Noise pollution in hospitals

This was a conference presentation I gave on my own at Acoustics 2019: Conference of the UK Institute of Acoustics. The paper, which will be published in conference proceedings, was based on an interdisciplinary project entitled HPNoSS, Hospital Project on Noise and Sleep in Hospitals. Although the presentation was entirely by me, the paper to be published was co-authored by Andreas Xyrichis and other members of the HPNoSS team (see separate item, BMJ article)

University Professors’ Perceptions About Patient Safety Teaching in an Interprofessional Education Experience: A Phenomenological Study

Background: Interprofessional education (IPE) and patient safety are recurrent and linked themes within the field of healthcare worldwide. International organizations have repeatedly called for and research has shown the benefits of health and social care professionals learning how to work collaboratively and efficiently to provide safer and better care. This study was undertaken to explore professors’ perceptions and experiences of an IPE curricula project with a view to improving future patient safety teaching in undergraduate health courses. Methods: This qualitative study utilized phenomenology as a theoretical framework. The participants were 11 professors from a public university in south-eastern Brazil, recruited through purposeful sampling. Data were collected through semi-structured interviews, which were transcribed and thematically analyzed. Findings: Four themes were identified: (a) sustaining IPE; (b) stakeholder involvement; (c) pedagogy; and (d) team learning. Enablers to patient safety teaching included the co-location of professors and sharing projects and lectures between them in consonance with the IPE project. Barriers included lack of knowledge of the patient safety national program, inadequate staffing, and significant academic workload. Conclusion: Professors revealed critical challenges to patient safety teaching within an IPE curriculum. They perceived patient safety to be an important topic for students but needed more support to integrate the topic into their routine as a formal activity. We call for patient safety policy to be more integrated within the educational system, with the active involvement of professors and other local stakeholders, and for its impact to be evaluated. Methods: This qualitative study utilized phenomenology as a theoretical framework. The participants were 11 professors from a public university in south-eastern Brazil, recruited through purposeful sampling. Data were collected through semi-structured interviews, which were transcribed and thematically analyzed. Findings: Four themes were identified: (a) sustaining IPE; (b) stakeholder involvement; (c) pedagogy; and (d) team learning. Enablers to patient safety teaching included the co-location of professors and sharing projects and lectures between them in consonance with the IPE project. Barriers included lack of knowledge of the patient safety national program, inadequate staffing, and significant academic workload. Conclusion: Professors revealed critical challenges to patient safety teaching within an IPE curriculum. They perceived patient safety to be an important topic for students but needed more support to integrate the topic into their routine as a formal activity. We call for patient safety policy to be more integrated within the educational system, with the active involvement of professors and other local stakeholders, and for its impact to be evaluated. Methods: This qualitative study utilized phenomenology as a theoretical framework. The participants were 11 professors from a public university in south-eastern Brazil, recruited through purposeful sampling. Data were collected through semi-structured interviews, which were transcribed and thematically analyzed. Findings: Four themes were identified: (a) Sustaining IPE; (b) Stakeholder involvement; (c) Pedagogy; and (d) Team learning. Enablers to patient safety teaching included the co-location of professors and sharing projects and lectures between them in consonance with the IPE project. Barriers included lack of knowledge of the patient safety national program, inadequate staffing, and significant academic workload. Conclusion: Professors revealed critical challenges to patient safety teaching within an IPE curriculum. They perceived patient safety to be an important topic for students but needed more support to integrate the topic into their routine as a formal activity. We call for patient safety policy to be more integrated within the educational system, with the active involvement of professors and other local stakeholders, and for its impact to be evaluated

Perspectives of Intensive Care patients and family members on competencies for Advanced Intensive Care nurses in Europe

