scholarly journals Easier and Faster Is Not Always Better: Grounded Theory of the Impact of Large-Scale System Transformation on the Clinical Work of Emergency Medicine Nurses and Physicians (Preprint)

2018 ◽  
Author(s):  
Elaine Zibrowski ◽  
Lisa Shepherd ◽  
Kamran Sedig ◽  
Richard Booth ◽  
Candace Gibson
Keyword(s):  
Health Care ◽  
Emergency Medicine ◽  
Grounded Theory ◽  
Health Care Professionals ◽  
Large Scale ◽  
Clinical Work ◽  
Well Being ◽  
Clinical Workflow ◽  
Nurses And Physicians ◽  
The Impact

BACKGROUND The effectiveness of Lean Thinking as a quality improvement method for health care has been contested due, in part, to our limited contextual understanding of how it affects the working conditions and clinical workflow of nurses and physicians. Although there are some initial indications, arising from prevalence surveys and interviews, that Lean may intensify work performed within medical environments, the evidence base still requires detailed descriptions of the changes that were actually introduced to individuals’ clinical workflow and how these changes impacted health care professionals. OBJECTIVE The aim of this study was to explore ways in which a Lean intervention may impact the clinical work of emergency medicine nurses and physicians. METHODS We used a realist grounded theory approach to explore the clinical work of nurses and physicians practicing in 2 emergency medicine departments from a single teaching hospital in Canada. The hospital has 1000 beds with 128,000 emergency department (ED) visits annually. In 2013, both sites began a large-scale, Lean-driven system transformation of their practice environments. In-person interviews were iteratively conducted with health care professionals from July to December 2017. Information from transcripts was coded into categories and compared with existing codes. With repeated review of transcripts and evolving coding, we organized categories into themes. Data collection continued to theoretical sufficiency. RESULTS A total of 15 emergency medicine nurses and 5 physicians were interviewed. Of these, 18 individuals had practiced for at least 10 years. Our grounded theory involved 3 themes: (1) organization of our clinical work, (2) pushed pace in the front cell, and (3) the toll this all takes on us. Although the intervention was supposed to make the EDs work easier, faster, and better, the participants in our study indicated that the changes made had the opposite impact. Nurses and physicians described ways in which the reconfigured EDs disrupted their established practice routines and resulted in the intensification of their work. Participants also identified indications of deskilling of nurses’ work and how the new push-forward model of patient care had detrimental impacts on their physical, cognitive, and emotional well-being. CONCLUSIONS To our knowledge, this is the first study to describe the impact of Lean health care on the working conditions and actual work of emergency medicine nurses and physicians. We theorize that rather than support health care professionals in their management of the complexities that characterize emergency medicine, the physical and process-based changes introduced by the Lean intervention acted to further complicate their working environment. We have illuminated some unintended consequences associated with accelerating patient flow on the clinical workflow and perceived well-being of health care professionals. We identify some areas for reconsideration by the departments and put forward ideas for future research.

scholarly journals Efficacy of a brief online mindfulness-based intervention on the psychological well-being of health care professionals and trainees during the COVID-19 pandemic: A mixed method design

2021 ◽  
Vol 26 ◽  
Author(s):  
Iram Osman ◽  
Shaista Hamid ◽  
Veena S. Singaram
Keyword(s):  
South Africa ◽  
Health Care ◽  
Mixed Method ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Well Being ◽  
Personal Accomplishment ◽  
Intervention Analysis ◽  
Health Crisis ◽  
The Impact

Background: During the coronavirus disease 2019 (COVID-19) pandemic, health professionals were pushed to the front line of a global health crisis unprepared and resource constrained, which affected their mental well-being.Aim: This study aimed to investigate the effectiveness of a brief online mindfulness-based intervention (MBI) on stress and burnout for health professionals training and working in South Africa during the COVID-19 crisis.Setting: The context of the study is the overburdened, under-resourced health care system in South Africa during a global pandemic.Methods: A mixed method framework was adopted for this study. The quantitative data was analysed using descriptive analysis and the participants’ qualitative experiences were interpreted using interpretative phenomenological analysis.Results: Forty-seven participants took part in this study. The study found a statistically significant (p 0.05) reduction in stress levels and emotional exhaustion as well as an increase in mindful awareness and feelings of personal accomplishment after the intervention. The participants’ shared experiences were analysed in two parts. The pre-intervention analysis presented with central themes of loss of control and a sense of powerlessness because of COVID-19. The post-intervention analysis comprised themes of a sense of acquired control and empowerment through increased mindfulness.Conclusions: The study found that a brief online MBI can be associated with reduced levels of stress and burnout as well as an increased sense of control and empowerment, felt both personally and professionally, during a global crisis.Contribution: The impact of an online MBI for health care professionals amidst a pandemic has not been previously documented.

