Workload effects of online consultation implementation from a Job-Characteristics Model perspective: a qualitative study.

BACKGROUND: Online consultation (OC) was previously promoted by the NHS to solve primary care workload challenges. Its implementation was sped up during the COVID-19 pandemic. Workload effects are widely debated. Using a job design perspective may enhance understandings of workload effect. AIM: To qualitatively interrogate the workload experiences of primary care staff involved in OC implementation, using the Job Characteristics Model (JCM) to enable the following: a clearer understanding of the primary care staff psychological experiences; and recommendations informing the design of digital implementations and continued use. DESIGN & SETTING: A qualitative interview study of GP practices using OC within South West England. METHOD: Thirteen participants representing seven practices completed JCM-based semi-structured telephone interviews. An abductive theoretically driven thematic analysis was completed. RESULTS: Participants experienced different tasks pre- and post-implementation of OC, and adapted differently to them. Differences included the following: contact modality change, some administrative staff felt removed from patient contact; and in perceived autonomy, some GPs valued increased workload control. Variation in workload experience was affected by job role and practice context, and the form of and rationale for implementation. Use of a psychological model (the JCM) allowed clearer consideration of the effects of change, as well as OC on workload. CONCLUSION: Psychological theory may be helpful in interpreting workload effects of technology implementation such as OC. Designing change to include consideration of technology effects, psychological experiences, differences across roles, and individual and practice contexts may be important for technology implementation and evaluation of its workload effects.

Keep safe: The when, why and how of epilepsy risk communication.

PURPOSE: Risk communication between clinicians and people with epilepsy (PWE) and their families is under researched. There is limited guidance about when and how to have these discussions. This paper explores the current evidence on quality of risk related conversations in epilepsy and suggests a concept of an evidence-based guideline for person centred structured risk communication. METHODS: A literature search of four electronic database, Ovid Medline, Ovid Embase, PUBMED, and CINAHL, was conducted by two independent reviewers using relevant search terms following the principals of the PRISMA guidance. No limits were applied. Supplementary searches included using backwards and forwards citation searching. A predesigned inclusion and exclusion criteria was administered to the identified results. RESULTS: From 376 results identified, 17 studies met the final criteria of which ten were quantitative, five qualitative and two mixed methods. Perspectives of PWE and clinicians were represented. Extracted data was clustered into three domains: communication initiation (e.g. timing, individual tailoring); communication methods (preference for face to face with neurologists); and communication content (acknowledging the anxiety produced by risk communication, the benefits of being self-aware, normalising risk etc.). No papers focused on conversation structure (e.g. helpful phrases), or the best locations to hold conversations. CONCLUSION: More research is needed to develop structured communication of risk. An attempt has been made to put current evidence into this format. Clearer guidance will enhance clinicians' confidence in communicating person centred epilepsy risk with PWE and their families thus improving outcomes.

A qualitative exploration of the experiences of students attending interprofessional Schwartz Rounds in a University context.

Schwartz Rounds are a cultural change initiative for interdisciplinary staff to reflect on their work to preserve the human connection. Their recent implementation in educational contexts means that there is limited research exploring the experience of students attending Rounds. This study aimed to develop understanding of how health-care students experience participation at Schwartz Rounds in a University context. Using an Interpretative Phenomenological Analysis approach, semi-structured interviews were conducted with eight health-care students about their experience of attending Rounds. Three themes were identified: ambivalence about safety to share "would it reflect badly on me?"; unifying through sharing emotions "you're not alone in feeling that"; and space to question professional cultures "there's not normally space given to that". The findings suggest that Rounds promote connectedness through humanizing professions and focusing on shared emotions; however, safety to share within Rounds can be limited by fear of judgment. This supports previous literature and suggests that Rounds may be well placed in educational contexts to support cultural change from the beginning of training.

The feasibility of following up prisoners, with mental health problems, after release: a pilot trial employing an innovative system, for engagement and retention in research, with a harder-to-engage population.

