Reporting of Clinical Adverse Events Scale: a measure of doctor and nurse attitudes to adverse event reporting

Objective: To develop a validated measure of professionals' attitudes towards clinical adverse event reporting (CAER). Design: Cross-sectional survey with follow-up. Participants: 201 doctors and nurse/nurse-midwives undergoing postqualification training in Leeds, York and Hull Universities in 2003. Materials: A questionnaire which comprised 73 items extracted from interviews with professionals; a second, statistically reduced version of this questionnaire. Results: The analysis supported a 25-item questionnaire comprising five factors: blame as a consequence of reporting (six items); criteria for reporting (six items); colleagues' expectations (six items); perceived benefits of reporting events (five items); and clarity of reporting procedures (two items). The resulting questionnaire, the Reporting of Clinical Adverse Effects Scale (RoCAES), had satisfactory internal consistency (Cronbach's alpha = 0.83) and external reliability (Spearman's correlation = 0.65). The construct validity hypothesis -doctors have less positive attitudes towards CAER than nurses -was supported (t = 5.495; p < 0.0001). Conclusion: Initial development of an evidence-based, psychometrically rigorous measure of attitudes towards CAER has been reported. Following additional testing, RoCAES may be used to systematically elicit professionals' views about, and inform interventions to improve, reporting behaviour

Barriers to domestic retrofit quality: Are failures in retrofit standards a failure of retrofit standards?

Thermal retrofits of homes are central to the UK's fuel poverty and net zero carbon policies but there are concerns about poor quality installation and so new standards are to be introduced (PAS2035). We have explored retrofit installers' perceptions of the barriers to installing internal wall insulation (IWI) and of current regulations and standards for retrofits. We conducted four focus groups with retrofit installers. Thematic analysis identified three themes. (1) IWI is viewed as impractical in situations other than new builds, extensions and conversions as it is too time-consuming and expensive. (2) Installing IWI is perceived as an unskilled job with no need for training or referring to standards during installation. (3) Because standards lack credibility, installers can be sceptical of potential problems caused by on-site installation adaptations, for example thermal bridging. Our results show that retrofit standards have not improved retrofit quality. Awareness and credibility of standards is low, and new standards (PAS2035) will introduce additional costs which may reduce the pool of installers willing to engage in the retrofit market. Policies need to address installer training, professional identity and social practices, and reduce barriers to change in order to increase success. </jats:p

Experiences following cataract surgery - patient perspectives

PURPOSE: Most patients report being highly satisfied with the outcome of cataract surgery but there are variable reports regarding the impact of cataract surgery on some real-world activities, such as fall rates. We hypothesised that adaptations to changed refractive correction and visual function may cause difficulties in undertaking everyday activities for some patients and used a series of focus groups to explore this issue. METHOD: Qualitative methods were used to explore patients' experiences of their vision following cataract surgery, including adaptation to vision changes and their post-surgical spectacle prescription. Twenty-six participants took part in five focus groups (Mean age = 68.2 ± 11.4 years), and the data were analysed using thematic analysis. RESULTS: We identified three themes. 'Changes to Vision' explores participants' adaptation following cataract surgery. While several had problems with tasks relying on binocular vision, few found them bothersome and they resolved following second eye surgery. Participants described a trial and error approach to solving these problems rather than applying solutions suggested by their eyecare professionals. 'Prescription Restrictions' describes the long-term vision problems that pre-surgery myopic patients experienced as a consequence of becoming emmetropic following surgery and thus needing spectacles for reading and other close work activities, which they did not need before surgery. Very few reported that they had the information or time to make a decision regarding their post-operative correction. 'Information Needs' describes participant's responses to the post-surgical information they were given, and the unmet information need regarding when they can drive following surgery. CONCLUSION: The findings highlight the need for clinicians to provide information on adaptation effects, assist patients to select the refractive outcome that best suits their lifestyle, and provide clear advice about when patients can start driving again. Patients need to be provided with better guidance from clinicians and prescribing guidelines for clinicians would be beneficial, particularly for the period between first- and second-eye surgery