Effects of Mindful Self-Compassion Training on Increasing Self-Compassion in Health Care Professionals

2021 ◽  
Vol 75 (Supplement_2) ◽  
pp. 7512515315p1-7512515315p1
Author(s):  
Susan M. Knier ◽  
Julie L. Watson ◽  
Jennifer O’Connor Duffy
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Well Being ◽  
Self Compassion ◽  
The Impact ◽  
Health And Well Being ◽  
Primary Author

Abstract Date Presented 04/22/21 Health care professionals are vulnerable to stress overload and risks that threaten health and well-being. This study investigated the impact of mindful self-compassion (MSC) training on people working in health care. Overall, self-compassion and subscale scores showed significant improvement. Participants indicated that self-compassion and positive mind states were integrated into their lives. OTs could assimilate MSC as an adjunct approach for their clients and their selves. Primary Author and Speaker: Susan M. Knier

scholarly journals Experiences of Using Web-Based and Mobile Technologies to Support Self-Management of Type 2 Diabetes: Qualitative Study (Preprint)

2017 ◽  
Author(s):  
Laura Kelly ◽  
Crispin Jenkinson ◽  
David Morley
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Health Care Professionals ◽  
Well Being ◽  
Mobile Technologies ◽  
Self Management ◽  
Coordinated Care ◽  
Web Based ◽  
The Impact

BACKGROUND The prevalence of type 2 diabetes is rising, placing increasing strain on health care services. Web-based and mobile technologies can be an important source of information and support for people with type 2 diabetes and may prove beneficial with respect to reducing complications due to mismanagement. To date, little research has been performed to gain an insight into people’s perspectives of using such technologies in their daily management. OBJECTIVE The purpose of this study was to understand the impact of using Web-based and mobile technologies to support the management of type 2 diabetes. METHODS In-depth interviews were conducted with 15 people with type 2 diabetes to explore experiences of using Web-based and mobile technologies to manage their diabetes. Transcripts were analyzed using the framework method. RESULTS Technology supported the users to maintain individualized and tailored goals when managing their health. A total of 7 themes were identified as important to participants when using technology to support self-management: (1) information, (2) understanding individual health and personal data, (3) reaching and sustaining goals, (4) minimizing disruption to daily life, (5) reassurance, (6) communicating with health care professionals, and (7) coordinated care. CONCLUSIONS Patients need to be supported to manage their condition to improve well-being and prevent diabetes-related complications from arising. Technologies enabled the users to get an in-depth sense of how their body reacted to both lifestyle and medication factors—something that was much more difficult with the use of traditional standardized information alone. It is intended that the results of this study will inform a new questionnaire designed to assess self-management in people using Web-based and mobile technology to manage their health.

scholarly journals A Qualitative Study of the Theory Behind the Chairs: Balancing Lean-Accelerated Patient Flow With the Need for Privacy and Confidentiality in an Emergency Medicine Setting (Preprint)

2018 ◽  
Author(s):  
Elaine Zibrowski ◽  
Lisa Shepherd ◽  
Richard Booth ◽  
Kamran Sedig ◽  
Candace Gibson
Keyword(s):  
Emergency Medicine ◽  
Qualitative Study ◽  
Health Care Professionals ◽  
Family Members ◽  
Value Added ◽  
Clinical Work ◽  
Patient Privacy ◽  
Privacy And Confidentiality ◽  
The Impact ◽  
The Chairs