BACKGROUND: Following up released prisoners is demanding, particularly for those prisoners with mental health problems, for whom stigma and chaotic lifestyles are problematic. Measurement of mental health outcomes after release is challenging. To evaluate mental healthcare for offender populations, using high-quality randomised controlled trials, evidenced-based methods must be developed to engage them while in custody, to locate and re-interview them after release, and to collect potentially stigmatising mental health outcomes data. METHODS: We developed an initial theoretical model and operational procedures for collecting baseline and follow-up data informed by a literature search, focus groups, and case studies. Male prisoners from five prisons in two sites were invited to participate. The inclusion criteria included individuals who were above threshold on nine-item Patient Health Questionnaire, seven-item Generalized Anxiety Disorder, or post-traumatic stress disorder scales, or who had reported mental health problems in the past 2 years or had been assessed with a likely personality disorder. Potential participants were interviewed to generate baseline data and were re-contacted before their release. We then contacted them for a follow-up interview, which included repeating the earlier data collection measures 2-8 weeks after release. A qualitative formative process evaluation produced and refined a model procedure for the recruitment and retention of male prison leavers in trials, identified the mechanisms which promoted engagement and retention, and mapped these against a theoretical behaviour change model. RESULTS: We developed a flexible procedure which was successful in recruiting male prison leavers to a pilot trial: 185/243 (76%, 95% confidence interval (CI) 70-81%) of those approached agreed to participate. We also retained 63% (95% CI 54-71%) of those eligible to participate in a follow-up interview 2-8 weeks after release. Mental health outcomes data was collected at both these time points. CONCLUSIONS: It is possible to design acceptable procedures to achieve sustained engagement critical for delivering and evaluating interventions in prison and in the community and to collect mental health outcomes data. These procedures may reduce attrition bias in future randomised controlled trials of mental health interventions for prison leavers. This procedure has been replicated and successfully delivered in a subsequent pilot trial and a definitive randomised controlled trial.

What a discursive understanding of interprofessional team meetings might reveal: an exploration of intellectual (learning) disability managers' performances.

Clinical and academic understandings of interprofessional working are focused mainly on individual factors such as knowledge about different professional roles, and organisational opportunities for interprofessional working (IPW). Less research has examined what happens between people at an interactional level, that is, how interprofessional working is conducted in everyday face-to-face interactions in clinical practice. The current paper proposes a discursive framework for understanding what constitutes IPW in interprofessional meetings at this interactional level. Clinical effectiveness meetings held in intellectual (learning) disability services were used as an example site for IPW. The analysis explored how agenda change points were negotiated, appropriate as agenda change points require collaboration (or agreement) between practitioners to progress to the next point The study found changes in agenda points were accomplished by practitioners conjointly through using discursive strategies including closing questions, and resources such as professional identity and laughter. The agenda provided a frame for the institutional order of the meetings, invoking a trajectory towards timely completion. However, this institutional order was at times subordinated to an 'order of concern', which seemed to enable challenges by managers to the meeting Chair and the agenda that demonstrated adherence not only to the procedural nature of the meetings, but also to the needs of service users and the services discussed. We suggest discursive strategies, resources, and both institutional orders, and order of concerns might provide a framework for developing future training and research, that is able to illuminate how IPW might be enacted in face-to-face team meetings.

"I Felt Like I Was Being Abused All Over Again": How Survivors of Child Sexual Abuse Make Sense of the Perinatal Period Through Their Narratives.

Sequelae following child sexual abuse pervade the lives of adult survivors, significantly impacting on pregnancy and childbirth. Symptoms of this distress are recognized, but meanings for women are less understood. This research aimed to examine the meaning for women themselves of the impact of child sexual abuse on experiences of pregnancy, childbirth, and the postnatal period. Taking a critical feminist perspective, three open-ended interviews with three survivors enabled women's narratives of pregnancy and childbirth to be heard, explored the structure of these narratives, including how experiences were connected, and identified key themes and how selves and others were positioned. Women themselves contributed to the analysis of their own narratives. The different struggles of each woman occurred within three domains of experience: identity, embodiment, and parenting. They were underpinned by a fluctuation between empowerment and disempowerment. These findings, although based on detailed analysis of the experiences of only three women, dovetail with, integrate, and extend the existent literature, offering a framework for understanding the complexity of meaning making for women. Further research might develop this. The framework may facilitate clinicians' understandings of what it is like for some women having children who have experienced child sexual abuse.

