Inductions buffer nurses’ job stress, health and organizational commitment

Nurses suffer disproportionate levels of stress and are at risk of sickness-absence and turnover intentions but there is a lack of research clarifying preventions. This study investigated the impact of inductions (job preparation courses) about mental health for nurses’ job stress, general health and organizational commitment. Data from 6,656 nurses were analyzed using structural equation modeling (SEM), showing that mental health inductions increase nurses’ job satisfaction, which reduces their occupational stress and improves their health. SEM showed that these occupational health benefits increase the nurses’ commitment to the organization. Job satisfaction (feeling valued, rewarded) also had a direct effect on nurses’ intentions to continue working for the organization. Mental health inductions are therefore beneficial beyond job performance: they increase occupational health in the nursing profession

A theory-based study of doctors' intentions to engage in professional behaviours

BACKGROUND The Theory of Planned Behaviour (TPB) has been proposed as an appropriate model for creating a theory-driven approach to teaching medical professionalism. However, there is a lack of empirical evidence into its efficacy. This study explores if the TPB can assess UK medical doctors’ professional behaviours and explores if there are differences in the TPB’s efficacy depending on doctors’ primary medical qualification (UK or outside). METHODS Three hundred fourteen doctors in England at 21 NHS Trusts completed a questionnaire about reflective practice, using the General Medical Council’s confidentiality guidance, and raising a patient safety concern. The majority of participants were male (52%), white (68%), consultants (62%), and UK medical graduates (UKGs) (71%). RESULTS The TPB variables of attitudes, subjective norms, and perceived behavioural control were predictive of intention to engage in raising concerns (R2 = 35%), reflection (R2 = 52%), and use of confidentiality guidance (R2 = 45%). Perceived behavioural control was the strongest predictor of intentions to raise a concern (β = 0.44), while attitude was the strongest predictor of intentions to engage in reflective practice (β = 0.61) and using confidentiality guidance (β = 0.38). The TBP constructs predicted intention for raising concerns and reflecting for both UKGs and non-UKGs (Fs ≥ 2.3; ps ≤ .023, βs ≥ 0.12). However, only perceived behaviour control was predictive of intentions to use guidance for both UKGs and non-UKGs (β = 0.24) while attitudes and norms were just predictive for UKGs (βs ≥ 0.26). CONCLUSIONS This study demonstrates the efficacy of the TPB for three professional behaviours. The implications for medical educators are to use the variables of the TPB (attitudes, subjective norms, and perceived behavioural control) in the education of professionalism, and for medical education researchers to further our understanding by employing the TPB in more empirical studies of non-clinical behaviours

Changing professional behaviours: mixed methods study utilising psychological theories to evaluate an educational programme for UK medical doctors

BACKGROUND: The Theory of Planned Behaviour (TPB) has been proposed as a useful framework to investigate professional behaviour, however, was not yet applied to the evaluation of an educational intervention. This study will address this gap by utilising the TPB to evaluate the effectiveness of an education programme delivered by the professional regulator for UK doctors in enhancing three professional behaviours: raising concerns, engaging in reflective practice, and use of regulator confidentiality guidance. METHODS: This is a comprehensive mixed methods study combining qualitative (interviews) and quantitative (quasi-experiment) data. Intervention participants were asked to complete a survey measuring the variables in the TPB (attitudes, subjective norms, perceived behavioural control, and intention) for the three professional behaviours before, immediately post, and 3-months later following the education programme. Ninety-four doctors completed the survey pre/post intervention and 38 at all three times. One hundred and eleven doctors from the same hospital trust who did not take part in the intervention completed the survey at two time points and formed the control group. Forty-two interviews were conducted with intervention participants. RESULTS: The quantitative study revealed that the educational intervention significantly improved attitudes (raising concerns, using confidentiality guidance), subjective norms (raising concerns, reflective practice, using confidentiality guidance), perceived control (raising concerns, using confidentiality guidance), and intentions (using confidentiality guidance) (Group and Time interaction; Fs ≥ 3.996, ps ≤ .047, ηp2 ≥ .020). Non-UK graduate doctors' subjective norms towards raising concerns and confidentiality guidance increased significantly after the intervention (Fs ≤ 6.602, ps ≥ .011, ηp2 = .032 F = 6.602, p = .011, ηp2 = .032), but not UK graduates (p > .05). Interviews revealed that doctors had positive views about professional behaviours but also mentioned numerous barriers to actually engage in more complex, context dependent behaviours. CONCLUSIONS: This study demonstrates that an educational intervention was successful in improving the TPB variables of three professional behaviours. It also revealed that teaching professionalism does not happen in isolation and, therefore, personal and contextual factors are crucial to consider. To change complex professional behaviours, barriers at all levels i.e., personal, organisational and system, should be addressed

