ObjectiveTo use a model of occupational stress to quantify and explain the impact of working in c... more ObjectiveTo use a model of occupational stress to quantify and explain the impact of working in critical care during the Covid-19 pandemic on critical care nurses and organisational outcomes.ParticipantsCritical care nurses (CCNs) who worked in the UK NHS between January to November 2021 (n=461).MethodsA self-reported survey measured the components of the Job-Demand Reward model of occupational stress. Job-demands, job-resources, health impairment (mental health (GHQ-12), burnout (MBI), PTSD symptoms (PCL-5)), work engagement and six organisational outcomes (commitment, job satisfaction, changing jobs, certainty about the future, quality of care, patient safety) were measured. Data were compared to baseline data (n=557) collected between April to October 2018. Regression analyses identified predictors of health impairment, work engagement and organisational outcomes.FindingsCompared to 2018, CCNs were at elevated risk of probable psychological distress (GHQ-12, OR 6.03 [95% C.I. 4.7...
Edited by Kiriakos Xenitidis and Colin Campbell Contents ▪ The shadow costs of dissociative ident... more Edited by Kiriakos Xenitidis and Colin Campbell Contents ▪ The shadow costs of dissociative identity disorder ▪ Authors' reply ▪ Letter to the editor about 'Context and outcome of first-episode psychosis in India and Canada' ▪ Author's response
A rehabilitation intervention to promote physical recovery following intensive care Citation for ... more A rehabilitation intervention to promote physical recovery following intensive care Citation for published version:
Most people experience at least one potentially traumatic event (PTE) during their life. Many wil... more Most people experience at least one potentially traumatic event (PTE) during their life. Many will develop only transient distress and not a psychological illness. Even the most inherently horrific event does not invariably lead to the development of a psychological disorder while an individual with sufficient vulnerabilit may develop post-traumatic stress disorder (PTSD) after what appears be an event of low magnitude. The diagnosis of PTSD differs fro most psychiatric disorders as it includes an aetiological factor, the traumatic event, as a core criterion. The DSM 5 core symptoms of PTSD are grouped into four key symptom clusters: re-experiencing, avoidance, negative cognitions and mood, and arousal. Symptoms must be present for at least one month and cause functional impairment. PTSD patients can avoid engaging in treatment and assertive follow-up may be necessary.
While the common perception of post-traumatic stress disorder (PTSD) is of an individual sufferin... more While the common perception of post-traumatic stress disorder (PTSD) is of an individual suffering from a single traumatic event, clinicians need to be aware of those people who have been exposed to multiple potentially traumatic events. Type 2 or complex trauma results from multiple or repeated traumatic events occurring over extended periods. Complex trauma is often associated with other adversity and stressors such as neglect, loss or deprivation. For many individuals these traumas occur at a developmentally vulnerable time with the perpetrator often in a caregiving role; thus the trauma incorporates a betrayal of trust. Disclosure can be a problem particularly with complex trauma such as sexual abuse or domestic violence, and is often incremental as trust with the clinician is formed. Patients who have experienced complex trauma should be assessed for the core symptoms of PTSD. In addition, patients should be assessed for disturbances in the three domains of emotional dysregulat...
Fatal accident inquiries in Scotland are similar to coroners' inquiries in England, Northern ... more Fatal accident inquiries in Scotland are similar to coroners' inquiries in England, Northern Ireland, and Wales. Justine McCulloch and Alastair Hull explain more about them and give some survival tips if you are ever called on as a witness
Got a career or related problem that needs answering? Can't find the right person to point yo... more Got a career or related problem that needs answering? Can't find the right person to point you in the right direction? Log on to the Advice Zone (www.bmjcareers.com/advicezone) for reliable medical careers advice. You can post a question or see if one of our 300 advisers has already answered a similar question. Here is a selection of questions and answers posted on the site.
Background: Interventions to support psychological recovery after critical illness, including inf... more Background: Interventions to support psychological recovery after critical illness, including information provision via an intensive care unit (ICU) diary or discharge summary, have been widely adopted in some regions, albeit without strong empirical evidence. Objective: To examine the feasibility and acceptability, for patients, family members and clinicians, of information provision via an ICU diary or discharge summary to support psychological recovery for critical illness survivors. Methods: A pilot, partially randomized patient preference study in a mixed ICU in a tertiary hospital in Australia. Eligible patients were in ICU>24 hours and able to converse in English. Interventions were ICU Diary or Discharge Summary compared to usual care. Feasibility was assessed throughout the study process, with acceptability assessed 3 and 6 months after hospital discharge, with data analysed descriptively and thematically. Results: Sixty-one patients were recruited, 45 completed 3 month follow-up (74%) and 37 (61%) 6 month followup. Participants were medical (39%), surgical (30%) and trauma (31%) patients; age 55 [interquartile range, IQR:36-67] years; and stayed in ICU 7 [IQR:3-13] days and hospital 23 [IQR:14-32] days. Within the partially randomised framework, 34 patients chose their intervention-4 chose usual care, 10 ICU Diary and 20 Discharge Summary. The remaining 27 patients were randomised-9 usual care, 10 ICU Diary and 7 Discharge Summary. The majority (>90%) considered each intervention helpful during recovery, however a significant proportion of patients reported distress associated with reading the ICU Diary (42%) or Discharge Summary (15%). Clinicians reported they were hesitant to make diary entries. Conclusions: When given choice, more patients chose a Discharge Summary over the ICU Diary or usual care. Participants considered both interventions acceptable. Given the reports of distress associated with information provision, clear empirical evidence is required to determine effectiveness, optimal timing, support needed and for whom they should be used.