Making education work

This conference presentation was given as part of the Achieving Compliance with Road Traffic Law: What can enforcement, prosecution and sentencing contribute? Conference by Dr Fiona Fylan, Consultant Health Psychologist and Reader in Psychology at Leeds Metropolitan University. The conference, jointly organised by PACTS and the Criminal Justice Research Centre with Brunel Law School, was hosted at Brunel University on the 13th June 2012, and was the first opportunity to review the evidence about how to improve compliance with road traffic law. Its aim was to set out the challenges facing the government over the next few years and the steps that need to be taken to improve levels of compliance on our roads. It took a wide look at the process of compliance from initial choices about enforcement through to the effectiveness of the court system

Young people's motivations to drive: expectations and realities

© 2017 Elsevier Ltd Fewer young adults are choosing to learn to drive and there is a safety argument for encouraging those who do learn to delay doing so. In this study we explore what motivates young people to learn to drive and we uncover their expectations – and the reality – of the difference driving makes to their short- and longer-term futures. We conducted 12 focus groups with 48 young people age 16–24. The discussions explored why they do or don't want to drive, the immediate life changes that driving brings as well as how driving might affect their life in the future. We analysed the data using thematic analysis using the question: what motivates young people to learn to drive? We identified five motivations in the data, organised into two themes. The first theme relates to the benefits of maturity. Young people believe driving provides independence and represents the first stage of becoming an adult. Most rely on their parents for lifts, and therefore parents control and scrutinise their social life. The car as a form of personal space was very important for young people, as they have complete control over this environment, which can be missing in other aspects of their lives. Driving also bestows kudos, particularly for those amongst the first in their peer group to pass their test. Novice drivers enjoy being able to offer lifts to friends and family, although described how this rapidly becomes an imposition. The second theme is about broadening horizons. Young people believe that driving expands their social world, enabling them to travel further afield with their friends for day trips because driving is faster, more convenient and cheaper than public transport. In practice, few of those who drive had used their car in this way, instead using it mainly for commuting and getting fast food. Participants talked about how driving opens up career opportunities, allowing them to travel to more distant cities for work and study. However, driving usually made accessing work and study opportunities more convenient rather than possible. Instead, the main benefit young people actually experienced was having more time to sleep in the morning. The qualitative nature of the study, together with the inclusion of pre-drivers, drivers and non-drivers, has provided insight into motivations for learning to drive and how the reality of driving often does not match expectations. The results could be used to inform the potential content of an intervention to encourage young people to delay learning to drive

“We can't save the planet, we're too busy saving lives”: Exploring beliefs about decarbonizing the NHS

Background: If health and social care delivery systems are to achieve net zero targets, fundamental changes are required to how organizations deliver care, how individuals practice clinically, how people access care, and how systems reduce the demand for healthcare. This paper explores how professionals, patients and citizens respond to this need for change. Methods: We conducted a mixed methods study, comprising 12 deliberative workshops (n = 35) and a survey (n = 413) with health and social care staff, patients and citizens in the North of England. Results: We found that while few people were aware of the net zero target, they supported it. Some, however, questioned organizational commitment, highlighting potential conflicts between cost and sustainability. Staff described a lack of agency to make changes to their practice, despite identifying many opportunities to do so. Some believed that healthcare should be exempt from carbon reduction targets. The strongest messages we found to interest, empower, and motivate people to make changes are: that individual actions matter; that we have a responsibility to set a good example of tackling climate change; and that making changes saves lives and should be a priority. We also found that people need to be reassured that the changes will not adversely affect clinical outcomes. Finally, progress towards targets needs to be tracked and publicly available. Conclusion: Our results indicate a need for clear leadership which gives sustainability a higher priority, a need for staff training to enable conversations about the environmental effects of treatment, and support for shifting the focus from treating illness to promoting health

Developing a taxonomy for discontinuities in internal wall insulation

Adopting a fabric first approach and installing thermal insulation in existing buildings is one of the most effective methods of improving energy efficiency. The use of internal wall insulation (IWI) has been shown to offer an effective thermal solution, especially where other methods of insulation are unsuitable. However, fitting internal wall insulation is not without risk as discontinuities (gaps) are often found in the insulation layer for a variety of reasons. This can lead to increased flow of heat from the interior to the exterior causing reduced local surface temperatures, which can lead to condensation or mould growth. Currently there is little or no consistency in the terminology used to discuss such discontinuities in IWI and as such categorising specific types of discontinuities and their relative magnitude and rate of recurrence in practice is difficult. This paper seeks to address the lack of consistency by proposing a taxonomy that practitioners and researchers can use when describing discontinuities in IWI. This paper brings together the findings from building performance research, part of which involved field studies forensically observing IWI installations. Alongside the site visits, a literature review of IWI research was undertaken to identify the types of discontinuities observed and the terminology used to describe the occurrence and characteristics. From this a taxonomy has been developed to standardise and characterise discontinuities. It is hoped this will improve the understanding of and appreciation for the importance and scale of discontinuities in the industry, in so doing setting out a route for reducing their occurrence. It is also proposed that this taxonomy could be adapted for use in discussion of other insulation types

