Perceived barriers and opportunities to improve working conditions and staff retention in Emergency Departments:a qualitative study

Background:Staff retention in Emergency Medicine (EM) is at crisis level and could be attributed in some part to adverse working conditions. This study aimed to better understand current concerns relating to working conditions and working practices in Emergency Departments (EDs).Methods:A qualitative approach was taken, using focus groups with ED staff (doctors, nurses, advanced care practitioners) of all grades, seniority and professional backgrounds from across the UK. Snowball recruitment was undertaken using social media and Royal College of Emergency Medicine communication channels. Focus groups were conducted online and organised by profession. A semi structured topic guide was used to explore difficulties in the work environment, impact of these difficulties, barriers and priorities for change. Data were analysed using a directive content analysis to identify common themes.Results:Of the 116 clinical staff who completed the eligibility and consent forms, 46 met criteria and consented, of those, 33 participants took part. Participants were predominantly White British (85%), female (73%) and doctors (61%). Four key themes were generated: ‘culture of blame and negativity’, ‘Untenable working environments’, ‘compromised leadership’ and ‘striving for support’. Data pertaining to barriers and opportunities for change were identified as sub-themes. In particular, strong leadership emerged as a key driver of change across all aspects of working practices.Conclusion:This study identified four key themes related to workplace concerns and their associated barriers and opportunities for change. Culture, working environment and need for support echoed current narratives across healthcare settings. Leadership emerged more prominently than in prior studies as both a barrier and opportunity for wellbeing and retention in the EM workplace. Further work is needed to develop leadership skills early on in clinical training, provide protected time and opportunity to refine leadership skills and a clear pathway to address higher levels of management

Psychologically Informed Practice and Policy (PIPP) Project:Key Recommendations for Retention and Workforce Wellbeing in Emergency Care

The PIPP project is a UKRI funded collaborative study between University of Bath and the Royal College of Emergency Medicine. The PiPP Project investigated current workplace concerns, barrier to change and opportunities for development and growth. This document details specific evidence-based recommendations relating to four key areas identified within the PIPP project as prioritised targets in emergency care workforce development: ‘an environment to thrive in’, ‘cultivating a better culture’, ‘a tailored pathway of care’ and ‘enhanced leadership’. The recommendations are based on new empirical data and supported by existing guidelines and research

Aversive Conditioning and Monk Seal–Human Interactions in the Main Hawaiian Islands

The mission of the National Oceanic and Atmospheric Administration (NOAA) is to understand and predict changes in the Earth=s environment and to conserve and manage coastal and oceanic marine resources and habitats to help meet our Nation=s economic, social, and environmental needs. As a branch of NOAA, the National Marine Fisheries Service (NMFS) conducts or sponsors research and monitoring programs to improve the scientific basis for conservation and management decisions. NMFS strives to make information about the purpose, methods, and results of its scientific studies widely available. NMFS = Pacific Islands Fisheries Science Center (PIFSC) uses the NOAA Technical Memorandum NMFS series to achieve timely dissemination of scientific and technical information that is of high quality but inappropriate for publication in the formal peerreviewed literature. The contents are of broad scope, including technical workshop proceedings, large data compilations, status reports and reviews, lengthy scientific or statistical monographs, and more. NOAA Technical Memoranda published by the PIFSC, although informal, are subjected to extensive review and editing and reflect sound professional work. Accordingly, they may be referenced in the formal scientific and technical literature. A NOAA Technical Memorandum NMFS issued by the PIFSC may be cited using the following format

Pre-operative experiences and post-operative benefits of ptosis surgery: A qualitative study