A national longitudinal cohort study of factors contributing to UK medical students' mental ill-health symptoms

Background The mental health of current medical students is predictive of their mental health as future doctors. The prevalence of anxiety, depression and burnout is high among medical students, but less is known about the occurrence of other mental ill-health symptoms, such as eating or personality disorders, and factors contributing to mental ill-health. Aims (1) To explore the prevalence of various mental ill-health symptoms in medical students and (2) to investigate what medical school factors and students’ attitudes contribute to these mental ill-health symptoms. Methods Between November 2020 and May 2021, medical students from nine geographically spread medical schools in the UK participated by completing online questionnaires at two points in time, approximately 3 months apart. Results Of the 792 participants who filled in the questionnaire at baseline, over half experienced medium to high somatic symptoms (50.8%; 402) and drank alcohol at hazardous levels (62.4%; 494). Adjusted longitudinal data analysis of 407 students who completed the follow-up questionnaire demonstrated that less supportive educational climates that were more competitive and less centralised around the students, lower feelings of belongingness, greater stigma towards mental ill-health and lower intentions to seek help for mental ill-health, all contributed to students’ mental ill-health symptoms. Conclusions Medical students experience a high prevalence of various mental ill-health symptoms. This study suggests that medical school factors and students’ attitudes towards mental ill-health are significantly associated with students’ mental health

Opportunities and challenges in designing and evaluating complex multilevel, multi-stakeholder occupational health interventions in practice

Extant research suggests the effectiveness of Occupational Health Psychology (OHP) interventions depends on their design in the broader organizational context. While the field recognizes that pre- and posttest evaluation do not sufficiently capture the complex dynamics around OHP interventions, complex multi-level OHP interventions are still scarce in the literature. As established intervention implementation frameworks suggest, it remains difficult to address this complexity in practice. The present position paper re-evaluates lessons learned from two complex European OHP intervention projects, by applying the Integrated Process Evaluation Framework (IPEF) and related theories to bridge the gap between the theoretically recognized complexity and practical challenges. The re-evaluations emphasize that program-multilevel theories rooted in OHP-perspectives contribute to adequately hypothesizing around systemic factors and mechanisms relevant to OHP interventions. Concretely, middle range theories that outline how an intervention’s mechanisms work within a specific context to produce certain outcomes are crucial. Additionally, strategically and actively involving key stakeholders at all levels of the system and across the different intervention phases improves the embedding of OHP interventions in organizations. We elaborate on these insights with seven concrete recommendations for complex OHP intervention research

Caring for Those Who Take Care of Others: Developing Systemic and Sustainable Mental Health Support for the Diverse Healthcare Workforce in the United Kingdom

Pressures such as high workload, stretched resources, and financial stress are resulting in healthcare workers experiencing high rates of mental health conditions, high suicide rates, high rates of staff absences from work, and high vacancy rates for certain healthcare professions. All of these factors point to the fact that a systematic and sustainable approach to mental health support at different levels and in different ways is more important than ever. In response, we present a holistic analysis of the mental health and wellbeing needs of healthcare workers across the United Kingdom healthcare ecosystem. We recommend that healthcare organisations should consider the specific circumstances of these staff and develop strategies to counter the negative impact of these factors and help safeguard the mental health of their staff

Uncovering trends in training progression for a national cohort of psychiatry trainees: discrete-time survival analysis

BACKGROUND: The global rise in mental health issues calls for a strong psychiatry workforce. Yet, psychiatry training worldwide is facing recruitment challenges, causing unfilled consultant posts and possibly threatening the quality of patient care. An in-depth understanding of trainees' progression through training is warranted to explore what happens to recruited trainees during training. AIMS: To uncover current trends in psychiatry trainees' progression through training in the UK. METHOD: This national retrospective cohort study with data from the UK Medical Education Database used discrete-time survival analysis to analyse training progression for those trainees who started their core psychiatry post in 2012-2017 (2820 trainees; 59.6% female, 67.6% UK graduates (UKGs)). The impact of sociodemographic characteristics on training progression were also investigated. RESULTS: The overall probability of completing training in 6 years (minimum years required to complete psychiatry training in the UK) was 17.2% (ranging from 4.8% for non-UKG females to 29% for UKG males). The probability to not progress was highest (57.1%) from core to specialty training. For UKGs, trainees from ethnicities other than White, trainees with a disability, and trainees who had experienced childhood social deprivation (measured as entitlement to free school meals) had a significantly (P ≤ 0.02) lower probability of completing training in 6 years. CONCLUSIONS: Less than one in five psychiatry trainees are likely to complete training in 6 years and this probability varies across groups of doctors. Completing psychiatry training in 6 years is, therefore, the exception rather than the norm and this has important implications for trainees, those planning psychiatry workforces or responsible for psychiatry training