Annual Retention Survey Results

Fiona Ellwood looks at the current recruitment landscape.

Prevalence, Attitudes, and Factors Influencing Uptake of the COVID-19 Vaccine in Saudi Arabia.

BACKGROUND: The availability and access to COVID-19 vaccinations are critical to a successful pandemic response. More than 70% of the population reportedly needs to be vaccinated against COVID-19 to achieve herd immunity worldwide. However, the reluctance to get vaccinated with the COVID-19 vaccines is holding up the process of vaccination and efforts to control the pandemic and its negative consequences for the global health system, society, and economy. Previous studies have shown low uptake of vaccination in some Middle Eastern countries due to negative attitudes toward vaccination, including concerns about safety and efficacy and doubts about the need for vaccination. AIM: The aim of this study is to investigate the prevalence, attitudes, and factors influencing COVID-19 vaccine acceptance among healthcare workers, academic staff, and students in Saudi Arabia after the vaccine was made widely available by the government. METHOD: A cross-sectional survey was conducted to determine the prevalence, attitudes, and association between demographic factors and uptake of the first or second dose of vaccination among Saudi Arabian health workers and students. Data were collected using an online questionnaire administered and distributed through the Qualtrics platform. RESULTS: The study recruited 173 participants from different countries and from different Saudi regions, most of whom were faculty members (n = 83). Results indicated significant differences between regions; the mean attitude score for the Western region (M 3.23) was significantly higher than that for other regions (M 3.08, p = 0.030). There was also an association between education level and number of vaccine doses received. Thus, the participants with higher education were the most compliant with national vaccination requirements (p = 0.004). Although the three professional groups reported social media as the most frequently reported source of information (p = 0.021), administrators were more likely to receive information from the MOH than other professional groups. Similarly, faculty members were more likely to receive information from colleagues and professional journals than the other two professional groups. CONCLUSIONS: Government officials should build public confidence through vaccination campaigns and devise effective health education programs to increase vaccination uptake. Authorized institutions can effectively use social media platforms to encourage vaccination and promote awareness among all audiences.

Patient Facilitators and Barriers to Accessing Chronic Pain Treatments for Persons with TBI: Provider Perspectives...American Congress of Rehabilitation Medicine (ACRM) 99th Annual Conference, November 8-11, 2022, Chicago, Illinois

To examine patient-focused facilitators and barriers to accessing chronic pain care for individuals with TBI from a national sample of providers. A descriptive, qualitative study guided by a conceptual framework of access to health care services. Medical facilities representing Veteran Affairs, Department of Defense, and civilian health care systems. 63 providers representing VA, DoD, and Civilian sites across the United States. N/A. Facilitators and barriers to chronic pain treatment. Several facilitators were identified by providers, including providing education to ensure comprehension of diagnosis and treatment;patient motivation and buy-in;patients having functional and realistic goals;insurance covering the costs of care and referrals;and patients seeing positive changes in themselves. Providers identified many barriers to care, including patient lack of participation such as no-showing to appointments or not participating in treatments;patients being unsure of telehealth;patient work schedules;lack of transportation;and no caregivers or visitors permitted due to Covid restrictions. Barriers and facilitators to chronic pain treatment exist across multiple dimensions of a healthcare access framework. Given importance of patient motivation and buy-in and engagement in treatment, provider training and experience in motivational enhancement and addressing health beliefs may help facilitate access to chronic pain care when adapted for persons with TBI. Targeted patient education that ensures rationale for treatment and patient acceptance of the treatment was the most discussed facilitator to care. Findings support multiple points of intervention to promote equitable access to chronic pain care for persons with TBI. None.

