of vulnerability, including the factors that influence vulnerability in PGME. METHODS Using a constructivist grounded theory approach, individual semi-structured interviews were conducted with 15 residents from 10 different specialities. Interview transcripts were coded and analysed iteratively. Themes were identified and relationships among themes were examined to develop a theory describing vulnerability in PGME. RESULTS Residents characterised vulnerability as a paradox represented by two overarching themes. 'Experiencing the tensions of vulnerability' explores the polarities between being a fallible, authentic learner and an infallible, competent professional. 'Navigating the vulnerability paradox' outlines the factors influencing the experience of vulnerability and its associated outcomes at the intrapersonal, interpersonal, and systems levels. Residents described needing to have the bandwidth to face the risks and emotional labour of vulnerability. Opportunities to build connections with social agents, including clinical teachers and peers, facilitated vulnerability. The sociocultural context shaped both the experience and outcomes of vulnerability as residents faced the symbolic mask of professionalism. CONCLUSION Residents experience vulnerability as a paradox shaped by intrapersonal, interpersonal, and systems level factors. These findings capture the nuance and complexity of vulnerability in PGME and offer insight into creating supportive learning environments that leverage the benefits of vulnerability while acknowledging its risks. There is a need to translate this understanding into systems-based change to create supportive PGME environments, which value and celebrate vulnerability.
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Affiliation(s)
- Heather Nichol
- Department of Physical Medicine and Rehabilitation, Queen's University, Ontario, Canada
| | - Jennifer Turnnidge
- Office of Professional Development and Educational Scholarship, Queen's University, Ontario, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Queen's University, Ontario, Canada
- Providence Care Hospital, Ontario, Canada
| | - Jessica Trier
- Department of Physical Medicine and Rehabilitation, Queen's University, Ontario, Canada
- Providence Care Hospital, Ontario, Canada
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Warmoth K, Rees J, Day J, Cockcroft E, Aylward A, Pollock L, Coxon G, Craig T, Walton B, Stein K. Assessing deprescribing tools for implementation in care homes: A qualitative study of the views of care home staff. Res Social Adm Pharm 2024; 20:379-388. [PMID: 38245383 DOI: 10.1016/j.sapharm.2023.11.008] [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] [Received: 08/23/2023] [Revised: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Care home residents often experience polypharmacy (defined as taking five or more regular medicines). Therefore, we need to ensure that residents only take the medications that are appropriate or provide value (also known as medicines optimisation). To achieve this, deprescribing, or the reduction or stopping of prescription medicines that may no longer be providing benefit, can help manage polypharmacy and improve outcomes. Various tools, guides, and approaches have been developed to help support health professionals to deprescribe in regular practice. Little evaluation of these tools has been conducted and no work has been done in the care home setting. OBJECTIVE This qualitative study aimed to assess distinct types of deprescribing tools for acceptability, feasibility, and suitability for the care home setting. METHODS Cognitive (think-aloud) interviews with care home staff in England were conducted (from December 2021 to June 2022) to assess five different deprescribing tools. The tools included a general deprescribing guidance, a generic (non-drug specific) deprescribing framework, a drug-specific deprescribing guideline/guide, a tool for identifying potentially inappropriate medications, and an electronic clinical decision support tool. Participants were recruited via their participation in another deprescribing study. The Consolidated Framework for Implementation Research informed the data collection and analysis. RESULTS Eight care home staff from 7 different care homes were interviewed. The five deprescribing tools were reviewed and assessed as not acceptable, feasible, or suitable for the care home setting. All would require significant modifications for use in the care home setting (e.g., language, design, and its function or use with different stakeholders). CONCLUSIONS As none of the tools were deemed acceptable, feasible, and suitable, future work is warranted to develop and tailor deprescribing tools for the care home setting, considering its specific context and users. Deprescribing implemented safely and successfully in care homes can benefit residents and the wider health economy.
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Affiliation(s)
- Krystal Warmoth
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK; National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK.
| | - Jessica Rees
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK; National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK
| | - Jo Day
- Health and Community Sciences, University of Exeter, Exeter, UK; National Institute for Health Research Applied Research Collaboration South West Peninsula, Exeter, UK
| | - Emma Cockcroft
- Health and Community Sciences, University of Exeter, Exeter, UK; National Institute for Health Research Applied Research Collaboration South West Peninsula, Exeter, UK
| | - Alex Aylward
- Peninsula Public Involvement Group, National Institute for Health Research Applied Research Collaboration South West Peninsula, Exeter, UK
| | - Lucy Pollock
- Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
| | | | | | - Bridget Walton
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Exeter, UK
| | - Ken Stein
- Health and Community Sciences, University of Exeter, Exeter, UK; National Institute for Health Research Applied Research Collaboration South West Peninsula, Exeter, UK
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Kumar S. Psychological Safety: What It Is, Why Teams Need It, and How to Make It Flourish. Chest 2024; 165:942-949. [PMID: 37977265 DOI: 10.1016/j.chest.2023.11.016] [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] [Received: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023] Open
Abstract
In health care, transforming individuals with diverse skills into an effective, cohesive team is fundamental to delivering and advancing patient care. All teams, however, are not created the same. Psychological safety has emerged as a critical feature of high-performing teams across many industries, including health care. It facilitates patient safety, quality improvement, learning, and innovation. This review presents an overview of psychological safety in medicine, describing its impact on learning, patient safety, and quality improvement. The review also explores interventions and essential leadership behaviors that foster psychological safety in teams.
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Affiliation(s)
- Santhi Kumar
- Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Ashby S, Watkins K, Wales K. An Investigation of the Professional Resilience Strategies Used by Experienced Occupational Therapists. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241237740. [PMID: 38491752 DOI: 10.1177/15394492241237740] [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: 03/18/2024]
Abstract
There is a paucity of research into the strategies occupational therapists use to maintain career longevity professional resilience. The objective of the study was to identify the strategies used by occupational therapists to maintain their professional resilience. Descriptive statistics were used to analyze data from a cross-sectional survey that investigated the professional resilience strategies used by experienced occupational therapists. Valid responses were received from 489 occupational therapists from 29 countries. The most used professional resilience strategies were maintaining a belief in the value of occupational therapy, taking time for reflection on positive outcomes, using personal time management strategies, and engagement in informal and formal professional support networks. A range of professional resilience strategies are used by experienced occupational therapists in health and social care settings. The findings can be used by managers and workplace organizations to support their occupational therapy workforce.
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Affiliation(s)
- Samantha Ashby
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Katrina Watkins
- Occupational Therapist, Wagga Wagga, New South Wales, Australia
| | - Kylie Wales
- The University of Newcastle, Callaghan, New South Wales, Australia
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Molloy L, Wilson V, O'Connor M, Merrick TT, Guha M, Eason M, Roche M. Exploring safety culture within inpatient mental health units: The results from participant observation across three mental health services. Int J Ment Health Nurs 2024. [PMID: 38415309 DOI: 10.1111/inm.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
In Australia, acute inpatient units within public mental health services have become the last resort for mental health care. This research explored barriers and facilitators to safe, person-centred, recovery-oriented mental health care in these settings. It utilised participant observations conducted by mental health nurses in acute inpatient units. These units were located in three distinct facilities, each serving different areas: a large metropolitan suburban area in a State capital, a mid-sized regional city, and a small city with a large rural catchment area. Our findings highlighted that, in the three inpatient settings, nurses tended to avoid common areas they shared with consumers, except for brief, task-related visits. The prioritisation of administrative tasks seemed to arise in a situation where nurses lacked awareness of alternative practices and activities. Consumers spent prolonged periods of the day sitting in communal areas, where the main distraction was watching television. Boredom was a common issue across these environments. The nursing team structure in the inpatient units provided a mechanism for promoting a sense of psychological safety for staff and were a key element in how safety culture was sustained.
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Affiliation(s)
- Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Val Wilson
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael O'Connor
- Mental Health Commission of New South Wales, Sydney, New South Wales, Australia
| | - Tammy Tran Merrick
- Illawarra Shoalhaven Local Health District Mental Health Service, Wollongong, New South Wales, Australia
| | - Monica Guha
- The Thriving Spirit Project, Orange, New South Wales, Australia
| | | | - Michael Roche
- University of Canberra & ACT Health, Canberra, Australian Capital Territory, Australia
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Vikan M, Deilkås EC, Valeberg BT, Bjørnnes AK, Husby VS, Haugen AS, Danielsen SO. The anatomy of safe surgical teams: an interview-based qualitative study among members of surgical teams at tertiary referral hospitals in Norway. Patient Saf Surg 2024; 18:7. [PMID: 38374077 PMCID: PMC10877820 DOI: 10.1186/s13037-024-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In spite of the global implementation of surgical safety checklists to improve patient safety, patients undergoing surgical procedures remain vulnerable to a high risk of potentially preventable complications and adverse outcomes. The present study was designed to explore the surgical teams' perceptions of patient safety culture, capture their perceptions of the risk for adverse events, and identify themes of interest for quality improvement within the surgical department. METHODS This qualitative study had an explorative design with an abductive approach. Individual semi-structured in-depth interviews were conducted between 10/01/23 and 11/05/23. The participants were members of surgical teams (n = 17), general and orthopedic surgeons (n = 5), anesthesiologists (n = 4), nurse anesthetists (n = 4) and operating room nurses (n = 4). Middle managers recruited purposively from general and orthopedic surgical teams in two tertiary hospitals in Norway, aiming for a maximum variation due to gender, age, and years within the specialty. The data material was analyzed following Braun and Clarke's method for reflexive thematic analysis to generate patterns of meaning and develop themes and subthemes. RESULTS The analysis process resulted in three themes describing the participants' perceptions of patient safety culture in the surgical context: (1) individual accountability as a safety net, (2) psychological safety as a catalyst for well-being and safe performance in the operating room, and (3) the importance of proactive structures and participation in organizational learning. CONCLUSIONS This study provided an empirical insight into the culture of patient safety in the surgical context. The study highlighted the importance of supporting the individuals' competence, building psychological safety in the surgical team, and creating structures and culture promoting a learning organization. Quality improvement projects, including interventions based on these results, may increase patient safety culture and reduce the frequency of adverse events in the surgical context.
