Community-based personal support workers' satisfaction with job-related training at the organization in Ontario, Canada: Implications for future training.

BACKGROUND AND AIMS: Complexity of community-based homecare for older adults has increased significantly in the past decade in Ontario, Canada. Personal support workers (PSWs), who are unregulated and vary in formal education, provide the majority of community homecare work for increasingly complex clients. This paper seeks to understand community-based PSWs' satisfaction with opportunities for job-related training at their employing organization to provide the skills and knowledge to meet the demands of their evolving role. METHODS: Data for this paper are from a cross-sectional survey of 1746 community-based PSWs in Ontario, Canada entitled, "The PSW Health and Safety Matters Survey" www.pswshaveasay.ca. This survey was part of a research project "Keeping Community Based PSWs Safe in a Changing World of Work," funded by the Ontario Ministry of Labour. The data were analyzed using descriptive statistics, correlations, multivariate regression, and thematic analysis. RESULTS: Quantitative analysis revealed most community homecare organizations offer PSWs job-related training to help them retain and update their skills and that PSWs have a moderate level of satisfaction with their job-related training. The analysis revealed that PSWs' satisfaction with organizational training is greater when the organization provides work-related training on challenging tasks, lifting and transferring tasks, and tasks delegated by nurses and supervisors. Data from the open-ended question highlighted seven key themes for desired training by PSWs: safe body mechanics for moving/lifting clients, managing aggression primarily with clients, infection control, CPR/first aid, mental illness, equipment training, and basic health and safety. CONCLUSION: Implications for factors associated with PSWs' satisfaction with opportunities for job-related training are discussed along with recommendations for mitigating variability in education and training to meet the demands of their evolving role.

Violence, Harassment, and Turnover Intention in Home and Community Care: The Role of Training.

BACKGROUND: Violence and harassment affect healthcare workers' well-being and career decisions in the home and community care sector. PURPOSE: The objective of this study is to assess the role of training in alleviating the relationship between violence and harassment at work and turnover intention among personal support workers (PSWs). METHODOLOGY/APPROACH: Cross-sectional survey data from 1401 PSWs in Ontario, Canada are analyzed with structural equation modeling. Utilizing a resource perspective, the associations between job demands (i.e., violence and harassment at work), personal resources (i.e., self-esteem), job resources (i.e., workplace violence training and challenging task training), stress, and intention to stay among personal support workers (PSWs) are examined. RESULTS: Challenging task training is positively associated with self-esteem and negatively associated with stress, whereas workplace violence training does not have a significant association with either variable. Stress has a negative relationship with intention to stay. Self-esteem is the mediator of both associations between violence and harassment at work and stress and between challenging task training and stress. DISCUSSION: The results point to varied degrees of training effectiveness that may be shaping turnover decisions of PSWs who experience violence and harassment in home and community care organizations. PRACTICE IMPLICATIONS: There seems to be a need to assess and redesign workplace violence training. Home and community care managers might be able to lower the impact of violence and harassment on PSWs' turnover by providing training that is not directly related to workplace violence and harassment.

21st Century Realities: The Urgency of Diversifying the Dental Professional Field.

This article asserts that U.S. demographic shifts make it imperative that academic dental institutions and, in turn, the dental profession must diversify to best meet the needs of the nation's quickly changing population. In particular, it argues that the severe underrepresentation of African American and Hispanic students in dental schools is a detriment to those students who are being excluded from a field critical to the well-being of the population, their prospective peers who are thus not afforded the benefits of compositional diversity in the classroom, and the millions of Americans who live in areas with little to no access to culturally competent oral health care. With such complex challenges facing the profession, dental schools must evolve to prepare students of all races, ethnicities, and socioeconomic backgrounds to provide adequate oral health care to the country's changing population.

The influence of autonomy on personal support workers' job satisfaction, capacity to care, and intention to stay.

Using survey data collected in Ontario, Canada, we explore the impacts of autonomy on community-based Personal Support Workers' intrinsic job satisfaction, capacity to care for and about clients, and intention to continue working in home care. Autonomy was measured as "freedom to decide how to do your job" and "working on your own." Findings show that freedom to do your job and working on your own are both positively associated with job satisfaction and capacity to care, and indirectly increase intention to stay through their relationships with job satisfaction and capacity to care. We suggest that policies should allow personal support workers to make decisions about how to do their job within the care plans provided, to facilitate retention of this highly needed workforce.