Occupational Therapists' Experiences in Conducting Home Assessments and Modifications: Virtual Versus In-person Home Visits...American Congress of Rehabilitation Medicine (ACRM) 99th Annual Conference, November 8-11, 2022, Chicago, Illinois

To investigate occupational therapists' experiences with home assessments and modifications in VHA, while comparing virtual to in-person home visits. A preliminary qualitative study using semi-structured individual interviews. Department of Veterans Affairs (VA) Home Based Primary Care (HBPC). Purposefully selected occupational therapists implementing home assessments and modifications for rural Veterans (N=3). Not applicable. Semi-structured individual interview via Microsoft Teams. Home visits to conduct home assessments and modifications for rural Veterans were standards of care delivery. However, travel restrictions and social distance during the COVID-19 pandemic required a shift toward virtual care. Our preliminary results show that the VA Video Connect (VVC) application allows occupational therapists to provide instant feedback and training to Veterans when new equipment is installed in the Veteran's home, without the need to drive long-distance. However, the VVC does not allow occupational therapists to measure physical features of the home, such as door threshold height and hallway width. Participants also reported difficulty evaluating Veterans' functioning, such as balance, strength, and gait pattern. Thus, the VVC improves access to the services but requires additional assistance from caregivers compared to in-home assessments. Initial home assessments are recommended to be conducted during home visits, but follow-up visits can be conducted via telehealth depending on Veterans' and caregivers' ability to utilize telehealth devices and perform self-assessments. The study team has no conflicts of interest to report.

Releasing the pressure

In his first NQP Perspective column, Derek Ford reflects on his journey as a mature student

A Covid-19-vakcinákkal kapcsolatos attitűdök vizsgálata az egészségügyi dolgozók és a laikusok körében

Aim: This study aimed to assess the attitudes towards Covid-19 vaccines among health care workers and laymen and to shed light on the similarities and differences between the two groups. Methods: A self-constructed online questionnaire was administered between June and September of 2022. The sampling method was not random, but we relied on the easy to access people. Data were analysed with IBM SPSS 20.6;descriptive statistics, chi-square, Mann-Whitney probes, and Fisher exact tests were applied (p<0.05). There were 1,041 questionnaires included in the final analysis. Results: There is a vast difference based on vaccination between the two groups;77.9% of healthcare workers have 3 or more vaccines, while 45.9% of laymen have at least 3. According to health care workers vaccination is the most effective way of defence against Covid-19, although they have experienced more side effects and psychological stress due to vaccination than laymen. Laymen are less trusting they think vaccines are dangerous and have more negative effects. Health care workers get information from experts, while laymen rely on online sources and social media. The majority would accept Western vaccines. Based on the vaccine acceptance defined by the WHO both groups are more repulsive than the populations studied earlier. Conclusions: The fears and negative attitudes towards Covid-19 vaccines among laymen can be diminished only by health care workers, therefore it is of high importance that they are well informed. Célkitűzés: A kutatás célja felmérni a laikusok és egészségügyi dolgozók attitűdjét a koronavírus elleni védőoltásokkal kapcsolatban, megkeresni a két csoport közötti hasonlóságokat, különbözőségeket. Vizsgálat módszere: Az online felmérés egy saját készítésű kérdőívvel történt 2022. október–november hónapokban, nem véletlenszerű mintavételi módszerrel, egyszerűen elérhető alanyokra támaszkodó mintavételi eljárással. Az adatfeldolgozás és adatelemzés IBM SPSS 20.6 statisztikai programmal, leíró statisztikai módszerrel, valamint χ2 és Mann–Whitney-próbákkal, Fisher-féle egzakt teszttel történt (p<0,05). Összesen 1041 értékelhető válasz érkezett. Eredmények: Három vagy annál több Covid elleni oltással rendelkezik az egészségügyi szakemberek 77,9%-a, a laikusok 45,9%-a. Az egészségügyi dolgozók szerint az oltás a leghatásosabb védekezés a koronavírus ellen, azonban közülük többen tapasztaltak mellékhatásokat az oltások után, és lelkileg jobban megviselte őket az oltakozás, mint a laikusokat. A laikusok bizalmatlanok, veszélyesebbnek tartják az oltásokat és több negatív hatást tulajdonítanak neki, mint az egészségügyi dolgozók. A legtöbb egészségügyi dolgozó a szakemberektől, míg a laikusok inkább az internetes hírportálokról, közösségi médiából szerzik az információkat. Többségében a nyugati vakcinák elfogadása jellemző a válaszadók körében, azonban a WHO védőoltás elfogadására való hajlandóság stációinak vizsgálata alapján megállapítható, hogy mindkét válaszadói csoportot a szakirodalmi arányokhoz képest elutasító attitűd jellemzi a koronavírus elleni oltással kapcsolatban. Következtetések: A laikusok félelmeit, negatív attitűdjét csak a jól informált egészségügyi dolgozók tudják csökkenteni, ezért fontos az egészségügyi szakember hiteles informálása a védőoltásokról.