BackgroundOne output from the International Nursing Advanced Competency-based Training for Intensive Care (INACTIC) collaboration is a set of core competencies for advanced practice Intensive Care Unit (ICU) nurses across Europe. Some European countries, such as the UK, have identified such competencies, however, these advanced practice roles are rarely practiced across the rest of Europe. The INACTIC competencies were developed with an expert panel of 184 ICU nurses from 20 countries. It is also important to examine what patients and relatives with experience of intensive care felt about these competencies. AimTo examine the views of recovered ICU patients and relatives regarding the INACTIC competencies.MethodsThree patient and relative focus groups were conducted in England (n=5), Scotland (n=4) and Greece (n=4) to discuss a lay version of the INACTIC competencies. Discussions were open ended, followed a topic guide, recorded and transcribed verbatim. Analysis followed a conventional thematic approach, with the findings discussed iteratively among the authors.ResultsThe feedback from across the focus groups resulted in three themes: 1) the importance of nurses being empowered to advocate for the patient; 2) the centrality of communication; and, 3) the impact of variability in ICU practices. There was a notable difference with the Greek focus group; because of restricted family visiting policies, relatives did not feel encouraged to participate in patient care.ConclusionsThe perspectives of patients and relatives largely aligned with the consensus of the INACTIC expert panel. Local differences in ICU experience highlight the changes that some ICUs would need to make for the INACTIC competencies to be embedded

Doing interprofessional research in the COVID-19 era : a discussion paper

The COVID-19 pandemic, and ensuing physical distancing measures, poses challenges for researchers in the field of interprofessional care. Pandemic management has highlighted the centrality of interprofessional working to effective healthcare delivery during crises. It is essential to find ways to maintain interprofessional research that has commenced, while also designing research to capture important learning from pandemic management and response. However, it also creates opportunities for new research projects and novel research designs. This discussion paper explores ways of adapting existing research methodologies and outlines potential avenues for new research. Specifically, considerations to bear in mind when designing interprofessional research during the pandemic include research ethics and integrity, research design, data collection methods, research opportunities, implications and limitations. Interprofessional research can continue to make a valuable contribution in informing global responses to COVID-19 and in planning for future global health crises. We call for, insofar as possible, for interprofessional research to continue to be developed during this time.PostprintPeer reviewe

Virtual visiting in intensive care during the COVID-19 pandemic: a qualitative descriptive study with ICU clinicians and non-ICU family team liaison members

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/Objective: To understand the experiences and perceived benefits of virtual visiting from the perspectives of intensive care unit (ICU)-experienced clinicians and non-ICU-experienced family liaison team members. Design: Qualitative descriptive study. Setting: Adult intensive care setting across 14 hospitals within the UK National Health Service. Participants: ICU-experienced clinicians and non-ICU-experienced family liaison team members deployed during the first wave of the COVID-19 pandemic. Methods: Semistructured telephone/video interviews were conducted with ICU clinicians. Analytical themes were developed inductively following a standard thematic approach, using ‘family-centred care’ and ‘sensemaking’ as sensitising concepts. Results: We completed 36 interviews, with 17 ICU-experienced clinicians and 19 non-ICU-experienced family liaison team members. In the context of inperson visiting restrictions, virtual visiting offered an alternative conduit to (1) restoring the family unit, (2) facilitating family involvement, and (3) enabling sensemaking for the family. Virtual visits with multiple family members concurrently and with those living in distant geographical locations restored a sense of family unit. Family involvement in rehabilitation, communication and orientation activities, as well as presence at the end of life, highlighted how virtual visiting could contribute to family-centred care. Virtual visits were emotionally challenging for many family members, but also cathartic in helping make sense of their own emotions and experience by visualising their relatives in the ICU. Being able to see and interact with loved ones and their immediate care providers afforded important cues to enable family sensemaking of the ICU experience. Conclusions: In this UK qualitative study of clinicians using virtual ICU visiting, in the absence of inperson visiting, virtual visiting was perceived positively as an alternative that promoted family-centred care through virtual presence. We anticipate the perceived benefits of virtual visiting may extend to non-pandemic conditions through improved equity and timeliness of family access to the ICU by offering an alternative option alongside inperson visiting.Peer reviewedFinal Published versio

Noise pollution in hospitals

Noise in hospitals is a common grievance among patients, families, and staff.1 In the US, “quietness of hospital environment” is among the lowest scoring items on patient surveys.2 In the UK, 40% of hospital patients are bothered by noise at night, a consistent finding of the NHS Inpatient Survey.1 Hospital noise is a steadily worsening problem, with levels regularly exceeding international recommendations.3 4 Noise levels over 100 dB have been measured in intensive care units,4 the equivalent of loud music through headphones and the point beyond which damage to hair cells in the ear can occur. This is an article published in the British Medical Journal (BMJ) based on an interdisciplinary project entitled HPNoSS, Hospital Project on Noise and Sleep in Hospitals

