Residential care for older people: job satisfaction and psychological health in care staff

Staff in local authority residential homes for older people care for dependent and demanding residents. Recent research has linked resident aggression to psychological disturbance in these staff. Despite this, little is known about the experiences of staff, many of whom are facing significant changes in the residents they care for. This paper examines psychological well-being, perceptions of the work environment and job satisfaction in 48 members of staff from two local authority homes. Results indicate that these staff experience equivalent stress to professional nurses in an NHS setting. Moderate levels of emotional exhaustion are associated with poor clarity about the job they are now required to perform. There is also a poor sense of personal accomplishment. Differences in the needs of staff, and the implications for staff development programs within individual homes are discussed. Given reports of high illness figures for care staff in public sector homes for older people, we argue that carefully targeted staff development programs have the potential for reducing burnout and days lost through illness. Such programs can also improve ‘therapeutic reciprocity’ which in turn might enhance psychological well-being in care staff, and the quality of life for residents.     

Dog-assisted interventions in care homes: A qualitative exploration of the nature,meaning and impact of interactions for older people

Dog-assisted interventions (DAI) have been shown to have a wide-range of potential benefits for older adults living in care homes. Yet, there is a lack of published qualitative research which explores the experiences of care home residents, staff and dog-owner volunteers involved in DAI to fully understand its meaning, impact and value. This study aimed to explore the impact of a DAI on the social and emotional wellbeing of older residents living in care homes. The research employed a qualitative study design comprising overt, naturalistic researcher observation of weekly DAI sessions with 54 older adult residents across four participating care homes in the South East region of England over 3 months in 2018. Data were also collected through focus groups with 12 care home staff and 7 dog-owner volunteers. The data from the observations and focus groups was individually coded followed by thematic analysis across the three data sources. Findings demonstrated there were clear benefits for older people who engaged with DAI, as well as for dog-owners and to some extent for care home staff members. Benefits included sensory, emotional stimulation and opportunities for social interaction, reminiscence on early life experiences and these were supported by the development of some new social relationships. While there were some environmental challenges to implementing DAI, the findings confirm its value for care home residents, with minimal drawbacks from an organizational standpoint. As a low cost intervention, adoption of DAI in care home settings appeared to strengthen relationships between residents and staff and enable wider relationships with an external community resource.     

Islamophobia in the National Health Service: an ethnography of institutional racism in PREVENT's counter-radicalisation policy

In 2015, the UK government made its counter-radicalisation policy a statutory duty for all National Health Service (NHS) staff. Staff are now tasked to identify and report individuals they suspect may be vulnerable to radicalisation. Prevent training employs a combination of psychological and ideological frames to convey the meaning of radicalisation to healthcare staff, but studies have shown that the threat of terrorism is racialised as well. The guiding question of our ethnography is: how is counter-radicalisation training understood and practiced by healthcare professionals? A frame analysis draws upon 2 years of ethnographic fieldwork, which includes participant observation in Prevent training and NHS staff interviews. This article demonstrates how Prevent engages in performative colour-blindness – the active recognition and dismissal of the race frame which associates racialised Muslims with the threat of terrorism. It concludes with a discussion of institutional racism in the NHS – how racialised policies like Prevent impact the minutia of clinical interactions; how the pretence of a ‘post-racial’ society obscures institutional racism; how psychologisation is integral to the performance of colour-blindness; and why it is difficult to address the racism associated with colourblind policies which purport to address the threat of the Far-Right.     

The home health care routing and scheduling problem with interdependent services

This paper presents a model for the daily planning of health care services carried out at patients’ homes by staff members of a home care company. The planning takes into account individual service requirements of the patients, individual qualifications of the staff and possible interdependencies between different service operations. Interdependencies of services can include, for example, a temporal separation of two services as is required if drugs have to be administered a certain time before providing a meal. Other services like handling a disabled patient may require two staff members working together at a patient’s home. The time preferences of patients are included in terms of given time windows. In this paper, we propose a planning approach for the described problem, which can be used for optimizing economical and service oriented measures of performance. A mathematical model formulation is proposed together with a powerful heuristic based on a sophisticated solution representation.     

