Hannah Family

The influence of organisational climate on care of patients with schizophrenia: a qualitative analysis of health care professionals’ views

Background Organizational climate relates to how employees perceive and describe the characteristics of their employing organization. It has been found to have an impact on healthcare professionals’ and patients’ experiences of healthcare (e.g. job satisfaction, patient satisfaction), as well as organizational outcomes (e.g. employee productivity). This research used organizational theory to explore dynamics between health care professionals (pharmacists, doctors and nurses) in mental health outpatients’ services for patients taking clozapine, and the perceived influence on patient care. Setting Seven clozapine clinics (from one NHS mental health Trust in the UK) which provided care for people with treatment resistant schizophrenia. Methods This study used qualitative methods to identify organizational climate factors such as deep structures, micro-climates and climates of conflict that might inhibit change and affect patient care. Using Interpretative Phenomenological Analysis, semistructured interviews were conducted with 10 healthcare professionals working in the clinics to explore their experiences of working in these clinics and the NHS mental health Trust the clinics were part of. Main outcome measure Health Care Professionals’ perceptions of the care of patients with treatment resistant schizophrenia. Results Three superordinate themes emerged from the data: philosophy of care, need for change and role ambiguity. Participants found it difficult to articulate what a philosophy of care was and in spite of expressing the need for change in the way the clinics were run, could not see how ‘changing things would work’. There was considerable role ambiguity with some ‘blurring of the boundaries between roles’. Factors associated with organizational climate (role conflict; job satisfaction) were inhibiting team working and preventing staff from identifying the patients’ health requirements and care delivery through innovation in skill mix. There were mixed attitudes towards the pharmacist’s inclusion as a team member. Conclusions Our findings suggest deficiencies within the clinics that may be manifestations of the wider culture of the NHS. The implications for mental health outpatient clinics are that local initiatives are crucial to the implementation of recovery models; clear guidance should be provided on the skill mix required in clozapine clinics and interprofessional learning should be encouraged to reduce role conflict.

Factors Associated with Sexual Risks and Risk of STIs, HIV and Other Blood-Borne Viruses Among Women Using Heroin and Other Drugs: A Systematic Literature Review

This systematic literature review identified factors associated with sexual risks related to sexually transmitted infections (STI), HIV and other blood-borne viruses (BBV) among women using heroin and other drugs. The search strategy included five databases (PubMed, EMBASE, PsycNET, Web of Science, Scopus), and PsycEXTRA for grey literature. Out of the 12,135 publications screened, 30 peer-reviewed articles were included. Most publications were cross-sectional (n = 25), quantitative (n = 23) and included 11,305 women. Factors identified were: (1) socio-demographics; (2) gender roles and violence against women; (3) substance use; (4) transactional sex; (5) partner characteristics, partner’s drug use, and context of sex; (6) preferences, negotiation and availability of condoms; (7) HIV status and STIs; (8) number of sexual partners; (9) love and trust; (10) reproductive health and motherhood; and (11) risk awareness and perception of control. Overall, this review highlights important implications for future research and practice, and provides evidence for developing STI/BBV preventive strategies.ResumenEsta revisión sistemática identifica factores asociados con el riesgo de enfermedades de transmisión sexual, VIH y otros virus de transmisión sanguínea, en mujeres que consumen heroína y otras drogas. La búsqueda bibliográfica se realizó en cinco bases de datos (PubMed, EMBASE, PsycNET, Web of Science, Scopus), y en PsycEXTRA para literatura gris. De las 12,135 publicaciones revisadas, 30 artículos publicados en revistas científicas se incluyeron en esta revisión sistemática. La mayoría de publicaciones son transversales (n=25), cuantitativas (n=23), e incluyen 11,305 mujeres. Los factores identificados son: 1) características sociodemográficas; 2) roles de género y violencia de género; 3) uso de sustancias; 4) trabajo sexual; 5) características y consumo de sustancias de la pareja sexual, y contexto de las relaciones sexuales; 6) preferencias, negociación y disponibilidad de preservativos; 7) estatus de VIH y otras enfermedades de transmisión sexual; 8) número de parejas sexuales; 9) amor y confianza; 10) salud reproductiva y maternidad; y 11) concienciación del riesgo y percepción de control. Esta revisión sistemática presenta importantes implicaciones para la investigación y prácticas preventivas. Además, reúne evidencia para el desarrollo de campañas para la prevención de enfermedades de transmisión sexual, VIH y otros virus de transmisión sanguínea.

