The role of the community pharmacy work system in the enactment of pharmacists' non-technical skills.

Non-technical skills are recognised as important in various work domains, but have been the subject of debate regarding their role in ergonomics/human factors, given their focus on human behaviour itself rather than the interaction between people and systems. This study aimed to examine the relationship between non-technical skills and the work system in which they are enacted. The study setting was community pharmacies in England. Qualitative data were obtained from observation of seven pharmacists and semi-structured interviews with 16 pharmacists, and subjected to thematic analysis. Elements of their work system were found to be related to their non-technical skills; either by creating a need for the skill in the first place, or by facilitating or inhibiting its enactment. The findings highlight the importance of considering the work system that contextualises individuals' and teams' behaviour, in addition to the behaviour itself, when investigating non-technical skills.

The obvious focus of interventions to enhance non-technical skills is the behaviour of individuals and teams. However, we highlight the importance of considering the work system within which people are operating, as this forms the context within which non-technical skills are exercised. We suggest particular ways in which the work system might influence the exercise of non-technical skills.

Genetics Needs Non-geneticists.

Answering genetics' big data questions often needs an interdisciplinary team whose members freely share their diverse expertise in analysis, statistics, and computation. Sharing requires mutual trust and open acknowledgement of strengths and weaknesses, including those of established geneticists. Only then will newcomers to genetics contribute far beyond their entry-level expectations.

Applying human factors to improve patient safety, morale and team working for oral pathology and medicine specialists.

BACKGROUND: Human error is inevitable, and therefore can be considered as a 'normal' part of everyday life. Unfortunately, error can never be eliminated completely. However, learning from our mistakes can help reduce problems in future. Fifty years ago, most clinicians paid little or no attention to the human factors (HF) that can affect individual and team performance. It has only been in the last 20-25 years that colleagues in healthcare have truly begun recognizing the importance of HF and non-technical skills in medicine and dentistry and how their application can significantly improve patient safety and aid better team working and staff morale in the clinical setting and laboratory. DISCUSSION: Personal factors such as stress, tiredness, hunger and dehydration all reduce human performance and can raise the risk of mistakes. In addition, how we work and interact with the wider team is important since many errors can occur because of ineffective communication, steep hierarchal (authority) gradients and loss of situational awareness.  This short HF overview in the 50th commemorative special of JOPM issue is timely. It provides a contemporary overview of human factors and performance that the authors consider important for oral medicine and pathology colleagues and which can affect individuals and teams This article also discuss ways to reduce the chances of medical and dental error and improve patient safety.

The impact of working as a peer worker in mental health services: a longitudinal mixed methods study.

BACKGROUND: Peer workers are increasingly employed in mental health services to use their own experiences of mental distress in supporting others with similar experiences. While evidence is emerging of the benefits of peer support for people using services, the impact on peer workers is less clear. There is a lack of research that takes a longitudinal approach to exploring impact on both employment outcomes for peer workers, and their experiences of working in the peer worker role. METHODS: In a longitudinal mixed methods study, 32 peer workers providing peer support for discharge from inpatient to community mental health care - as part of a randomised controlled trial - undertook in-depth qualitative interviews conducted by service user researchers, and completed measures of wellbeing, burnout, job satisfaction and multi-disciplinary team working after completing training, and four and 12 months into the role. Questionnaire data were summarised and compared to outcomes for relevant population norms, and changes in outcomes were analysed using paired t-tests. Thematic analysis and interpretive workshops involving service user researchers were used to analysis interview transcripts. A critical interpretive synthesis approach was used to synthesise analyses of both datasets. RESULTS: For the duration of the study, all questionnaire outcomes were comparable with population norms for health professionals or for the general population. There were small-to-medium decreases in wellbeing and aspects of job satisfaction, and increase in burnout after 4 months, but these changes were largely not maintained at 12 months. Peer workers felt valued, empowered and connected in the role, but could find it challenging to adjust to the demands of the job after initial optimism. Supervision and being part of a standalone peer worker team was supportive, although communication with clinical teams could be improved. CONCLUSIONS: Peer workers seem no more likely to experience negative impacts of working than other healthcare professionals but should be well supported as they settle into post, provided with in-work training and support around job insecurity. Research is needed to optimise working arrangements for peer workers alongside clinical teams.

Does standardisation improve post-operative anaesthesia handoffs? Meta-analyses on provider, patient, organisational, and handoff outcomes.

