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OBJECTIVE: This observational study aimed to determine whether attachment style predicted first responders' mental health and resilience. METHOD: Data were from a treatment-seeking sample of first responders ( N = 237). Each participant completed six assessments measuring attachment, resilience, generalized anxiety, depression, suicidality, and posttraumatic stress disorder. RESULTS: On the attachment assessment, 25.3% were categorized as secure, 19.0% as dismissive, 25.3% as preoccupied, and 30.4% as fearfully attached. As predicted, securely attached participants had the lowest scores for generalized anxiety, depression, suicidality, and posttraumatic stress disorder and the highest scores on the resiliency measure, followed by dismissive, preoccupied, and fearfully attached participants. LIMITATIONS: These data are cross-sectional and causality cannot be inferred. CONCLUSIONS: Results highlight the importance of the study of attachment to psychotherapy and mental health treatment with first responders.
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Emergency Responders , Stress Disorders, Post-Traumatic , Humans , Mental Health , Cross-Sectional Studies , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Anxiety/epidemiologyABSTRACT
Introduction/Aim: Studies of the lived experience of Chronic Obstructive Pulmonary Disease (COPD) reveal a number of challenges patients face when interacting with healthcare providers that may be exacerbated by unwillingness or inability to quit smoking. However, none have explored, in-depth, primary care experiences among patients with COPD in community healthcare settings. The study investigated primary care experiences of patients living independently in the community with doctor diagnosed COPD, who smoke or had recently quit smoking and focused on how vulnerability, stigma and emotional components of care shape care experiences. Method(s): An Interpretative Phenomenological Analysis (IPA) involving thirteen participants purposively recruited from social media posts in COPD and carer support groups, general community groups, community noticeboards and paid adverts on social media. In-depth interviews were held between February and April 2022 by phone or Zoom TM and explored healthcare experiences, smoking, stigma and impact of care during COVID-19. Cross-case analysis was conducted to form group experiential themes. Result(s): Participants were aged between 45 to 75 years. Nine were female and two-thirds were current daily smokers. Both positive and negative experiences were explored. Problematic experiences including time-constrained consultations ('You're a number, and that's where I feel like a sheep and [that] can stress you out more'), having to self-advocate for care, and guilt about smoking were common. Positive care experiences described non-judgemental interpersonal interactions with doctors, timely referral, proactive care and trust ('I have an actual great trust for my GP. they're awesome, they'll look after you'). Conclusion(s): Pro-active, empathetic care from GPs is desired by patients living with COPD who continue to smoke but this is not always reflected in the lived experience of care. Stigma and fear of judgement were important underlying drivers of negative care experiences and need to be carefully considered in provision of care for this group.
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School closures because of the COVID-19 pandemic affected over a billion young people worldwide and presented a threat to long-term learning, particularly for public school students in low socioeconomic situations. This article offers quasi-experimental evidence on a low-cost strategy for distance learning applied in the Republic of Panama to minimize the negative consequences of the pandemic on public elementary school children's reading levels. We conducted a 12-week intervention that utilized mobile phone technology and dissemination of reading material through WhatsApp, a cross-platform messaging freeware service, to maintain and improve children's reading levels during the pandemic school shutdown. The objective was to determine the feasibility of using WhatsApp as a digital tool to facilitate education and inform evolving practice and policy responses. Results among 292 students between the second and sixth grades indicated overall mean gains of up to 10.3% in the number of words read per minute, with statistically significant improvements overall and higher gains among the second and third grades. In addition, the adoption rate was high, with a reported average of 84% completion of the daily readings. The results of this low-tech intervention have immediate and longer-term implications for using mobile technology as a supplemental or complementary learning tool, especially for developing regions and during school closures or school vacations. © 2022, The International Academic Forum (IAFOR). All rights reserved.
