The Impact of Computing Device Design on Patient-Centered Communication: An Experimental Study

Prior research has studied the impact of use of a single computing device, such as a desktop or a tablet computer, on patient-provider communication. While some studies have considered how contextual features such as room layout and software interface design affect computer use and patient-provider interaction in the exam room, it is not known how the choice of computing device impacts patient-provider communication. We conducted a within-participant experimental study. Three physicians participated in nine simulated consultations, using a desktop computer, a tablet computer, and a tabletop computer. Consultations were video-recorded and the video data were analyzed using framework analysis. Findings reveal the choice of device impacts the extent to which the consultation is patient-centered. To better support patient-centered communication, a large adjustable horizontal screen can facilitate eye contact and patient engagement. Findings also highlight the need for design of future systems to consider the characteristics of both openness and privacy

Recruitment and retention of care workers: A rapid review

YesIntroduction: Challenges in the recruitment and retention of care workers is a long-standing issue [1]. However, these challenges have worsened during the Covid-19 pandemic. In October 2021, there was an average staff vacancy rate of 17% [2], and in November 2021, care homes feared they would lose around 8% of their care home staff as a direct result of the policy of vaccination being a condition of deployment in care homes [3]. This has profound impacts, not only on those in care homes and receiving care at home, but on the health service as a whole, with 33% of social care providers limiting or stopping admissions from hospital [2]. Therefore, this review was undertaken to identify learning about how to support recruitment and retention of care workers during the pandemic. Methods: To identify strategies that are currently being used to support recruitment and retention of care workers, a Google search was undertaken, combining termsthat referred to the setting or role (“social care”, “care worker”) and the topics of interest (recruitment, retention), and for some searches adding in terms that referred to the type of literature being sought (“case study”). Through this, we identified that research on recruitment and retention of care workers since the pandemic was already being published and so a search was also undertaken on Google Scholar for research published since 2020. This was supplemented by a review of websites recommended by an expert working in the area: Care England, National Care Forum, Care Forum, Care Choices, Care Workers Charity, National Association of Care & Support Workers, and Skills for Care. We also reviewed the websites of NHS Confederation, NHS Employers, and the Local Government Association. Inclusion criteria were reports that included recommendations and/or examples of strategies to recruit and retain the social care workforce. While we focused on reports published since the start of the pandemic, given that recruitment and retention of care workers is a long-standing challenge, we also included some significant reports that were published before then. A number of the documents included did not provide a publication date. While many of the reports identified discussed the problems that have led to the social care workforce crisis, we limit our discussion of these in this report, instead focusing on possible solutions. Findings: From the Google and Google Scholar searches, 190 records were screened and 22 potentially relevant documents were reviewed in detail for possible inclusion. Alongside this, seven potentially relevant documents from the websites listed above were reviewed in detail for possible inclusion. From this, 21 relevant documents were identified and included in this review. These included seven documents reporting case studies, one Government report, one report based on a survey of employers, four reports based on surveys of care workers, two reports based on interviews with stakeholders, one report based on interviews and focus groups with care workers, managers, and commissioners, and one based on interviews with care workers. It quickly became apparent that potential strategies for improving recruitment of care workers were closely interlinked with strategies for improving retention of care workers. Below we consider those strategies relevant to both, before moving on to consider specific recruitment strategies and strategies focused specifically on increasing retention

The ConStratO model of handover: a tool to support technology design and evaluation

Handovers are a specific kind of multidisciplinary team meeting. Shift handovers and transfers are both regular features of hospital work but there is currently great variation in how such handovers are conducted, presenting a challenging for those seeking to develop technology to support handover. This paper presents the ConStratO model of handover, which captures aspects of the context that influence how the handover is conducted, a range of different handover strategies relating to different aspects of the handover, and possible outcomes of handover. The model is based on detailed data collection in a range of clinical settings. We present the model as a tool for developing and evaluating technology support for handover

Beyond Dualism: The Challenge for Feminist Theory

Since the 1970s, most feminist philosophical work, in some form or another, has sought to expose, define and/or combat the “maleness” of philosophy. This thesis is written from the position that the “maleness” of philosophy is not inevitable, but a feature of our dualised discourse. From this perspective, dualism and male bias are deeply implicated in current structures of thought. And yet, from this perspective, philosophy and theory construction should not be rejected as antagonistic to feminist aims, but reinvented through unthinking dualism. This thesis explores the state of dualism within Western discourse in order to describe how feminists must approach the task of reinventing discourse. One aim of this thesis, then, is to examine to what extent feminist theory shares in the wider criticism of dualistic thinking: the critique of thinking in terms of domination. Thus this thesis sets up the problem of how to unthink dualism as being more complicated than many have thought, and as entailing the reinvention of both philosophy and feminist theory. Chapter One begins by distinguishing the position toward dualism taken in this thesis from other prominent feminist approaches based on politics of equality and difference. From there Chapter Two provides an initial description of my account of dualism, based predominantly on Plumwood’s (1993) critique of dualism, as well as of the problem of how to unthink dualism. Chapters Three, Four and Five then describe the problem of how to unthink dualism in greater depth through an examination of Plumwood’s three principles of dualism: hyper-separation, denied dependency and relational definition. These middle chapters explore how resistant this problem is to a solution by addressing feminist theories’ own reliance on dualistic thinking. Central to this is the problem of difference which has been a major concern of contemporary feminist theory. Finally, Chapter Six draws on this discussion to describe the shape of a satisfactory solution to the problem of how to unthink dualism, and of the road ahead for feminist theory.Thesis (MPhil) -- University of Adelaide, School of Humanities, 202

