Mental health nurses' encounters with occupational health services

This is a pre-copyedited, author-produced version of an article accepted for publication in Occupational Medicine following peer review. Under embargo until 16 June 2019. The version of recordJ. Oates, J. Jones, and N. Drey, ‘Mental health nurses’ encounters with occupational health services’, Occupational Medicine, kqy084, (2018), is available online at: https://doi.org/10.1093/occmed/kqy084.Background: Staff wellbeing is vital to the functioning of the UK National Health Service (NHS). Mental health nurses with personal experience of mental illness can offer a professionally and personally informed insight into the occupational health service offered by their employer. Aims: To investigate mental health nurses’ views of occupational health provision in the NHS, based on their personal experience. Methods: A qualitative interview study using a purposive sample of mental health nurses with personal experience of mental illness. Results: Twenty-seven mental health nurses met the inclusion criteria. Thematic analysis identified three themes: comparisons of ‘relative expertise’ between the mental health nurse and the occupational health clinician; concerns about ‘being treated’ by a service at their work; and ‘returning to work’. Conclusion: Occupational health provision in mental health settings must take account of the expertise of its staff. Further research, looking at NHS occupational health provision from the provider perspective is warranted.Peer reviewe

The validity of hand hygiene compliance measurement by observation: a critical systematic review

BACKGROUND: Hand hygiene is monitored by direct observation to improve practice, but this approach can potentially cause information, selection, and confounding bias, threatening the validity of findings. The aim of this study was to identify and describe the potential biases in hand hygiene compliance monitoring by direct observation; develop a typology of biases and propose improvements to reduce bias; and increase the validity of compliance measurements. METHODS: This systematic review of hospital-based intervention studies used direct observation to monitor health care workers' hand hygiene compliance. RESULTS: Seventy-one publications were eligible for review. None was free of bias. Selection bias was present in all studies through lack of data collection on the weekends (n = 61, 86%) and at night (n = 46, 65%) and observations undertaken in single-specialty settings (n = 35, 49%). We observed inconsistency of terminology, definitions of hand hygiene opportunity, criteria, tools, and descriptions of the data collection. Frequency of observation, duration, or both were not described or were unclear in 58 (82%) publications. Observers were trained in 56 (79%) studies. Inter-rater reliability was measured in 26 (37%) studies. CONCLUSIONS: Published research of hand hygiene compliance measured by direct observation lacks validity. Hand hygiene should be measured using methods that produce a valid indication of performance and quality. Standardization of methodology would expedite comparison of hand hygiene compliance between clinical settings and organizations

Interventions to improve hand hygiene compliance in patient care: Reflections on three systematic reviews for the Cochrane Collaboration 2007-2017

This article presents highlights from a recently updated systematic Cochrane review evaluating the effectiveness of interventions to improve hand hygiene compliance in patient care. It is an advance on the two earlier reviews we undertook on the same topic as it has, for the first time, provided very rigorous synthesis of evidence that such interventions can improve practice. In this article, we provide highlights from a recently updated Cochrane systematic review. We identify omissions in the information reported and point out important aspects of hand hygiene intervention studies that were beyond the scope of the review. A full report of the review is available free of charge on the Cochrane website

Student nurses' experiences of infection prevention and control during clinical placements

Background: Little is known about nursing students' experiences of infection control in the clinical setting despite its importance protecting patients and reducing risks of occupational exposure. Methods: We conducted an online survey involving a fixed choice Likert-type scale with 19 items and an open question to solicit more detailed information with a national sample of student nurses in the United Kingdom. Results: Four hundred eighty-eight student nurses completed questionnaires. All participants reported lack of compliance for every item on the Likert scale, most frequently from community settings and long-term care facilities for older people. Incidents most commonly witnessed were failure to comply with hand hygiene protocols, failure to comply with isolation precautions, poor standards of cleaning in the patient environment, not changing personal protective clothing between patients, and poor management of sharp instruments. Qualified nurses did not provide good role models. Medical staff were the occupational group most heavily criticized for poor compliance. Conclusion: Students demonstrated sound understanding of infection control and were able to identify lack of compliance on the basis of preclinical classroom instruction. The study findings indicate that ensuring safe infection control practice remains a challenge in the United Kingdom despite its high priority

Associations between Age, Years in Post, Years in the Profession and Personal Experience of Mental Health Problems in UK Mental Health Nurses

Nurses' mental health is of paramount importance, both in terms of patient safety and the sustainability of the workforce. Age, years in the profession, in post and personal experience or exposure to mental health problems are relevant to the mental health nursing workforce crisis in the United Kingdom. This study aimed to determine the relationship between age, years in the profession and post and self-reported experience of mental health problems using an online cross-sectional survey of 225 UK mental health nurses. Number of years in post was inversely correlated with overall experience of mental health problems, particularly living with someone else with mental health problems. Those with experience of living with someone with mental health problems had significantly fewer years of professional experience than those without. This article discusses possible explanations for this phenomenon and makes the case for future research on the topic

The epidemiology of diagnosed chronic renal failure in Southampton and Southwest Hampshire Health Authority