Meet Lynda Enos: The Occupational Health Master

The article focuses on Lynda Enos a certified professional ergonomist who has worked in various healthcare and occupational health settings. Topics include discussing her background and how she became interested in occupational health, preventing violence in healthcare settings, and her work for a nursing union.

The Use of Interpreters in Health Centers: A Mixed-Methods Analysis

Health centers serve millions of patients with limited English proficiency (LEP) through highly variable language services programs that reflect patient language preferences, the availability of bilingual staff, and very limited sources of third-party funding for interpreters. We conducted a mixed-methods study to understand interpreter services delivery in federally qualified health centers during 2009–2019. Using the Uniform Data System database, we conducted a quantitative analysis to determine characteristics of centers with and without interpreters, defined as staff whose time is devoted to translation and/or interpreter services. We also analyzed Medicaid-relevant policies' association with health centers' interpreter use. The qualitative component used a sample of 28 health centers to identify interpreter services models. We found that the use of interpreters, as measured by the ratio of interpreter full-time equivalents per patients with LEP, decreased between 2009 and 2019. We did not find statistically significant relationships between interpreter staffing and number of patients with LEP served, or in our examination of Medicaid-relevant policies. Our qualitative analysis uncovered homegrown models with varying program characteristics. Key themes included the critical role of bilingual staff, inconsistent interpreter training, and the reasonably smooth transition to virtual interpretation during COVID-19.

Remote or in-person cancer support? Therapist and service user preferences

Background/Aims: Remote service delivery became a key method of providing therapy for psychological oncology services during the COVID-19 pandemic and beyond. This study aimed to understand the experiences and preferences of both patients and therapists who undertook remote psychological therapy in a cancer support service, with a view to informing ongoing service provision. Methods: A total of 99 out of 152 invited patients completed an online mixed-methods (quantitative and qualitative) audit survey. All patient participants had accessed therapy with the psycho-oncology support team at Guy's Cancer Centre in London. Of the 12 therapists and four trainee therapists working in this service, 11 and two from each group (respectively) completed a corresponding survey about their experiences as therapists. For quantitative data, descriptive statistics were collated. Results: Patients rated their experience of remote therapy as positive, reporting that they felt respected, understood and confident during therapy, and acknowledged the associated advantages of increased accessibility and infection control. Despite this, 87% of patients and 100% of therapists expressed a preference to access or deliver therapy in person, with patients identifying human connection and relationship building as key reasons for choosing in-person delivery. Therapists valued the relational aspects of in-person psychological support and reported that remote delivery had negatively affected the quality of therapy delivered. Conclusions: Understanding the needs and preferences of patients and therapists is important in informing ongoing psychological service delivery. The results highlight the importance of retaining provision for in-person service delivery and offering choice to patients in how they access psychological support, in line with personalised care recommendations made by the NHS Long Term Plan.

Implementation of a digital early warning score (NEWS2) in a cardiac specialist and general hospital settings in the COVID-19 pandemic: a qualitative study.