Safe use of symbols in handover documentation for medical teams

Concern has been reported about the safe use of medical abbreviations in documents such as handover sheets and medical notes, especially when information is being communicated between staff of different specialties (BBC 2008, Sheppard et al. 2008). This article describes a study to investigate whether the use of symbols in handover documentation that is shared within and between multidisciplinary teams (MDTs) has similar safety implications. We asked 19 healthcare professionals from a range of specialties to identify 45 different combinations of 38 individual symbols. The symbols and combinations of symbols were extracted from 102 handover sheets taken from 6 different healthcare contexts in 4 London hospitals. Three symbols proposed in Microsoft's Common User Interface guidelines for alert symbols were also included. Results reveal that while some symbols are well understood, many others are either ambiguous or unknown. These results have implications for the safe use of symbols in medical documents, including paper and electronic handover documents and Electronic Patient Records (EPRs), especially where teams comprise individuals from different professional backgrounds, i.e. MDTs. We offer initial suggestions for standardisation and further research

Diagnosis of major cancer resection specimens with virtual slides: Impact of a novel digital pathology workstation

Digital pathology promises a number of benefits in efficiency in surgical pathology, yet the longer time required to review a virtual slide than a glass slide currently represents a significant barrier to the routine use of digital pathology. We aimed to create a novel workstation that enables pathologists to view a case as quickly as on the conventional microscope. The Leeds Virtual Microscope (LVM) was evaluated using a mixed factorial experimental design. Twelve consultant pathologists took part, each viewing one long cancer case (12-25 slides) on the LVM and one on a conventional microscope. Total time taken and diagnostic confidence were similar for the microscope and LVM, as was the mean slide viewing time. On the LVM, participants spent a significantly greater proportion of the total task time viewing slides and revisited slides more often. The unique design of the LVM, enabling real-time rendering of virtual slides while providing users with a quick and intuitive way to navigate within and between slides, makes use of digital pathology in routine practice a realistic possibility. With further practice with the system, diagnostic efficiency on the LVM is likely to increase yet more

Variation in National Clinical Audit Data Capture:Is Using Routine Data the Answer?

National Clinical Audit (NCA) data are collected from all National Health Service providers in the UK, to measure the quality of care and stimulate quality improvement initatives. As part of a larger study we explored how NHS providers currently collect NCA data and the resources involved. Study results highlight a dependence on manual data entry and use of professional resources, which could be improved by exploring how routine clinical data could be captured more effectively

Offloading devices for the prevention of heel pressure ulcers: a realist evaluation

Background Heel pressure ulcers can cause pain, reduce mobility, lead to longer hospital stays and in severe cases can lead to sepsis, amputation, and death. Offloading boots are marketed as heel pressure ulcer prevention devices, working by removing pressure to the heel, yet there is little good quality evidence about their clinical effectiveness. Given that evidence is not guiding use of these devices, this study aims to explore, how, when, and why these devices are used in hospital settings. Objective To explore how offloading devices are used to prevent heel pressure ulcers, for whom and in what circumstances. Methods A realist evaluation was undertaken to explore the contexts, mechanisms, and outcomes that might influence how offloading devices are implemented and used in clinical practice for the prevention of heel pressure ulcers in hospitals. Eight Tissue Viability Nurse Specialists from across the UK (England, Wales, and Northern Ireland) were interviewed. Questions sought to elicit whether, and in what ways, initial theories about the use of heel pressure ulcers fitted with interviewee's experiences. Results Thirteen initial theories were refined into three programme theories about how offloading devices are used by nurses ‘proactively’ to prevent heel pressure ulcers, ‘reactively’ to treat and minimise deterioration of early-stage pressure ulcers, and patient factors that influence how these devices are used. Conclusions Offloading devices were used in clinical practice by all the interviewees. It was viewed that they were not suitable to be used by every patient, at every point in their inpatient journey, nor was it financially viable. However, the interviewees thought that identifying suitable ‘at risk’ patient groups that can maintain use of the devices could lead to proactive and cost-effective use of the devices. This understanding of the contexts and mechanisms that influence the effective use of offloading devices has implications for clinical practice and design of clinical trials of offloading devices. Tweetable abstract How, for whom, and in what circumstances do offloading devices work to prevent heel pressure ulcers? Tissue viability nurses' perspectives