The study comprised an investigation of the incidence of chronic renal failure (CRF) in a defined English health authority and a retrospective cohort of newly incident cases of CRF.Incidence rates were derived from new cases in Southampton Health Authority (pop 404,547) 1992-94, as determined by a raised serum creatinine (SCr 150 mmol/L) from chemical pathology records. A retrospective study of all diagnosed CRF (n=1076) and a randomly selected sub-cohort (n=213) for detailed medial note search. Follow-up was until 31/12/98, mean 5 ½ years. Outcomes were mortality, referral to nephrologists and acceptance on to renal replacement therapy (RRT).The median age was 77, overall rate of CRF 1330 (1253-1412) per million population and the M:F rate ratio was 1.6 (1.4-1.8). Areas of high social deprivation had higher rates of CRF. By 31/12/98, 741 (69%) of cases had died. Less than 50% of cases are referred to a nephrologist with age and co-morbidity being negatively associated with referral. Acceptance for renal replacement therapy was also negatively associated with increasing age.CRF is relatively common especially in men, the elderly, those in deprived areas and amongst South Asians. Survival is poor in CRF. Mortality is high, 66% mortality at five years, with an excess in younger age groups and in women. Most cases never see a nephrologist and there is scope to increase referral by four times the current rate. Routine data were found to be incomplete and inaccurate requiring extensive cross-checking and validation. Investment is needed to improve the quality of routine data in the NHS.</p

Routine hand hygiene audit by direct observation: has nemesis arrived?

Infection prevention and control experts have expended valuable health service time developing and implementing tools to audit health workers' hand hygiene compliance by direct observation. Although described as the ‘gold standard’ approach to hand hygiene audit, this method is labour intensive and may be inaccurate unless performed by trained personnel who are regularly monitored to ensure quality control. New technological devices have been developed to generate ‘real time’ data, but the cost of installing them and using them during routine patient care has not been evaluated. Moreover, they do not provide as much information about the hand hygiene episode or the context in which hand hygiene has been performed as direct observation. Uptake of hand hygiene products offers an inexpensive alternative to direct observation. Although product uptake would not provide detailed information about the hand hygiene episode or local barriers to compliance, it could be used as a continuous monitoring tool. Regular inspection of the data by infection prevention and control teams and clinical staff would indicate when and where direct investigation of practice by direct observation and questioning of staff should be targeted by highly trained personnel to identify local problems and improve practice

A population-based study of the incidence and outcomes of diagnosed chronic kidney disease

Background: This study aims to determine the incidence rate and prognosis of detected chronic kidney disease (CKD) in a defined population.Methods: This is a retrospective cohort study of all new cases of CKD from Southampton and South-West Hampshire Health Authority (population base, 405,000) determined by a persistently increased serum creatinine (SCr) level (?1.7 mg/dL [?150 µmol/L] for 6 months) identified from chemical pathology records. Follow-up was for a mean of 5.5 years for survival, cause of death, and acceptance to renal replacement therapy (RRT).Results: The annual incidence rate of detected CKD was 1,701 per million population (pmp; 95% confidence interval [CI], 1,613 to 1,793) and 1,071 pmp (95% CI, 1,001 to 1,147) in those younger than 80 years. There was a steep age gradient; median age was 77 years. The man-woman rate ratio was 1.6 (95% CI, 1.4 to 1.8), with a male excess in all age groups older than 40 years. Incidence increased in areas with greater socioeconomic deprivation. Median survival was 35 months. Age, SCr level, and deprivation index were all significantly associated with survival. Standardized mortality ratios were 36-fold in those aged 16 to 49 years, 12-fold in those aged 50 to 64 years, and more than 2-fold in those older than 65 years. Cardiovascular disease (CVD) was the most common cause of death (46%). Only 4% of patients were accepted to RRT.Conclusion: The incidence of diagnosed CKD is common, especially in the elderly, and is greater in more deprived areas. Prognosis is poor, with CVD prominent. More research is needed to assess the effectiveness and costs of increasing referral to nephrologists of patients with CKD

Measuring handwashing performance in health service audits and research studies

Handwashing is regarded as the most effective way of controlling healthcare-associated infection. A search of the literature identified 42 intervention studies seeking to increase compliance in which the data were collected by directly observing practice. The methods used to undertake observation were so poorly described in most studies that it is difficult to accept the findings as reliable or as valid indicators of health worker behaviour. Most studies were limited in scope, assessing the frequency of handwashing in critical care units. The ethical implications of watching health workers during close patient contact were not considered, especially when observation was covert or health workers were misinformed about the purpose of the study. Future studies should take place in a range of clinical settings to increase the generalizability of findings. Observation should be timed to capture a complete picture of 24 h activity and should include all health workers in contact with patients because all have the potential to contribute to cross-infection. Reported details of observation should include: vantage of data collectors; inter-rater reliability when more than one individual is involved; and attempts to overcome the impact of observation on usual health worker behaviour. Ideally an additional data collection method should be used to corroborate or refute the findings of observation, but no well-validated method is presently available