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Affiliation(s)
- Magnhild Vikan
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway.
| | - Ellen Ct Deilkås
- Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
| | - Berit T Valeberg
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Ann K Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
| | - Vigdis S Husby
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Orthopedic Surgery, Trondheim University Hospital, Trondheim, Norway
- Department of Health Sciences Aalesund, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Aalesund, Norway
| | - Arvid S Haugen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Stein O Danielsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, Oslo, 0130, Norway
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Glarcher M, Vaismoradi M. A systematic integrative review of specialized nurses' role to establish a culture of patient safety: A modelling perspective. J Adv Nurs 2024. [PMID: 38366739 DOI: 10.1111/jan.16105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
AIMS To understand specialized nurses' role in the culture of patient safety and their ability to promote and enforce it within healthcare. DESIGN A systematic integrative review using the approach of Whittemore and Knafl. METHODS Systematic literature search for qualitative, quantitative and mixed-methods studies, followed by data evaluation, quality assessment, analysis and research synthesis with a narrative perspective. Findings were contextualized within a 'framework for understanding the development of patient safety culture'. DATA SOURCES Searches were conducted in PubMed [including MEDLINE], Scopus, CINAHL, Web of Science and EMBASE from Jan 2013 until Sep 2023. RESULTS Sixteen studies published in English from six different countries were selected and used for research synthesis. Diverse enabling factors and enacting behaviours influencing specialized nurses' roles to promote patient safety culture were identified, mainly focusing on nurses' workload, professional experiences and organizational commitment. Patient safety outcomes focused on medication management, infection prevention, surveillance process in critical care, oversight on quality and safety of nurses' practice, patient care management, continuity of care, adherence to the treatment plan and implementation of a specialized therapeutic procedure. CONCLUSION Specialized nurses can make a significant contribution to promote patient safety culture and support organizational initiatives to prevent adverse events. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Stronger participation and leadership of specialized nurses in initiatives to improve patient safety culture requires appropriate investments and support by policy makers and managers in terms of resources and training. IMPACT There is a gap in existing literature on the contribution that specialized nurses can make in promoting patient safety culture. Review results highlight the importance of interprofessional collaboration and teamwork by involving specialized nurses. They inform healthcare policy makers about recognizing their roles and competencies in patient safety culture. Preferred reporting items for systematic reviews and meta-analysis. No patient or public contribution.
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Affiliation(s)
- Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, New South Wales, Australia
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14
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Drozd F, Pettersen Sandtrø H, Leksbø TS, Haga SM, Jacobsen H, Størksen HT. Identifying and developing strategies for implementation of a guided internet- and mobile-based infant sleep intervention in well-baby and community mental health clinics using group concept mapping. BMC Health Serv Res 2024; 24:175. [PMID: 38326797 PMCID: PMC10851561 DOI: 10.1186/s12913-024-10632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND This study aimed to identify strategies for the implementation of a guided internet- and mobile-based intervention (IMI) for infant sleep problems ("Sleep Well, Little Sweetheart") in well-baby and community mental health clinics. STUDY DESIGN We used group concept mapping, a two-phased mixed methods approach, conducted as a two-day workshop in each clinic. We recruited 20 participants from four clinics and collected sorting and rating data for implementation strategies based on the Expert Recommendations for Implementing Change taxonomy and brainstorming sessions. Data were analyzed using descriptive statistics, multidimensional scaling, and hierarchical cluster analysis to create cluster maps, laddergrams, and Go-Zone graphs. Participants were presented with the results and discussed and interpreted the findings at each of the clinics in spring 2022. RESULTS Participants identified 10 clusters of strategies, of which Training, Embedding and Coherence, User Involvement and Participation, and Clinician Support and Implementation Counseling were rated as most important and feasible. Economy and Funding and Interactive and Interdisciplinary Collaboration were rated significantly lower on importance and feasibility compared to many of the clusters (all ps < 0.05). There was a correlation between the importance and feasibility ratings (r =.62, p =.004). CONCLUSIONS The use of group concept mapping made it possible to efficiently examine well-baby and community clinics' perspectives on complex issues, and to acquire specific knowledge to allow for the planning and prioritization of strategies for implementation. These results suggest areas of priority for the implementation of IMIs related to infant sleep problems. TRIAL REGISTRATION The study was pre-registered at Open Science Framework ( www.osf.io/emct8 ).
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Affiliation(s)
- Filip Drozd
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway.
| | - Hege Pettersen Sandtrø
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
| | - Turid Skjerve Leksbø
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
| | - Silje Marie Haga
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
| | - Heidi Jacobsen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
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15
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Rennie SC, Rudland JR. Psychological safety in surgery: the negative impact of bullying for surgeons and patients and how we can all do better. ANZ J Surg 2024; 94:6-7. [PMID: 38407559 DOI: 10.1111/ans.18868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Sarah C Rennie
- Dean's Department, Te Kura Hauora o Ōtākou Otago Medical School, Ōtepoti Dunedin, Aotearoa New Zealand
| | - Joy R Rudland
- Faculty Education Unit, Te Kura Hauora o Ōtākou Otago Medical School, Ōtepoti Dunedin, Aotearoa New Zealand
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16
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Robinson L, Andrew I, Kenny L, Garrad S, Thomson R, Fisher J. 'That's someone's grandma': Teaching person-centred care in a frailty context. CLINICAL TEACHER 2024; 21:e13627. [PMID: 37823435 DOI: 10.1111/tct.13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/22/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The ability to provide person-centred care (PCC) is an essential skill for doctors and requires therapeutic empathy. We sought to evaluate a novel teaching approach to understand how medical students' personal reflections on an older person impact their views about PCC and frailty. APPROACH We designed a teaching session where students prepared an image and story about an older person they knew. Given the innovative nature of this, we set it in the context of a Plan Do Study Act cycle to ensure evaluation and continuous improvement at each stage. Students' contributions were discussed in a supportive environment, weaving together stories about individuals with the impacts of ageing they experienced. We evaluated the teaching with a pre- and post-session 'frailty' word cloud and an online focus group. EVALUATION Word cloud analysis showed a shift in the words students used when considering 'frailty', from words associated with illness and vulnerability to those associated with character and experience. Focus group themes supported these findings. Students expressed a change in their perception of frailty to consider 'the person behind the patient', which, unexpectedly, led to them also seeing 'the person behind the medical student'. The session stimulated student reflection on challenges that may impact on delivery of truly person-centred care. IMPLICATIONS This flexible teaching technique was an effective stimulus for medical students to consider the person behind the patient. Future work could consider how to promote retention of empathy as medical students make the transition to working as a doctor.
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Affiliation(s)
- Lucy Robinson
- Northumbria Healthcare NHS Foundation Trust, Medical Education, Education Centre, North Tyneside General Hospital, North Shields, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Inga Andrew
- Northumbria Healthcare NHS Foundation Trust, Medical Education, Education Centre, North Tyneside General Hospital, North Shields, UK
| | - Lee Kenny
- Northumbria Healthcare NHS Foundation Trust, Medical Education, Education Centre, North Tyneside General Hospital, North Shields, UK
| | - Sophie Garrad
- Northumbria Healthcare NHS Foundation Trust, Medical Education, Education Centre, North Tyneside General Hospital, North Shields, UK
| | - Richard Thomson
- Northumbria Healthcare NHS Foundation Trust, Medical Education, Education Centre, North Tyneside General Hospital, North Shields, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James Fisher
- Northumbria Healthcare NHS Foundation Trust, Medical Education, Education Centre, North Tyneside General Hospital, North Shields, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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17
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Grossman R, Billotti BM, Ha JJ, Cassara M. Should the existing science of teams be applied to fluid teams? An exploration of fluid team effectiveness within the context of healthcare simulation. Front Psychol 2024; 15:1323469. [PMID: 38362245 PMCID: PMC10867970 DOI: 10.3389/fpsyg.2024.1323469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Fluid teams have become increasingly prevalent and necessary for modern-day issues, yet they differ from more traditional teams, on which much of the current teams literature is based. For example, fluid teams are often comprised of members from different disciplines or organizational divisions who do not have a shared history or future, as they come together to perform a critical, time-sensitive task, and then disband. For these reasons, the mechanisms through which they function and perform may differ from those of more traditional teams, and research is needed to better understand these differences. Methods To this end, this study utilized critical incident techniques and thematic analysis to examine fluid teams within healthcare, one of the primary contexts in which they are prevalent. Interdisciplinary faculty and students in the medical field who encounter fluid teams within simulation-based education were prompted to reflect on key factors that facilitate or hinder fluid team effectiveness. Results Primary themes extracted pertained to the conditions fluid teams operate within (e.g., high-stress), the behaviors and emergent states that contribute to their success (e.g., communication), and the KSAO's of value for members of fluid teams to possess (e.g., readiness). These themes were then compared to existing literature, yielding the identification of some similarities but also many important differences between fluid and traditional teams. Discussion A series of practical recommendations for how to promote fluid team effectiveness is then presented.
