Evaluation of a culture change program to reduce unprofessional behaviours by hospital co-workers in Australian hospitals.

BACKGROUND: Unprofessional behaviours between healthcare workers are highly prevalent. Evaluations of large-scale culture change programs are rare resulting in limited evidence of intervention effectiveness. We conducted a multi-method evaluation of a professional accountability and culture change program "Ethos" implemented across eight Australian hospitals. The Ethos program incorporates training for staff in speaking-up; an online system for reporting co-worker behaviours; and a tiered accountability pathway, including peer-messengers who deliver feedback to staff for 'reflection' or 'recognition'. Here we report the final evaluation component which aimed to measure changes in the prevalence of unprofessional behaviours before and after Ethos. METHODS: A survey of staff (clinical and non-clinical) experiences of 26 unprofessional behaviours across five hospitals at baseline before (2018) and 2.5-3 years after (2021/2022) Ethos implementation. Five of the 26 behaviours were classified as 'extreme' (e.g., assault) and 21 as incivility/bullying (e.g., being spoken to rudely). Our analysis assessed changes in four dimensions: work-related bullying; person-related bullying; physical bullying and sexual harassment. Change in experience of incivility/bullying was compared using multivariable ordinal logistic regression. Change in extreme behaviours was assessed using multivariable binary logistic regression. All models were adjusted for respondent characteristics. RESULTS: In total, 3975 surveys were completed. Staff reporting frequent incivility/bullying significantly declined from 41.7% (n = 1064; 95% CI 39.7,43.9) at baseline to 35.5% (n = 505; 95% CI 32.8,38.3; χ2(1) = 14.3; P < 0.001) post-Ethos. The odds of experiencing incivility/bullying declined by 24% (adjusted odds ratio [aOR] 0.76; 95% CI 0.66,0.87; P < 0.001) and odds of experiencing extreme behaviours by 32% (aOR 0.68; 95% CI 0.54,0.85; P < 0.001) following Ethos. All four dimensions showed a reduction of 32-41% in prevalence post-Ethos. Non-clinical staff reported the greatest decrease in their experience of unprofessional behaviour (aOR 0.41; 95% CI 0.29, 0.61). Staff attitudes and reported skills to speak-up were significantly more positive at follow-up. Awareness of the program was high (82.1%; 95% CI 80.0, 84.0%); 33% of respondents had sent or received an Ethos message. CONCLUSION: The Ethos program was associated with significant reductions in the prevalence of reported unprofessional behaviours and improved capacity of hospital staff to speak-up. These results add to evidence that staff will actively engage with a system that supports informal feedback to co-workers about their behaviours and is facilitated by trained peer messengers.

Factors leading to disruptive behaviours at central hospitals in Harare Metropolitan Province: Radiography managers perspectives.

BACKGROUND: The negative consequences of disruptive behaviours involving healthcare workers threatens the institution's image, staff morale, finances, and patient safety. While all kinds of health organisations or settings are potentially exposed to disruptive behaviours, some are at higher risk than others because of both environmental and cultural factors. Such risk should be assessed having regard to the specific situation and conditions in which each healthcare organization operates. AIM: The aim of this study was to explore radiography manager's perspectives on the environmental and cultural factors leading to DBs involving radiographers at central hospitals in Harare Metropolitan Province. METHODS: An exploratory qualitative study employing in-depth interviews with 11 radiography managers across five departments at three central hospitals selected by criterion purposive sampling was done. The interview data were analysed using Tesch's method of qualitative analysis. RESULTS: The key environmental and cultural factors identified included three themes: power hierarchy, work environment and reporting framework. Power hierarchy comprised categories, superiority, professional boundaries and representation. The work environment incorporated categories, trust in leadership, burnout and fatigue and remuneration. Lastly, reporting framework included categories, lack of protocol and reporting culture. CONCLUSION: Radiography managers believe that environmental factors play a bigger role in leading to disruptive behaviours that involve radiographers at central hospitals in Harare Metropolitan Province. This underscores the need for hospital and radiography managers to pay particular emphasis on these when formulating policies and procedures to address these behaviours. Addressing DBs ensures that healthy work environments are promoted which in turn ensures that patients receive optimum and safe care. IMPLICATIONS FOR PRACTICE: The paper provides an insight into the environmental and cultural dynamics that may trigger disruptive behaviours involving radiographers. This information is invaluable in formulating policies and procedures for addressing these unprofessional behaviours.