Communication and virtual visiting for families of patients in intensive care during the COVID-19 pandemic:A UK National Survey

© 2021 by the American Thoracic Society. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0.https://creativecommons.org/licenses/by-nc-nd/4.0/Rationale: Restriction or prohibition of family visiting intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic poses substantial barriers to communication and family- and patient-centered care. Objectives: To understand how communication among families, patients, and the ICU team was enabled during the pandemic. The secondary objectives were to understand strategies used to facilitate virtual visiting and associated benefits and barriers. Methods: A multicenter, cross-sectional, and self-administered electronic survey was sent (June 2020) to all 217 UK hospitals with at least one ICU. Results: The survey response rate was 54%; 117 of 217 hospitals (182 ICUs) responded. All hospitals imposed visiting restrictions, with visits not permitted under any circumstance in 16% of hospitals (28 ICUs); 63% (112 ICUs) of hospitals permitted family presence at the end of life. The responsibility for communicating with families shifted with decreased bedside nurse involvement. A dedicated ICU family-liaison team was established in 50% (106 ICUs) of hospitals. All but three hospitals instituted virtual visiting, although there was substantial heterogeneity in the videoconferencing platform used. Unconscious or sedated ICU patients were deemed ineligible for virtual visits in 23% of ICUs. Patients at the end of life were deemed ineligible for virtual visits in 7% of ICUs. Commonly reported benefits of virtual visiting were reducing patient psychological distress (78%), improving staff morale (68%), and reorientation of patients with delirium (47%). Common barriers to virtual visiting were related to insufficient staff time, rapid implementation of videoconferencing technology, and challenges associated with family members’ ability to use videoconferencing technology or access a device. Conclusions: Virtual visiting and dedicated communication teams were common COVID-19 pandemic innovations addressing the restrictions to family ICU visiting, and they resulted in valuable benefits in terms of patient recovery and staff morale. Enhancing access and developing a more consistent approach to family virtual ICU visits could improve the quality of care, both during and outside of pandemic conditions.Peer reviewedFinal Published versio

How is Integration Defined and Measured, and what Factors Drive Success in Brazil? An Integrative Review

Introduction: Integration in health and care can improve quality and outcomes, but it is challenged by expansion of medical knowledge, social pressures on patient needs, and demands to deliver critical information. In Latin American and in other lower and middle-income countries integrated care remains in development. This paper examined the available literature on integrated care to understand how Latin American countries identify and measure integration, and what factors influence success. Methods: This integrative literature review included systematic searches in Global Health, PubMed, SciELO and BVSPsi databases for articles on integrated care in Spanish, Portuguese, and English in the period from January of 1999 to December 2020. The articles were screened for selection and assessed independently by five reviewers that used the inclusion criteria of papers about integration in health care systems. The sample excluded articles that did not deal with the integration of health care, which addressed issues related to public health campaigns, programs to control endemics and epidemics, reports on the experience of implementing health services, health promotion guidelines, food safety, oral health, and books evaluation. Results: 24 articles were included: qualitative (75%), quantitative (12,5%), and mixed-method research (4%) published between 2000 and 2017. All studies were undertaken in Brazil, and two of them were also conducted in Latin American countries. In 15 articles there was an interchangeable use between concepts of integration of services and integrated care, while nine studies did not define integration. Barriers to integration included absence of shared understanding of knowledge among members of interprofessional teams, lack of clarity on professional roles, missing consensus on a definition and measurement of integrated care, power struggles between professionals, poor institutional support, insufficient team preparation and training and unequal valuation of professions by society. Conclusion: Several types of integration and factors contributing to the success of implementation of integrated care in various contexts in Brazil were identified. The concept of integration reflected the varied local and regional realities including different health settings and levels of health and care, suggesting a need for further clarifications on its objective and components especially in LMIC contexts