Psychosocial determinants of sexual practices among women using heroin and other drugs: a systematic literature review

Introduction Women using heroin and other drugs (WHOD) are at high risk of sexually transmitted infections (STIs) and blood-borne viruses (BBVs). However, little attention has been paid to identify the psychosocial determinants of sexual practices among these women. An overview of these determinants could be key for health professionals and policy makers, to tackle STIs and BBVs and promote health among WHOD. The main aims of this study were to review the literature on the psychosocial determinants of sexual practices among WHOD, and to determine the nature and quality of the evidence. Methods The search strategy included five databases: PubMed, EMBASE, PsycNET, Web of Science and Scopus. PsycEXTRA was used for grey literature and other publications. Search terms included ‘women*, ‘heroin use*’, ‘sexual behaviour*’, and ‘HIV’. Only publications in English, and published between 1995 and June 2016 were included. The PRISMA 2009 guidelines and the Hawken method were used for quality assessment purposes. This systematic review was registered with PROSPERO (Ref. CRD42016039842). Results Out of the 11 985 publications screened, 30 peer-reviewed articles were included. Most publications were cross-sectional (n=27) quantitative studies (n=23), amounting 10 808 women. Psychosocial determinants identified included socio-demographic characteristics, sexual orientation, financial constraints, gender roles, gender-based violence, HIV status, feelings of love and trust, and unavailability of condoms. Conclusion This systematic review provides an insight into the psychosocial determinants of sexual risk practices of WHOD, and highlights the importance of conducting women-only studies. It also identifies research gaps, such as the need to focus on protective factors, relationship dynamics, sexual risks with non-paying partners, and the study of the broader sociocultural context of sex and sexuality. Overall, these findings could be crucial for the development of preventive strategies to tackle STIs and BBVs, and promote the sexual health and psychosocial wellbeing of WHOD.

Interpersonal relationships in adolescent chronic pain: A qualitative synthesis

Numerous qualitative studies suggest that adolescents with chronic pain experience disruptions to their interpersonal relationships. A synthesis of this research has not yet been conducted. Using a qualitative metasynthesis approach, we collated, interpreted and (re)presented what is known about how adolescents with chronic pain and their significant others describe their interpersonal relationships. A systematic search strategy was developed to identify and retrieve all primary studies focused on exploring social relationships of adolescents with chronic pain and their significant others using qualitative methodology published by December 31, 2016. Searches identified 1,309 articles, with 8 articles meeting inclusion criteria. Included articles were reviewed for quality and thematic content. Overall, these articles included 127 participants, comprising adolescents with pain, parents, siblings, and peers. Data was characterized by two themes: restriction and tensions. Findings highlighted the complex and typically deleterious impact of chronic pain on relationships held by adolescents with chronic pain and significant others (e.g., parents). Data illustrated tensions between adolescents’ and others’ perceptions of pain on everyday life in addition to a sense of pain restricting adolescent and parental relationships through processes of isolation and difference. Findings also identified the strengthening of relationships due to challenges associated with living with adolescent chronic pain. Study results highlight the importance of assessing the impact of pain on interpersonal relationships. Second, findings illustrate the need to develop and test treatment approaches to enable adolescents and their family members to maintain and strengthen positive interpersonal relationships and to develop more adaptive social functioning.