Implementation challenges of maternal health care in Ghana: the case of health care providers in the Tamale Metropolis

Background

Knowledge regarding the best approaches to improving the quality of healthcare and their implementation is lacking in many resource-limited settings. The Medical Department of Kamuzu Central Hospital in Malawi set out to improve the quality of care provided to its patients and establish itself as a recognized centre in teaching, operations research and supervision of district hospitals. Efforts in the past to achieve these objectives were short-lived, and largely unsuccessful. Against this background, a situational analysis was performed to aid the Medical Department to define and prioritize its quality improvement activities.

Methods

A mix of quantitative and qualitative methods was applied using checklists for observed practice, review of registers, key informant interviews and structured patient interviews. The mixed methods comprised triangulation by including the perspectives of the clients, healthcare providers from within and outside the department, and the field researcher’s perspectives by means of document review and participatory observation.

Results

Human resource shortages, staff attitudes and shortage of equipment were identified as major constraints to patient care, and the running of the Medical Department. Processes, including documentation in registers and files and communication within and across cadres of staff were also found to be insufficient and thus undermining the effort of staff and management in establishing a sustained high quality culture. Depending on their past experience and knowledge, the stakeholder interviewees revealed different perspectives and expectations of quality healthcare and the intended quality improvement process.

Conclusions

Establishing a quality improvement process in resource-limited settings is an enormous task, considering the host of challenges that these facilities face. The steps towards changing the status quo for improved quality care require critical self-assessment, the willingness to change as well as determined commitment and contributions from clients, staff and management.     

The patient's partner: the spouse in residential care

When an elderly patient enters residential care, tensions often arise because the patient's partner attempts to defend a threatened spousal role that is incompatible with the new setting. Patterns of patient entry into the facility also influence the interaction between the patient's spouse and nursing staff. The social worker's task is to reduce friction between the spouse and staff members by sustaining the husband or wife in an acceptable caring role.     

某大学医院职工的心理健康与人格特征分析

目的评估高校医院职工心理健康及人格特征,探讨提高医院职工心理素质的方法与途径,为医院职工心理健康和综合素质的提高提供参考依据。方法用SCL-90症状自评量袁和艾森克人格问卷（EPQ）对陕西师范大学医院58名职工进行问卷调查。结果医院职工在人际关系敏感、抑郁2个因子上的得分高于全国常模;不同性别、学历、岗位职工在部分SCL-90因子得分上的差异有统计学意义;非医生岗位职工的EPQ情绪性因子分高于医生岗位医务人员。结论医院职工在人际关系敏感、抑郁方面健康水平低于全国平均水平;医院职工心理健康受性别、学历、岗位影响;医生岗位职工情绪稳定性好于非医生岗位。     

舒缓院前急救人员压力的心理支持策略

目的通过对院前急救工作人员的心理学分析,探讨其存在的心理问题及对工作产生的影响,将心理支持引入院前急救工作。方法通过对院前急救工作人员的寻访,并结合工作实践体会,将心理支持策略与院前急救工作有机结合。结果用心理支持能更好地推进院前急救工作。结论心理支持策略在急救工作中有推广价值。     