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Affiliation(s)
- Rebecca Grossman
- Department of Psychology, Hofstra University, Hempstead, NY, United States
| | | | - Joseph J. Ha
- Department of Psychology, Hofstra University, Hempstead, NY, United States
| | - Michael Cassara
- Northwell, New Hyde Park, NY, United States
- Center for Learning and Innovation, New Hyde Park, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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18
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Keller S, Jelsma JGM, Tschan F, Sevdalis N, Löllgen RM, Creutzfeldt J, Kennedy-Metz LR, Eppich W, Semmer NK, Van Herzeele I, Härenstam KP, de Bruijne MC. Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network. BMC Health Serv Res 2024; 24:71. [PMID: 38218788 PMCID: PMC10788034 DOI: 10.1186/s12913-024-10555-6] [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] [Received: 01/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research. METHODS In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary "Behavioral Sciences applied to Acute care teams and Surgery (BSAS)" research network - a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria - usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations. RESULTS Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic. CONCLUSIONS Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.
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Affiliation(s)
- Sandra Keller
- Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research (DBMR), Bern University, Bern, Switzerland.
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, KCL, London, UK
| | - Ruth M Löllgen
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, (CAMST), Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Lauren R Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, VA Boston Healthcare System, Boston, MA, USA
- Psychology Department, Roanoke College, Salem, VA, USA
| | - Walter Eppich
- Department of Medical Education & Collaborative Practice Centre, University of Melbourne, Melbourne, Australia
| | - Norbert K Semmer
- Department of Work Psychology, University of Bern, Bern, Switzerland
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Karin Pukk Härenstam
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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19
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Jing T, Li X, Yu C, Bai M, Zhang Z, Li S. Examining Medical Staff Well-Being through the Application and Extension of the Job Demands-Resources Model: A Cross-Sectional Study. Behav Sci (Basel) 2023; 13:979. [PMID: 38131835 PMCID: PMC10741122 DOI: 10.3390/bs13120979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/13/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
For medical staff, job satisfaction is essential for advancement on an individual and organizational level. This study looked into the relationships between challenging job demands, job resources, personal resources, and well-being. Additionally, it examined the potential mediating effects of emotional exhaustion and work motivation within the framework of the job demands-resources (JD-R) model. Results from a cross-sectional study of 267 medical employees at a second-grade comprehensive hospital in Jiangsu, China's mainland, indicated that challenging job demands and job satisfaction were positively correlated and mediated via (decreasing) emotional exhaustion. The relationship between job resources and job satisfaction was found to be mediated via (decreasing) emotional exhaustion and (increasing) work motivation. The investigation also demonstrated that the two regulatory focuses serve different purposes. It was discovered that promotion focus had a favorable effect on work motivation but a negative effect on emotional exhaustion. Conversely, preventive focus only positively predicted emotional exhaustion. Thus, the JD-R model offers a valuable structure for clarifying the job satisfaction of health personnel. The implications for enhancing individual and job outcomes are discussed.
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Affiliation(s)
| | | | | | | | - Zhiruo Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Sisi Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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20
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Warmoth K, Rees J, Day J, Cockcroft E, Aylward A, Pollock L, Coxon G, Craig T, Walton B, Stein K. Determinants of implementing deprescribing for older adults in English care homes: a qualitative interview study. BMJ Open 2023; 13:e081305. [PMID: 37996237 PMCID: PMC10668129 DOI: 10.1136/bmjopen-2023-081305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES To explore the factors that may help or hinder deprescribing practice for older people within care homes. DESIGN Qualitative semistructured interviews using framework analysis informed by the Consolidated Framework for Implementation Research (CFIR). SETTING Participants were recruited from two care home provider organisations (a smaller independently owned organisation and a large organisation) in England. PARTICIPANTS A sample of 23 care home staff, 8 residents, 4 family members and 1 general practitioner were associated with 15 care homes. RESULTS Participants discussed their experiences and perceptions of implementing deprescribing within care homes. Major themes of (1) deprescribing as a complex process and (2) internal and external contextual factors influencing deprescribing practice (such as beliefs, abilities and relationships) were interrelated and spanned several CFIR constructs and domains. The quality of local relationships with and support from healthcare professionals were considered more crucial factors than the type of care home management structure. CONCLUSIONS Several influencing social and contextual factors need to be considered for implementing deprescribing for older adults in care homes. Additional training, tools, support and opportunities need to be made available to care home staff, so they can feel confident and able to question or raise concerns about medicines with prescribers. Further work is warranted to design and adopt a deprescribing approach which addresses these determinants to ensure successful implementation.
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Affiliation(s)
- Krystal Warmoth
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK
| | - Jessica Rees
- Department of Global Health & Social Medicine, King's College London, London, UK
| | - Jo Day
- University of Exeter Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Exeter, UK
| | - Emma Cockcroft
- University of Exeter Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Exeter, UK
| | - Alex Aylward
- Patient and Public Involvement Group, National Institute for Health Research Applied Research Collaboration South West Peninsula, Exeter, UK
| | | | | | | | - Bridget Walton
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Exeter, UK
| | - Ken Stein
- University of Exeter Medical School, University of Exeter, Exeter, UK
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Exeter, UK
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21
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Hoare J. The power of connected clinical teams: from loneliness to belonging. Philos Ethics Humanit Med 2023; 18:16. [PMID: 37946267 PMCID: PMC10633999 DOI: 10.1186/s13010-023-00143-7] [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] [Received: 01/31/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND We need to preserve the lessons of the COVID-19 pandemic in caring for the mental health of clinicians, of shared experiences, interdependence, team cohesion and vulnerability, among others. We need reform in the way that clinicians are cared for, and a resistance to the idea of a post-pandemic 'return to normal'. MAIN TEXT To build connected and optimally functioning clinical teams, we need to create an inclusive culture in which difficult conversations and caring are the expectation. If we are to be better at solving problems and better at serving our patients, we should be vigilant about creating a psychologically safe medical culture in which colleagues feel safe, seen, heard, and respected. CONCLUSION Going forward, each of us, regardless of seniority, needs to take responsibility for this culture change. We need to create and participate in weekly collegial peer support sessions that feel nurturing and safe, that allow us to reveal parts of ourselves, to be vulnerable with each other in a way that reduces loneliness, and encourages and maintains social connections and a sense of belonging within clinical teams, improves clinician well-being and reduces the risk of burnout. "Care is a practice of informed responsive actions on behalf of the one cared for and authentically aimed toward their growth and flourishing." Care Ethics in the Age of Precarity; Maurice Hamington and Michael Flower.
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Affiliation(s)
- Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa.
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22
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Shroff FM, Mehta DH. Wellbeing Convene during COVID-19: A pilot intervention for improving wellbeing and social connectedness for staff, students, residents, and faculty. J Clin Transl Sci 2023; 7:e269. [PMID: 38380389 PMCID: PMC10877516 DOI: 10.1017/cts.2023.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/06/2023] [Accepted: 10/31/2023] [Indexed: 02/22/2024] Open
Abstract
Background Canada is facing its worst crisis among healthcare workers in recent healthcare history. Anxiety, depression, suicidal ideation, and severe burnout are higher than before the COVID-19 pandemic. University Faculties of Medicine (FoMs) are vital to healthcare systems. Not only are they responsible for training personnel, but clinicians and staff from FoMs often work directly within healthcare systems. FoMs include students, staff, residents, faculty members, residents, researchers, and others, many experiencing higher stress levels due to pandemic tensions. Most FoMs emphasize cognitive and psychomotor learning needs. On the other hand, affective learning needs are not as well addressed within most FoMs. Finding innovative means to ameliorate mental and emotional health status, particularly at this critical juncture, will improve health and wellness, productivity, and retention. This article discusses a pilot program, Wellbeing Convene during COVID-19, in a Canadian FoM, which aimed to (1) provide staff, faculty, residents, and students with a toolkit for greater wellbeing and (2) build a sense of community during isolating times. Results Participants found the program beneficial in both regards. We recommend that these kinds of programs be permanently available to all members in FoMs, at no cost. Wellness programs alone, however, will not solve the root causes of mental and emotional stress, often based on concerns related to finances, hierarchical workplace structures, and nature of the work itself, among other factors. Conclusion Addressing the mental and emotional health of people in FoMs is vital to improving productivity and reducing stress of FoMs, healthcare professionals, and, ultimately, patients.
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Affiliation(s)
- Farah M. Shroff
- Maternal and Infant Health Canada, Vancouver,
BC, Canada
- Department of Family Practice, University of British Columbia
Faculty of Medicine, Vancouver, BC,
Canada
- School of Population and Public Health, University of British Columbia Faculty
of Medicine, Vancouver, BC,
Canada
- Harvard HealthLab Accelerators Venture Board
Member, Boston, MA, USA
| | - Darshan H. Mehta
- Harvard Medical School, Boston, MA,
USA
- Benson-Henry Institute for Mind Body Medicine, Massachusetts
General Hospital, Boston, MA,
USA
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23
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Chang CL, Dyess NF, Johnston LC. Simulation in a blended learning curriculum for neonatology. Semin Perinatol 2023; 47:151824. [PMID: 37748941 DOI: 10.1016/j.semperi.2023.151824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Blended learning is a learner-centered educational method that combines online and traditional face-to-face educational strategies. Simulation is a commonly utilized platform for experiential learning and an ideal component of a blended learning curriculum. This section describes blended learning, including its strengths and limitations, educational frameworks, uses within health professions education, best practices, and challenges. Also included is a brief introduction to simulation-based education, along with theoretical and real-world examples of how simulation may be integrated into a blended learning curriculum. Examples of blended learning in Neonatal-Perinatal Medicine, specifically within the Neonatal Resuscitation Program, procedural skills training, and the National Neonatology Curriculum, are reviewed.
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Affiliation(s)
- Catherine L Chang
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Nicolle Fernández Dyess
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Lindsay C Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States.