A diary study of community pharmacists' mental workload

BackgroundMental Workload (MWL) is a widely studied concept within the human factors and patient safety fields. MWL is measured to identify how busy employees are, the complexity of tasks being carried out and whether additional tasks can be added to their current workload without reducing task performance or safety. [1] To date, the MWL of community pharmacists (CPs) practising in the United Kingdom (UK) has not been measured. This study aimed to measure CPs’ MWL throughout a day in their usual practice. MethodFollowing receipt of university ethics approval a convenience sample of 104 CPs who had participated in an earlier study were invited to participate. The 104 CPs were strategically recruited through superintendent pharmacists and social media to be demographically representative of UK CPs. Fifty CPs expressed interest in this follow-up study and were posted a diary containing questions on demographics, the enhanced and locally commissioned services offered and seven copies of the NASA Task Load Index (TLX).[2] The NASA-TLX is a self-report measure of MWL that measures six facets of MWL (time pressure, mental effort, mental demand, physical demand, task frustration and performance concern), each rated on an 11 point scale (0-10). The mean of the scores on the six items provides an overall MWL score. Participants were asked to complete between two and seven MWL ratings over one day and received a £5 highstreet voucher for their participation. MWL ratings were plotted against time of day. Bivariate correlations were produced between overall MWL and the demographic characteristics of participants. Potentially significant relationships were explored further with an independent t-test. ResultsForty CPs (19 men) returned their diaries (response rate of 38%) and a total of 186 MWL ratings were made across the diaries, providing sufficient power to carry out the planned analyses. MWL ratings were plotted against time of day. Peaks in overall MWL were seen at 11 o’clock in the morning and five o’clock in the afternoon. Time pressure, mental and physical demand were the highest rated facets of MWL. Bivariate correlations revealed no relationship between participant sex, age, pharmacy experience, or the type of community pharmacy CPs worked in and overall MWL. However, the correlations indicated a relationship between overall MWL and whether the CP worked full time (> 35 hours a week) or part-time (48 ratings were from part-time CPs). An independent t-test showed that part-time CPs reported significantly lower overall MWL (mean = 4.39) compared to full-time CPs (mean = 5.14) (t (184) =2.29, p < .05, r= .17).Discussion and ConclusionsThese results suggest that MWL peaks for many CPs at specific times of the day and that part-time CPs experience significantly less MWL compared to their full-time colleagues. However, the effect size of this difference was small. The diary ratings also suggest that time pressure, mental and physical demands are the primary sources of MWL that CPs experience. This initial study highlights the impact working patterns have on MWL and has implications for the times of day that safety critical tasks are carried out by CPs. References 1. Wickens CD, Hollands JG, Banbury S, Parasuraman R. Mental workload, stress, and individual differences: cognitive and neuroergonomic perspectives. Engineering psychology and human performance (international edition). 4th ed. Upper Saddle River (NJ): Pearson; 2013. p. 346-76. 2. Hart SG, Staveland LE. Development of the NASA-TLX (Task Load Index); results of empirical and theoretical research. In: Hancock PA, Meskkati N, editors. Human Mental Workload. Amsterdam, Netherlands: North-Esland; 1988.BackgroundSelf-care support by healthcare professionals (HCPs) is a distinct holistic, patient-centred approach to managing LTCs.1 People with LTCs are regular users of community pharmacies, and dispensing and other services provide opportunities for self-care support. This study aimed to explore the views of people with LTCs on self-care and how they utilise community pharmacy for support.MethodsSemi-structured, face-to-face interviews were conducted with people with LTCs between May 2013 and June 2014. Participants were approached via a convenient sample of one General Practice and four community pharmacies in Northwest England, and four pharmacists in two Health Boards in Scotland. Forty-four participants in England and twenty-three in Scotland were identified purposively; fifteen in England and nine in Scotland were recruited and interviewed to achieve maximal variation2 of LTC type and demographics. Interview topics were developed from the literature and used as a framework for the analysis. Topics covered living with LTCs and undertaking self-care, sources of self-care support, and use of community pharmacy. All interviews were audio-taped, transcribed verbatim and analysed thematically. Interviews and data analysis were undertaken simultaneously until data saturation was reached. NHS Research Ethics and RD the few who had experience of these services did not view them as a resource to improve their self-care behaviours. While some participants recognized the support that community pharmacy provided to them such as with minor ailments and some public health services (e.g. stop smoking), most appeared reluctant to acknowledge community pharmacy?s role in supporting their LTCs needs, including self-care.ConclusionsWhile study participants with LTCs engaged in self-care supported by their family, friends and some HCPs, they did not view community pharmacy as playing much of a role in the management and self-care support of their LTCs. The perspectives and needs of people with LTCs need to be better understood, so that community pharmacy services can be designed so as to contribute to their self-care needs.References1. Kennedy, A., A. Rogers, and P. Bower, Support for self care for patients with chronic disease. BMJ, 2007. 335(7627): p. 968-70.2. Creswell, J.W., Qualitative inquiry & research design: choosing among five approaches. 2006, Thousand Oaks, California: SAGE Publications, Inc.

Illness and medication beliefs among elderly Kuwaiti patients with type 2 diabetes in primary health care setting in Kuwait:a qualitative study