OBJECTIVES: To evaluate implementation of digital National Early Warning Score 2 (NEWS2) in a cardiac care setting and a general hospital setting in the COVID-19 pandemic. DESIGN: Thematic analysis of qualitative semistructured interviews using the non-adoption, abandonment, scale-up, spread, sustainability framework with purposefully sampled nurses and managers, as well as online surveys from March to December 2021. SETTINGS: Specialist cardiac hospital (St Bartholomew's Hospital) and general teaching hospital (University College London Hospital, UCLH). PARTICIPANTS: Eleven nurses and managers from cardiology, cardiac surgery, oncology and intensive care wards (St Bartholomew's) and medical, haematology and intensive care wards (UCLH) were interviewed and 67 were surveyed online. RESULTS: Three main themes emerged: (1) implementing NEWS2 challenges and supports; (2) value of NEWS2 to alarm, escalate and during the pandemic; and (3) digitalisation: electronic health record (EHR) integration and automation. The value of NEWS2 was partly positive in escalation, yet there were concerns by nurses who undervalued NEWS2 particularly in cardiac care. Challenges, like clinicians' behaviours, lack of resources and training and the perception of NEWS2 value, limit the success of this implementation. Changes in guidelines in the pandemic have led to overlooking NEWS2. EHR integration and automated monitoring are improvement solutions that are not fully employed yet. CONCLUSION: Whether in specialist or general medical settings, the health professionals implementing early warning score in healthcare face cultural and system-related challenges to adopting NEWS2 and digital solutions. The validity of NEWS2 in specialised settings and complex conditions is not yet apparent and requires comprehensive validation. EHR integration and automation are powerful tools to facilitate NEWS2 if its principles are reviewed and rectified, and resources and training are accessible. Further examination of implementation from the cultural and automation domains is needed.

Clinical psychologists' well-being and experiences of home working during COVID-19

Purpose: The purpose of this paper was to explore the well-being and experiences of working from home (WFH) for psychology staff across a range of specialties working within one health board in Scotland during the COVID-19 pandemic. Design/methodology/approach: In total, 161 clinical psychology professionals took part in an online survey that explored experiences of WFH during the COVID-19 pandemic and assessed well-being during this period. Findings: A number of challenges with WFH were identified, including challenges with carrying out clinical work (e.g. communication difficulties, risk assessment) and fewer opportunities for collaborative working and technical/equipment issues. During the WFH period, 46% experienced fatigue, 45% felt stressed and anxious and 30% felt lonely and isolated, compared to normal. Physical health complaints were also common with 37% experiencing aches/pains in back compared to normal and 40% experiencing headaches or migraines. Practical implications: Remote therapy should be directed to those with less complex needs or who require straightforward assessments. There should be increased access to occupational health assessments and provision of ergonomic furniture when WFH, and all staff should be supported to access well-being resources available within the health board. Further evaluation should be carried out to support evidence-based practice of remote clinical work. Originality/value: Few studies have explored the experiences of WFH and/or remotely from the perspectives of clinical psychologists in a Scottish health board. It is expected that this way of working will continue, albeit to a smaller extent;therefore, WFH policy will be informed by the findings.

Supporting staff at a low secure mental health setting during the COVID-19 pandemic

Why you should read this article: • To learn about some adaptations to practice adopted by a low secure mental health unit during the COVID-19 pandemic • To be aware of interventions used to enable staff to continue to support patients during the COVID-19 pandemic • To appreciate that staff's experience of the adaptations to practice and the well-being support offered to them during the pandemic can be used to inform post-pandemic practice The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted the work of healthcare professionals in forensic mental health settings, but also prompted them to adopt new ways of working that have benefits and challenges. A low secure mental health unit in the UK adapted its ways of working during the pandemic by providing staff who could work remotely with the necessary equipment. The unit also implemented a stepped psychological response, as recommended by The British Psychological Society, to assist its staff to continue to support patients. This article describes the unit's response to the pandemic and discusses the findings of two evaluations – staff experiences of remote working and of a group relaxation session. The findings could help inform post-pandemic practice in forensic mental health settings.