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Background: Studies of adults living with Chronic Obstructive Pulmonary Disease (COPD) reveal a number of challenges when interacting with healthcare providers and may be exacerbated by unwillingness or inability to quit smoking. However, none have explored in-depth, primary care experiences among patients with COPD in the Australian healthcare setting. Aim/Objectives: The study used Interpretive Phenomenological Analysis (IPA) to explore healthcare experiences of participants in primary care settings amongst current smokers or those who had recently quit smoking. Method(s): The study was guided by principles of IPA and participants' sense-making of their personal and social 'world', particular experiences, events and emotions were explored. Thirteen participants were purposively recruited from 33 responses to social media posts in COPD and carer support groups, general community groups, community noticeboards and paid adverts. In-depth interviews were held between February and April 2022 by phone or Zoom. Interviews explored healthcare experiences, smoking and stigma. Cross-case analysis was conducted to form group experiential themes. Finding(s): Participants self-reported doctor diagnosed COPD, were living in Australia and aged between 45 to 75 years. Nine were female and 60% were current smokers. Interviews explored experiences of care including access, interpersonal care, coordination, comprehensiveness of services and trust. Participants described how their care experience shifted as primary care adapted care delivery during COVID. Problematic experiences included timeconstrained consultations 'You're a number, and that's where I feel like a sheep and they can stress you out more', having to self-advocate for care and guilt about smoking. Positive care experiences described non-judgemental interpersonal interactions with doctors, timely referral, proactive care and trust 'I have an actual great trust for my GP they're awesome, they'll look after you'. Implications: Understanding and valuing the patient experience in healthcare interactions provides insights to how care can be transformed for vulnerable patients living with socially stigmatised illness.
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Introduction Increased demand for endoscopy has created a need to increase the number of Clinical Endoscopists (CEs) contributing to service delivery. From April 2019 CEs were recruited to an accelerated programme of blended training interventions (Core teaching;Masters level modules;Simulation;JAG courses;online lesion recognition (SLATE) courses;Training lists;and Online Tutorials) - providing a pathway from novice to JAG certification within 12 months for Upper GI endoscopy, and 2 years for Colonoscopy. Methods We conducted quantitative and qualitative evaluation mapped to a logic model of the impact and effectiveness of two CE cohorts using triangulated evidence sources - literature review;workplace observation, surveys and interviews with trainees;interviews with stakeholders - trainers and mentors;discussions with course leaders;Data from the Cognitive Load Inventory for Colonoscopy (CLIC) survey;and Programme outcome data. Results Of ten trainees evaluated, one resigned (lack of local support). COVID adversely affected time taken to complete training - six completed all elements of training in time (3 JAG Certified, 3 in process of certification);three still in training were all redeployed. All trainees and trainers agreed the programme supports the development of technical skills required for the CE role. Endoscopic non-technical skills (ENTS) were highlighted as important - lesion recognition, decision-making, report writing & patient management - and take time to develop. All trainees reported positive impact on them personally, their career prospects and on their Units. They enjoyed peer learning and developed new skills in negotiating with colleagues and advocating for patients. Prior experience in an endoscopy unit correlated with better progress through the course and older trainees reported less extrinsic cognitive load. A dedicated trainer was critical to success, supported rapid progression and resolved training issues more effectively. Lack of training lists was the biggest barrier to progression. Academic supervision and support was valued. Trainers felt selection of the 'right' trainee was critical and wanted greater involvement in the selection process. A number of areas for programme improvement have been identified - recruitment process, trainer involvement in induction, programme manual, training agreements, developing independent prescribing competency. Conclusions The blended CE training pathway supports the acquisition of technical skills and ENTS from novice to JAG Certification. Qualitative review has highlighted several areas where the programme can be improved.
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Introduction There is a UK-wide need to increase the number of Clinical Endoscopists (CEs). From April 2019 CEs were recruited to an accelerated programme of training (small group teaching, Masters level modules;simulation;JAG courses;training lists;and on-line courses & tutorial groups) - to achieve JAG accreditation. Methods We conducted quantitative & qualitative evaluation mapped to a logic model (1) of the impact of the training. We combined evidence from literature review, observation, surveys and interviews with trainees, trainers & mentors;discussion with course leaders;data from the Cognitive Load Inventory for Colonoscopy (CLIC) survey (2) and review of programme outcome data. Results Ten trainees in two cohorts were evaluated - six completed all elements of training, three are still in training (redeployed due to COVID). Thematic analysis highlighted eight areas: technical skills, non-technical skills, the programme, academic elements, training units, trainers, personal qualities, and career development. All trainees reported acquiring technical skills enabling them to undertake procedures safely. Trainees reported significant highs and lows. Older trainees and those with experience of working in endoscopy units reported less cognitive load. Non-technical skills took longer but leading the team or writing reports with support from tutors were helpful in overcoming anxieties. Trainees valued the structure the programme provided - structured handbooks and parallel training for independent prescribing would have added value. Good clinical and senior nurse support correlated with good progression. Trainees described barriers of professional jealousy, no identified trainer or training list, or lack of senior support. COVID-19 was a factor. Trainers identified the resilience, resourcefulness and negotiating as key skills and felt they could identify applicants most likely to succeed. Trainees were motivated to take on the role but needed help and support if training had not gone well. Conclusion The journey taken by CEs to acquire the skills required for advanced practice roles tests a wide range of knowledge, motor, and professional skills. Developing the crucial critical thinking and cognitive skills must develop alongside mental resilience, and requires support from course tutors, optimally designed course elements, access to training lists and supportive local teams.