Narrative Abilities and Episodic Memory in School-Aged Children Followed by Child Protective Services.

The ability to narrate routine familiar events develops gradually during middle childhood, in increasingly higher levels of coherence and temporal cohesion. Improvements in episodic memory are also observed, reflecting children's increasing ability to recall specific circumstances of past events and personal experiences. Even though several studies have evaluated children's narrative abilities and episodic memory, little information is available regarding the children exposed to risks that justify their referral to Child Protective Services (CPS). The current study analysed children's narrative abilities and episodic memory performance, according to the circumstances related to the referral to CPS. Event schema representation, narrative coherence, narrative temporal cohesion, and episodic memory concerning routine and specific personal events in family context were analysed in a sample of 56 school-aged children followed by the CPS in Portugal. Children referred to CPS due to disruptive behaviour presented higher episodic memory performance, compared to those exposed to domestic violence, neglect, and abuse. No significant differences were found between groups regarding narrative abilities related to familiar routine events. Results highlight the relevance of evaluating the adverse circumstances that lead to CPS referral, considering the levels of risk and danger involved, given its differential effects on children's episodic memory development.

Behavioural intervention to reduce disruptive behaviours in adult day care centres users: A randomizsed clinical trial (PROCENDIAS study).

AIM: This study assesses the effect of an intervention to reduce the disruptive behaviours (DB) presented by care recipient users of adult day care centres (ADCC), thereby reducing caregiver overload. While ADCC offer beneficial respite for family caregivers, the DB that many care recipients show promote resistance to attending these centres, which can be a great burden on their family caregivers. DESIGN: Randomized controlled clinical trial. METHODS: The study was carried out with 130 family caregivers of people attending seven ADCC in the municipality of Salamanca (Spain), randomly distributed into intervention and control groups. The intervention was applied across eight sessions, one per week, in groups of 8-10 people where caregivers were trained in the Antecedent-Behavior-Consequence (ABC) model of functional behaviour analysis. The primary outcome was the reduction of DB measured with the Revised Memory and Behavior Problems Checklist (RMBPC). RESULTS: An average reduction in the RMBPC of 4.34 points was obtained in the intervention group after applying the intervention (p < 0.01 (U de Mann-Whitney); Cohen d = 1.00); furthermore, differences were found in the Center for Epidemiologic Studies Depression Scale (CES-D) (U = -2.67; p = 0.008; Cohen d = 0.50) and in the Short Zarit Burden Interview (Short ZBI) (t = -4.10; p < 0.01; Cohen d = 0.98). CONCLUSION: The results obtained suggest that the implementation of this intervention could reduce both the frequency of DB occurrence and the reaction of the caregiver to their appearance. Improvement was also noted in the results regarding overload and emotional state of the family caregiver. IMPACT: To our knowledge, this is the first randomized clinical trial to show that an intervention based on the ABC model could reduce the frequency and reaction of DB of care recipients in ADCC increasing their quality of life, and improving the mental health and overload of their family caregivers.

Ambivalence and guilt feelings: Two relevant variables for understanding caregivers' depressive symptomatology.