新冠肺炎流行期间安徽省疾控人员心理状况调查研究

目的 调查分析安徽省疾病预防控制机构(简称疾控机构)工作人员在新型冠状病毒肺炎(简称新冠肺炎,COVID-19)流行期间工作、生活现状及其心理健康状况。 方法 采用便利抽样方法于2020年2月对安徽省各级疾控机构工作人员进行问卷调查和心理学量表的评测。 结果 本研究获得有效问卷679份,其中男性381名(56.1%),女性298名(43.9%)。研究对象中663人(97.6%)参与新冠肺炎防控工作;疫情期间需要加班者658人(96.9%),其中每周加班时长超过20 h者318人(48.6%)。149人(21.9%)出现焦虑症状,且不同工作年限和年龄者焦虑状况不同(χ²=7.428、8.588,均P<0.05);234人(34.4%)出现抑郁症状,且因年龄、工作年限、最高学历、职称和所在疾病预防控制中心级别的不同,抑郁状况也不同(χ²=35.336、17.121、25.291、22.152和40.847,均P<0.05)。 结论 新冠肺炎流行期间安徽省疾控机构工作人员身心健康受到影响,有必要采取相应干预措施,提高其应对突发公共卫生事件时心理健康调节的能力。     

Pastoral care staff participate on treatment team

Clinical department members at Marianjoy Rehabilitation Center identified problems with their staffing conferences, in which they plan patient care. The problems included a deemphasis on social and spiritual aspects and an overemphasis on billing concerns. To correct these difficulties, the hospital adopted the Patient Evaluation Conference System (PECS), adding a pastoral care component. Central to the new system is the addition of pastoral care data from scales that assess patient status in four areas: (1) awareness of spiritual dimension of disability, (2) knowledge of spiritual resources, (3) skill in spiritual self-management, and (4) use of spiritual resources. Pastoral care staff write evaluations in easily understood language so other staff members can understand pastoral care's purpose. They formulate specific short-term objectives in order to delineate the pastoral services needed. Integration with the treatment team has resulted in greater accountability for the pastoral care staff. Patient progress charts now include specific pastoral care goals, and a daily report of pastoral care services is included on patient bills, although no fee is charged. Program evaluation and feedback systems to enable pastoral care staff to make more accurate assessments are planned. The new system has enhanced staff communication, service documentation, discharge planning, and the quality of pastoral care.     

The Performance of Dialysis Care: Routinization and Adaptation on the Floor

Previous studies of communication in dialysis centers primarily focused on communication between nurses and patients. In this study, ethnographic methods were used to explore the dominant communication performances enacted by dialysis staff members, including registered nurses, patient care technicians, technical aides, a social worker, and a dietitian. Findings suggest a dialectic between extreme routinization of care and continual adaptation. The dominant routine involved repeating the same preparation, treatment, and discharge process 3 shifts per day, thrice weekly for each patient. At the same time, near-constant adjustments to scheduling, coordination of tasks, and problem solving were needed to maintain the performance of repetition. The balancing of this dialectic has significant implications for new staff training and socialization, understanding the role of technology and routine in dialysis and in health care systems more generally, and in further theorizing the role of unbounded communication interactions in health care.     

The performance of dialysis care: routinization and adaptation on the floor

Previous studies of communication in dialysis centers primarily focused on communication between nurses and patients. In this study, ethnographic methods were used to explore the dominant communication performances enacted by dialysis staff members, including registered nurses, patient care technicians, technical aides, a social worker, and a dietitian. Findings suggest a dialectic between extreme routinization of care and continual adaptation. The dominant routine involved repeating the same preparation, treatment, and discharge process 3 shifts per day, thrice weekly for each patient. At the same time, near-constant adjustments to scheduling, coordination of tasks, and problem solving were needed to maintain the performance of repetition. The balancing of this dialectic has significant implications for new staff training and socialization, understanding the role of technology and routine in dialysis and in health care systems more generally, and in further theorizing the role of unbounded communication interactions in health care.     

