Workplace wellbeing in emergency departments in Aotearoa New Zealand 2020.

AIM: To quantify staff burnout and wellbeing in emergency departments (EDs) throughout New Zealand (NZ). METHODS: A national cross sectional electronic survey of New Zealand clinical and non-clinical ED staff was conducted between 9 March and 3 April 2020. Burnout and wellbeing were assessed using the Copenhagen Burnout Inventory (CBI) and a variety of quantitative measures. Differences between measures were assessed by demography and work role using univariate analyses. Multivariate analyses assessed associations between burnout and wellbeing. RESULTS: 1,372 staff responded from 22 EDs around New Zealand (response rate 43%). Most were female (n=678, 63%), NZ European (n=799, 59%), aged 20-39 years (n=743, 54%) and nurses (n=711, 52%). The overall prevalence of personal burnout was 60%, work-related burnout 55% and patient-related burnout 19%. There was a wide variation of burnout across all EDs. Females and nurses showed the highest degree of burnout by gender and role, respectively. Measures of wellbeing with significant negative correlations with burnout were work-related happiness, work-life balance, job satisfaction and perceived workplace excellence. Work stress had significant positive correlation with burnout. CONCLUSION: New Zealand ED staff have a high degree of burnout. Safety, financial sustainability and quality of care are likely being adversely affected. Stakeholders can be informed by findings from this study to inspire meaningful interventions in EDs and throughout the New Zealand healthcare system.

Facilitators, barriers and opportunities in workplace wellbeing: A national survey of emergency department staff.

INTRODUCTION: Emergency department (ED) staff face daily exposure to the illness, injury, intoxication, violence and distress of others. Rates of clinician burnout are high and associated with poor patient outcomes. This study sought to measure the prevalence of burnout in ED personnel as well as determine the important facilitators of and barriers to workplace wellbeing. METHOD: An anonymous online survey including six open-ended questions on workplace wellbeing was completed by 1372 volunteer participants employed as nurses, doctors, allied health or nonclinical roles at 22 EDs in Aotearoa, New Zealand in 2020. Responses to the questions were analysed using a general inductive approach. RESULTS: The three key themes that characterise what matters most to participants' workplace wellbeing are: (1) Supportive team culture (2) Delivering excellent patient-centred care and (3) Professional development opportunities. Opportunities to improve wellbeing also focused on enhancements in these three areas. CONCLUSION: In order to optimise workplace wellbeing, emergency departments staff value adequate resourcing for high-quality patient care, supportive and cohesive teams and professional development opportunities. Initiatives in these areas may facilitate staff wellbeing as well as improving safety and quality of patient care.

Limited evidence of hierarchical encoding in the cheerleader effect.

"The cheerleader effect" refers to the increase in attractiveness that an individual face experiences when seen in a group of other faces. It has been proposed that the cheerleader effect occurs because (a) the visual system rapidly summarises a group of faces into an ensemble representation, (b) which is hypothesised to be highly attractive because of its average facial characteristics, and (c) observers remember individual faces to be more alike the ensemble representation than they were, due to hierarchical structure of visual working memory. Across three experiments, we investigated whether the cheerleader effect is consistent with hierarchical encoding, by asking observers to give attractiveness ratings to the same target faces shown in groups and alone. Consistent with hierarchical encoding, the largest attractiveness increases of 1.5-2.0% occurred when target faces were presented in groups of faces that could be mentally summarised to create an ensemble representation with average facial characteristics. Surprisingly, smaller cheerleader effects still occurred in conditions that were incompatible with hierarchical encoding (i.e., groups with non-human images). Together, these results offer only limited evidence for the role of hierarchical encoding in the cheerleader effect, suggesting that alternative mechanisms must be explored in future research.

Workplace wellbeing in an urban emergency department in Aotearoa New Zealand.