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24
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Moore G, Khurshid Z, McDonnell T, Rogers L, Healy O. A resilient workforce: patient safety and the workforce response to a cyber-attack on the ICT systems of the national health service in Ireland. BMC Health Serv Res 2023; 23:1112. [PMID: 37848947 PMCID: PMC10583305 DOI: 10.1186/s12913-023-10076-8] [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] [Received: 01/31/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND In May 2021, the Irish public health service was the target of a cyber-attack. The response by the health service resulted in the widespread removal of access to ICT systems. While services including radiology, diagnostics, maternity, and oncology were prioritised for reinstatement, recovery efforts continued for over four months. This study describes the response of health service staff to the loss of ICT systems, and the risk mitigation measures introduced to safely continue health services. The resilience displayed by frontline staff whose rapid and innovative response ensured continuity of safe patient care is explored. METHODS To gain an in-depth understanding of staff experiences of the cyber-attack, eight focus groups (n = 36) were conducted. Participants from a diverse range of health services were recruited, including staff from radiology, pathology/laboratories, radiotherapy, maternity, primary care dental services, health and wellbeing, COVID testing, older person's care, and disability services. Thematic Analysis was applied to the data to identify key themes. RESULTS The impact of the cyber-attack varied across services depending on the type of care being offered, the reliance on IT systems, and the extent of local IT support. Staff stepped-up to the challenges and quickly developed and implemented innovative solutions, exhibiting great resilience, teamwork and adaptability, with a sharp focus on ensuring patient safety. The cyber-attack resulted in a flattening of the healthcare hierarchy, with shared decision-making at local levels leading to an empowered frontline workforce. However, participants in this study felt the stress placed on staff by the attack was more severe than the cumulative effect of the COVID-19 pandemic. CONCLUSIONS Limited contingencies within the health system IT infrastructure - what we call a lack of system resilience - was compensated for by a resilient workforce. Within the context of the prevailing COVID-19 pandemic, this was an enormous burden on a dedicated workforce. The adverse impact of this attack may have long-term and far-reaching consequences for staff wellbeing. Design and investment in a resilient health system must be prioritised.
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Affiliation(s)
- Gemma Moore
- Health Service Executive, National Quality and Patient Safety Directorate, Dublin, Ireland
| | - Zuneera Khurshid
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- Improvement Academy, Bradford Institute for Health Research, National Health Service, Bradford, England
| | - Thérèse McDonnell
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - Lisa Rogers
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Orla Healy
- Health Service Executive, National Quality and Patient Safety Directorate, Dublin, Ireland
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Hallam KT, Popovic N, Karimi L. Identifying the Key Elements of Psychologically Safe Workplaces in Healthcare Settings. Brain Sci 2023; 13:1450. [PMID: 37891818 PMCID: PMC10605501 DOI: 10.3390/brainsci13101450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Psychological safety is a key concern in the workplace as organisations continue to see increases in psychological injuries that have significant ramifications on individuals and workplaces. The COVID-19 pandemic has exacerbated this issue in healthcare workforces facing extraordinary pressures. This preliminary study aims to enhance our understanding of the factors that healthcare workers value in relation to psychological safety in their respective healthcare settings. METHODS To achieve the research objective, qualitative self-reflection examples were conducted with 12 participants from various health professional backgrounds across public, private, and aged-care settings. The data obtained were thematically analysed using NVivo software (V 12), enabling the identification of key elements associated with psychologically safe workplaces. RESULTS The results revealed several significant elements that contribute to psychologically safe workplaces in healthcare settings. These elements include effective communication, organisational culture, leadership practices, performance feedback mechanisms, respect among colleagues, staff development opportunities, teamwork, and trust. The findings underscore the critical importance of these foundational elements in fostering psychological safety within healthcare. CONCLUSION This study contributes to the existing body of knowledge by specifically identifying the key elements that healthcare workers value in terms of psychological safety. By exploring a wide range of healthcare professionals' perspectives, this research offers valuable insights into the unique challenges faced by healthcare workforces and the necessary conditions for fostering psychological safety. The implications of these findings are discussed in relation to the lessons they provide for healthcare employers, highlighting the potential for improving workplace wellbeing and performance.
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Affiliation(s)
- Karen T. Hallam
- Psychology Department, School of Applied Health, RMIT University, Melbourne, VIC 3000, Australia;
- Institute for Mental and Physical Health and Health Translation, Deakin University, Geelong, VIC 3217, Australia
| | - Natasha Popovic
- School of Health Sciences, La Trobe University, Geelong, VIC 3217, Australia
| | - Leila Karimi
- Psychology Department, School of Applied Health, RMIT University, Melbourne, VIC 3000, Australia;
- School of Medicine and Healthcare Management, Caucasus University, 0102 Tbilisi, Georgia
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Collini A, Alstead E, Knight A, Page M. "You may think that the consultants are great, and they know everything, but they don't": exploring how new emergency medicine consultants experience uncertainty. Emerg Med J 2023; 40:624-629. [PMID: 37236780 DOI: 10.1136/emermed-2022-213013] [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] [Received: 11/30/2022] [Accepted: 05/13/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Uncertainty is particularly obvious in emergency medicine (EM) due to the characteristics of the patient cohort, time constraints, and busy environment. Periods of transition are thought to add to uncertainty. Managing uncertainty is recognised as a key ability for medical practice, but is often not addressed explicitly. This study explored how new consultants in EM experience uncertainty, with the aim of making explicit what is often hidden and potentially informing support for doctors to manage the uncertainty they face. METHODS This was a qualitative study using interpretive phenomenological analysis (IPA). Five consultants working in the UK within one year of achieving a certificate of completion of training were interviewed online during 2021, these were transcribed and analysed using IPA. RESULTS Three superordinate themes were identified: 'transition and performance as a source of uncertainty', 'uncertainty and decision-making in the context of the emergency department' and 'sharing uncertainty and asking for help'. The transition created uncertainty related to their professional identity that was compounded by a lack of useful feedback. There was tension between perceived expectations of certainty and the recognition of uncertainty in practice. EM doctors were seen as experts in managing uncertainty, with responses to uncertainty including gathering information, sharing uncertainty and seeking help. Expressing uncertainty was viewed as necessary for good patient care but could be risky to credibility, with psychological safety and role modelling behaviour making it easier for the participants to express uncertainty. CONCLUSION This study highlights the need for new consultants to have psychologically safe, reflective spaces to think through uncertainties with others. This appears to reduce uncertainty, and also act as a source of feedback. The study adds to the existing calls to address uncertainty more explicitly in training, and challenge the expectations of certainty that exist within medicine.
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Affiliation(s)
- Anna Collini
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Elspeth Alstead
- Institute for Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alec Knight
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Michael Page
- Institute for Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Pestian T, Awtrey E, Kanov J, Winick N, Thienprayoon R. The impact of organizational compassion in health care on clinicians: A scoping review. Worldviews Evid Based Nurs 2023; 20:290-305. [PMID: 37340547 DOI: 10.1111/wvn.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/19/2023] [Accepted: 05/27/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The unprecedented exodus of workers from the healthcare system is a patient safety crisis. Organizational compassion in health care is the proactive, systematic, and continuous identification, alleviation, and prevention of all sources of suffering. AIMS This scoping review aimed to describe the evidence regarding the impact of organizational compassion on clinicians, identify gaps, and provide recommendations for future research. METHODS A comprehensive librarian-assisted database search was conducted. Databases searched were PubMed, SCOPUS, EMBASE, Web of Science, PsychInfo, and Business Source Complete. Combinations of search terms regarding health care, compassion, organizational compassion, and workplace suffering were used. The search strategy was limited to English language articles and those published between 2000 and 2021. RESULTS Database search yielded 781 articles. After removing duplicates, 468 were screened by title and abstract, and 313 were excluded. One-hundred and fifty-five underwent full-text screening, and 137 were removed, leaving 18 eligible articles, two of which were set in the United States. Ten articles evaluated barriers or facilitators to organizational compassion, four evaluated elements of compassionate leadership, and four evaluated the Schwartz Center Rounds intervention. Several described the need to create systems that are compassionate to clinicians. Lack of time, support staff, and resources impeded the delivery of such interventions. LINKING EVIDENCE TO ACTION Little research has been done to understand and evaluate the impact of compassion on US clinicians. Given the workforce crisis in American health care and the potential positive impact of increasing compassion for clinicians, there is an urgent need for researchers and healthcare administrators to fill this gap.
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Affiliation(s)
- Teresa Pestian
- College of Education, Criminal Justice and Human Services, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Anesthesia, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Eli Awtrey
- Lindner College of Business, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jason Kanov
- College of Business and Economics, Western Washington University, Bellingham, Washington, USA
| | - Naomi Winick
- Department of Pediatrics, College of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rachel Thienprayoon
- Department of Anesthesia, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Abahuje E, Diaz CM, Lin KA, Tesorero K, Bushara O, Yang S, Berry ABL, Rafferty MR, Johnson JK, Stey AM. A qualitative study of how team characteristics and leadership are associated with information sharing in multidisciplinary intensive care units. Surgery 2023; 174:350-355. [PMID: 37211509 DOI: 10.1016/j.surg.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Better information sharing in intensive care units has been associated with lower risk-adjusted mortality. This study explored how team characteristics and leadership are associated with information sharing in 4 intensive care units in a single large urban, academic medical center. METHODS A qualitative study was conducted to understand how team characteristics and leadership are associated with information sharing. Qualitative data were conducted through ethnographic observations. One postdoctoral research fellow and one PhD qualitative researcher conducted nonparticipant observations of a Medical, Surgical, Neurological, and Cardiothoracic intensive care unit morning and afternoon rounds, as well as nurse and resident handoffs from May to September 2021. Field notes of observations were thematically analyzed using deductive reasoning anchored to the Edmondson Team Learning Model. This study included nurses, physicians (ie, intensivists, surgeons, fellows, and residents), medical students, pharmacists, respiratory therapists, dieticians, physical therapists, physician assistants, and nurse practitioners. RESULTS We conducted 50 person-hours of observations involving 148 providers. Three themes emerged from the qualitative analysis: (1) team leaders used variable leadership techniques to involve team members in discussions for information sharing related to patient care, (2) predefined tasks for team members allowed them to prepare for effective information sharing during intensive care unit rounds, and (3) a psychologically safe environment allowed team members to participate in discussions for information sharing related to patient care. CONCLUSION Inclusive team leadership is foundational in creating a psychologically safe environment for effective information sharing.