Effective learning environments - the process of creating and maintaining an online continuing education tool.

Continuing medical education (CME) is an indispensable part of maintaining physicians' competency. Since attending conferences requires clinical absenteeism and is not universally available, online learning has become popular. The purpose of this study is to conduct a retrospective analysis examining the creation process of an anesthesia website for adherence to the published guidelines and, in turn, provide an illustration of developing accredited online CME. Using Kern's guide to curriculum development, our website analysis confirmed each of the six steps was met. As well, the technical design features are consistent with the published literature on efficient online educational courses. Analysis of the database from 3937 modules and 1628 site evaluations reveals the site is being used extensively and is effective as demonstrated by the participants' examination results, content evaluations and reports of improvements in patient management. Utilizing technology to enable distant learning has become a priority for many educators. When creating accredited online CME programs, course developers should understand the educational principles and technical design characteristics that foster effective online programs. This study provides an illustration of incorporating these features. It also demonstrates significant participation in online CME by anesthesiologists and highlights the need for more accredited programs.

Health and safety matters! Associations between organizational practices and personal support workers' life and work stress in Ontario, Canada.

BACKGROUND: The home and community care sector is one of the fastest growing sectors globally and most prominently in mature industrialized countries. Personal support workers (PSWs) are the largest occupational group in the sector. This paper focuses on the emotional health of PSWs working in the home and community care sector in Ontario, Canada. The purpose of this paper is to present evidence on the associations between PSWs' life and work stress and organizational practices of full-time and guaranteed hours, and PSWs' perceptions of support at work and preference for hours. METHODS: Data come from our 2015 survey of 1543 PSWs. Dependent variables are life and work stress. Independent variables are: objective organizational practices of full-time and guaranteed hours, and subjective organizational practices of perceived support at work, and preferred hours of work. Descriptive statistics, correlations and ordinary least square regression analyses with collinearity tests are conducted. RESULTS: Organizational practices of employing PSWs in full-time or guaranteed hours are not associated with their life and work stress. However, those who perceive support from their organizations are also the ones reporting lower life and work stress. In addition, those PSWs perceiving support from their supervisor report lower work stress. PSWs would like to work in their preferred hours, and those who prefer to work more hours report lower life and work stress, and conversely, those who prefer to work less hours report life and work stress. CONCLUSION: For PSWs in home and community care, perceived support from their organizations and supervisors, and employment in preferred hours are important factors related to their life and work stress.

The effect of gowning on labor epidural catheter colonization rate: a randomized controlled trial.

BACKGROUND: The need to gown for labor epidural catheter insertion is controversial. The American Society of Regional Anesthesia and Pain Medicine has identified a lack of randomized controlled trials investigating this issue. The purpose of this study was to examine the effect of gowning on colonization rates following epidural catheter insertion for labor analgesia. METHODS: Following research ethics board approval and informed written consent, parturients were randomized to undergo epidural analgesia with the anesthesiologist either ungowned or wearing a sterile gown. Cultures were obtained from each of the operator forearms, the work area under the insertion site, and from the epidural catheter tip as well as from the catheter segment adjacent to the insertion site. The primary outcome was growth of any microbial organisms from the cultured sites. RESULTS: Two hundred fourteen patients completed the study. There were no significant differences in catheter-tip colonization rates between the ungowned and gowned groups (9.2% vs 7.6%, respectively). The most common microorganism that was cultured was coagulase-negative Staphylococcus. CONCLUSIONS: The use of gowns in the current study did not affect catheter colonization rate. Overall, there was a relatively high incidence of catheter-tip colonization in both groups, which underscores the need for strict aseptic technique.

Low-fidelity simulation improves mastery of the aseptic technique for labour epidurals: an observational study.