OBJECTIVES: Staff wellbeing is important for individuals and considered integral to the development and maintenance of high performing health systems. Unless baseline parameters of wellbeing are known, the effects of any interventions to improve staff wellbeing will remain uncertain. By clarifying staff perceptions and objective measures of important factors related to wellbeing, our primary goal was to assess the baseline wellbeing of staff in our central city ED. METHODS: A survey template, the WoWe@AED (Workplace Wellbeing at the Adult Emergency Department) was developed from several sources. Burnout was measured using the Copenhagen Burnout Inventory. Inclusion in the survey required that participants worked in our ED, all staff groups were eligible. The electronic survey was conducted between 22 January and 5 February 2018. Quantitative and qualitative data were analysed. RESULTS: Two hundred and seventy (71.1%) of 380 potential participants participated. All staff groups were represented. About 72.4% agreed/strongly agreed that Adult Emergency Department was an excellent place to work, 80.7% found their work meaningful. About 42.0% felt well informed regarding important decisions. One hundred and eighty-three (48.2%) out of 380 completed the Copenhagen Burnout Inventory. Overall, personal burnout was 42.1% (n = 77), work-related burnout was 35% (n = 64) and client-related burnout was 27.9% (n = 51). Females were significantly (<0.05) more likely to have burnout in some or all domains. Four key themes were identified: supportive teamwork and relationships; providing high quality patient care; resourcing; and workload issues. CONCLUSIONS: Baseline indices of wellbeing of the frontline staff in a central city ED have been documented. These have informed wellbeing interventions. Future measures can be compared against these data.

Own attractiveness and perceived relationship quality shape sensitivity in women's memory for other men on the attractiveness dimension.

Although recent work suggests that opposite-sex facial attractiveness is less salient in memory when individuals are in a committed romantic relationship, romantic relationship quality can vary over time. In light of this, we tested whether activating concerns about romantic relationship quality strengthens memory for attractive faces. Partnered women were exposed briefly to faces manipulated in shape cues to attractiveness before either being asked to think about a moment of emotional closeness or distance in their current relationship. We measured sensitivity in memory for faces as the extent to which they recognized correct versions of studied faces over versions of the same person altered to look either more or less-attractive than their original (i.e., studied) version. Contrary to predictions, high relationship quality strengthened hit rate for faces regardless of the sex or attractiveness of the face. In general, women's memories were more sensitive to attractiveness in women, but were biased toward attractiveness in male faces, both when responding to unfamiliar faces and versions of familiar faces that were more attractive than the original male identity from the learning phase. However, findings varied according to self-rated attractiveness and a psychometric measure of the quality of their current relationship. Attractive women were more sensitive to attractiveness in men, while their less-attractive peers had a stronger bias to remember women as more-attractive and men as less-attractive than their original image respectively. Women in better-quality romantic relationships had stronger positive biases toward, and false memories for, attractive men. Our findings suggest a sophisticated pattern of sensitivity and bias in women's memory for facial cues to quality that varies systematically according to factors that may alter the costs of female mating competition ('market demand') and relationship maintenance.

Accuracy of working diagnosis by paramedics for patients presenting with dyspnoea.

OBJECTIVE: The present study aims to determine the agreement between paramedic and ED or hospital working diagnosis in dyspnoeic patients. METHODS: Non-consecutive written patient report forms were retrospectively audited for patients suffering from dyspnoea, who were transported to a tertiary hospital ED by ambulance paramedics. Accuracy of the paramedic working diagnosis was assessed by comparing agreement with either the primary or secondary ED diagnoses or hospital discharge diagnosis. RESULTS: The study cohort was 293 patients. Exact agreement between paramedic versus ED or hospital diagnosis was 64%, 95% CI 58-69, k = 0.58, 95% CI 0.52-0.64. Only 226 (77%) had a 'clearly documented' paramedic diagnosis. Among these, agreement with either ED or hospital diagnosis was 79%, and there was a trend towards more agreement as paramedic level of practice increased (74%, 78% and 87% for Basic, Intermediate and ALS paramedics, respectively, P = 0.07). Conversely, ALS paramedics were less likely to document a working diagnosis (30/98, 31%) compared with Intermediate (22/102, 23%) and BLS paramedics (15/93, 16%), P = 0.008. Diagnostic agreement varied according to medical condition, from anaphylaxis (100%) and asthma (86%) to acute pulmonary oedema (46%). CONCLUSIONS: There was moderate agreement between paramedic and ED or hospital diagnosis. The number of cases with no clearly documented working diagnosis suggested that a singular working diagnosis may not always serve the complexity of presentation of some dyspnoea patients: more open descriptors such as 'mixed disease' or 'atypical features' should be encouraged.