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Affiliation(s)
- Egide Abahuje
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Carmen M Diaz
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Kaithlyn Tesorero
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Omar Bushara
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Sohae Yang
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Andrew B L Berry
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Julie K Johnson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Robinson ET, Jones C, Brazeau GA. Addressing an Uncertain Future With a Culture of Psychological Safety. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100032. [PMID: 37380278 DOI: 10.1016/j.ajpe.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 06/30/2023]
Abstract
Faculty, staff, and administrators in our pharmacy colleges and schools work in well-known organizational structures that form the foundations for cultures and subcultures. The importance of promoting a positive culture and subculture is a frequent discussion in our own institutions and across the academy. However, the impact of these cultures and subcultures on individual and collective success and how they influence inclusion and innovation in our organizations are often not considered in these conversations. Psychological safety promotes an environment in an organization where an individual feels included in the culture or subculture; is safe to learn; is safe to contribute; and is safe to challenge the status quo all without the fear of being embarrassed, marginalized, or penalized in some way. Psychological safety is the foundation for enabling learning, innovation, and change in our colleges and schools of pharmacy. This commentary will highlight elements of cultures and subcultures, the importance of fostering a psychologically safe environment in our colleges and schools, and suggestions for success.
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Affiliation(s)
- Evan T Robinson
- Creighton University, School of Pharmacy and Health Professions, Omaha, NE, USA
| | - Cynthia Jones
- Department of Pharmaceutical Sciences, Marshall University, School of Pharmacy, Huntington, WV, USA
| | - Gayle A Brazeau
- Department of Pharmaceutical Sciences, Marshall University, School of Pharmacy, Huntington, WV, USA; Editor, American Journal of Pharmaceutical Education.
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Dietl JE, Derksen C, Keller FM, Lippke S. Interdisciplinary and interprofessional communication intervention: How psychological safety fosters communication and increases patient safety. Front Psychol 2023; 14:1164288. [PMID: 37397302 PMCID: PMC10310961 DOI: 10.3389/fpsyg.2023.1164288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Background Effective teamwork and communication are imperative for patient safety and quality care. Communication errors and human failures are considered the main source of patient harm. Thus, team trainings focusing on communication and creating psychologically safe environments are required. This can facilitate challenging communication and teamwork scenarios, prevent patient safety risks, and increase team performance perception. The sparse research concerning communication interventions calls for an understanding of psychological mechanisms. Therefore, this study investigated mechanisms of an interpersonal team intervention targeting communication and the relation of psychological safety to patient safety and team performance perception based on the applied input-process-output model of team effectiveness. Methods Before and after a 4-h communication intervention for multidisciplinary teams, a paper-pencil survey with N = 137 healthcare workers from obstetric units of two university hospitals was conducted. Changes after the intervention in perceived communication, patient safety risks, and team performance perception were analyzed via t-tests. To examine psychological mechanisms regarding psychological safety and communication behavior, mediation analyses were conducted. Results On average, perceived patient safety risks were lower after the intervention than before the intervention (MT1 = 3.220, SDT1 = 0.735; MT2 = 2.887, SDT2 = 0.902). This change was statistically significant (t (67) = 2.760, p =.007). However, no such effect was found for interpersonal communication and team performance perception. The results illustrate the mediating role of interpersonal communication between psychological safety and safety performances operationalized as perceived patient safety risks (α1∗β1 = -0.163, 95% CI [-0.310, -0.046]) and team performance perception (α1∗β1 = 0.189, 95% CI [0.044, 0.370]). Discussion This study demonstrates the psychological mechanisms of communication team training to foster safety performances and psychological safety as an important predecessor for interpersonal communication. Our results highlight the importance of teamwork for patient safety. Interpersonal and interprofessional team training represents a novel approach as it empirically brings together interpersonal communication and collaboration in the context of patient safety. Future research should work on follow-up measures in randomized-controlled trials to broaden an understanding of changes over time.
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Affiliation(s)
- Johanna Elisa Dietl
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, Bremen, Germany
| | - Christina Derksen
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, Bremen, Germany
| | - Franziska Maria Keller
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, Bremen, Germany
- Klinikum Bremerhaven Reinkenheide gGmbH, Treatment Center for Psychiatry, Psychotherapy and Psychosomatic, Bremerhaven, Germany
| | - Sonia Lippke
- Health Psychology and Behavioral Medicine, School of Business, Social and Decision Science, Constructor University, Bremen, Germany
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Byeon YV, Brookman-Frazee L, Aarons GA, Lau AS. Misalignment in Community Mental Health Leader and Therapist Ratings of Psychological Safety Climate Predicts Therapist Self-Efficacy with Evidence-Based Practices (EBPs). ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01269-8. [PMID: 37145223 DOI: 10.1007/s10488-023-01269-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/06/2023]
Abstract
Therapist self-efficacy in delivering evidence-based practices (EBPs) is associated with implementation outcomes, including adoption and sustainment in community mental health settings. Inner context organizational climate, including psychological safety, can proximally shape therapist learning experiences within EBP implementation. Psychologically safe environments are conducive to learning behaviors including taking risks, admitting mistakes, and seeking feedback. Organization leaders are instrumental in facilitating psychological safety, but may have differing perspectives of organizational climate than front-line therapists. Discrepant leader and therapist views of psychological safety may have independent associations with therapist EBP learning and implementation outcomes over and above average therapist perceptions of climate. This study examined survey data from 337 therapists and 123 leaders from 49 programs contracted to deliver multiple EBPs within a study examining determinants of sustainment within a large system-driven implementation. Both leaders and therapists completed measures of psychological safety climate and therapists reported on their self-efficacy in delivering multiple EBPs in children's mental health services. Polynomial regression and response surface analysis models were conducted to examine the associations of therapist and leader reports of psychological safety and therapist EBP self-efficacy. Greater discrepancies between leader and therapist reports of psychological safety, in either direction, were associated with lower therapist EBP self-efficacy. Alignment in leader and therapist views of psychological safety climate may impact EBP implementation outcomes. Strategies for improving alignment in perceptions and priorities among organizational members can be included in organizational implementation interventions and may represent unexamined implementation mechanisms of action.
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Affiliation(s)
- Y Vivian Byeon
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Coakley N, Wiese A, O'Leary P, Bennett D. Experience of enhanced near-peer support for new medical graduates of an Irish university: a phenomenological study. BMJ Open 2023; 13:e069101. [PMID: 37137555 PMCID: PMC10163558 DOI: 10.1136/bmjopen-2022-069101] [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] [Indexed: 05/05/2023] Open
Abstract
CONTEXT Factors contributing to the stressful transition from student to doctor include issues with preparedness for practice, adjusting to new status and responsibility, and variable support. Existing transitional interventions provide inconsistent participation, responsibility and legitimacy in the clinical environment. Enhanced support by near peers for new doctors may ease the transition. Irish medical graduates of 2020 commenced work early, creating an unprecedented period of overlap between new graduates and the cohort 1 year ahead. OBJECTIVE To explore the experience of commencing practice for these new doctors with this increased near-peer support. DESIGN We used interpretive phenomenological analysis as our methodological approach, informed by the cognitive apprenticeship model, to explore the experience of enhanced near-peer support at the transition to practice. Participants recorded audio diaries from their commencement of work, and a semistructured interview was conducted with each, after 3 months, concerning their experience of their overlap with the previous year's interns. SETTING University College Cork, one of six medical schools in Ireland. PARTICIPANTS Nine newly qualified medical doctors. MAIN OUTCOME MEASURES An exploration of their experience of transition to clinical practice, in the context of this enhanced near-peer support, will inform strategies to ease the transition from student to doctor. RESULTS Participants felt reassured by having a near-peer in the same role and safe to seek their support. This empowered them to gradually assume increasing responsibility and to challenge themselves to further their learning. Participants perceived that commencing work before the annual change-over of other grades of doctor-in-training enhanced their professional identities and improved patient safety. CONCLUSIONS Enhanced near-peer support for new doctors offers a potential solution to the stressful transition to practice. Participants were legitimate members of the community of practice, with the status and responsibility of first-year doctors. Furthermore, this study reinforces the benefit of asynchronous job change-over for doctors-in-training.
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Affiliation(s)
- Niamh Coakley
- Department of Medicine, University College Cork, Cork, Ireland
| | - Anel Wiese
- Medical Education Unit, University College Cork, Cork, Ireland
| | - Paula O'Leary
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Deirdre Bennett
- Medical Education Unit, University College Cork, Cork, Ireland
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Hitchner L, Yore M, Burk C, Mason J, Sawtelle Vohra S. The resident experience with psychological safety during interprofessional critical event debriefings. AEM EDUCATION AND TRAINING 2023; 7:e10864. [PMID: 37013133 PMCID: PMC10066498 DOI: 10.1002/aet2.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Interprofessional feedback and teamwork skills training are important in graduate medical education. Critical event debriefing is a unique interprofessional team training opportunity in the emergency department. While potentially educational, these varied, high-stakes events can threaten psychological safety for learners. This is a qualitative study of emergency medicine resident physicians' experience of interprofessional feedback during critical event debriefing to characterize factors that impact their psychological safety. METHODS The authors conduced semistructured interviews with resident physicians who were the physician team leader during a critical event debriefing. Interviews were coded and themes were generated using a general inductive approach and concepts from social ecological theory. RESULTS Eight residents were interviewed. The findings suggest that cultivating a safe learning environment for residents during debriefings involves the following: (1) allowing space for validating statements, (2) supporting strong interprofessional relationships, (3) providing structured opportunities for interprofessional learning, (4) encouraging attendings to model vulnerability, (5) standardizing the process of debriefing, (6) rejecting unprofessional behavior, and (7) creating the time and space for the process in the workplace. CONCLUSIONS Given the numerous intrapersonal, interpersonal, and institutional factors at play, educators should be sensitive to times when a resident cannot engage due to unaddressed threats to their psychological safety. Educators can address these threats in real time and over the course of a resident's training to enhance psychological safety and the potential educational impact of critical event debriefing.
