Enhancing Self-Reported Assessment of Working Conditions in Policing: Revisiting the Psychometric Properties and Applications of the Police Stress Questionnaire.

OBJECTIVES: Policing is recognized as a highly stressful occupation, encompassing stressors not commonly encountered in other fields. In response, police-specific stress scales have been developed and used when studying police work. Despite changes in the composition of police personnel, most studies examining police working conditions focus on sworn police officers (SPO), excluding employees without police education (EWPE). To advance research and practice on stress in the police, align results, and increase the possibilities for comparisons across studies using police-specific measures (PSMs) we conducted a psychometric evaluation of the two scales in the Police Stress Questionnaire (PSQ). We examined whether adding "Not Applicable" to the response scales would reduce vulnerability and make the PSQ more robust. METHOD: Based on a survey with a randomised sample (N = 560) of SPO and EWPE in the Norwegian Police, we tested the original factor structures of the PSQ through Confirmatory Factor Analysis including tests of factor structures from previous studies. RESULTS: For all models, the indicators of fit indicated a poor fit with either our whole or stratified sample. The response choice 'Not Applicable' provided extended information for SPOs and EWPEs on the PSQ. CONCLUSIONS: To promote aligning results and enabling comparisons across studies using the PSQ, we suggest treating the PSQ scales as formative indexes, rather than reflective scales. Adding "Not Applicable" to the response scale offers an influential elaboration of the PSQ with beneficial and extended information. Generalised studies of stress in the police should include the entire population working there.

Evaluation of Work Mode and Its Importance for Home-Work and Work-Home Relationships: The Role of Resilience, Coping with Stress, and Passion for Work.

The COVID-19 pandemic necessitated and facilitated the introduction of telework in organizations. This has also impacted the workers' relationship between work and private life. The aim of the current study was to examine the links between resilience and mode of work (stationary vs. remote) and the work-home and home-work relationships, and whether they are mediated by passion for work and strategies of coping with stress. The study was carried out on a sample of 1251 participants from Great Britain, India, Latvia, Lithuania, Norway, Poland, Romania, Serbia, Slovakia, and Vietnam. The following measures were used: The Survey Work-Home Interaction, The Brief Resilience Coping Scale, The Passion Scale, and the Brief COPE. Results showed that the more stationary the mode of work, the lower the intensity of the negative influence of personal life on work. Resilience was revealed to have a positive effect on worker functioning. The study also showed a relationship between education and gender and passion for work. Finally, the importance of furthering the knowledge on the home-work and work-home relationships among teleworkers is discussed.

The Impact of COVID-19 Pandemic on Corporate Social Responsibility and Job Embeddedness in China.

This article aims to investigate the impact of employee perceptions of corporate social responsibility (CSR) on job embeddedness under the drastic circumstances of coronavirus disease 2019 (COVID-19). This study also investigated the role of organizational identification as a psychological mechanism linking employee perceptions of corporate social responsibility (CSR) to job embeddedness. Survey data were collected from 325 employees in banking industry of China and analyzed using partial least squares structural equation modeling (PLS-SEM). Results revealed that CSR to employees and organizational identification were positively and significantly related to job embeddedness, while CSR to customers, CSR to government, and CSR to society did not significantly predict job embeddedness. Organizational identification fully mediated the relationship between CSR to customers, CSR to government, CSR to society and job embeddedness, and partially mediated the relationship between CSR to employees and job embeddedness. The results suggest engaging in CSR activities can lead employees to identify themselves with the organization and enhance their embeddedness. The article concludes with several implications for practice and recommendations for future research.

A cluster randomised trial of a Needs Assessment Tool for adult Cancer patients and their carers (NAT-C) in primary care: A feasibility study.