BACKGROUND Many emergency departments (EDs) have used the Lean methodology to guide the restructuring of their practice environments and patient care processes. Despite research cautioning that the layout and design of treatment areas can increase patients’ vulnerability to privacy breaches, evaluations of Lean interventions have ignored the potential impact of these on patients’ informational and physical privacy. If professional regulatory organizations are going to require that nurses and physicians interact with their patients privately and confidentially, we need to examine the degrees to which their practice environment supports them to do so. OBJECTIVE This study explored how a Lean intervention impacted the ability of emergency medicine physicians and nurses to optimize conditions of privacy and confidentiality for patients under their care. METHODS From July to December 2017, semistructured interviews were iteratively conducted with health care professionals practicing emergency medicine at a single teaching hospital in Ontario, Canada. The hospital has 1000 beds, and approximately 128,000 patients visit its 2 EDs annually. In response to poor wait times, in 2013, the hospital’s 2 EDs underwent a Lean redesign. As the interviews proceeded, information from their transcripts was first coded into topics and then organized into themes. Data collection continued to theoretical sufficiency. RESULTS Overall, 15 nurses and 5 physicians were interviewed. A major component of the Lean intervention was the construction of a three-zone front cell at both sites. Each zone was outfitted with a set of chairs in an open concept configuration. Although, in theory, professionals perceived value in having the chairs, in practice, these served multiple, and often, competing uses by patients, family members, and visitors. In an attempt to work around limitations they encountered and keep patients flowing, professionals often needed to move a patient out from a front chair and actively search for another location that better protected individuals’ informational and physical privacy. CONCLUSIONS To our knowledge, this is the first qualitative study of the impact of a Lean intervention on patient privacy and confidentiality. The physical configuration of the front cell often intensified the clinical work of professionals because they needed to actively search for spaces better affording privacy and confidentiality for patient encounters. These searches likely increased clinical time and added to these patients’ length of stay. We advocate that the physical structure and configuration of the front cell should be re-examined under the lens of Lean’s principle of value-added activities. Future exploration of the perspectives of patients, family members, and visitors regarding the relative importance of privacy and confidentiality during emergency care is warranted.

scholarly journals When One is Sick and Two Need Help: Caring for the Caregiver

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Susan Law
Keyword(s):  
Health Care ◽  
Healthcare Professional ◽  
Healthcare System ◽  
Health Care Professionals ◽  
Well Being ◽  
Physical Illness ◽  
Chronic Physical Illness ◽  
Video And Audio ◽  
Educational Modules ◽  
The Impact

Objectives: To increase public and professional understanding of caregiving experiences of people who care for adults with chronic physical illness; to promote the use of caregivers’ lived experiences in the education of healthcare professionals.Methods: Part 1: 40 qualitative audio/video recorded interviews were conducted with adult caregivers in a maximum variation sample from across Canada. Data collection and analysis is via rigorous qualitative research. 25 topics or themes are identified reflective of the participants’ concerns, meanings and priorities.Results including video, audio or text clips, and evidence-informed resources are published on www.healthexperiences.ca. The methods are adopted from the award-winning website (www.healthtalkonline.org) from Oxford University, UK.Part 2: collaboration with healthcare professionals, educational experts, researchers and caregivers to design educational modules to be piloted in University setting for healthcare professional education.Results: Caregivers described their experiences with the healthcare system as part of their role. They provide advice to health care professionals about issues such as access to information and services, attitude and behaviours, the impact of caregiving on their own well-being , and reflections on their role. Participants emphasize the importance of recognition for their role as part of the care team for patients with chronic physical illnesses. Some described the need for the healthcare system to consider caregivers as an important component in the ‘a circle of care’ around the patient. If caregivers suffer physical or mental illness, burn-out or lack of resources, the support system for the patient falls away. Educational modules featuring video and audio clips of caregivers’ stories are powerful educational tools in developing healthcare professional sensitivity to these issues in patient care.Conclusion: The www.healthexperiences.ca / www.experiencessante.ca sites are unique in Canada in the field of patient experiences and healthcare communication. It is a great resource to educate health care professionals about the caregivers’ perspective on caring for adults with chronic physical illness.

Pre-Implementation Case Studies Evaluating Workflow and Informatics Challenges in Private Primary Care Clinics for Electronic Medical Record Implementation

2020 ◽  
pp. 1297-1305
Author(s):  
Calvin Or
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Professionals ◽  
Clinical Work ◽  
Work Processes ◽  
Clinical Workflow ◽  
Design Work ◽  
Health Care Clinics ◽  
Primary Health ◽  
Potential Benefits

Despite the potential benefits of electronic medical records (EMRs), their implementations have failed in a number of instances because of misfit between the technology design, work practices, workflows, and clinicians' needs. To promote effective design and implementation of an EMR system, the present pre-implementation study modeled the clinical workflow processes in private primary health care clinics and identified the associated gaps, weaknesses, and informatics challenges in the processes. Systematic field observations were performed to collect workflow data. Forty-three health care professionals (16 physicians and 27 clinical assistants) of fifteen private primary health care clinics were studied. The results, presented in a workflow diagram, demonstrate step-by-step details of the clinical work processes, their gaps and weaknesses, and possible improvement opportunities offered by the application of EMR. The workflow model provides important implications that may be applicable to other health care settings that plan to implement EMRs.