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Affiliation(s)
- Lily Hitchner
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
| | - Mackensie Yore
- UCLA National Clinician Scholars Program, Department of Emergency MedicineGreater Los Angeles VA Medical CenterCaliforniaLos AngelesUSA
| | - Charney Burk
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
| | - Jessica Mason
- Department of Emergency MedicineJohn Peter Smith HospitalFort WorthTexasUSA
| | - Stacy Sawtelle Vohra
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
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Cassidy D, Edwards G, Bruen C, Kelly H, Arnett R, Illing J. Are We Ever Going Back? Exploring the Views of Health Professionals on Postpandemic Continuing Professional Development Modalities. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:172-180. [PMID: 36877815 PMCID: PMC10461717 DOI: 10.1097/ceh.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has profoundly altered the ways in which health care professionals engage with continuing professional development (CPD), but the extent to which these changes are permanent remains unknown at present. This mixed-methods research aims to capture the perspectives of health professionals on their preferences for CPD formats, including the conditions that inform preferences for in-person and online CPD events and the optimum length and type of online and in-person events. METHODS A survey was used to gain a high-level perspective on health professionals' engagement with CPD, areas of interest, and capabilities and preferences in relation to online formats. A total of 340 health care professionals across 21 countries responded to the survey. Follow-up semistructured interviews were conducted with 16 respondents to gain deeper insights into their perspectives. RESULTS Key themes include CPD activity before and during COVID, social and networking aspects, access versus engagement, cost, and time and timing. DISCUSSION Recommendations regarding the design of both in-person and online events are included. Beyond merely moving in-person events online, innovative design approaches should be adopted to capitalize on the affordances of digital technologies and enhance engagement.
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Affiliation(s)
- Dara Cassidy
- Dr. Cassidy: Head of Online Education, Health Professions Education Centre, RCSI, Dublin, Ireland. Mr. Edwards: Research Officer, Health Professions Education Centre, RCSI, Dublin, Ireland. Ms. Bruen: Technology enhanced Learning (TEL) Manager, Health Professions Education Centre, RCSI, Dublin, Ireland. Ms. Kelly: Lecturer in Communications, Health Professions Education Centre, RCSI, Dublin, Ireland. Prof. Arnett: Director of Psychometrics & Associate Professor, Health Professions Education Centre, RCSI, Dublin, Ireland. Prof. Illing: Director, Health Professions Education Centre, RCSI, Dublin, Ireland
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Lackie K, Hayward K, Ayn C, Stilwell P, Lane J, Andrews C, Dutton T, Ferkol D, Harris J, Houk S, Pendergast N, Persaud D, Thillaye J, Mills J, Grant S, Munroe A. Creating psychological safety in interprofessional simulation for health professional learners: a scoping review of the barriers and enablers. J Interprof Care 2023; 37:187-202. [PMID: 35403551 DOI: 10.1080/13561820.2022.2052269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Interprofessional simulation-based education (IP-SBE) supports the acquisition of interprofessional collaborative competencies. Psychologically safe environments are necessary to address socio-historical hierarchies and coercive practices that may occur in IP-SBE, facilitating fuller student participation. A scoping review was conducted to understand the barriers and enablers of psychological safety within IP-SBE. Research papers were eligible if they included two or more undergraduate and/or post-graduate students in health/social care qualifications/degrees and discussed barriers and/or enablers of psychological safety within simulation-based education. Sources of evidence included experimental, quasi-experimental, analytical observational, descriptive observational, qualitative, and mixed-methodological peer-reviewed studies. English or English-translated articles, published after January 1, 1990, were included. Data were extracted by two members of the research team. Extraction conflicts were resolved by the principal investigators. In total, 1,653 studies were screened; 1,527 did not meet inclusion criteria. After a full-text review, 99 additional articles were excluded; 27 studies were analyzed. Psychological safety enablers include prebriefing-debriefing by trained facilitators, no-blame culture, and structured evidenced-based simulation designs. Hierarchy among/between professions, fear of making mistakes, and uncertainty were considered barriers. Recognition of barriers and enablers of psychological safety in IP-SBE is an important first step towards creating strategies that support the full participation of students in their acquisition of IPC competencies.
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Affiliation(s)
| | | | | | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University
| | | | | | - Tanya Dutton
- Nova Scotia Rehabilitation & Arthritis Centre, Canada
| | - Doug Ferkol
- Centre for Collaborative Clinical Learning and Research
| | | | | | | | | | | | | | - Shannan Grant
- Department of Applied Human Nutrition, Mount Saint Vincent University
| | - Andrew Munroe
- Nova Scotia Rehabilitation & Arthritis Centre, Canada
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Havsteen-Franklin D, de Knoop J, Agtarap T, Hackett S, Haeyen S. Evaluation of an Arts Therapies Approach to Team Development for Non-Acute Healthcare Teams in Low Control and High-Pressure Environments. ARTS IN PSYCHOTHERAPY 2023. [DOI: 10.1016/j.aip.2023.102003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Khan NU, Zada M, Estay C. Servant leadership and employee prosocial rule-breaking: The underlying effects of psychological safety and compassion at work. PLoS One 2023; 18:e0282832. [PMID: 37098027 PMCID: PMC10128937 DOI: 10.1371/journal.pone.0282832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/23/2023] [Indexed: 04/26/2023] Open
Abstract
The study intends to investigate the impact of servant leadership on pro-social rule-breaking directly and through the intervening mechanism of psychological safety. More, the study also plans to investigate whether compassion at work moderates the effect of servant leadership on psychological safety and pro-social rule-breaking and the indirect intervening effect of psychological safety between servant leadership and pro-social rule-breaking. Responses were collected from 273 frontline public servants in Pakistan. Using social information processing theory, the results revealed that servant leadership positively influences pro-social rule-breaking and psychological safety and that psychological safety influences pro-social rule-breaking. Results also revealed that psychological safety acts as an intervening mechanism in the relationship between servant leadership and pro-social rule-breaking. Moreover, compassion at work significantly moderates the relationships of servant leadership with psychological safety and pro-social rule-breaking, and that compassion at work ultimately alters the size of the intervening effect of psychological safety between the connection of servant leadership and pro-social rule-breaking.
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Affiliation(s)
- Naqib Ullah Khan
- School of Public Administration, Central South University, Changsha, China
| | - Muhammad Zada
- Facultad de Administración y Negocios, Universidad Autónoma de Chile, Santiago, Chile
- Department of Management Science and Commerce, Alhamd Islamic University, Islamabad, Pakistan
| | - Christophe Estay
- FERRANDI Paris, France / University of Lyon, Jean Moulin, Magellan, France, Paris, France
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Collins J, Bonner P, Cafferkey A. Preventing unrecognised oesophageal intubation: addressing hierarchies and the importance of critical language. Anaesthesia 2023; 78:130-131. [PMID: 36256690 DOI: 10.1111/anae.15891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 12/13/2022]
Affiliation(s)
- J Collins
- St. James's Hospital, Dublin, Ireland
| | - P Bonner
- Irish Air Corps, Dublin, Ireland
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Mogård EV, Rørstad OB, Bang H. The Relationship between Psychological Safety and Management Team Effectiveness: The Mediating Role of Behavioral Integration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:406. [PMID: 36612729 PMCID: PMC9819141 DOI: 10.3390/ijerph20010406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
This study explores whether there is an indirect effect of psychological safety on team effectiveness in management teams, operating through the mediating variable of behavioral integration. Whilst there exists a fair amount of research on the relationship between psychological safety and team effectiveness, few have looked at potential mechanisms that can explain this association in management teams. We propose behavioral integration to be a potential mediator. Data are collected from 1150 leaders in 160 Norwegian management teams, answering a questionnaire measuring team functioning and effectiveness. Team size ranged from 3 to 19 members. Our results show a significant indirect effect of psychological safety on management team effectiveness, mediated by behavioral integration. Thus, the more team members perceive the climate as safe in terms of speaking their mind without the fear of repercussions, the more they partake in mutual collaboration, information sharing and experience ownership in the decisions being made. This is associated with management teams performing better. We also found a positive relationship between psychological safety and behavioral integration, and-in line with previous studies-that psychological safety and behavioral integration both were positively related to team effectiveness. This study adds to the existing team research literature by expanding our knowledge about the importance of psychological safety and the way it influences management team performance at all levels throughout the organizational hierarchy.
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Lin MW, Papaconstantinou HT, White BAA. Moving beyond teamwork in the operating room to facilitating mutual professional respect. Proc (Bayl Univ Med Cent) 2022; 36:45-53. [PMID: 36578613 PMCID: PMC9762787 DOI: 10.1080/08998280.2022.2148987] [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: 12/23/2022] Open
Abstract
Psychological safety enables the interpersonal risk-taking necessary for providing safer patient care in the operating room (OR). Limited studies look at psychological safety in the OR from the perspectives of each highly specialized team member. Therefore, we investigated each member's perspective on the factors that influence psychological safety in the OR. Interviews were conducted with operative team members of a level 1 trauma center in central Texas. The interviews were transcribed, de-identified, and coded by two investigators independently, and thematic analysis was performed. Responses were collected from 21 participants representing all surgical team roles (attending surgeons, attending anesthesiologists, circulating nurses, nurse anesthetists, scrub techs, and residents). Circulating nurse responses were redacted for confidentiality (n = 1). Six major themes influencing psychological safety in the OR were identified. Psychological safety is essential to better, safer patient care. Establishing a climate of mutual respect and suspended judgment in an OR safe for learning will lay the foundation for achieving psychological safety in the OR. Team exercises in building rapport and mutual understanding are important starting points.
