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Carlisle N, Dalkin S, Shennan AH, Sandall J. IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation (The IMPART Study). Implement Sci Commun 2024; 5:57. [PMID: 38773632 PMCID: PMC11110199 DOI: 10.1186/s43058-024-00594-9] [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: 10/11/2023] [Accepted: 05/07/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND In the UK, 7.6% of babies are born preterm, which the Department of Health aims to decrease to 6% by 2025. To advance this, NHS England released Saving Babies Lives Care Bundle Version 2 Element 5, recommending the Preterm Birth Pathway for women at risk of preterm birth. The success of this new pathway depends on its implementation. The IMPART (IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation) study aimed to research how, why, for whom, to what extent and in what contexts the prediction and prevention aspects of Preterm Birth Surveillance Pathway is implemented through a realist evaluation. Realist implementation studies are growing in popularity. METHODS Initial programme theories were developed through a realist informed literature scope, interviews with developers of the NHS England guidance, and a national questionnaire of current practice. Implementation theory was utilised in developing the programme theories. Data (interviews and observations with staff and women) were undertaken in 3 case sites in England to 'test' the programme theories. Substantive theory was utilised during data analysis to interpret and refine the theories on how implementation could be improved. RESULTS Three explanatory areas were developed: risk assessing and referral; the preterm birth surveillance clinic; and women centred care. Explanatory area 1 dealt with the problems in correct risk assessment and referral to a preterm clinic. Explanatory area 2 focused on how once a correct referral has been made to a preterm clinic, knowledgeable and supported clinicians can deliver a well-functioning clinic. Explanatory area 3 concentrated on how the pathway delivers appropriate care to women. CONCLUSIONS The IMPART study provides several areas where implementation could be improved. These include educating clinicians on knowledge of risk factors and the purpose of the preterm clinic, having a multidisciplinary preterm team (including a preterm midwife) with specialist preterm knowledge and skills (including transvaginal cervical scanning skills), and sites actively working with their local network. This multidisciplinary preterm team are placed to deliver continuity of care for women at high-risk of preterm birth, being attentive to their history but also ensuring they are not defined by their risk status. TRIAL REGISTRATION ISRCTN57127874.
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Affiliation(s)
- Naomi Carlisle
- Department of Women and Children's Health, The School of Life Course & Population Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Sonia Dalkin
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Andrew H Shennan
- Department of Women and Children's Health, The School of Life Course & Population Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jane Sandall
- Department of Women and Children's Health, The School of Life Course & Population Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Weyman A, O'Hara R, Nolan P, Glendinning R, Roy D, Coster J. Determining the relative salience of recognised push variables on health professional decisions to leave the UK National Health Service (NHS) using the method of paired comparisons. BMJ Open 2023; 13:e070016. [PMID: 37699606 PMCID: PMC10514647 DOI: 10.1136/bmjopen-2022-070016] [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: 11/17/2022] [Accepted: 07/10/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE The primary and secondary impacts from the COVID-19 pandemic are claimed to have had a detrimental impact on health professional retention within the UK National Health Service (NHS). This study set out to identify priorities for intervention by scaling the relative importance of widely cited push (leave) influences. DESIGN During Summer/Autumn 2021, a UK-wide opportunity sample (n=1958) of NHS health professionals completed an online paired-comparisons exercise to determine the relative salience of work-related stress, workload intensity, time pressure, staffing levels, working hours, work-homelife balance, recognition of effort and pay as reasons why health professionals leave NHS employment. SETTING The study is believed to be the first large-scale systematic assessment of factors driving staff exits from the NHS since the COVID-19 pandemic. RESULTS All professions gave primacy to work-related stress, workload intensity and staffing levels. Pay was typically located around the midpoint of the respective scales; recognition of effort and working hours were ranked lowest. However, differences were apparent in the rank order and relative weighting of push variables between health professions and care delivery functions. Ambulance paramedics present as an outlier, notably with respect to staffing level (F-stat 4.47, p=0.004) and the primacy of work-homelife balance. Relative to staffing level, other push variables exert a stronger influence on paramedics than nurses or doctors (f 4.29, p=0.006). CONCLUSION Findings are relevant to future NHS health professional retention intervention strategy. Excepting paramedics/ambulance services, rankings of leave variables across the different health professional families and organisation types exhibit strong alignment at the ordinal level. However, demographic differences in the weightings and rankings, ascribed to push factors by professional family and organisation type, suggests that, in addition to signposting universal (all-staff) priorities for intervention, bespoke solutions for different professions and functions may be needed.