Facing up to stereotypes: surgeons and physicians are no different in their emotional expressiveness.

Of all the differences between surgeons and physicians that are discussed in the medical profession and in the community at large, one distinction stands out for its frequency of use: surgeons are less emotional than physicians, particularly in their relationships with patients. Here we tested this stereotype by analysing the portraits that 5914 surgeons and physicians had provided for patients to view when selecting a doctor. There is an asymmetry in the degree to which emotional information is conveyed by the face, with the right side being less expressive than the left. Hence, if the stereotype were true, surgeons would be more likely than physicians to show their right cheek in the photographs. While the results for doctors confirmed previous reports of a difference due to sex in which female doctors were more likely to show the left cheek than male doctors, we found that the doctors' specialization did not predict the way they turned in their portraits. Hence, the notion that surgeons face their patients less emotionally than physicians is not supported by the data.

Emoticons in mind: an event-related potential study.

It is now common practice, in digital communication, to use the character combination ":-)", known as an emoticon, to indicate a smiling face. Although emoticons are readily interpreted as smiling faces, it is unclear whether emoticons trigger face-specific mechanisms or whether separate systems are utilized. A hallmark of face perception is the utilization of regions in the occipitotemporal cortex, which are sensitive to configural processing. We recorded the N170 event-related potential to investigate the way in which emoticons are perceived. Inverting faces produces a larger and later N170 while inverting objects which are perceived featurally rather than configurally reduces the amplitude of the N170. We presented 20 participants with images of upright and inverted faces, emoticons and meaningless strings of characters. Emoticons showed a large amplitude N170 when upright and a decrease in amplitude when inverted, the opposite pattern to that shown by faces. This indicates that when upright, emoticons are processed in occipitotemporal sites similarly to faces due to their familiar configuration. However, the characters which indicate the physiognomic features of emoticons are not recognized by the more laterally placed facial feature detection systems used in processing inverted faces.

How academics face the world: a study of 5829 homepage pictures.

It is now standard practice, at Universities around the world, for academics to place pictures of themselves on a personal profile page maintained as part of their University's web-site. Here we investigated what these pictures reveal about the way academics see themselves. Since there is an asymmetry in the degree to which emotional information is conveyed by the face, with the left side being more expressive than the right, we hypothesised that academics in the sciences would seek to pose as non-emotional rationalists and put their right cheek forward, while academics in the arts would express their emotionality and pose with the left cheek forward. We sourced 5829 pictures of academics from their University websites and found that, consistent with the hypotheses, there was a significant difference in the direction of face posing between science academics and English academics with English academics showing a more leftward orientation. Academics in the Fine Arts and Performing Arts however, did not show the expected left cheek forward bias. We also analysed profile pictures of psychology academics and found a greater bias toward presenting the left check compared to science academics which makes psychologists appear more like arts academics than scientists. These findings indicate that the personal website pictures of academics mirror the cultural perceptions of emotional expressiveness across disciplines.

The phantom in the mirror: a modified rubber-hand illusion in amputees and normals.

The bodily boundaries in amputees may seem to be more malleable than in non-amputees, given the propensity for a phantom limb to embody a mirror-reflected hand. However, in the present investigation, in which phantom-limb illusions within body space are induced and manipulated, we found that perceiving phantom sensations and illusory embodiment does not require amputation. Surprisingly, in the present modified rubber-hand illusion, we found that simultaneous stroking or stimulation of the participant's target hand was not necessary to induce illusions of embodiment and corresponding perceptual illusions. We tested this upper-limb paradigm in fourteen upper-limb amputees and twenty-six controls (including fourteen lower-limb amputees). We propose a model for embodiment of a rubber or real hand passively observed in a mirror. In this model, passive observation of the hand in the mirror triggers body representations (body image and body schema), most likely through activation of the posterior parietal cortex and temporo-parietal junction. Activity in these regions heightens awareness of peripersonal space and increases tactile sensitivity, and may subsequently enhance perception of illusory touch and embodiment. Furthermore, sense of embodiment may be more apparent to the participant when the hand is threatened; however, embodiment may even be strengthened when the motor system is engaged, evoking motor schemata to support the more easily induced perceptual embodiment via body image.