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Affiliation(s)
- Melody W. Lin
- Department of Surgery, Baylor Scott & White Medical Center – Temple, Temple, Texas
| | | | - Bobbie Ann Adair White
- Department of Surgery, Baylor Scott & White Medical Center – Temple, Temple, Texas,Department of Health Professions Education, MGH Institute of Health Professions, Boston, Massachusetts,Corresponding author: Bobbie Ann Adair White, EdD, MA, Health Professions Education, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA02129 (e-mail: , )
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Purdy E, Borchert L, El‐Bitar A, Isaacson W, Jones C, Bills L, Brazil V. Psychological safety and emergency department team performance: A mixed‐methods study. Emerg Med Australas 2022; 35:456-465. [PMID: 36519387 DOI: 10.1111/1742-6723.14149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Team culture underpins team performance. Psychological safety - 'a shared belief held by members of a team that the team is safe for interpersonal risk taking' - is a critical component of team culture for high-performing teams across contexts. However, psychological safety in ED teams has not been well explored. We aimed to explore this core teamwork concept in the ED. METHODS This was a sequential mixed-methods study of nursing and medical staff at a large tertiary care ED in Australia from October 2020 to March 2021. First, participants completed the 'Team Learning and Psychological Safety Survey' and a narrative questionnaire. These findings informed semi-structured interviews. We determined median psychological safety and compared results across role and length of time working in the department. Qualitative results were analysed using a deductive thematic analysis using a previously generated framework for enablers of psychological safety at the individual, team and organisational levels. RESULTS The survey was completed by 72/410 participants and 19 interviews were conducted. The median psychological safety score was 37/49 (IQR 13). Psychological safety was not experienced universally, with nurses and new staff experiencing lower levels. Individual, team and organisational factors impacted psychological safety. The primary force shaping psychological safety was familiarity with colleagues and leaders. CONCLUSION Familiarity of team members and leaders was critical to the development of psychological safety within the ED. Fostering familiarity should be a focus for frontline leadership each shift and a priority in broader departmental decisions for those seeking to enhance the psychological safety of their teams.
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Affiliation(s)
- Eve Purdy
- Emergency Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Laura Borchert
- Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
| | - Anthony El‐Bitar
- Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
| | - Warwick Isaacson
- Emergency Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Cindy Jones
- Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
| | - Lucy Bills
- Emergency Department Gold Coast University Hospital Gold Coast Queensland Australia
| | - Victoria Brazil
- Emergency Department Gold Coast University Hospital Gold Coast Queensland Australia
- Faculty of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
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Hardie P, O’Donovan R, Jarvis S, Redmond C. Key tips to providing a psychologically safe learning environment in the clinical setting. BMC MEDICAL EDUCATION 2022; 22:816. [PMID: 36443730 PMCID: PMC9706932 DOI: 10.1186/s12909-022-03892-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
Having psychological safety embedded in preceptorship relationships facilitates positive interpersonal and educational experiences for students. Psychological safety refers to a student's belief as to whether or not it is safe for them to take interpersonal risks, such as asking questions, sharing an idea for improvement or speaking up to maintain patient safety. Having psychological safety leads to collaboration, positive student learning experiences and effective patient care. This article presents key guidelines for preceptors to provide a psychologically safe learning environment for their students. Guidelines fall under four categories 1) before meeting students, 2) first meeting students, 3) continued relationship with students, and 4) general rules. These guidelines are informed by current literature on psychological safety and preceptorship and the author's clinical expertise in nursing preceptorship. We conceptualise psychological safety in a nursing preceptorship for preceptors to denote the experience of inclusivity, empowerment, and well-being of students within the social, cultural and physical clinical learning environment. A crucial attribute to cultivating a psychologically safe environment involves being an accessible and approachable preceptor.
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Affiliation(s)
- Philip Hardie
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Roisin O’Donovan
- Centre for Positive Psychology and Health, RCSI, Dublin, Ireland
| | - Suzi Jarvis
- Innovation Academy, University College Dublin, Dublin, Ireland
| | - Catherine Redmond
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Kerrissey MJ, Hayirli TC, Bhanja A, Stark N, Hardy J, Peabody CR. How psychological safety and feeling heard relate to burnout and adaptation amid uncertainty. Health Care Manage Rev 2022; 47:308-316. [PMID: 35135989 PMCID: PMC9422764 DOI: 10.1097/hmr.0000000000000338] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psychological safety-the belief that it is safe to speak up-is vital amid uncertainty, but its relationship to feeling heard is not well understood. PURPOSE The aims of this study were (a) to measure feeling heard and (b) to assess how psychological safety and feeling heard relate to one another as well as to burnout, worsening burnout, and adaptation during uncertainty. METHODOLOGY We conducted a cross-sectional survey of emergency department staff and clinicians (response rate = 52%; analytic N = 241) in July 2020. The survey measured psychological safety, feeling heard, overall burnout, worsening burnout, and perceived process adaptation during the COVID-19 crisis. We assessed descriptive statistics and construct measurement properties, and we assessed relationships among the variables using generalized structural equation modeling. RESULTS Psychological safety and feeling heard demonstrated acceptable measurement properties and were correlated at r = .54. Levels of feeling heard were lower on average than psychological safety. Psychological safety and feeling heard were both statistically significantly associated with lower burnout and greater process adaptation. Only psychological safety exhibited a statistically significant relationship with less worsening burnout during crisis. We found evidence that feeling heard mediates psychological safety's relationship to burnout and process adaptation. CONCLUSION Psychological safety is important but not sufficient for feeling heard. Feeling heard may help mitigate burnout and enable adaptation during uncertainty. PRACTICE IMPLICATIONS For health care leaders, expanding beyond psychological safety to also establish a feeling of being heard may further reduce burnout and improve care processes.
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COVID-19 Pandemic Highlights the Importance of Inclusive Leadership in Egyptian Hospitals to Improve Nurses’ Psychological Distress. PSYCH 2022. [DOI: 10.3390/psych4030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The pandemic has highlighted the crucial role of nurses in health services. Nurses work at the forefront of the healthcare system, provide infection control training, and help reduce the spread of misinformation about the pandemic. Inclusive leaders create psychological safety that improves motivation and boosts job performance. Aim: To explore the effect of nurse managers’ inclusive leadership style on nurses’ psychological distress during the COVID-19 pandemic in Egyptian hospitals. Method: This was a quasi-experimental study. The study subjects consisted of two groups: managers (171) and staff nurses (1573). The study was conducted in four hospitals (one university hospital, one private hospital, one therapeutic institution, and one health insurance hospital). Three tools were used for collecting data (Inclusive Leader Questionnaire, Nurse Managers’ Knowledge about Inclusive Leadership, and Kessler Psychological Distress Scale). Results: In total, 67.25% of staff nurses perceived their nurse managers as poor inclusive leaders, and only 12.86% perceived them as good inclusive leaders. Regarding nurse managers’ knowledge about inclusive leadership, 76.023% had unsatisfactory knowledge levels before awareness sessions, and only 7.017% had a satisfactory level compared to after awareness sessions, when the majority of them had satisfactory knowledge levels. Furthermore, before awareness sessions, staff nurses experienced mild to moderate psychological distress during the COVID-19 pandemic, and only 8.2% were severe. After awareness sessions, 58.55% of them experienced mild psychological distress, and others became well (25.8%). Conclusions: Nurse managers lack knowledge about inclusive leadership before conducting awareness sessions. The majority of staff nurses perceived their nurse managers as poor inclusive leaders. Satisfactory knowledge levels among nurse managers after awareness sessions improved nurses’ psychological distress. Finally, there were strong, statistically significant positive correlations between inclusive leadership and nurses’ psychological distress.
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Xin Z. The Influence of Work Environment on Employee's Psychological Relationship: A Case Study of Japanese Literature. Occup Ther Int 2022; 2022:5387795. [PMID: 35677567 PMCID: PMC9155952 DOI: 10.1155/2022/5387795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
The new generation of employees grows up in the environment of rapid economic development, fierce competition, diversified values, and multiple channels of cultural communication, and their unique growth environment creates characteristics such as their unstable psychological state, poor adjustment ability, and significant self-awareness. The special psychological condition of the new generation employees will affect their own development and that of the organization. How to effectively manage the psychological capital of new generation employees has become an urgent problem for modern human resource management. Based on the social exchange theory and resource conservation theory, this study explores the relationship between the psychological capital of new generation employees and their job performance and propensity to leave and proposes research hypotheses and research models. Based on the survey data of 330 new generation employees, SPSS software was used to analyze the data and test the hypotheses. The psychological capital, job performance, and turnover tendency of new generation employees differed to different degrees in terms of age, education, years of work experience, and position level. The psychological capital of the new generation employees had a significant negative effect on the propensity to leave. Psychological capital had a significant positive effect on the relational performance dimension of job performance, and among the four dimensions of psychological capital, resilience and optimism had a significant positive effect on relational performance, while self-efficacy and hope had no significant effect on relational performance. The psychological capital of new generation employees mainly contributes to task performance through hope, resilience, and optimism and to relational performance through resilience and optimism.