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Affiliation(s)
- Andrew Weyman
- Department of Psychology, University of Bath, Bath, UK
| | - Rachel O'Hara
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Peter Nolan
- School of Management, University of Leicester, Leicester, UK
| | | | - Deborah Roy
- Department of Psychology, University of Bath, Bath, UK
| | - Joanne Coster
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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De Kock JH, Latham HA. Will we ever be the same again? The mental health impact of the COVID-19 pandemic on health care staff and institutions. Cytopathology 2023; 34:450-455. [PMID: 37128960 DOI: 10.1111/cyt.13242] [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: 01/05/2023] [Revised: 03/28/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
As a group, health care workers (HCWs) were vulnerable to poor mental health (MH) prior to the COVID-19 pandemic. The added burdens of COVID-19 have put extra stressors on the health system and its most precious resource-its workers. This pandemic has exacerbated already poor MH in HCWs, leading to a workforce that is burnt out and struggling to cope with growing demands. Throughout the COVID-19 pandemic, risk factors for poor HCW mental health have been identified. The changes in practices brought about by the COVID-19 pandemic and identified as risk factors for poor MH that were experienced in other areas of health care and medical establishments were also witnessed by HCWs working in cytology. Indeed, all health care staff have been affected by this pandemic, and we now know that MH problems in HCWs are negatively impacting the public health response to the COVID-19 pandemic and its aftermath as they adversely influence quality of care. The question is then rightfully asked: Will we, as health care staff working in medical establishments, ever be the same again, or has COVID-19 forever changed our working lives? Fortunately, protective factors and multi-level interventions associated with adaptive MH outcomes during the COVID-19 pandemic have also been identified. In this article, we conclude that whilst working life is unlikely to return to pre-pandemic practices, the health care system now has an opportunity to promote individual and systemic growth by adhering to the principles that protect HCWs' MH and mitigate burnout during these challenging times.
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Affiliation(s)
- Johannes H De Kock
- Department of Clinical Psychology, New Craigs Psychiatric Hospital, Inverness, UK
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Malinauskas R, Malinauskiene V. Characteristics of Stress and Burnout among Lithuanian University Coaches: A Pre-Pandemic Coronavirus and Post-Pandemic Period Comparison. Healthcare (Basel) 2023; 11:2096. [PMID: 37510538 PMCID: PMC10379386 DOI: 10.3390/healthcare11142096] [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: 06/04/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: The majority of studies analyzing associations between burnout, gender, and perceived stress have utilized a cross-sectional design. This present longitudinal study investigated associations between burnout, perceived stress, and gender compared during the pre-pandemic Coronavirus and post-pandemic period among Lithuanian university coaches. (2) Methods: 214 university coaches were randomly selected for the study. Study participants completed two measurements: one pre-pandemic and the second post-pandemic. (3) Results: Gender differences were identified on all burnout elements but not on perceived stress. Repeated measures (RM) multivariate analysis of variance (MANOVA) results did not show a significant effect for the interaction between gender and time. Results of hierarchical (stepwise) regression analyses revealed that perceived stress after the pandemic predicted burnout levels for all three burnout components (exhaustion, depersonalization, and reduced accomplishment) after the pandemic. (4) Conclusions: The current study contributes to the understanding of burnout components in relation to perceived stress through a longitudinal approach using a representative sample of Lithuanian university coaches.
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Affiliation(s)
- Romualdas Malinauskas
- Department of Physical and Social Education, Lithuanian Sports University, Sporto 6, LT-44221 Kaunas, Lithuania
| | - Vilija Malinauskiene
- Department of Physical and Social Education, Lithuanian Sports University, Sporto 6, LT-44221 Kaunas, Lithuania
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Wheater K, Montgomery C, Clark R, Nimmo G. Self care and wellbeing in the face of COVID-19: Multidisciplinary perspectives and interprofessional experiences. J R Coll Physicians Edinb 2023; 53:137-143. [PMID: 37114378 PMCID: PMC10140767 DOI: 10.1177/14782715231168208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
The human toll which has resulted from the coronavirus disease 2019 pandemic is clearly recognised. No single event in recent times has had such profound effects on health services and their staff wellbeing around the world. Policy making has been led by the requirement for confinement and surveillance to limit spread of the disease, and in clinical settings the impact of the necessity for the use of personal protective measures has caused huge strains on practice clinically and professionally. In this paper we share experiences from the pandemic, explore the social and organisational factors at stake and make some suggestions for both personal wellbeing practice and a systems response to the ongoing staff wellbeing challenges of the pandemic.