© 2017 Taylor & Francis. This qualitative study sought to explore the experiences of patients who had undergone successful ptosis correction surgery. Participants were recruited from Bristol Eye Hospital. Nine participants were interviewed using a semi-structured interview schedule and open ended questions. Data were analysed using inductive thematic analysis. Four major themes were identified from patient accounts. Patients described the psychosocial and functional difficulties they experienced living with ptosis, and the subsequent benefits of surgery. Patients reported experiencing appearance related anxiety pre-operatively due to their condition and engaging in behaviours to avoid social encounters. Gender differences were noted in the internalization of perceived negative reactions from others, with men describing fewer adverse impacts. Patients described perceived barriers to seeking surgery including a lack of awareness of ptosis as a treatable condition, the perception that being concerned with their appearance could be seen as vain and the view that ptosis surgery is synonymous with cosmetic surgery. Following successful surgery patients outlined positive impacts on their vision, appearance and psychosocial well-being after successful surgery. This qualitative study highlights the complexities of the factors and processes contributing to the psychosocial impacts of ptosis and the potential benefits of surgery and/or psychosocial support. An increased awareness amongst people with ptosis of the potential positive impacts of surgery and an enhanced understanding of the reasons why patients may not seek treatment amongst health care professionals are likely to benefit this often overlooked patient group

Experiences of living with visible difference: Individual and social reflections

Many health conditions impact upon an individual’s appearance and result in an altered appearance (“visible difference”). The presence of visible difference is associated with a variety of psychosocial difficulties and challenges, yet calls for an integrated theory of adjustment remain largely unanswered. This qualitative research, conducted in the United Kingdom, drew upon 22 interviews conducted with participants who had a variety of visible differences. It examined their experiences and reflections related to their difference and the impact that their visible difference had upon their lives. A thematic analysis produced two themes. The first of which was predominantly concerned with the impact of visible difference upon the individual whilst the second captured the inherently social nature of appearance and appearance based judgements. The analysis is considered in light of the contention that an integrated theory of adjustment to visible difference is required and participants’ experiences with healthcare professionals and the implications for those providing care are introduced

Young people’s perceptions of visible difference

Visible facial differences (VFDs) can pose a number of psychosocial challenges for those affected by them. In particular, the experience of being stigmatised may have a harmful effect on the psychological adjustment of the individual concerned. This is especially pertinent for young people, who are at an age where appearance becomes increasingly central to social interaction and self-esteem. Suitable and effective interventions are needed to reduce stigma in general, but in the case of appearance-relateddiscrimination the prevalence and the processes involved are poorly understood. The aim of this research was therefore to explore young people’s perceptions of visible difference.A mixed-methods online questionnaire was administered to a cross-sectional sample of 412 pupils aged 12–14 years, recruited from three UK schools. Participants were asked to look at five photographs of people with VFDs and to indicate their level of agreement with 30 statements using a 5-point Likert scale. They were also asked to answer the open-ended question ‘What do you think when you see people with facial differences?’ Although quantitative responses were overwhelmingly neutral, inductive content analysis revealed a number of insights. Four main themes were identified: them and us, initial reactions, common assumptions and behavioural intentions. Participants reported a wide range of complex responses. Although negative reactions and judgements were described, these were often due to seeing something unusual, or to a lack of understanding, rather than to the intention to cause harm. Conflicting emotions led to uncertainty and lack of confidence about how best to behave around peoplewith VFDs. The findings suggest the need for a two tieredapproach to intervention: first, to raise awareness of VFDs and to facilitate the development of appropriate social skills within the general population, and secondly, to provide support to enable those with VFDs to cope with any negative reactions they may encounter

The relationship between intolerance of uncertainty and anxiety in autism: a systematic literature review and meta-analysis

The association between intolerance of uncertainty and anxiety has proved robust in neurotypical populations and has led to effective interventions targeting intolerance of uncertainty. The aim of this systematic review and meta-analysis was to investigate this association in autistic people, given the high prevalence of anxiety in this population and the limited effectiveness of therapies used currently to treat anxiety in autism. A protocol was published on the Prospero database (CRD42019125315), and electronic databases were searched using terms related to intolerance of uncertainty, anxiety and autism. Included in the systematic review were 12 studies, of which 10 were included in a meta-analysis. Results showed that anxiety and intolerance of uncertainty were consistently elevated in autistic participants. Examining the correlation between these two constructs, the meta-analysis revealed a large sample-weighted effect size, r = 0.62, 95% confidence interval = [0.52, 0.71], p < 0.001. The strength of this association was comparable to meta-analyses conducted on neurotypical populations, and therefore, it was concluded intolerance of uncertainty may be an appropriate target for intervention for autistic individuals. However, conclusions were limited due to the small number of relevant studies that were available and due to issues with methodological quality. Lay abstract People who find it especially hard to cope with the unexpected or unknown are said to have an intolerance of uncertainty. Autistic individuals often report a preference for certainty and experience levels of anxiety that can interfere with their daily life. Understanding more about the link between the intolerance of uncertainty and anxiety in autistic people might lead to better treatments for anxiety being developed. Therefore, this work aimed to review previous research in order to explore this link. Twelve studies were found and their results were compared and contrasted. The autistic people who participated in the studies completed questionnaires that suggested a large number of them experienced very high levels of anxiety and intolerance of uncertainty. Of 10 studies that used relevant statistics, nine found a statistically significant link between anxiety and the intolerance of uncertainty. In general, the strength of the link was about the same as previous research found in people who did not have a diagnosis of autism. This might mean that interventions that aim to help people who are intolerant of uncertainty could be effective for autistic individuals