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Affiliation(s)
- Ziyu Xin
- Business College of Shanxi University, Taiyuan, Shanxi 030031, China
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Chênevert D, Brown TL, Pomey MP, Benomar N, Colombat P, Fouquereau E, Loiselle CG. Investigating a Participatory Intervention in Multidisciplinary Cancer Care Teams Using an Integrative Organizational Model: A Study Protocol. Front Psychol 2022; 13:798863. [PMID: 35592179 PMCID: PMC9113022 DOI: 10.3389/fpsyg.2022.798863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/30/2022] [Indexed: 12/03/2022] Open
Abstract
Multidisciplinary teams encounter many challenges that can lead to higher levels of distress and burnout. This trend is acutely prevalent among multidisciplinary cancer care teams who frequently contend with increased task complexity and numbers of patients. Resilience is emerging as a critical resource that may optimize team members’ psychological health and wellbeing, work efficiency, and organizational agility, while reducing burnout. Accordingly, the proposed study aims to implement and evaluate a promising participatory interventional approach that fosters team resilience. Specifically, the effects of the intervention on participating team members will be compared to a control group of non-participating team members. This intervention’s core components include skills training, patient-centered meetings, talking spaces, and an agile problem-solving approach. The proposed study also seeks to determine whether enhanced resilience improves team mental health status and organizational outcomes. A participatory interventional approach will be implemented and assessed at three-time intervals [i.e., pre-intervention deployment (N = 375), 12 months post-deployment (N = 236), and 24 months post-deployment (N = 146)] across five cancer care teams in three Quebec healthcare institutions. A mixed methods design will be used that includes observations, semi-structured interviews, focus groups, and self-report questionnaires. Direct observation will document team functioning and structural resources (e.g., meetings, conflict management, and leadership). Semi-structured interviews will explore participants’ experience with activities related to the participatory interventional approach, its perceived benefits and potential challenges. Focus groups will explore participants’ perceptions of their team’s resilience and the effectiveness of the intervention. Questionnaires will assess support, recognition, empowerment, organizational justice, individual resilience, psychological safety, work climate, team resilience, workplace burnout, engagement, quality of work life, wellbeing, and organizational citizenship behaviors, and sociodemographic variables. Moreover, objective measures including absenteeism and staff turnover will be obtained via human resource records. Structural equation modeling will be used to test the study’s hypotheses. The proposed protocol and related findings will provide stakeholders with quantitative and qualitative data concerning a participatory interventional approach to optimize team effectiveness. It will also identify critical factors implicated in favorable organizational outcomes in connection with multidisciplinary cancer care teams. Expected results and future directions are also presented herein.
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Affiliation(s)
- Denis Chênevert
- Department of Human Resources, HEC Montreal, Montreal, QC, Canada.,Healthcare Management Hub, HEC Montreal, Montreal, QC, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Unité de Soutien SSA, Université de Sherbrooke, Campus de Longueuil, Longueuil, QC, Canada
| | - Tyler L Brown
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Nadia Benomar
- Healthcare Management Hub, HEC Montreal, Montreal, QC, Canada
| | - Philippe Colombat
- Qualipsy EE 1901, Department of Psychology, Université de Tours, Tours, France
| | - Evelyne Fouquereau
- Qualipsy EE 1901, Department of Psychology, Université de Tours, Tours, France
| | - Carmen G Loiselle
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada
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Jun J, Siegrist K, Weinshenker D. Evaluation of Nurses’ Experiences with Digital Storytelling Workshop: New Way to Engage, Connect, And Empower. J Nurs Manag 2022; 30:1317-1323. [PMID: 35403291 PMCID: PMC9543513 DOI: 10.1111/jonm.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Jin Jun
- The Ohio State University, College of Nursing Center for Healthy Aging, Self‐Management, and Complex Care 1585 Neil Ave Columbus OH
| | - Kate Siegrist
- Chief Nursing Officer, Nurse‐Family Partnership, National Service Office Denver CO
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Crisan C, Van Dijk PA, Oxley J, De Silva A. Worker and manager perceptions of the utility of work-related mental health literacy programmes delivered by community organisations: a qualitative study based on the theory of planned behaviour. BMJ Open 2022; 12:e056472. [PMID: 35351719 PMCID: PMC8961141 DOI: 10.1136/bmjopen-2021-056472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Reluctance to seek help is a leading contributor to escalating mental injury rates in Australian workplaces. We explored the benefit of using community organisations to deliver mental health literacy programmes to overcome workplace barriers to help-seeking behaviours. DESIGN This study used a qualitative application of the theory of planned behaviour to examine underlying beliefs that may influence worker's intentions to participate in mental health literacy programmes delivered by community organisations and manager support for them. SETTING This study took place within three large white-collar organisations in the Australian state of Victoria. PARTICIPANTS Eighteen workers and 11 managers (n=29) were interviewed to explore perspectives of the benefits of such an approach. RESULTS Community organisations have six attributes that make them suitable as an alternative mental health literacy programme provider including empathy, safety, relatability, trustworthiness, social support and inclusivity. Behavioural beliefs included accessibility, understanding and objectivity. The lack of suitability and legitimacy due to poor governance and leadership was disadvantages. Normative beliefs were that family and friends would most likely approve, while line managers and colleagues were viewed as most likely to disapprove. Control beliefs indicated that endorsements from relevant bodies were facilitators of participation. Distance/time constraints and the lack of skills, training and lived experiences of coordinators/facilitators were seen as barriers. CONCLUSIONS Identifying workers' beliefs and perceptions of community organisations has significant implication for the development of effective community-based strategies to improve worker mental health literacy and help seeking. Organisations with formal governance structures, allied with government, peak bodies and work-related mental health organisations would be most suitable. Approaches should focus on lived experience and be delivered by qualified facilitators. Promoting supervisor and colleague support could improve participation. Models to guide cross-sector collaborations to equip community organisations to deliver work-related mental health literacy programmes need to be explored.
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Affiliation(s)
- Corina Crisan
- Monash Sustainable Development Institute, BehaviourWorks Australia, Monash University, Melbourne, Victoria, Australia
| | | | - Jennie Oxley
- Monash University Accident Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Andrea De Silva
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Purdy E, Borchert L, El-Bitar A, Isaacson W, Bills L, Brazil V. Taking simulation out of its "safe container"-exploring the bidirectional impacts of psychological safety and simulation in an emergency department. Adv Simul (Lond) 2022; 7:5. [PMID: 35123580 PMCID: PMC8818167 DOI: 10.1186/s41077-022-00201-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Simulation facilitators strive to ensure the psychological safety of participants during simulation events; however, we have limited understanding of how antecedent levels of psychological safety impact the simulation experience or how the simulation experience impacts real-world psychological safety. METHODS We explored the experience of participants in an embedded, interprofessional simulation program at a large tertiary emergency department (ED) in Australia. We engaged in theoretical thematic analysis of sequential narrative surveys and semi-structured interviews using a previously derived framework of enablers of psychological safety in healthcare. We sought to understand (1) how real-world psychological safety impacts the simulation experience and (2) how the simulation experience influences real-world psychological safety. RESULTS We received 74 narrative responses and conducted 19 interviews. Simulation experience was both influenced by and impacted psychological safety experienced at the individual, team, and organizational levels of ED practice. Most strikingly, simulation seemed to be an incubator of team familiarity with direct impact on real-world practice. We present a model of the bidirectional impact of psychological safety and simulation within healthcare environments. CONCLUSION Our model represents both opportunity and risk for facilitators and organizations engaging in simulation. It should inform objectives, design, delivery, debriefing, and faculty development and firmly support the situation of simulation programs within the broader cultural ethos and goals of the departments and organizations.
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Affiliation(s)
- Eve Purdy
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia.
| | - Laura Borchert
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Anthony El-Bitar
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Warwick Isaacson
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia
| | - Lucy Bills
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia
| | - Victoria Brazil
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
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Wolcott MD, Kornegay EC, Brame JL. Safe to speak: Fostering psychological safety among incoming predoctoral dental students. J Dent Educ 2022; 86:863-873. [PMID: 35118647 DOI: 10.1002/jdd.12891] [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: 11/09/2021] [Revised: 12/18/2021] [Accepted: 01/15/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To describe the implementation and impact of an introductory session on psychological safety for incoming first-year Doctor of Dental Surgery (DDS) learners. METHODS In August 2020, first-year DDS students participated in a 2-h online instructional session focused on defining psychological safety, the behaviors that promote and disrupt it, and setting expectations for learner and faculty behavior to foster it. Learners worked in small groups to discuss the various components of psychological safety and document their discussion in a collaborative workspace before a large group debriefs. Participants were requested to complete an electronic survey before and after the session to evaluate their change in knowledge, confidence in performing tasks to foster psychological safety, and perceptions about their level of control. Six months after the session, learners were requested to participate in a focus group for additional feedback and reflections. RESULTS Seventy-four participants completed the before and after experience survey. There was a statistically significant increase in knowledge of the components of psychological safety and perceptions of control. In addition, self-reported measures of confidence to perform the tasks increased from an average rating of 36% confident before the session to 86% confident afterward. In the experience, learners were active in their discussion and generated many ideas about behaviors that promote and disrupt psychological safety, which informed the creation of learner and faculty classroom expectations. CONCLUSION Engaging learners in discussions about psychological safety can be a useful activity to establish expectations and create group norms that may support collaborative learning environments.
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Affiliation(s)
- Michael D Wolcott
- Division of Primary Care, High Point University School of Dental Medicine and Oral Health, High Point, North Carolina, USA.,Division of Oral and Craniofacial Health Sciences, University of North Carolina Adams School of Dentistry, Chapel Hill, North Carolina, USA.,Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Elizabeth C Kornegay
- Division of Comprehensive Oral Health, University of North Carolina Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Jennifer L Brame
- Division of Comprehensive Oral Health, University of North Carolina Adams School of Dentistry, Chapel Hill, North Carolina, USA
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