Providing care for a relative with dementia is considered to be a chronic stressor that has been linked to negative mental health consequences for caregivers. A theoretical model was developed and tested to assess the degree to which ambivalence and guilt feelings contribute to caregivers' depressive symptomatology. Participants included 212 dementia family caregivers. In addition to ambivalence and guilt feelings, sociodemographic characteristics, behavioural and psychological symptoms of dementia, and depressive symptomatology were assessed. Hypotheses derived from the stress and coping model were tested using path analysis. The analysed model showed an excellent fit to the data. In total, 35% of the variance in depressive symptomatology was explained by the assessed variables. Although significant correlations were obtained between frequency and appraisal of behavioural and psychological symptoms of dementia and depression, the obtained model suggests that this effect was mediated through ambivalence. In addition, ambivalence had an indirect effect on depression. The association of ambivalence with depression was explained through feelings of guilt; that is, respondents who reported ambivalent feelings were more likely to experience guilt, leading in turn to greater depressive symptomatology. The findings suggest that dementia caregivers' ambivalence and guilt feelings are relevant for understanding their depressive symptomatology. These factors should be addressed in psychological interventions with caregivers.

Violent typologies among women inpatients with severe mental illness.

PURPOSE: Extant severe mental illness (SMI) and physical violence literature focus disproportionately on community-based men samples. To address this empirical imbalance, the current study explored violence towards others and oneself among women inpatients with SMI. As those with SMI are more likely to be victims than perpetrators of violence, victimisation was also an important factor assessed in this study. METHODS: The study used a quantitative within-subject cross-sectional design. Data were extracted from 5675 inpatient women cases between 2009 and 2013. RESULTS: Women with a manic disorder (without psychotic features) were 4.5 times, whilst those with psychotic disorders were 2 times, more likely to be physically violent to others compared to those with major mood disorders. Conversely, women with a major mood disorders were 4.8 times and 7.5 times more likely to engage in violence towards oneself (deliberate self-harm), compared to those with psychotic disorder and manic disorders, respectively. The past victimisation increased the likelihood of later physical violence. CONCLUSION: The data illuminate differential risk factors among women inpatients with SMI that may help predict violence occurring towards others and oneself and allow gender comparisons with the established literature.

An Evaluation of Multisystemic Therapy with Australian Families.

This study aims to evaluate the effectiveness of the Multisystemic Therapy (MST) intervention for Australian families invloved with the Specialist Child and Adolescent Mental Health Service (CAMHS). This program was implemented within the Western Australian Department of Health in 2005, and has continually operated two small clinical teams within the Perth metropolitan area since then. This intervention was specifically chosen to improve service access, engagement, and intervention with vulnerable families having young persons with a history of significant and enduring behavioural problems. The study reports on data collected from July 2007 to July 2013 which includes baseline, post-treatment, 6-month, and 12-month follow-up. There were 153 MST families participating in the research at all time points (71% male; 11% Australian Aboriginal; average youth age was 13.6 years). Caregivers completed a set of questionnaires including Child Behaviour Checklist, Parenting Styles and Dimensions Questionnaire, and Depression, Anxiety and Stress Scale. One-way repeated measure ANOVA were used to measure changes over time. Significant caregiver-reported improvements in all measures were reported at post-treatment, and most improvements were maintained at the follow-up periods of 6 and 12 months post-intervention. These preliminary outcomes demonstrate that the 4-5 month MST intervention significantly reduces behavioural problems and emotional difficulties in young Australians and these improvements are generally maintained by caregivers over time. Primary caregivers reported improved skills and mental health functioning that were also maintained over the follow-up period. A proposed randomised controlled trial of the program will address potential placebo and selection bias effects.

The investigation and comparison of the underlying needs of common disruptive behaviours in patients with Alzheimer's disease.