BACKGROUND: People with cancer often have unidentified symptoms and social care needs. The Needs Assessment Tool-Cancer (NAT-C) is a validated, structured method of assessing patient/carer concerns and prompting action, to address unmet need. AIMS: Assess feasibility and acceptability of a definitive two-armed cluster randomised trial of NAT-C in primary care by evaluating: recruitment of GP practices, patients and carers; most effective approach of ensuring NAT-C appointments, acceptability of study measures and follow-up. METHODS: Non-blinded, feasibility study in four General Practices, with cluster randomisation to method of NAT-C appointment delivery, and process evaluation. Adults with active cancer were invited to participate with or without carer. Practices cluster randomised (1:1) to Arm I: promotion and use of NAT-C with a NAT-C trained clinician or Arm II: clinician of choice irrespective of training status. Participants completed study questionnaires at: baseline, 1, 3 and 6 months. Patients booked a 20 minute needs-assessment appointment post-baseline. Patients, carers and GP practice staff views regarding the study sought through interviews/focus groups. Quantitative data were analysed descriptively. Qualitative data were analysed thematically, informed by Normalisation Process Theory. Progression to a definitive trial was assessed against feasibility outcomes, relating to: recruitment rate, uptake and delivery of the NAT-C, data collection and quality. RESULTS: Five GP practices approached, four recruited and trained to use the NAT-C. Forty-seven participants and 17 carers recruited. At baseline, 34/47 (72%) participants reported at least one moderate-severe unmet need, confirming study rationale. 32/47 (68%) participants received a NAT-C-guided consultation, 19 of which on Arm I. Study attrition at one month (n = 44 (94%), n = 16 (94%)), three months (n = 38 (81%), n = 14 (82%)) and six months (n = 32 (68%), n = 10 (59%)). Fifteen patient interviews conducted across the whole study and one focus group at each GP practice. Participants supported a definitive study and found measures acceptable. CONCLUSION: The feasibility trial indicated that recruitment rate, intervention uptake and data collection were appropriate, with refinements, for a definitive multi-centre cluster randomised controlled trial. Feasibility outcomes informed the design of a 2-armed cluster randomised controlled trial to test the effectiveness and cost-effectiveness of the NAT-C compared with usual care.

Information Overload in Emergency Medicine Physicians: A Multisite Case Study Exploring the Causes, Impact, and Solutions in Four North England National Health Service Trusts.

BACKGROUND: Information overload is affecting modern society now more than ever because of the wide and increasing distribution of digital technologies. Social media, emails, and online communications among others infuse a sense of urgency as information must be read, produced, and exchanged almost instantaneously. Emergency medicine is a medical specialty that is particularly affected by information overload with consequences on patient care that are difficult to quantify and address. Understanding the current causes of medical information overload, their impact on patient care, and strategies to handle the inflow of constant information is crucial to alleviating stress and anxiety that is already crippling the profession. OBJECTIVE: This study aims to identify and evaluate the main causes and sources of medical information overload, as experienced by emergency medicine physicians in selected National Health Service (NHS) trusts in the United Kingdom. METHODS: This study used a quantitative, survey-based data collection approach including close- and open-ended questions. A web-based survey was distributed to emergency physicians to assess the impact of medical information overload on their jobs. In total, 101 valid responses were collected from 4 NHS trusts in north England. Descriptive statistics, principal component analysis, independent sample two-tailed t tests, and one-way between-group analysis of variance with post hoc tests were performed on the data. Open-ended questions were analyzed using thematic analysis to identify key topics. RESULTS: The vast majority of respondents agreed that information overload is a serious issue in emergency medicine, and it increases with time. The always available culture (mean 5.40, SD 1.56), email handling (mean 4.86, SD 1.80), and multidisciplinary communications (mean 4.51, SD 1.61) are the 3 main reasons leading to information overload. Due to this, emergency physicians experience guideline fatigue, stress and tension, longer working hours, and impaired decision making, among other issues. Aspects of information overload are also reported to have different impacts on physicians depending on demographic factors such as age, years spent in emergency medicine, and level of employment. CONCLUSIONS: There is a serious concern regarding information overload in emergency medicine. Participants identified a considerable number of daily causes affecting their job, particularly the traditional culture of emergency departments being always available on the ward, exacerbated by email and other forms of communication necessary to maintain optimal, evidence-based practice standards. However, not all information is unwelcome, as physicians also need to stay updated with the latest guidelines on conditions and treatment, and communicate with larger medical teams to provide quality care.

Whistleblowing over patient safety and care quality: a review of the literature.

PURPOSE: The purpose of this paper is to review existing research on whistleblowing in healthcare in order to develop an evidence base for policy and research. DESIGN/METHODOLOGY/APPROACH: A narrative review, based on systematic literature protocols developed within the management field. FINDINGS: The authors identify valuable insights on the factors that influence healthcare whistleblowing, and how organizations respond, but also substantial gaps in the coverage of the literature, which is overly focused on nursing, has been largely carried out in the UK and Australia, and concentrates on the earlier stages of the whistleblowing process. RESEARCH LIMITATIONS/IMPLICATIONS: The review identifies gaps in the literature on whistleblowing in healthcare, but also draws attention to an unhelpful lack of connection with the much larger mainstream literature on whistleblowing. PRACTICAL IMPLICATIONS: Despite the limitations to the existing literature important implications for practice can be identified, including enhancing employees' sense of security and providing ethics training. ORIGINALITY/VALUE: This paper provides a platform for future research on whistleblowing in healthcare, at a time when policymakers are increasingly aware of its role in ensuring patient safety and care quality.