PURPOSE: The objective of this study was to determine the impact of a low-fidelity simulation model on mastering the sterile technique during placement of epidural catheters. METHODS: Trainees, including residents and fellows, were given conventional teaching consisting of a lecture and a video demonstration on the appropriate sterile technique to apply during the placement of epidural catheters. The trainees were then provided with a one-on-one demonstration session using a low-fidelity Styrofoam™ epidural model, followed by a series of simulation sessions. After conventional teaching and following each simulation session, the trainees were assessed on their performance until competence was achieved based on a 15-point checklist. The retention of competence was subsequently evaluated bi-weekly in clinical practice for four assessments. RESULTS: Twenty-one trainees participated in the study. The average score for the residents following conventional teaching was 6.0 out of 15 points on the checklist. Following the initial one-on-one hands-on demonstration, the average score increased to 10.8 (difference = 4.8, 95% confidence interval (CI): 3.3 to 6.2; P < 0.001). The average score for the fellows following conventional teaching was 7.9 out of 15 points on the checklist. Following the initial one-on-one hands-on demonstration the average score increased to 11.2 (difference = 3.3, 95% CI: 0.05 to 6.6; P = 0.047). During the retention of competence phase, scores ranged from 13-15 for both residents and fellows. CONCLUSION: This study describes a comprehensive teaching model for mastering the sterile technique during epidural catheter placement. It suggests that low-fidelity simulation improves the learning process when used in addition to conventional teaching.

Minors or suspects? A discussion of the legal and ethical issues surrounding the indefinite storage of DNA collected from children aged 10-18 years on the National DNA Database in England and Wales.

There are currently over 250,000 children between the ages of 10 and 18 years who have their genetic information stored on the National DNA Database. This paper explores the legal and ethical issues surrounding this controversial subject, with particular focus on juvenile capacity and the potential results of criminalizing young children and adolescents. The implications of the adverse legal judgement of the European Court of Human Rights in S and Marper v UK (2008) and the violation of Article 8 of the Convention are discussed. The authors have considered the requirement to balance the rights of the individual, particularly those of minors, against the need to protect the public and have compared the position in Scotland to that of the rest of the UK. The authors conclude that a more ethically acceptable alternative could be the creation of a separate forensic database for children aged 10-18 years, set up to safeguard the interests of those who have not been convicted of any crime.

Management of simulated maternal cardiac arrest by residents: didactic teaching versus electronic learning.

PURPOSE: Successful resuscitation of a pregnant woman undergoing cardiac arrest and survival of the fetus require prompt, high-quality cardiopulmonary resuscitation. The objective of this observational study was to assess management of maternal cardiac arrest by anesthesia residents using high-fidelity simulation and compare subsequent performance following either didactic teaching or electronic learning (e-learning). METHODS: Twenty anesthesia residents were randomized to receive either didactic teaching (Didactic group, n = 10) or e-learning (Electronic group, n = 10) on maternal cardiac arrest. Baseline management skills were tested using high-fidelity simulation, with repeat simulation testing one month after their teaching intervention. The time from cardiac arrest to start of perimortem Cesarean delivery (PMCD) was measured, and the technical and nontechnical skills scores between the two teaching groups were compared. RESULTS: The median [interquartile range] time to PMCD decreased after teaching, from 4.5 min [3.4 to 5.1 min] to 3.5 min [2.5 to 4.0 min] (P = 0.03), although the change within each group was not statistically significant (Didactic group 4.9 to 3.8 min, P = 0.2; Electronic group 3.9 to 2.5 min, P = 0.07; Didactic group vs Electronic group, P = 1.0). Even after teaching, only 65% of participants started PMCD within four minutes. Technical and nontechnical skills scores improved after teaching in both groups, and there were no differences between the groups. CONCLUSION: There are gaps in the knowledge and implementation of resuscitation protocols and the recommended modifications for pregnancy among residents. Teaching can improve performance during management of maternal cardiac arrest. Electronic learning and didactic teaching offer similar benefits.

Psychopathology in children before and after surgery for extratemporal lobe epilepsy.

AIM: To establish the rates and types of psychiatric disorder in children before and after surgery for extratemporal epilepsy. Relationships between psychiatric morbidity and demographic/clinical variables were examined. METHOD: A retrospective case note review of 71 children undergoing extratemporal focal resection for drug resistant epilepsy in a specialist epilepsy surgery programme between 1997 and 2008. Psychiatric diagnoses were derived from pre- and postoperative assessments according to DSM-IV criteria. RESULTS: Seventy-one children (38 males, 33 females) were eligible for this study. Mean age (SD) at surgery was 9 (5) years. Frontal resections were performed in 73% of the children, parietal in 17%, and occipital in 10%. Mental health problems were present in 37 of 71 (52%) children pre- and/or postoperatively. A similar proportion of children had psychiatric diagnoses pre- and postoperatively: 31 of 71 (44%) and 32 of 71 (45%) respectively. INTERPRETATION: Psychopathology is common in children with extratemporal epilepsy. In this sample, the impact of surgery on psychiatric symptoms was not predictable: some children were unchanged, others improved, and others acquired new psychiatric diagnoses postoperatively. Given the high rates of psychiatric disorder in this group of patients, detection and treatment of mental health needs may be important.