BACKGROUND: Management of the disruptive behaviours is one of the most challenging aspects of caring for patients with Alzheimer's dementia (PwAD). The underlying needs of disruptive behaviours in PwAD had rarely been studied, especially the comparison of the underlying needs of disruptive behaviours in PwAD have never been mentioned. AIMS AND OBJECTIVES: The purpose of this study was to investigate and compare the underlying needs of five common disruptive behaviours including hoarding, aggressive behaviour, repetitive behaviour, altered eating behaviour and delusion in PwAD, as perceived by family caregivers, and to relate these needs from the perspective of Maslow's hierarchy. METHODS: An exploratory research design with qualitative data collection techniques was employed. Informed consent was obtained from each participant prior to the data collection. A total of 65 pairs of caregiver-patient with Alzheimer's disease participated in the study. A semi-structured interview guide was used during the interview, and the directed content analysis method was conducted to analyse data. RESULTS: Four themes related to the underlying needs of the five selected disruptive behaviours emerged from the data, and these included a desire for comfort (physical and psychological), a desire for security (psychological and economic), a need for a sense of belonging (including a need to connect with the outside world and a need for attention) and a need for self-control. These behaviour features were found closely related to Maslow's hierarchy model of human needs. CONCLUSION: Although the data were gathered from the caregivers, and the views of the patients were thus not included in the analysis, the findings provide information for health providers that can enable them to better understand the underlying needs of common disruptive behaviours in patients with Alzheimer's disease and thus help develop better patient-centred care plans.

Exploring the influence of workplace supports and relationships on safe medication practice: A pilot study of Australian graduate nurses.

BACKGROUND: Despite the growing awareness of the benefits of positive workplace climates, unsupportive and disruptive workplace behaviours are widespread in health care organisations. Recent graduate nurses, who are often new to a workplace, are particularly vulnerable in unsupportive climates, and are also recognised to be at higher risk for medication errors. OBJECTIVES: Investigate the association between workplace supports and relationships and safe medication practice among graduate nurses. DESIGN AND PARTICIPANTS: Exploratory study using quantitative survey with a convenience sample of 58 nursing graduates in two Australian States. METHODS: Online survey focused on graduates' self-reported medication errors, safe medication practice and the nature of workplace supports and relationships. RESULTS: Spearman's correlations identified that unsupportive workplace relationships were inversely related to graduate nurse medication errors and erosion of safe medication practices, while supportive Nurse Unit Manager and supportive work team relationships positively influenced safe medication practice among graduates. CONCLUSIONS: Workplace supports and relationships are potentially both the cause and solution to graduate nurse medication errors and safe medication practices. The findings develop further understanding about the impact of unsupportive and disruptive behaviours on patient safety and draw attention to the importance of undergraduate and continuing education strategies that promote positive workplace behaviours and graduate resilience.

Habilidades socio-cognitivas en niños con conductas disruptivas y víctimas de maltrato / Socio-cognitive skills in children with disruptive behavior and victims of maltreatment

Los objetivos fueron: 1) comparar las habilidades cognitivas para la solución de problemas interpersonales en niños con conductas disruptivas y víctimas de maltrato y 2) analizar las emociones identificadas por ambos grupos al describir situaciones de interacción social conflictivas. La muestra estuvo conformada por 49 niños/as entre 6 y 10 años de edad: 27 con conductas disruptivas y 22 en situación de riesgo por maltrato, pertenecientes a Mendoza, Argentina. En ambos grupos se evaluaron las habilidades cognitivas para la solución de problemas interpersonales. Se concluye que, dependiendo de la edad, existen diferencias entre ambos grupos en las siguientes habilidades: identificación del problema, generación de alternativas de solución y anticipación de consecuencias. Además, los niños víctimas de maltrato detectaron la emoción "miedo" en mayor proporción en comparación con los niños con conductas disruptivas.

The goals were: 1) to compare cognitive skills in the solution of interpersonal problems in children with disruptive behaviour and those victimsof maltreatment, and 2) to assess the emotions identified in both groupswithin frames of conflictive social interaction. The sample consisted of 49 boys/girls aged 6 to 10 years old – 27 children showing disruptive behaviourand the other 22 at risk for maltreatment. All of them live in Mendoza, Argentina. In both groups, cognitive skills in the solution of interpersonal problems were evaluated. We conclude that there are differences between the two groups – always taking age into consideration – in the following skills: identifying problem solving, generation of solution alternatives and anticipation of consequences. Moreover, those children victims of maltreatment clearly showed “fear” in a higher proportion than those with disruptive behaviour.