军队医院护理骨干心理护理培训需求

目的了解军队医院护理骨干心理护理实践现状及培训需求,为构建系统性心理护理培训方案提供参考。方法采用临床护士心理护理知信行及需求调查问卷、自编心理护理培训需求问卷等对2018年4批次接受任职教育培训的103名军队医院护理骨干调查。结果军队医院护理骨干心理护理知识、行为、态度、需求维度分别得分56.18±12.61分、28.52±2.38分、57.94±12.93分、18.62±1.72分;97.1%的护理骨干希望接受心理学相关培训,83%希望将“护士职业心理健康促进”作为培训内容,89%希望培训中应用案例分析;军队医院护理骨干的心理护理态度、需求、知识得分分别在工作年限、初始学历、工作科室与培训经历上的差异有统计学意义(P<0.05)。结论军队医院护理骨干心理护理知识掌握不足,一定程度阻碍临床心理护理工作的开展,亟需开展心理护理培训;并且应根据军队医院护理骨干对心理护理培训内容及培训方式的需求,侧重于临床实践应用,构建系统性、模块化、参与式培训,以切实提高军队医院护理骨干心理护理水平。     

Prioritizing Threats to Patient Safety in Rural Primary Care

CONTEXT: Rural primary care is a complex environment in which multiple patient safety challenges can arise. To make progress in improving safety with limited resources, each practice needs to identify those safety problems that pose the greatest threat to patients and focus efforts on these. PURPOSE: To describe and field-test a novel approach to prioritizing safety problems in rural primary care based on the method of Failure Modes and Effects Analysis. METHODS: A survey instrument designed to assess perceptions of medical error frequency, severity, and cause was administered anonymously to staff of 2 rural primary care practices in New York State. Responses were converted to quantitative hazard scores, which were used to make priority rankings of safety problems. Concordance analysis was conducted. RESULTS: Response rate was 94% at each site. Analysis yielded a list of priorities for each site. Comparison between staff groups (provider vs nursing vs administration), based on the top 10 priorities perceived by staff, showed 53% concordance at one site and 30% at the other. Concordance between sites was lower, at 20%. CONCLUSIONS: Initial field-testing of a Failure Modes and Effects Analysis approach in rural primary care suggests that it is feasible and can be used to estimate, based on staff perceptions, the greatest threats to patient safety in an individual practice so that limited resources can be focused appropriately. Higher concordance between staff within a practice than between practices lends preliminary support to the validity of the approach.     

Violence towards health care staff and possible effects on the quality of patient care

Much of the research on violence in the health care sector has focused on the immediate and long-term effects of patient violence on staff victims. There is a lack of studies, however, examining whether individual reactions to violent episodes, such as anger and increased fear in one's work, have any measurable effect on staff behaviour toward their patients, and ultimately on the quality of patient care. The aim of the present study was to investigate whether an association exists between staff experiences with violence and patient-rated quality of patient care. A theoretical model was presented, suggesting that violence or threats experienced by health care staff have a negative effect on the quality of health care services offered, as measured by patients. In addition, it was theorised that there would be an association between staff work environment and staff reports of violence. Six questionnaire studies, three concerning hospital staff's views of their work environment and three dealing with patients' perceptions of the quality of care, provided the data for evaluating the model. Work environment and quality of care studies were carried out simultaneously at a single hospital in 1994, 1995, and again in 1997. Regression analysis was used to see which combination of work environment and quality of care variables would best predict a positive overall grade for quality of care from the patient perspective. Violence entered consistently as an important predictor into each of the three best regression equations for 1994, 1995, and 1997, respectively. The results of this analysis suggest that the violence experienced by health care staff is associated with lower patient ratings of the quality of care. The study indicates that violence is not merely an occupational health issue, but may have significant implications for the quality of care provided.     

Physician care in assisted living: a qualitative study

OBJECTIVES: To identify patterns and emerging concepts used by assisted living (AL) residents, their families, and the facility staff to describe the care provided by physicians to the AL residents. DESIGN: Qualitative research and analysis based on audio-taped and transcribed ethnographic interviews with residents, family members, and staff of AL facilities. SETTING: Three AL facilities representing small and traditional AL facilities. PARTICIPANTS: Forty-three in-depth interviews including 16 AL residents, 13 family members, three facility managers, and 11 staff members. MEASUREMENTS: Ethnographic, audio-taped interviews coded by consensus by a doctoral-level analysis team. Coding focused broadly on any references to physicians or doctors in the interviews. RESULTS: Emergent themes included four major physician-related themes in AL including: magnification of physician authority; disagreements with physician care; physician communication; and continuity/discontinuity of physician care. CONCLUSION: Physicians caring for residents of AL facilities should consider how residents, families, and staff stakeholders may influence their patient care for AL residents in terms of their authority, decision-making, communication, and continuity of care.     

