The use of emergency lights and sirens by ambulances and their effect on patient outcome and public safety

Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.The use of emergency lights and sirens as warning devices by ambulances is a hotly debated topic within the Emergency Medical Services. For the last few decades, research has shown that lights and sirens have only a minimal effect on time required to transport patients to the hospital, and essentially no positive effect on patient outcome. Meanwhile, thousands of ambulance crashes occur every year (usually during the operation of lights and sirens), and its possible that's tens of thousands of crashes are occurring as a result of a passing ambulance, though not directly involving the ambulance itself. This paper is meant to provide a thorough review of the science behind the use of lights and sirens, the risks they pose to EMS providers, patients, and the public, and strategies to help curb the cost they pose both in dollars and lives. The available literature on this subject all points to the use of lights and sirens being out dated, ineffective, and dangerous, and yet almost nothing has been done to solve the problems they cause. Continued research and development is needed to help make ambulances safer for their occupants, more effective driver training programs need to be offered to EMS providers, and protocols need to be adopted to limit the unnecessary use of L&S.2031-01-0

New indeterminate music: The influence of the Cagean trajectory in the importance of being earmarked

This paper explores the influence of John Cage (1912-1992) on contemporary experimental music focusing on the indeterminate work The Importance of Being Earmarked (2008). Firstly through an investigation of selected works from Cage (written between the 1930s- 1960\u27s) and the concepts that form a Cagean trajectory, and secondly by showing how a contemporary composer has adopted this trajectory in the composition of a new work that combines sound-installation, theatre, and Max/MSP programming

Implicit Dependency Regulation: Self-Esteem, Relationship Closeness, and Implicit Evaluations of Close Others

We argue that people possess implicit evaluations of close others and that dependency regulation processes moderate these implicit evaluations. Study 1 revealed that implicit evaluations of romantic partners for people with high explicit self-esteem were not contingent on how things were currently going in their relationships. In contrast, the implicit evaluations of romantic partners for people with low explicit self-esteem were contingent on how things were currently going in their relationships. That is, people with low self-esteem liked their partners’ name letters only if the relationship was currently going well. Study 2 revealed a conceptually similar pattern of results for implicit evaluations of people’s best friends. We suggest that these findings reflect an unconscious form of dependency regulation

Perceptions of risk and safety in the ICU: a qualitative study of cognitive processes relating to staffing

Objectives: The aims of this study were to 1) examine individual professionals’ perceptions of staffing risks and safe staffing in intensive care and 2) identify and examine the cognitive processes that underlie these perceptions. Design: Qualitative case study methodology with nurses, doctors, and physiotherapists. Setting: Three mixed medical and surgical adult ICUs, each on a separate hospital site within a 1,200-bed academic, tertiary London hospital group. Subjects: Forty-four ICU team members of diverse professional backgrounds and seniority. Interventions: None. Main Results: Four themes (individual, team, unit, and organizational) were identified. Individual care provision was influenced by the pragmatist versus perfectionist stance of individuals and team dynamics by the concept of an “A” team and interdisciplinary tensions. Perceptions of safety hinged around the importance of achieving a “dynamic balance” influenced by the burden of prevailing circumstances and the clinical status of patients. Organizationally, professionals’ risk perceptions affected their willingness to take personal responsibility for interactions beyond the unit. Conclusions: This study drew on cognitive research, specifically theories of cognitive dissonance, psychological safety, and situational awareness to explain how professionals’ cognitive processes impacted on ICU behaviors. Our results may have implications for relationships, management, and leadership in ICU. First, patient care delivery may be affected by professionals’ perfectionist or pragmatic approach. Perfectionists’ team role may be compromised and they may experience cognitive dissonance and subsequent isolation/stress. Second, psychological safety in a team may be improved within the confines of a perceived “A” team but diminished by interdisciplinary tensions. Third, counter intuitively, higher “situational” awareness for some individuals increased their stress and anxiety. Finally, our results suggest that professionals have varying concepts of where their personal responsibility to minimize risk begins and ends, which we have termed “risk horizons” and that these horizons may affect their behavior both within and beyond the unit

A Qualitative, Grounded Theory Exploration of Patients’ Experience of Early Mobilisation, Rehabilitation and Recovery after Critical Illness.