Anaesthesia handoffs are associated with negative outcomes (e.g. inappropriate treatments, post-operative complications, and in-hospital mortality). To minimise these adverse outcomes, federal bodies (e.g. Joint Commission) have mandated handoff standardisation. Due to the proliferation of handoff interventions and research, there is a need to meta-analyze anaesthesia handoffs. Therefore, we performed meta-analyses on the provider, patient, organisational, and handoff outcomes related to post-operative anaesthesia handoff protocols. We meta-analysed 41 articles with post-operative anaesthesia handoffs that implemented a standardised handoff protocol. Compared to no standardisation, a standardised post-operative anaesthesia handoff changed provider outcomes with an OR of 4.03 (95% CI 3.20-5.08), patient outcomes with an OR of 1.49 (95% CI 1.32-1.69), organisational outcomes with an OR of 4.25 (95% CI 2.51-7.19), handoff outcomes with an OR of 8.52 (95% CI 7.05-10.31). Our meta-analyses demonstrate that standardised post-operative anaesthesia handoffs altered patient, provider, organisational, and handoff outcomes. Practitioner Summary: We conducted meta-analyses to assess the effects of post-operative anaesthesia handoff standardisation on provider, patient, organisational, and handoff outcomes. Our findings suggest that standardised post-operative anaesthesia handoffs changed all listed outcomes in a positive direction. We discuss the implications of these findings as well as notable limitations in this literature base.

Drawingvoice 2.0: classroom joint designing and Facebook interactions to develop reflexivity and awareness.

Drawingvoice 2.0 is an instructional method of collaborative pencil and paper drawing to use in the school classroom, followed by Facebook interaction on the drawing produced in class. It is based on a participatory and meta reflective approach, explicitly aimed at deconstructing, negotiating, and reconstructing the meaning that students attribute to themselves regarding their professional expectations and educational pathways. In particular, the collaborative pencil and paper drawing allows for the student's emotional symbolisation processes underlying their educational pathway. Drawingvoice 2.0 induces a multidimensional cognitive and meta-cognitive process further supported by the following interaction on Facebook. Therefore, the World Wide Web is the added resource for sharing and deepening the classmates' discussion. Finally, Drawingvoice 2.0 supported structural group interaction and was an important supportive and instructional method to bring about transformational and developmental training practices. As the main result, in our experience, psychology students increased their reflectivity about their strengths and threats in being psychologists within their cultural contexts and potential positive resources underlying their choice. Drawingvoice 2.0 thus enhanced their self-awareness about the lights and shadows of their training and future professional career.

A novel team Familiarity Score for operating teams is a predictor of length of a procedure: A retrospective Bayesian analysis.

OBJECTIVE: The aim of our retrospective study was to assess whether a novel team Familiarity Score (FS) is associated with the length of procedure (LOP), postoperative length of stay (LOS), and complication rate after vascular procedures. METHODS: We retrospectively analyzed 326 vascular procedures performed at a tertiary care vascular surgery center between April 2012 and September 2014. Data collected included patients' age, American Society of Anesthesiologists grade, LOP, type and urgency of procedure, LOS, and complications. Familiarity Score (FS) was defined as the sum of the number of times that each possible pair of the team (vascular consultant, vascular registrar, scrub nurse, anesthetic consultant) within the team had worked together during the previous 6 months, divided by the number of possible combinations of pairs in the team. Bayesian statistics was used to analyze the data. RESULTS: FS was significantly associated with type and urgency of the procedure (Bayes factor [BF] >1000). Emergency procedures were performed by less familiar teams, and the least familiar teams were involved in the emergency aortic procedures-endovascular and open. FS was strongly associated with LOP (BF = 37) but not with LOS (BF = 4.0) and complication rate. CONCLUSIONS: FS in vascular teams was shown to be strongly associated with LOP, suggesting that more familiar teams might collaborate more efficiently.

Sustaining the commitment to patient safety huddles: insights from eight acute hospital ward teams.

BACKGROUND: A recent initiative in hospital settings is the patient safety huddle (PSH): a brief multidisciplinary meeting held to highlight patient safety issues and actions to mitigate identified risks. AIM: The authors studied eight ward teams that had sustained PSHs for over 2 years in order to identify key contributory factors. METHODS: Unannounced observations of the PSH on eight acute wards in one UK hospital were undertaken. Interviews and focus groups were also conducted. These were recorded and transcribed for framework analysis. FINDINGS: A range of factors contributes to the sustainability of the PSH including a high degree of belief and consensus in purpose, adaptability, determination, multidisciplinary team involvement, a non-judgemental space, committed leadership and consistent reward and celebration. CONCLUSION: The huddles studied have developed and been shaped over time through a process of trial and error, and persistence. Overall this study offers insights into the factors that contribute to this sustainability.

Human factors in preventing complications in anaesthesia: a systematic review.