Marginalisation of men in family planning texts: An analysis of training manuals

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Objective: Men’s engagement in family planning has become part of the global health agenda; however, little is known about the training manuals health practitioners’ use and how these manuals describe and explain men’s roles within a family planning context. Design:To further understand engagement, this paper examines how training manuals written for health practitioners describe and define men’s participation within family planning. Setting:The training manuals were written for UK health practitioners and covered men’s contributions to family planning. Method:Discourse analysis was used to examine the three training manuals focused upon. Results:Three main discourses were identified: ‘contraception is a woman’s responsibility’, ‘men disengage with health practitioners’ and ‘men are biologically predisposed to avoid sexual responsibility’. Conclusion:Together, these three discourses function to marginalise men in family planning, constructing them as detached accessories that lack the ability to engage

A qualitative analysis of stressors affecting 999 ambulance call handlers' mental health and well-being

Purpose: The 999 ambulance call handler is critical in responding to emergency patient treatment; however, the call handlers are often a hidden component of the healthcare workforce and an under-researched group. The objective of this study is to understand stress triggers experienced by 999 ambulance call handlers that could lead to burnout and examine personal and organisational mechanisms and strategies which reduced the risk of burnout. Design/methodology/approach: A single interview case study approach applying qualitative methods was undertaken. Participants were identified through a purposive sample of 999 ambulance call handlers with the Yorkshire Ambulance Service National Health Service Trust (UK). Participants were interviewed via telephone between July 2019 and September 2019. Findings: In total, 18 staff participated in this study. Societal factors including public incivility and media representation and organisational factors, such as a demanding environment, lack of appreciation and career progression, training issues and protocols were key stressors. Organisational well-being services were helpful for some, but for others lacked accessibility and appropriateness. Positive public feedback and speaking with peers bolstered well-being. 999 ambulance call handlers suggested that sufficient breaks, co-design or feeding back on training and protocols and creating more informal opportunities to discuss ongoing everyday stressors as methods to reduce stress and burnout. Originality/value: This paper explores a previously under researched area on stressors and potential burnout in 999 call handlers. This paper highlights the need for improved organisational support services and appropriate public and sector peer recognition of the role of ambulance 999 ambulance call handlers

Investigating target refraction advice provided to cataract surgery patients by UK optometrists and ophthalmologists

Purpose: To determine whether UK optometrists and ophthalmologists provide target refraction advice to patients prior to cataract surgery, and when this should first be discussed. Methods: Optometrists and ophthalmologists were asked to complete a survey of two clinical vignettes (both older patients with cataract; a pre-operative myope who routinely read without glasses and a patient using a monovision approach), plus multiple choice and short answer questions either using hard copy or online. Results: Responses were obtained from 437 optometrists and 50 ophthalmologists. Optometrists who reported they would provide target refraction advice were more experienced (median 22 years) than those who would leave this to the Hospital Eye Service (median 10 years). The former group reported it was in the patients’ best interest to make an informed decision as they had seen many myopic patients who read uncorrected pre-operatively, and were unhappy that they could no longer do so after surgery. Inexperienced optometrists reported that they did not want to overstep their authority and left the decision to the ophthalmologist. The ophthalmologists estimated their percentage of emmetropic target refractions over the last year to have been 90%. Conclusion: Currently, some long-term myopes become dissatisfied after cataract surgery due to an emmetropic target refraction that leaves them unable to read without glasses as they did prior to surgery. Although experienced optometrists are aware of this and attempt to discuss this issue with patients, less experienced optometrists tend not to. This suggests that target refraction needs greater exposure in university training and continuing professional development. To provide patients with the knowledge to make informed decisions regarding their surgery, we suggest an agreed protocol within funded direct referral schemes of initial target refraction discussions by optometrists to introduce the idea of refractive outcomes and outline options, with further discussion with the ophthalmologist to clarify understanding