Rationale: Physical rehabilitation (encompassing early mobilisation) of the critically ill patient is recognized best practice, however further work is needed to explore the patients’ experience of rehabilitation qualitatively; a better understanding may facilitate implementation of early rehabilitation, and elucidate the journey of survivorship. Objectives: To explore patient experience of physical rehabilitation from critical illness during and after a stay on ICU. Design: Exploratory grounded theory study using semi-structured interviews. Setting: Adult medical/surgical ICU of a London teaching hospital. Participants: A purposive sample of ICU survivors with intensive care unit acquired weakness (ICUAW) and an ICU length of stay of >72 hours. Analysis: Data analysis followed a four-stage constant comparison technique: open coding, axial coding, selective coding, and model development, with the aim of reaching thematic saturation. Peer debriefing and triangulation through a patient support group were carried out to ensure credibility. Main results: Fifteen people were interviewed (with four relatives in attendance). The early rehabilitation period was characterized by episodic memory loss, hallucinations, weakness, and fatigue, making early rehabilitation ardous and difficult to recall. Participants craved a paternalised approach to care in the early days of ICU. The central idea that emerged from this study was recalibration of the self. This is driven by a lost sense of self, with loss of autonomy and competence; dehumanized elements of care may contribute to this. Participants described a fractured life narrative due to episodic memory loss, meaning that patients were shocked on awakening from sedation by the discrepancy between their physical form and cognitive representation of themselves. Conclusions: Recovery from ICUAW is a complex process that often begins with survivors exploring and adapting to a new body, followed by a period of recovering autonomy. Rehabilitation plays a key role in this recalibration period, helping survivors to reconstruct a desirable future

Distribution of the genus Alexandrium (Halim) and paralytic shellfish toxins along the coastline of New South Wales, Australia

Blooms of Alexandrium species, in particular the species Alexandrium catenella, accounted for more than 50% of algal related, shellfish aquaculture harvest zone closures in New South Wales (NSW) Australia since 2005. While there are indications that species of Alexandrium are more abundant than they were formerly, there is little data available on the spatial and temporal distribution and abundance of the genus in NSW. A six and a half year dataset comprising a total of 8649 fortnightly samples from 31 estuaries spread over 2000. km of NSW coastline was analysed. The greatest abundances of Alexandrium spp. were observed during the austral Spring and Summer, in estuaries in the mid and southern latitudes of the state. In identifying these high risk zones, we propose variables such as season, temperature, rainfall and estuarine flushing to be targeted in intensive site specific studies, to support the development of predictive tools for resource managers. © 2013 Elsevier Ltd

Exploring the working environment of Hospital Managers: a mixed methods study investigating stress, stereotypes, psychological safety and individual resilience

Background: Hospital managers are responsible for the delivery of organisational strategy, development of clinical services and maintaining quality standards. There is limited research on hospital managers, in particular how stress manifests and impacts managers and the presence of individual resilience. Managers must work closely with clinical colleagues, however these relationships can be hindered by the perception of stereotyping and differing priorities. This study aimed to explore the working environment of hospital managers, focusing upon the unique stresses faced, psychological safety and the presence of resilience. Methods: This study utilised mixed methodology using an embedded approach. Participants were purposively recruited from all levels of hospital management within one National Health Service Trust in London, United Kingdom. An exploration of managers experiences was undertaken using semi-structured qualitative interviews. Psychological safety and individual resilience were additionally assessed using validated surveys. Qualitative data were analysed iteratively using inductive thematic analysis, and triangulated with quantitative data. Kruskal-Wallis statistical analysis was performed to evaluate differences in resilience and psychological safety according to seniority and background experience. Results: Twenty-two managers were recruited and interviewed, with 20 returning completed surveys. Key findings from the thematic analysis included the importance of good working relationships with clinical colleagues, the persistence of some stereotyping, and feeling unsupported in times of challenge. Stresses described included the bureaucracy involved when delivering change, conflict with colleagues and target driven expectations. Participants described their own psychological safety as lower than desired, supported by quantitative data; but recognised its importance and strived to create it within their own teams. Sixteen participants had ‘normal’ scores for resilience, with senior managers more likely to have higher scores than those more junior (p=0.011). Conclusion: Positive working relationships, high psychological safety and individual resilience are important for organisational safety and individual wellbeing. Our data illustrate unique stressors faced by hospital managers, provide detail on sometimes challenging working relationships, and demonstrate scope to improve both the psychological safety and resilience of those in managerial positions. A map for senior healthcare leaders was constructed, facilitating the identification of modifiable areas within their organisation to promote good working relationships and improve the working environment of hospital managers