Human factors in anaesthesia were first highlighted by the publication of the Anaesthetists Non-Technical Skills Framework, and since then an awareness of their importance has gradually resulted in changes in routine clinical practice. This review examines recent literature around human factors in anaesthesia, and highlights recent national reports and guidelines with a focus on team working, communication, situation awareness and human error. We highlight the importance of human factors in modern anaesthetic practice, using the example of complex trauma.

Agency modulates interactions with automation technologies.

The increasing presence of automation between operators and automated systems tends to disrupt operators from action outcomes, leading them to leave the control loop. The theoretical framework of agency suggests that priming the operator about the system's upcoming behaviour could help restore an appropriate sense of control and increase user acceptance of what the system is doing. In a series of two experiments, we test whether providing information about what the system is about to do next leads to an increase in the level of user acceptance, concomitant with an increase in control and performance. Using an aircraft supervision task, we demonstrated the benefit of prime messages regarding system acceptance and performance. Taken together, our results indicate that the principles proposed by this framework could be used to improve human-machine interaction and maintain a high level of sense of control in supervisory tasks. Practitioner Summary: The out-of-the-loop performance problem is a major potential consequence of automation, leaving operators helpless to takeover automation in case of failure. Using an aircraft supervision task, the following article illustrates how the psychological approach of agency can help improving human-system interactions by designing more acceptable and more controllable automated interfaces.

Nonlinear dynamical systems for theory and research in ergonomics.

Nonlinear dynamical systems (NDS) theory offers new constructs, methods and explanations for phenomena that have in turn produced new paradigms of thinking within several disciplines of the behavioural sciences. This article explores the recent developments of NDS as a paradigm in ergonomics. The exposition includes its basic axioms, the primary constructs from elementary dynamics and so-called complexity theory, an overview of its methods, and growing areas of application within ergonomics. The applications considered here include: psychophysics, iconic displays, control theory, cognitive workload and fatigue, occupational accidents, resilience of systems, team coordination and synchronisation in systems. Although these applications make use of different subsets of NDS constructs, several of them share the general principles of the complex adaptive system. Practitioner Summary: Nonlinear dynamical systems theory reframes problems in ergonomics that involve complex systems as they change over time. The leading applications to date include psychophysics, control theory, cognitive workload and fatigue, biomechanics, occupational accidents, resilience of systems, team coordination and synchronisation of system components.

The fundamental managerial challenges in the role of a contemporary district nurse: A discussion.

This article examines some of the fundamental challenges facing the district nurse in delivery of the managerial aspects of her role in contemporary practice. It discusses the personal attributes that are essential for this role to ensure safe, effective and compassionate leadership and management. The communication skills and ethos underpinning collaborative multidiscilplinary team work and person-centred care are discussed. Issues that compromise positive and productive team working are identified, and strategies dealing with conflict and also change management are debated. These factors are interrelated with the everyday demands of caseload management, the development of educational needs to meet the demands of increased complexity in care needs, and the place of technology in modern health care. It is evidenced that sustained organisational support for this role is more important than ever, due to increasing demand and decreasing capacity. Potential solutions to these challenges are offered to assist the contemporary district nurse.

Inter-professional prescribing masterclass for medical students and non-medical prescribing students (nurses and pharmacists): a pilot study.

BACKGROUND AND AIMS: Prescribing errors cause significant patient morbidity and mortality. Current legislation allows prescribing by different health professions. Inter-professional collaboration and learning may result in safer prescribing practice. This study aimed to develop, pilot and test the feasibility of a simulated inter-professional prescribing masterclass for non-medical prescribing students, medical students and pharmacists. METHODS AND RESULTS: A three-scenario, simulated patient session was designed and implemented by an expert panel. Medical students, non-medical prescribing students and pharmacists worked together to formulate and implement evidence-based prescriptions. The Readiness for Inter-professional Learning Score (RIPLS) and a self-efficacy score were administered to the students and the Trust in Physician Score to the simulated patients. Overall, the RIPLS and self-efficacy scores increased. Pharmacists showed the highest rating in the Trust in Physician score. Post masterclass group discussions suggested that the intervention was viewed as a positive educational experience. CONCLUSION: An inter-professional prescribing masterclass is feasible and acceptable to students. It increases self-efficacy, readiness for inter-professional learning and allows students to learn from, about and with each other. A larger study is warranted and the use of feedback from simulated patients explored further.

Critical care nurses' experiences of helicopter transfers.