BackgroundMental Workload (MWL) is a widely studied concept within the human factors and patient safety fields. MWL is measured to identify how busy employees are, the complexity of tasks being carried out and whether additional tasks can be added to their current workload without reducing task performance or safety. [1] To date, the MWL of community pharmacists (CPs) practising in the United Kingdom (UK) has not been measured. This study aimed to measure CPs’ MWL throughout a day in their usual practice. MethodFollowing receipt of university ethics approval a convenience sample of 104 CPs who had participated in an earlier study were invited to participate. The 104 CPs were strategically recruited through superintendent pharmacists and social media to be demographically representative of UK CPs. Fifty CPs expressed interest in this follow-up study and were posted a diary containing questions on demographics, the enhanced and locally commissioned services offered and seven copies of the NASA Task Load Index (TLX).[2] The NASA-TLX is a self-report measure of MWL that measures six facets of MWL (time pressure, mental effort, mental demand, physical demand, task frustration and performance concern), each rated on an 11 point scale (0-10). The mean of the scores on the six items provides an overall MWL score. Participants were asked to complete between two and seven MWL ratings over one day and received a £5 highstreet voucher for their participation. MWL ratings were plotted against time of day. Bivariate correlations were produced between overall MWL and the demographic characteristics of participants. Potentially significant relationships were explored further with an independent t-test. ResultsForty CPs (19 men) returned their diaries (response rate of 38%) and a total of 186 MWL ratings were made across the diaries, providing sufficient power to carry out the planned analyses. MWL ratings were plotted against time of day. Peaks in overall MWL were seen at 11 o’clock in the morning and five o’clock in the afternoon. Time pressure, mental and physical demand were the highest rated facets of MWL. Bivariate correlations revealed no relationship between participant sex, age, pharmacy experience, or the type of community pharmacy CPs worked in and overall MWL. However, the correlations indicated a relationship between overall MWL and whether the CP worked full time (> 35 hours a week) or part-time (48 ratings were from part-time CPs). An independent t-test showed that part-time CPs reported significantly lower overall MWL (mean = 4.39) compared to full-time CPs (mean = 5.14) (t (184) =2.29, p < .05, r= .17).Discussion and ConclusionsThese results suggest that MWL peaks for many CPs at specific times of the day and that part-time CPs experience significantly less MWL compared to their full-time colleagues. However, the effect size of this difference was small. The diary ratings also suggest that time pressure, mental and physical demands are the primary sources of MWL that CPs experience. This initial study highlights the impact working patterns have on MWL and has implications for the times of day that safety critical tasks are carried out by CPs. References 1. Wickens CD, Hollands JG, Banbury S, Parasuraman R. Mental workload, stress, and individual differences: cognitive and neuroergonomic perspectives. Engineering psychology and human performance (international edition). 4th ed. Upper Saddle River (NJ): Pearson; 2013. p. 346-76. 2. Hart SG, Staveland LE. Development of the NASA-TLX (Task Load Index); results of empirical and theoretical research. In: Hancock PA, Meskkati N, editors. Human Mental Workload. Amsterdam, Netherlands: North-Esland; 1988.BackgroundSelf-care support by healthcare professionals (HCPs) is a distinct holistic, patient-centred approach to managing LTCs.1 People with LTCs are regular users of community pharmacies, and dispensing and other services provide opportunities for self-care support. This study aimed to explore the views of people with LTCs on self-care and how they utilise community pharmacy for support.MethodsSemi-structured, face-to-face interviews were conducted with people with LTCs between May 2013 and June 2014. Participants were approached via a convenient sample of one General Practice and four community pharmacies in Northwest England, and four pharmacists in two Health Boards in Scotland. Forty-four participants in England and twenty-three in Scotland were identified purposively; fifteen in England and nine in Scotland were recruited and interviewed to achieve maximal variation2 of LTC type and demographics. Interview topics were developed from the literature and used as a framework for the analysis. Topics covered living with LTCs and undertaking self-care, sources of self-care support, and use of community pharmacy. All interviews were audio-taped, transcribed verbatim and analysed thematically. Interviews and data analysis were undertaken simultaneously until data saturation was reached. NHS Research Ethics and RD the few who had experience of these services did not view them as a resource to improve their self-care behaviours. While some participants recognized the support that community pharmacy provided to them such as with minor ailments and some public health services (e.g. stop smoking), most appeared reluctant to acknowledge community pharmacy?s role in supporting their LTCs needs, including self-care.ConclusionsWhile study participants with LTCs engaged in self-care supported by their family, friends and some HCPs, they did not view community pharmacy as playing much of a role in the management and self-care support of their LTCs. The perspectives and needs of people with LTCs need to be better understood, so that community pharmacy services can be designed so as to contribute to their self-care needs.References1. Kennedy, A., A. Rogers, and P. Bower, Support for self care for patients with chronic disease. BMJ, 2007. 335(7627): p. 968-70.2. Creswell, J.W., Qualitative inquiry & research design: choosing among five approaches. 2006, Thousand Oaks, California: SAGE Publications, Inc.