Healthcare Workers Weather Respiratory Onslaught

The article offers information on how healthcare workers are facing a rare convergence of a pandemic virus and unusually high levels of seasonal flu and respiratory syncytial virus (RSV). Topics include information on increase in patients with respiratory virus;comments of Ryan Stanton, MD, and a member of Central Emergency Physicians in Lexington, Kentucky;and how physicians are facing lot of strain.

Reshaping wound care: Evaluation of an artificial intelligence app amid the COVID-19 pandemic...Wounds Australia Conference, 14-17 September 2022, Sydney, Australia

Objectives: To evaluate the usability and effectiveness of a digital application for wound care from a clinician-and-patient user perspective. Methods: A quasi-experimental design was conducted in four settings in an Australian health service from July to December 2019 to October 2020. Owing to the coronavirus disease pandemic, the study paused in March 2020 but then restarted immediately after 3 weeks. Data were collected from patients in the standard group (n = 166, 243 wounds), and intervention group (n = 124, 184 wounds). Clinicians participated in a survey (n = 10) and focus group interviews (n = 13) and patients were interviewed (n = 4). Wound documentation data were analysed descriptively. Interviews were thematically analysed. Results: Positive evaluations identified improvements such as instantaneous objective wound assessment, shared wound plans, increased patient adherence and enhanced efficiency in providing virtual care. Compared to the standard group, wound documentation in the intervention group improved significantly (more than two items documented 24% versus 70%, p < .001). During the intervention, 101 out of 132 wounds improved (mean wound size reduction = 53.99 %). The travel-related fuel cost saved for a patient living in a rural area was on average $72.90. Conclusions: The digital application provided real-time wound data with an interface for communication between the patient and clinician and clinicians in a hospital, community, and outpatient setting in a variety of settings. The use of the application facilitated remote patient monitoring, and reduced patient travel time, while maintaining optimal wound care.

[Online schema therapy: a cross-sectional survey among Dutch therapists]

BACKGROUND: Long waiting lists exist for the treatment of personality disorders, which can be shortened by using videoconference treatment. During the COVID-19 pandemic, by necessity, videoconferencing was used to provide schema therapy, a specific treatment for personality disorders.

Charity programme supports practices' mental health services

The article reports that the charity Mind Cymru has urged practice nurses in Wales to refer patients with mild to moderate mental health problems for Great Britain National Health Service (NHS) counseling to a free, guided self-help service. It mentions that the Active Monitoring programme can support practices' mental health service delivery.

Intensive Care Unit, Cardiac Care Unit, and Emergency Department Nurses? Perceptions of Medical Device-Related Pressure Injuries: A Cross-Sectional Study br

BACKGROUND: Nurses' perception of medical device-related pressure injuries (MDRPIs) may affect their performance, but there is a lack of studies in this area.PURPOSE: The current study aimed to examine intensive care unit (ICU), cardiac care unit (CCU) and emergency department nurses' perception of proper prevention of MDRPIs and care for individuals with such injuries.METHODS: This descriptive study was conducted in 4 general hospitals in Iran in 2021. All nurses (N = 310) working in ICUs, CCUs and emergency departments of these facilities were invited to complete a researcher-made demographic check-list and an 11-item questionnaire to assess attitudes toward MDRPIs. The questionnaire item responses were scored from 1 (strongly agree) to 5 (strongly disagree) with the total score for the 11 items ranging from 11 to 55. A score of 11 to 25 was categorized as indicating a negative attitude toward proper prevention of MDRPIs and care for such patients;a score of 26 to 40 indicated a neutral attitude, and a score >40 indicated a positive attitude.RESULTS: A total of 260 nurses fulfilled the data col-lection tool. The response rate was 83.8%. The mean total score of attitude toward MDRPIs was 41.7. No significant relationship was observed between the total score of nurses' attitudes and their demographic variables. Of the 260 participants, 159 stated they had not received any trainings on MDRPIs at nursing schools during their education, 212 stated they had not participated in any scientific workshops on MDRPIs, and 167 described their knowledge about the prevention and care of MDRPIs as insuf-ficient.CONCLUSION: Among ICU, CCU, and emergency nurses in Iran, most had a positive attitude toward the prevention and care of MDRPIs, but steps should be taken to offer more opportunities for nurses to increase their knowledge in this area