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Background: During the COVID-19 pandemic possible substance use disorders (SUD) were exacerbated from increased stress and isolation. Experiences of symptomology differ widely by occupations.Objectives: The objectives were to determine if there is a temporal relationship between COVID-19 vulnerability and possible SUDs among first responders, and to examine the association with neighborhood vulnerability.Methods: We conducted an analysis with two distinct cohorts dependent on time of entry: 1) First responders that began counseling prior to COVID-19 and 2) First responders that began counseling after the start of COVID-19. Data were collected at intake from first responders seeking mental health services between 2017 and 2021 at an organization in Dallas/Fort Worth, Texas. The study sample included 195 mostly male (75%) first responders (51% law enforcement officers; 49% emergency medical technicians/firefighters). Bivariate models tested unadjusted relationships between covariates and possible SUD. Adjusted models consisted of a two-level multivariable logistic regression models.Results: Nearly 40% (n = 77) screened positive for a possible SUD. Those beginning counseling after COVID-19 did not have higher odds of SUDs. For every unit increase in neighborhood Severe COVID-19 Health Risk Index at a first responder's residential location there was an increase in the odds of a possible SUD (AOR = 3.14, 95% CI: 1.47, 6.75).Conclusions: Our study highlights the degree to which personal and residential vulnerability to COVID-19 impacted first responders. The increased occupational stress of this population, and an established pattern of maladaptive coping, elucidates the need for preventative and clinical approaches to strengthen the resilience of this population.
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Background: The University of Queensland Medical School Mental Health (MH) curriculum had a large online presence prior to 2020, with interactive learning resources and assessments. However, the teaching of clinical skills such as history-taking and mental state examination was typically conducted through small group-based learning and clinical placement. Objectives: To describe The University of Queensland Medical School MH rotation adaptations to teaching clinical skills to account for appropriate social distancing and lockdown learning. Methods: The benefits and challenges associated with physically distanced and online patient simulation for clinical psychiatric skills will be explored. The organisational requirements will also be detailed. Findings: Online patient simulation sessions, facilitated by psychiatrist tutors, allowed appropriate progression of learning and assessment of clinical skills during times when medical students were unable to undertake clinical placement. Feedback provided by students, tutors and patient simulators did not indicate a difference in quality or tolerability. Additional advantages included allowing for increased consistency of teaching across multiple clinical sites and improvement of telehealth interviewing skills. There were significantly increased tutor time requirements, as well as administrative and financial implications. Conclusion: Future development of MH curriculums, including patient simulation, can be enhanced with the MHMELANZ network.
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Background: The mental health (MH) curriculum within undergraduate and postgraduate medical programmes in Australia and New Zealand is fundamental to MH competencies in graduate doctors. Despite a shared professional practice, there is an absence of a community of MH lead educators in medical degrees. Objectives: To develop a community of practice network, to enhance the quality, consistency and delivery of the MH curriculum and to enhance standards, resource development, teaching learning and assessment methodology. Challenges to consider include space in the curriculum, online learning during the COVID-19 pandemic and approaches to curriculum delivery posed by lived experiences of students. Methods: Development of the Mental Health Medical Education Leads Australia and New Zealand (MHMELANZ) Mental Health Educators network will be presented. Findings: MH medical education leads from a range of universities bi-nationally, representing graduate and undergraduate courses, will present an overview of the MH curriculum and current challenges and areas of focus for the MHMELANZ. Conclusion: There will be opportunity for discussion, and further development of a network, and a future special interest group with the Royal Australian and New Zealand College of Psychiatrists.