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Affiliation(s)
- Kitty Wheater
- Chaplaincy Centre, University of Edinburgh, Edinburgh, Scotland, UK
| | - Catherine Montgomery
- Chancellor’s Fellow in Sociology of Biomedicine, Science, Technology and Innovation Studies, University of Edinburgh, Edinburgh, Scotland, UK
| | - Rowena Clark
- Welfare Lead & Consultant in Anaesthetics and Intensive Care Medicine, NHS Lothian, Edinburgh, Scotland, UK
| | - Graham Nimmo
- Formerly MSc Critical Care, University of Edinburgh, Edinburgh, Scotland, UK
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Affdal A, Malo MF, Blum D, Ballesteros F, Beaubien-Souligny W, Caron ML, Nadeau-Fredette AC, Vasilevsky M, Rios N, Suri RS, Fortin MC. Lived Experiences of Hemodialysis Health Care Workers during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network. KIDNEY360 2023; 4:188-197. [PMID: 36821610 PMCID: PMC10103388 DOI: 10.34067/kid.0004252022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
Key Points Hemodialysis workers' well-being and work were affected by the COVID-19 pandemics. Effective communication strategies and taking into account psychological distress are ways to mitigate the challenges faced by health care workers. Background The COVID-19 pandemic has disrupted health systems and created numerous challenges in hospitals worldwide for patients and health care workers (HCWs). Hemodialysis centers are at risk of COVID-19 outbreaks given the difficulty of maintaining social distancing and the fact that hemodialysis patients are at higher risk of being infected with COVID-19. During the COVID-19 pandemic, HCWs have had to face many challenges and stressors. Our study was designed to gain HCWs' perspectives on their experiences of the impacts of the COVID-19 pandemic in hemodialysis units. Methods Semistructured interviews were conducted with 22 HCWs (nurses, nephrologists, pharmacists, social workers, patient attendants, and security agents) working in five hemodialysis centers in Montreal, between November 2020 and May 2021. The content of the interviews was analyzed using thematic analysis. Results Four themes were identified during the interviews. The first was the impact of COVID-19 on work organization, regarding which participants reported an increased workload, a need for a consistent information strategy, and positive innovations such as telemedicine. The second theme was challenges associated with communicating and caring for dialysis patients during the pandemic. The third theme was psychological distress experienced by hemodialysis staff and the psychosocial impact of COVID-19 on their personal lives. The fourth theme was recommendations made by participants for future public health emergencies, such as maintaining public health measures, ensuring an adequate supply of protective equipment, and developing a consistent communication strategy. Conclusions During the first and second waves of the COVID-19 pandemic, HCWs working in hemodialysis units faced multiple challenges that affected their well-being and their work. To minimize challenges for HCWs in hemodialysis during a future pandemic, the health care system should provide an adequate supply of protective equipment, develop effective communication strategies, and take into account the psychological distress related to HCWs' professional and personal lives.
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Affiliation(s)
- Aliya Affdal
- Bioethics Program, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Françoise Malo
- Bioethics Program, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Dan Blum
- Division of nephrology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - William Beaubien-Souligny
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Line Caron
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | | | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Rita S. Suri
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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Ho S, Cook KV, Chen ZJ, Kurniati NMT, Suwartono C, Widyarini N, Wong PTP, Cowden RG. Suffering, psychological distress, and well-being in Indonesia: A prospective cohort study. Stress Health 2022; 38:879-890. [PMID: 35244330 PMCID: PMC10078741 DOI: 10.1002/smi.3139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 12/16/2022]
Abstract
Research on the subjective experience of suffering has typically focussed on older clinical samples living in Western, educated, industrialised, rich, and democratic (WEIRD) countries. To further extend the existing body of empirical research on suffering to less WEIRD contexts, we use three waves of data (Wave 1: December 2020; Wave 2: January 2021; Wave 3: February 2021) from a sample of nonclinical Indonesian adults (n = 594) to examine associations between suffering, two indices of psychological distress, and 10 facets of well-being. In our primary analysis, we estimated a series of multiple regression models that adjusted for a range of sociodemographic characteristics, financial and material stability, religious/spiritual factors, prior values of overall suffering, and prior values of each outcome assessed in Wave 1. Results indicated that overall suffering assessed in Wave 2 was associated with an increase in both indices of psychological distress and a decrease in eight facets of well-being assessed in Wave 3. Using a similar analytic approach, results from a secondary analysis indicated that higher scores on both indices of psychological distress and lower scores on seven of the well-being facets assessed in Wave 2 were associated with worse subsequent overall suffering assessed in Wave 3. These findings contribute to empirical literature on the implications of suffering for well-being.