Quality of hysterectomy care in rural Gujarat: the role of community-based health insurance.

Community-based health insurance (CBHI) may be a mechanism for improving the quality of health care available to people outside the formal sector in developing countries. The purpose of this paper is: (1) to identify problems associated with the quality of hysterectomy care accessed by members of SEWA, an Indian CBHI scheme; and (2) to discuss mechanisms that might be put in place by SEWA, and CBHI schemes more generally, to optimize quality of health care. Data on the structure and process of hysterectomy care were collected primarily through review of 63 insurance claims and semi-structured interviews with 12 providers. Quality of hysterectomy care accessed by SEWA's members varies tremendously, from potentially dangerous to excellent. Seemingly dangerous aspects of structure include: operating theatres without separate hand-washing facilities or proper lighting; and the absence of qualified nursing staff. Dangerous aspects of process include: performing hysterectomy on demand; removing both ovaries without consulting or notifying the patient; and failing to send the excised organs for histopathology, even when symptoms and signs are suggestive of disease. Women pay substantial amounts of money even for care of poor, and potentially dangerous, quality. In order to improve the quality of hospital care accessed by its members, a CBHI scheme can: (1) gather data on the costs and complications for each provider, and investigate cases where these are excessive; (2) use incentives to encourage providers to make efficient and equitable resource allocation decisions; (3) select, and contract with, providers who provide a high standard of care or who agree to certain conditions; and (4) inform and advise doctors and the insured about the costs and benefits of different interventions. In the case of SEWA, it is most feasible to identify a limited number of hospitals providing better-quality care and contract directly with them.     

Social aspects in the activities of radiodiagnostic services

Results of sociological investigation of the staff members and patients of radiodiagnosis departments of treatment and prophylaxis institutions of St. Petersburg are analyzed. Anonymous questionnaires were distributed in 50 institutions of different profiles among 200 staff members (physicians--roentgenologists and radiologists, and x-ray laboratory assistants) and 300 patients (from x-ray rooms and radiodiagnosis departments). The study showed an objective picture of the state of radiological care rendered to the population viewed from two sides, by those rendering this care and those rendered it. The results helped develop recommendations for public health organization.     

Control measures against Serratia marcescens colonization at the neonatal intensive care unit of UOEH hospital

In September 2001, twelve neonatal intensive care unit (NICU) patients were found to be colonized with pigment-producing strains of Serratia marcescens. The UOEH Infection Control Group (ICG) committee investigated the source of this epidemic and carried out several remedial measures. Immediate investigation of both the environment and the hands of health care workers were enforced. The most likely means of transmission was thought to be from the hands contaminated with S. marcescens that was found on antiseptic cotton, kept in shared stainless steel canisters, used for wiping the patients' buttocks. Therefore, we suggested the following interventions: 1) abolish the stainless steel canisters, and prepare antiseptic cottons for each patient, 2) monitor cultures with some specimens for all patients in the NICU, 3) periodically investigate the environment, 4) enforce workers to wash and disinfect their hands before and after patient care, 5) use new gloves for each treatment, 6) re-examine and modify the caring procedures for inpatients by the nursing staff. In January 2002, this nosocomial colonization came to an end without any serious infection. One of the key points of this success was the quick response by the clinical staff and ICG committee members to the laboratory results of bacteriological examinations. Furthermore, the early investigation of reservoir and good communication between the clinical staff and ICG committee members mostly prevented this nosocomial colonization from becoming worse.