BACKGROUND: Intensive care is conducted in intensive care units (ICUs), and also during the transportation of critically ill people. AIM: The aim of the study was to describe critical care nurses' (CCNs) experiences of nursing critically ill patients during helicopter transport. PARTICIPANTS: Seven CCNs, five women and two men participated in this study. DESIGN: Seven participants from two centres in Sweden were recruited. The design uses an inductive, qualitative approach with data collected by means of qualitative interviews with seven CCNs. METHODS: The interviews were transcribed verbatim and subjected to qualitative thematic content analysis. RESULTS: The analysis resulted in one theme which is safe nursing care, but sometimes feeling afraid and six categories as follows: experiencing the care environment as an ICU with limited space; a loud environment complicates communication; planning and checking to minimize risks; experience and good co-operation; facing the dilemma of allowing relatives to accompany the patient or not; feeling the patient's and their own fear. CONCLUSION: CCNs plan for the transportation and control of patients to improve patient safety, but can sometimes feel afraid. Good co-operation is necessary. RELEVANCE TO CLINICAL PRACTICE: The possibilities for CCNs to provide effective nursing care in helicopters are good, although in some cases limited by the environmental conditions.

Introduction of a new ward round approach in a cardiothoracic critical care unit.

BACKGROUND: Francis (2013) described inconsistent ward rounds and failures to conduct ward rounds properly as contributing factors to the poor care seen at the Mid Staffordshire Foundation Trust. He suggested that the absence of a nurse at the bedside had clear consequences for communication, ward round efficiency and patient safety. He recommended that nurses should be actively involved in ward rounds and linked this to high quality patient care. AIM: To share an experience of introducing a ward round checklist, a bedside nurse verbal summary and the development of standard operating procedure for Ward Rounds in cardiothoracic critical care unit to improve patient safety and care. DESIGN AND METHODS: Semi structured interviews of six registered nurses. A questionnaire to 69 registered nurses. An electronic questionnaire sent to 23 members of the MDT. An observational audit of seven ward rounds reviewing 69 patients. RESULTS: 97% of nurses agreed that verbal summarizing had improved clarity and 90% felt that it had improved patient care. 87% of the MDT respondents stated that they had noticed an improvement in the attendance of the bedside nurse at the ward round review. The ward round checklist reduced omissions. Communication with patients during ward rounds was an area which needed to be improved. CONCLUSIONS: The introduction of a new ward round approach and audit of its practice has enabled an improvement in the quality of patient care by: Giving more opportunity for the nurse to participate and feel part of the ward round. Reduction of omissions through the use of a ward round checklist. Improved clarity among the MDT by the use of bedside nurse verbal summarizing of the plan of care. RELEVANCE TO CLINICAL PRACTICE: Nurses' full participation in ward rounds is essential to ensure effective communication and enhance patient safety.

Nursing practice in stroke rehabilitation: systematic review and meta-ethnography.

AIMS AND OBJECTIVES: To identify and synthesise the available research evidence in order to generate an explanatory framework for nursing practice in stroke rehabilitation. BACKGROUND: Although nurses are the largest professional group working with stroke survivors, there is limited understanding of nursing practice in stroke units. In particular, there is currently very little evidence in respect of nurses' involvement in poststroke rehabilitation. DESIGN: Meta-ethnography. METHOD: A systematic review was undertaken. The review question was: 'What is the nature of nursing practice in the care and rehabilitation of inpatient stroke survivors?' Searches of 12 electronic databases identified 14,655 publications, and after screening, 778 remained; 137 papers were obtained and 54 retained for mapping. Sixteen qualitative studies were included in the meta-ethnography. RESULTS: Nurses' involvement in poststroke rehabilitation was limited. Contextual factors impacted on nurses' perceptions and practice. Nurses' integration of rehabilitation skills was perceived to be contingent on adequate nurse staffing levels and management of demands on nurses' time. Team working practices and use of the built environment indicated separation of nursing and therapy work. Physical care and monitoring were prioritised. Stroke-specific education and training was evident, but not consistent in content or approach. Stroke survivors and families needed help to understand nurses' role in rehabilitation. CONCLUSION: The review provides compelling evidence that there is an need to re-examine the role of nurses in contributing to poststroke rehabilitation, including clarifying when this process can safely begin and specifying the techniques that can be integrated in nurses' practice. RELEVANCE TO CLINICAL PRACTICE: Integrating stroke-specific rehabilitation skills in nurses' practice could contribute substantially to improving outcomes for stroke survivors. The explanatory framework developed from the review findings identifies issues which will need to be addressed in order to maximise nurses' contribution to the rehabilitation of stroke survivors.

Jordanian intensive care nurses' perspectives on evidence-based practice in nutritional care.