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Affiliation(s)
- Samuel Ho
- Human Flourishing Program, Harvard University, Cambridge, Massachusetts, USA
| | - Kaye V Cook
- Department of Psychology, Gordon College, Wenham, Massachusetts, USA
| | - Zhuo Job Chen
- School of Nursing, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | | | - Christiany Suwartono
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, South Jakarta, Indonesia
| | - Nilam Widyarini
- Department of Psychology, Gunadarma University, Depok, Indonesia
| | - Paul T P Wong
- Department of Psychology, Trent University, Peterborough, Ontario, Canada
| | - Richard G Cowden
- Human Flourishing Program, Harvard University, Cambridge, Massachusetts, USA
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De Kock JH, Latham HA, Cowden RG. The mental health of healthcare workers during the COVID-19 pandemic: a narrative review. Curr Opin Psychiatry 2022; 35:311-316. [PMID: 35855506 DOI: 10.1097/yco.0000000000000805] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Mental health (MH) problems among healthcare workers (HCWs) have the potential to impact negatively on the capacity of health systems to respond effectively to COVID-19. A thorough understanding of the factors that degrade or promote the MH of HCWs is needed to design and implement suitable intervention strategies to support the wellbeing of this population. RECENT FINDINGS MH problems among HCWs were elevated prior to the COVID-19 pandemic. Accumulating evidence indicates that this public health crisis has had a disproportionately negative impact on the MH of specialised populations, including HCWs. Literature from prior health pandemics suggests that the adverse effects of the COVID-19 pandemic on the MH of HCWs are likely to persist in the aftermath of the public health crisis. Primary and secondary risk factors for adverse MH outcomes have been identified and should be considered when implementing interventions to protect the MH of HCWs. SUMMARY The MH of HCWs has been negatively impacted by the COVID-19 pandemic, which is having a detrimental influence on the public health response to COVID-19. Protecting the MH of HCWs both during and beyond this public health crisis should remain a top priority, with particular emphasis on multifaceted interventions that aim to balance the psychological needs of individual HCWs with organisational-level strategies that could be targeted to promote their wellbeing.
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Affiliation(s)
| | | | - Richard G Cowden
- Human Flourishing Program, Harvard University, Cambridge, Massachusetts, USA
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Effects of COVID-19 on Adolescent Mental Health and Internet Use by Ethnicity and Gender: A Mixed–Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158927. [PMID: 35897302 PMCID: PMC9331135 DOI: 10.3390/ijerph19158927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022]
Abstract
Evidence suggests that mental health problems in young people have been exacerbated by COVID-19, possibly related to a lack of social connection. Young people report using the internet for connecting with their peers and mental health support. However, how they may have used the internet for support during COVID-19 is not clear. We wanted to know how mood and internet use may have changed in young people during COVID-19 and if this was different for those with and without depression symptoms. 108 adolescents were recruited. Participants with high and low levels of depressive symptomatology answered questions about their mood, internet use, loneliness and life satisfaction during July and August 2020. We found that the high depression group reported significantly more loneliness and less life satisfaction than the low depression group. We found that most young people used the internet for mental health information during COVID-19 but that the high depression group used the internet more for mental health information than the low depression group. The high depression group also had a worsening of mood compared to the low depression group during COVID-19. We found that Black, Asian and Minority Ethnic participants reported increased use of the internet compared to White participants during COVID-19 and that the role of the family facilitated coping during COVID-19 for some adolescents, but for others, it made the lockdown more difficult. Finally, we found that adolescents perceived school anxiety as stressful as COVID-19. To conclude this study supports the use of the internet as a way to help young people with mental health challenges. It also suggests that the internet is a way to help young people from ethnic minorities, who otherwise might be hard to reach, during challenging times. This study also shows that supportive family units can be important during times of stress for young people and that school anxiety is a major issue for young people in today’s society even outside of the pandemic.
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Cogan N, Archbold H, Deakin K, Griffith B, Sáez Berruga I, Smith S, Tanner G, Flowers P. What have we learned about what works in sustaining mental health care and support services during a pandemic? Transferable insights from the COVID-19 response within the NHS Scottish context. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2056386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Nicola Cogan
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Heather Archbold
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Karen Deakin
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Bethany Griffith
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Isabel Sáez Berruga
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Samantha Smith
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Gary Tanner
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Paul Flowers
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
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