scholarly journals Radiation Injury and Emergency Medicine

2020 ◽  
Author(s):  
James Shen ◽  
Linda Ding ◽  
Kevin O’Connor ◽  
Ameer Elaimy ◽  
Carla Bradford ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Medicine ◽  
Radiation Exposure ◽  
Health Care Professionals ◽  
Well Being ◽  
Acute Injury ◽  
Initial Exposure ◽  
Treatment Management ◽  
Minimize Radiation Exposure ◽  
Effects Of Radiation

The discovery of radiation has led to many advances. Guidelines have been created to minimize radiation exposure and treatment management following both unintentional and intentional exposure. The effects of radiation exposure on specific tissues varies. Tragic consequences can result, ranging from severe, acute injury to long- lasting effects that present years after the initial exposure. In this chapter we provide observations that demonstrate the importance of understanding guidelines to minimize radioactive exposure and the expectations and treatment management following exposure. For the safety and well-being of patients, health care professionals need to remain well-informed to minimize the risks of this tool.

scholarly journals Death and Mourning Process in Frontline Health Care Professionals and Their Families During COVID-19

2021 ◽  
Vol 12 ◽  
Author(s):  
Sreeja Das ◽  
Tushar Singh ◽  
Rahul Varma ◽  
Yogesh Kumar Arya
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Health Care Professionals ◽  
Healthcare Professionals ◽  
Well Being ◽  
Post Traumatic Stress ◽  
Personal Protection Equipment ◽  
Care Workers ◽  
The Impact ◽  
Mourning Process

The COVID-19 epidemic has mushroomed globally, disrupting the existence of millions. Under this current pandemic situation, the frontline health care professionals are looped in the clutch of the virus and are relatively more exposed to the patients infected with the disease. In this precarious situation, the frontline health care professionals have contributed their best to provide utmost care to the patients infected with the ailment. The direct involvement of these professionals, however, has taken a toll on their physical health as well as on their mental well-being. Several studies conducted recently have reported that frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 are associated with a higher risk of symptoms of depression, post-traumatic stress disorder and other mental health issues. Lack of personal protection equipment, unreasonable amounts of work, improper medicines, fear of contracting the disease, and lack of skilled training have interposed the frontline health care workers with unimaginable stress. Due to the widespread outbreak, the death count of the frontline health care professionals has also surged. However, studies exploring the physical and mental welfare of the frontline health care professionals and their families are very few and far behind. To address this aperture, the present paper attempts to highlight the psychological and physical impact of the COVID-19 pandemic on the frontline health care professions and to understand the impact of the death of these frontline health care professionals on the psychological well-being, mourning process, and complicated grief among the family members of healthcare professionals. The paper also presents some recommendations for providing psychological support to healthcare professionals and their bereaved families.

The Source of Display Rules and their Effects on Primary Health Care Professionals' Well-Being

2009 ◽  
Vol 12 (2) ◽  
pp. 618-631 ◽  
Author(s):  
David Martínez-Iñigo ◽  
Peter Totterdell ◽  
Carlos Maria Alcover ◽  
David Holman
Keyword(s):  
Job Satisfaction ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Professionals ◽  
Well Being ◽  
Relative Contribution ◽  
Primary Health ◽  
Organizational Rules ◽  
The Impact ◽  
Different Sources

Employees‘ perceptions of the emotional requirements of their work role are considered a necessary antecedent of emotion work. The impact of these requirements on the emotions employees display, their well-being, and their clients' satisfaction has been explored in previous research. Emotional requirements have been characterized as organizationally-based expectations (e.g., Brotheridge & Lee, 2003), formal and informal organizational rules (e.g., Cropanzano, Weiss & Elias, 2004), occupational norms (e.g., Rafaeli & Sutton, 1987; Smith & Kleinman, 1989) and job-based demands (Brotheridge & Lee, 2002). Although all these definitions assume some kind of shared source for perceptions of emotional requirements, it remains unclear to what extent these different sources contribute and to what extent the requirements are shared by different units, teams and individuals in the organization. The present study analyses the perception of emotional requirements from a survey of ninety-seven Primary Health Care teams composed of general practitioners, nurses and administrative staff (N = 1057). The relative contribution of different sources of variance (team, organizational, and occupational) to perceived emotional requirements and the effects on employees’ job satisfaction and well being are examined. Results confirm the relevance of the source and show the contribution of emotional demands to prediction of emotional exhaustion and job satisfaction levels.

Sign in / Sign up

Export Citation Format

Share Document