How Families Make Sense of Their Child's Behaviour When on an Autism Assessment and Diagnosis Waiting List.

Families waiting for an Autism Spectrum Condition assessment often experience difficulties explaining, or making sense of, the referred young person's behaviour. Little is known about this sense making, or how clinicians might support this ambiguity. This paper explored finite details of how five families do 'sense-making' in conversations with each other, while on the waiting list for an ASC assessment. A Discursive Psychology analysis of these conversations found that sense making was affected by (1) an interactional pattern of interruptions impeding the progress of sense making narratives; (2) face saving to maintain positive identities and shared understanding; and (3) difficulties in word finding within sense making narratives. These practices challenged the production of a coherent family sense making narrative.

Making sense of dementia: Exploring the use of the Markers of Assimilation of Problematic Experiences in Dementia scale to understand how couples process a diagnosis of dementia.

This qualitative study aimed to see whether the Markers of Assimilation of Problematic Experiences in Dementia (MAPED) scale could be applied to couples. It aimed to explore the interactions between couples and how this affected the levels of assimilation. Semi-structured interviews were conducted with four heterosexual couples. The results suggested that MAPED can be usefully applied to couples. It highlighted the oscillating process which couples undergo as they process a dementia diagnosis. This supports the notion that making sense of a dementia diagnosis is not static, but a fluctuating and ever changing process. The strategies couples employed either facilitated or prevented the expression and integration of the Problematic Voice. The study highlights the importance of supporting couples together during a dementia diagnosis.

Attachment and coping of dementia care staff: The role of staff attachment style, geriatric nursing self-efficacy, and approaches to dementia in burnout.

Past research suggests that dementia care staff are vulnerable to the development of burnout, which has implications for staff well-being and hence the quality of care for people with dementia. Studying personal vulnerability factors in burnout is important as it can guide staff training and support. Attachment theory suggests that adult attachment styles affect caregiving relationships and individuals' responses to stress, providing a framework for understanding caregivers' styles of coping. This cross-sectional survey study examined relationships between staff attachment styles, geriatric nursing self-efficacy, and approaches to dementia in burnout. Seventy-seven members of dementia care staff working on inpatient wards for older people completed self-report questionnaires. Insecure attachment, lower levels of self-efficacy, and more optimistic attitudes in staff were related to higher levels of burnout. Staff training on the role of attachment in dementia care is recommended. Further research is required to explore mediating factors between adult attachment styles and burnout.

An exploration of family dynamics and attachment strategies in a family with ADHD/conduct problems.

This article reports the preliminary findings of a study of attachment patterns and relationship themes using the TAAI (Transition to Adulthood Attachment Interview), AAI (Adult Attachment Interview) and family interviews (based on the first of 15 families). Research data is presented on a young man aged 16 with a diagnosis of ADHD and his family. Individual interviews, attachment interviews, and family interviews were conducted in order to explore the link between family dynamics, ADHD and attachment strategies. In contrast to findings from existing research indicating pre-occupied patterns for young people diagnosed with ADHD, the young man displayed a complex 'disoriented' attachment pattern which primarily featured a dismissive strategy. However, this was combined with pre-occupied patterns triggered by intrusions from unresolved traumas and memories of his parents' continuing unresolved conflicts. His sense of confusion and lack of a coherent strategy appeared to be closely related to his position of being triangulated into his parents' conflicts. Trans-generational processes were also influential, in that the parents' corrective intentions at more positive parenting were impeded by their own lack of experience of positive attachments in their own childhoods. The study emphasizes the need to consider the relationship between attachment patterns and problems within wider systemic process in the family, in particular triangulation and corrective scripts.