Attitudes of Physicians and Nurses in Oman Toward Mandatory COVID-19 Vaccination.

Objectives: To investigate the relationship between attitudes toward COVID-19 vaccines and disapproval of the policy of mandatory COVID-19 vaccination among unvaccinated physicians and nurses in Oman. Methods: The subjects were (N = 346) unvaccinated physicians and nurses in Oman. Their demographic data and attitudes regarding COVID-19 vaccines and mandatory vaccination policy were collected through an anonymous web-based survey and statistically analyzed. Results: The participants' negative attitudes toward COVID-19 vaccines were positively related (r = 0.68, p < 0.001) to the extent of their non-support for COVID-19 mandatory vaccination policy. Analysis of variance test showed that after controlling for age, male healthcare providers were more likely to endorse mandating COVID-19 vaccinations. There was no difference between physicians and nurses in support of mandatory vaccination, after controlling for age. Conclusions: Regardless of job type, male, and older physicians, and nurses in Oman were more supportive of mandatory COVID-19 vaccination than their younger and female counterparts. This research provides insights from an Arabian Gulf country about the attitudes of its unvaccinated healthcare providers toward compulsory COVID-19 vaccination.

Healthcare practitioner perceptions on barriers impacting cannabis prescribing practices.

BACKGROUND: Canadians seeking medical cannabis (MC) may encounter difficulties in finding a healthcare provider (HCP) who authorizes their access to it. Barriers that HCPs face in authorizing MC are unclear. The objectives of this study were to evaluate HCP opinions, knowledge, comfort, and practice in MC prescribing and counseling on recreational cannabis use, and whether the COVID-19 pandemic affected MC prescribing practices. METHODS: Eligible participants included HCPs (e.g., attending physicians, nurses, pharmacists) in Canada. A questionnaire evaluating their knowledge, comfort, and practice in medical and recreational cannabis was designed based on instruments developed in previous studies. Between April 13th-December 13th 2021, ninety-one healthcare associations were asked to distribute the survey to their members, and an advertisement was placed in the online Canadian Medical Association Journal. Descriptive statistics were used to analyze the results. RESULTS: Twenty-four organizations agreed to disseminate the survey and 70 individuals completed it. Of respondents, 71% were attending physicians or medical residents, while the remainder were nurses, pharmacists or other HCPs. Almost none (6%) received training in MC in professional school but 60% did receive other training (e.g., workshops, conferences). Over half (57%) received more questions regarding MC since recreational cannabis was legalized, and 82% reported having patients who use MC. However, 56% felt uncomfortable or ambivalent regarding their knowledge of MC, and 27% were unfamiliar with the requirements for obtaining MC in Canada. The most common symptoms for recommending MC were pain and nausea, whereas the most common conditions for recommending it were cancer and intractable pain. The strongest barrier to authorizing MC was uncertainty in safe and effective dosage and routes of administration. The strongest barrier to recommending or authorizing MC was the lack of research evidence demonstrating its safety and efficacy. During the pandemic, many respondents reported that a greater number of their patients used cannabis to relieve anxiety and depression. CONCLUSIONS: Our results suggest that HCPs across Canada who responded to our survey are unfamiliar with topics related to MC. The strongest barriers appear to be lack of clinical research, and uncertainty in safe and effective MC administration. Increasing research, training, and knowledge may help HCPs feel more equipped to make informed treatment/prescribing decisions, which may help to improve access to MC.