Developing approaches to the collection and use of evidence of patient experience below the level of national surveys

National approaches to collecting patient feedback provide trust level information which although can provide a benchmark for trusts often doesn’t provide information about specific services or patients experiences of pathways of care. This more granular level of data could be more informative for local service development and improvement. This research explored the feasibility and usefulness of such approaches. A conceptual model and standard questionnaire of patient experience was developed that might work across a range of services and pathways of care. Seven trusts were recruited as collaborating sites in which the model and survey instrument was tested. These were from different geographical locations and settings. The impact of the pilot and survey results on the improvement and development of services was evaluated. The service- line approach to capturing patient feedback was generally more feasible and considered of value for service improvement. The collection of patients’ experiences across pathways of care was more challenging in terms of the development of the survey and interpretation of results. However, many sites identified specific actionable areas for improvement. This study has shown that it is possible to develop and apply a standardised survey in a range of services and provides evidence that a consistent unified approach to monitoring patient experiences is feasible. However several methodological problems are acknowledged such as the availability of resources and capacity for improvements to services and care. Evidence is now particularly needed to establish how best to produce positive impact from patient feedback

The use of “art” as a resource in recovery from the impact of sexual abuse in childhood: A qualitative systematic review

Background: A qualitative systematic review was undertaken to identify the therapeutic impact of arts-based activities as experienced by adults sexually abused in childhood. Methods: Sixteen studies, identified through a systematic search protocol, were included in a thematic synthesis. Quality of studies was assessed using the Critical Appraisal Skills Programme tool. Findings: Arts-based activities were identified as offering a safe space, in which to find a voice, to engage in self-exploration, and to communicate experience and connect with others where a new sense of self and empowerment could emerge. Conclusion: Creative activities can play a significant role in the unique paths to recovery that sexual abuse survivors develop. Limitations to the review derive from the small number of papers, methodological weaknesses of the studies and the variation in focus. More research is needed into impact of specific media, and barriers and enablers to using creative activities as a resource

How effective are psychosocial interventions at improving body image and reducing disordered eating in adult men? A systematic review

Disordered eating and body image concerns significantly impact a growing number of men. This systematic review assessed the evidence of the effectiveness of psychosocial interventions to improve body image and eating pathology in men. Searches were conducted in December 2022 in 13 databases (PsycINFO, MEDLINE, CINAHL Plus, AMED, PubMed, Scopus, Cochrane, EMBASE, ASSIA, British Nursing Index, Wiley and OpenGrey). Studies that quantitatively evaluated psychosocial interventions and reported pre-post body image or disordered eating outcomes in men aged 18 years and over were eligible. Articles including boys, uncontrolled designs, or not in English were excluded. Findings were narratively synthesised and presented according to intervention approach. Quality was assessed using EPHPP. Eight studies including six RCTs were reviewed. Five were assessed as being moderate quality and three as weak. Evidence from moderate quality studies suggested that dissonance-based interventions showed promising improvements in body image and disordered eating for up to six months post-intervention in men with and without body dissatisfaction. Evidence for media literacy and psychoeducational interventions was limited. Findings were limited by heterogeneity in outcome measures and homogeneity of participants preventing generalisability. Robust research with longer follow-ups is needed to confirm effectiveness. [Abstract copyright: Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.