This study aimed to explore Jordanian nurses' perspectives on the implementation of evidence-based practice and team-working related to nutritional care in the critically ill. Poor adherence to evidence-based practice and poor collaboration may contribute to nutritional failure. Fourteen critical care nurses from three healthcare sectors in Jordan were selected purposively and interviewed using semi-structured interviews. The information obtained was subjected to a thematic analysis. Four themes emerged from the study: 'undertaking nutritional responsibilities', 'approaching evidence-based practice', 'multidisciplinary team working' and 'consequences of enteral nutrition care deficits'. Although evidence-based practice was emphasised by nurses, lack of evidence-based resources, and ineffective aspiration reduction measures were found to impede adherence to evidence-based practice. Multidisciplinary team working was introduced as means to improve practice. However, ineffective nursing involvement and poor interaction were obstacles to effective sharing.

A realist process evaluation of an intervention to promote competencies in interprofessional collaboration among interdisciplinary integrated care teams for older people: Study protocol.

Background: International policy is increasingly committed to placing interdisciplinary team-working at the centre of health and social care integration across the lifespan. The National Clinical Programme for Older People in Ireland has a critical role in the design and implementation of the National Older Person's Service Model, which aims to shift the delivery of care away from acute hospitals towards community-based care. Interdisciplinary Community Specialist Teams for older persons (CST-OPs) play an important role in this service model. To support the development of competencies for interprofessional collaboration and an interdisciplinary team-based approach to care integration, a culture shift will be required within care delivery. Design:This study builds upon a collaborative partnership project which co-designed a framework describing core competencies for interprofessional collaboration in CST-OPs. A realist-informed process evaluation of the framework will be undertaken as the competencies described in the framework are being fostered in newly developed CST-OPs under the national scale-up of the service model. Realist evaluation approaches reveal what worked, why it worked (or did not), for whom and under what circumstances. Three iterative and integrated work packages are proposed which combine multiple methods of data collection, analysis and synthesis. Prospective data collection will be undertaken within four CST-OPs, including qualitative exploration of the care experiences of older people and family carers. Discussion: The realist explanatory theory will provide an understanding of how interprofessional collaboration can be fostered and sustained in various contexts of care integration for older people. It will underpin curriculum development for team-based education and training of health and social care professionals, a key priority area in the national Irish health strategy. It will provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and to realise the goals of integrated care for older people.

Standing strong amid a pandemic: How a global online team project stands up to the public health crisis.

The annual instructional virtual team Project X brings together professors and students from across the globe to engage in client projects. The 2020 project was challenged by the global disruption of the COVID-19 pandemic. This paper draws on a quantitative dataset from a post-project survey among 500 participating students and a qualitative narrative inquiry of personal experiences of the faculty members. The findings reveal how innovative use of a variety of collaboration and communication technologies helped students and their professors in building emotional connection and compassion to support each other in the midst of the crisis, and to accomplish the project despite connectivity disruptions. The results suggest that the role of an instructor changed to a coach and mentor, and technology was used to create a greater sense of inclusion and co-presence in student-faculty interactions. Ultimately, the paper highlights the role of technology to help the participants navigate sudden crisis affecting a global online instructional team project. The adaptive instructional teaching strategies and technologies depicted in this study offer transformative potential for future developments in higher education.

Carrying on with liver transplantation during the COVID-19 emergency: Report from piedmont region.

BACKGROUND: The COVID-19 pandemic is an emergency worldwide. In Italy, liver transplant activity was carried on, but despite all efforts, a 25% reduction of procured organs has already been observed during the first 4 weeks of the outbreak. AIMS: To analyze if our strategy and organization of LT pathway during the first two months of the COVID-19 emergency succeeded in keeping a high level of LT activity, comparing the number of LT in the first two months with the same period of time in 2019. METHODS: We compared the liver transplants performed in our Center between February 24th and April 17th, 2020 with liver transplants performed in the same period in 2019. RESULTS: In 2020, 21 patients underwent liver transplantation from deceased donors, exactly as the year before, without statistically significant difference. All patients survived in both groups, and the rate of early graft dysfunction was 24% in 2020 and 33% in 2019. In 2020 Median MELD was higher (17 vs 13). We were able to perform 3 multiorgan transplants and one acute liver failure. Nobody died on waiting list. The performance of our Center, despite the maxi-emergency situation, was steady and this was the result of a tremendous team working within the hospital and in our region. CONCLUSIONS: Team working allowed our Center to maintain its activity level, taking care of patients before and after liver transplantation. Sharing our experience, we hope to be helpful to other Centers that are facing the pandemic and, if another pandemic comes, to be more prepared to deal with it.