The influence of personality on psychological safety, the presence of stress and chosen professional roles in the healthcare environment

Healthcare teams are expected to deliver high quality and safe clinical care, a goal facilitated by an environment of psychological safety. We hypothesised that an individual’s personality would influence psychological safety, perceived stressors in the clinical environment and confer a suitability for different professional roles. Staff members were recruited from the Emergency or Critical Care Departments of one National Health Service Trust. Qualitative interviews explored participants’ experiences of personality, incorporating quantitative surveys to evaluate psychological safety and perceived stressors. The 16 Primary Factor Assessment provided a quantitative measure of personality. Participants demonstrated midrange scores for most personality traits, highlighting an ability to adapt to changing environments and requirements. There was a signal that different personality traits predominated between the two professional groups, and that certain traits were significantly associated with higher psychological safety and certain perceived stressors. Personality was described as having a strong influence on teamwork, the working environment and leadership ability. Our analysis highlights that personality can influence team dynamics and the suitability of individuals for certain clinical roles. Understanding the heterogeneity of personalities of team members and their likely responses to challenge may help leaders to support staff in times of challenge and improve team cohesiveness

The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis

Introduction: Psychological safety is the shared belief that the team is safe for interpersonal risk taking. Its presence improves innovation and error prevention. This evidence synthesis had 3 objectives: explore the current literature regarding psychological safety, identify methods used in its assessment and investigate for evidence of consequences of a psychologically safe environment. Methods: We searched multiple trial registries through December 2018. All studies addressing psychological safety within healthcare workers were included and reviewed for methodological limitations. A thematic analysis approach explored the presence of psychological safety. Content analysis was utilised to evaluate potential consequences. Results: We included 62 papers from 19 countries. The thematic analysis demonstrated high and low levels of psychological safety both at the individual level in study participants and across the studies themselves. There was heterogeneity in responses across all studies, limiting generalisable conclusions about the overall presence of psychological safety. A wide range of methods were used. Twenty-five used qualitative methodology, predominantly semi-structured interviews. Thirty quantitative or mixed method studies used surveys. Ten studies inferred that low psychological safety negatively impacted patient safety. Nine demonstrated a significant relationship between psychological safety and team outcomes. The thematic analysis allowed the development of concepts beyond the content of the original studies. This analytical process provided a wealth of information regarding facilitators and barriers to psychological safety and the development of a model demonstrating the influence of situational context. Discussion: This evidence synthesis highlights that whilst there is a positive and demonstrable presence of psychological safety within healthcare workers worldwide, there is room for improvement. The variability in methods used demonstrates scope to harmonise this. We draw attention to potential consequences of both high and low psychological safety. We provide novel information about the influence of situational context on an individual’s psychological safety and offer more detail about the facilitators and barriers to psychological safety than seen in previous reviews. There is a risk of participation bias - centres involved in safety research may be more aligned to these ideals. The data in this synthesis are useful for institutions looking to improve psychological safety by providing a framework from which modifiable factors can be identified

Learning about our Disciplinary Reading through Interdisciplinary Conversations

This reflective essay explores some of what we have learned by participating in an interdisciplinary Scholarship of Teaching and Learning project about disciplinary reading. In dialogic form, we reflect on why we chose to get involved in this project, how this project has changed our understanding of reading in and across the disciplines, and how it affects our teaching practices going forward. We hope this form will reflect our excitement in these interdisciplinary conversations and will encourage readers to seek opportunities for their own interdisciplinary dialogues about reading. In our conclusion we offer a few framing suggestions for those who wish to set up more conversations about reading &nbsp