Healthcare scandals and the failings of doctors.

PURPOSE: The purpose of this paper is to explore whether official inquiries are an effective method for holding the medical profession to account for failings in the quality and safety of care. DESIGN/METHODOLOGY/APPROACH: Through a review of the theoretical literature on professions and documentary analysis of key public inquiry documents and reports in the UK National Health Service (NHS) the authors examine how the misconduct of doctors can be understood using the metaphor of professional wrongdoing as a product of bad apples, bad barrels or bad cellars. FINDINGS: The wrongdoing literature tends to present an uncritical assumption of increasing sophistication in analysis, as the focus moves from bad apples (individuals) to bad barrels (organisations) and more latterly to bad cellars (the wider system). This evolution in thinking about wrongdoing is also visible in public inquiries, as analysis and recommendations increasingly tend to emphasise cultural and systematic issues. Yet, while organisational and systemic factors are undoubtedly important, there is a need to keep in sight the role of individuals, for two key reasons. First, there is growing evidence that a small number of doctors may be disproportionately responsible for large numbers of complaints and concerns. Second, there is a risk that the role of individual professionals in drawing attention to wrongdoing is being neglected. ORIGINALITY/VALUE: To the best of the authors' knowledge this is the first theoretical and empirical study specifically exploring the role of NHS inquiries in holding the medical profession to account for failings in professional practice.

Listening to the family's voice: evaluation of a tool to improve symptom control and communication.

BACKGROUND:: Acute hospitals provide a high proportion of end-of-life care but some families experience poor communication with clinical staff. AIM:: To evaluate the use of the Family's Voice diary communication tool across nine healthcare settings. METHODS:: A mixed method practice development approach was used incorporating: an audit of the usage of Family's Voice; collation and analysis of written comments; and collation of written feedback from the principal investigators at data collection sites. FINDINGS:: There were 112 completed diaries. Families rated pain and vomiting as well controlled, but agitation and breathlessness were difficult to control. Families were positive about care provided to the patients and themselves. Ten themes were identified from analysis of the families' written comments that echoed national concerns. CONCLUSION:: Evidence for the utility of the diary is building. Future work could focus on strategies for embedding the diary into routine care for all end-of-life patients.

What About Leadership?: Comment on "Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations".

In their valuable discussion of whistleblowing in healthcare organisations, Mannion and Davies highlight the importance of organisational culture in influencing whether people raise concerns, and whether these concerns are listened to and acted upon. The role of leadership in shaping organisational culture is well-established and in this commentary, we will examine the influence of leaders in creating cultures of silence or cultures of voice.

Communication diary to aid care at the end of life.

This study describes how clinical staff at an acute hospital developed and introduced a diary tool that improved communication with the relatives (or carers) of patients receiving end-of-life care. The "Relatives'/carers' diary" was given to relatives of patients on the Liverpool Care Pathway. The diary enables relatives to be more meaningfully engaged in end-of-life care. It also enables nurses to monitor the quality of their care and respond quickly to any concerns.

Use of the proportion of patients dying on an End of Life Pathway as a quality marker: considerations for interpretation.

The Department of Health as part of its End of Life Care Strategy has developed a set of markers as a quality of care proxy for adults at the end of life. 'The number/proportion of patients dying with the Liverpool Care Pathway (or equivalent) in place' is suggested as a quality metric for all care providers. A retrospective audit of uptake of use of the Liverpool Care Pathway (LCP) in an NHS hospital in the North of England showed that 39% of all patients who died had been placed on the LCP. Overall 58% of patients who died were judged to meet the criteria for LCP use. This represented 81% of patients dying with cancer as a primary cause compared to 51% of patients dying with non-cancer. This difference was statistically very significant. In the Trust under study, 67% of dying patients who fulfilled the LCP criteria were placed on the pathway. The results of this study suggest that a simple percentage of deaths on the pathway is an unsophisticated statistic which needs to be interpreted with care. In particular it will be influenced by the proportion of people dying with cancer or non-cancer. This should be considered particularly when presenting the results to the public and to healthcare stakeholders or when making comparisons between provider organizations.