Treatment dilemmas in a young man presenting with narcolepsy and psychotic symptoms.

Psychotic features can be present in both narcolepsy and psychosis, which can result in challenges in diagnosis and management. The prevalence of both conditions is low and the reports in young people are scarce. Our report illustrates the relevance of a thorough differential diagnosis as well as the need to explore treatment avenues based on the evidence available for both narcolepsy and psychosis symptoms to try and maximise the therapeutic impact.

Casualized employment and turnover intention: home care workers in Ontario, Canada.

The purpose of this paper is to examine the associations between casualized employment and turnover intention in home care. Casualized employment refers to employment conditions of non-permanent contracts, part-time or casual hours, involuntary hours, on-call work, split shifts, pay per visit, and hourly pay with variable hours. Casualized employment also refers to perceived employment insecurity and labour market insecurity. Data are from a survey of 991 visiting nurses, therapists and home support workers in a medium-sized city in Ontario, Canada. Results show that, controlling for many other factors, casual hours and perceived employment insecurity and labour market insecurity are positively and on-call work is negatively associated with home care workers' turnover intention. Non-permanent contract, part-time hours, involuntary hours, split shifts, and non-salaried pay are features of the market-modelled home care work environment and therefore may not be associated with turnover intention. Results provide evidence on the effects of casualized employment strategies on home care workers' turnover intention.

Atypical presentation of an epidural hematoma in a patient receiving aspirin and low molecular weight heparin. Was epidural analgesia the right choice?

A case of postoperative epidural hematoma with an atypical presentation and an excellent outcome in an 80 year-old woman who received both prophylactic aspirin and enoxaparin following a primary total knee arthroplasty, is presented. She developed lower limb neurological symptoms, fully recovered, and then deteriorated again. The hematoma was surgically evacuated, resulting in full neurological recovery. Epidural analgesia may not be the best choice for pain management in patients who require the combined use of aspirin and low-molecular weight heparin postoperatively.

Office home care workers' occupational health: associations with workplace flexibility and worker insecurity.

Office home care workers provide support to visiting staff, although their work tends to be invisible in many respects. This paper focuses on managers, supervisors, coor dinators, case managers and office administrative staff in home care. We examine the effects of workplace flexibility and worker insecurity on office home care workers' occupational health, particularly their self-reported stress and musculoskeletal disorders. Data come from our survey of 300 home care office staff in a mid-sized city in Ontario. Results show that workers' perceptions of insecurity are positively associated with musculoskeletal disorders but not workplace flexibility measures. We recommend that managers and other decision-makers in the home care field pay attention to the perceptions of workers' insecurity in initiating workplace flexibility measures.

Experience is not enough: repeated breaches in epidural anesthesia aseptic technique by novice operators despite improved skill.

BACKGROUND: Invasive procedures such as epidural anesthesia carry risks for complications such as erroneous placement arising from inadequate manual skills and infection secondary to breaches in aseptic technique. Although it is assumed that improvement in aseptic technique parallels improved dexterity, this assertion remains unproven. The aim of this study was to determine whether increased proficiency in the manual skills for epidural anesthesia is associated with improved aseptic technique. METHODS: Second-year anesthesia residents were repeatedly videotaped performing epidural anesthesia over 6-month periods. Three independent examiners blinded to the level of training of the residents evaluated the procedures for manual skills and aseptic technique. Each procedure was graded using a manual skills checklist, a global rating scale, and an aseptic technique checklist. The main outcome measures were the scores for these three tools. RESULTS: Thirty-five sessions were videotaped over 1 yr. Interrater reliability was nearly perfect. A strong positive association was found between increased experience and manual skills, as reflected by the scores achieved on both the manual skills checklist and the global rating scale. In contrast, a nonsignificant or very weak correlation was found between the aseptic technique checklist total scores and the number of epidurals performed. CONCLUSION: Manual skills for invasive procedures improved with increasing experience, but aseptic technique did not, despite formal teaching. These findings reflect major gaps in the understanding and teaching of the principles of aseptic technique, most likely due to lack of structured training. Educational initiatives are needed to correct these teaching gaps.