Much of the theoretical focus in post-traumatic stress disorder has been on the role of the amygd... more Much of the theoretical focus in post-traumatic stress disorder has been on the role of the amygdala, the hippocampus and the prefrontal cortex. Crucially, in unresolved traumatic experiences that underlie clinical presentations, this focus misses the brain areas key to the defence responses of fight, flight and freeze-and the associated affects of anger, fear and grief. The periaqueductal gray in the midbrain, with the hypothalamus, is essential for these somatic and emotional responses to traumatic experiences. We argue that when treatment approaches thought to work at the
BackgroundFindings from neuroimaging studies complement our understanding of the wide-ranging neu... more BackgroundFindings from neuroimaging studies complement our understanding of the wide-ranging neurobiological changes in trauma survivors who develop post-traumatic stress disorder (PTSD).
Family members could play an important role in preventing and reducing the development of deliriu... more Family members could play an important role in preventing and reducing the development of delirium in Intensive Care Units (ICU) patients. This study sought to assess the feasibility of design and recruitment, and acceptability for family members and nurses of a family delivered intervention to reduce delirium in ICU patients. A single centre randomised controlled trial in an Australian medical/surgical ICU was conducted. Sixty-one family members were randomised (29 in intervention and 32 in non-intervention group). Following instructions, the intervention comprised the family members providing orientation or memory clues (family photographs, orientation to surroundings) to their relative each day. In addition, family members conducted sensory checks (vision and hearing with glasses and hearing aids); and therapeutic or cognitive stimulation (discussing family life, reminiscing) daily. Eleven ICU nurses were interviewed to gain insight into the feasibility and acceptability of imple...
ObjectiveTo use a model of occupational stress to quantify and explain the impact of working in c... more ObjectiveTo use a model of occupational stress to quantify and explain the impact of working in critical care during the Covid-19 pandemic on critical care nurses and organisational outcomes.ParticipantsCritical care nurses (CCNs) who worked in the UK NHS between January to November 2021 (n=461).MethodsA self-reported survey measured the components of the Job-Demand Reward model of occupational stress. Job-demands, job-resources, health impairment (mental health (GHQ-12), burnout (MBI), PTSD symptoms (PCL-5)), work engagement and six organisational outcomes (commitment, job satisfaction, changing jobs, certainty about the future, quality of care, patient safety) were measured. Data were compared to baseline data (n=557) collected between April to October 2018. Regression analyses identified predictors of health impairment, work engagement and organisational outcomes.FindingsCompared to 2018, CCNs were at elevated risk of probable psychological distress (GHQ-12, OR 6.03 [95% C.I. 4.7...
Edited by Kiriakos Xenitidis and Colin Campbell Contents ▪ The shadow costs of dissociative ident... more Edited by Kiriakos Xenitidis and Colin Campbell Contents ▪ The shadow costs of dissociative identity disorder ▪ Authors' reply ▪ Letter to the editor about 'Context and outcome of first-episode psychosis in India and Canada' ▪ Author's response
A rehabilitation intervention to promote physical recovery following intensive care Citation for ... more A rehabilitation intervention to promote physical recovery following intensive care Citation for published version:
Most people experience at least one potentially traumatic event (PTE) during their life. Many wil... more Most people experience at least one potentially traumatic event (PTE) during their life. Many will develop only transient distress and not a psychological illness. Even the most inherently horrific event does not invariably lead to the development of a psychological disorder while an individual with sufficient vulnerabilit may develop post-traumatic stress disorder (PTSD) after what appears be an event of low magnitude. The diagnosis of PTSD differs fro most psychiatric disorders as it includes an aetiological factor, the traumatic event, as a core criterion. The DSM 5 core symptoms of PTSD are grouped into four key symptom clusters: re-experiencing, avoidance, negative cognitions and mood, and arousal. Symptoms must be present for at least one month and cause functional impairment. PTSD patients can avoid engaging in treatment and assertive follow-up may be necessary.
While the common perception of post-traumatic stress disorder (PTSD) is of an individual sufferin... more While the common perception of post-traumatic stress disorder (PTSD) is of an individual suffering from a single traumatic event, clinicians need to be aware of those people who have been exposed to multiple potentially traumatic events. Type 2 or complex trauma results from multiple or repeated traumatic events occurring over extended periods. Complex trauma is often associated with other adversity and stressors such as neglect, loss or deprivation. For many individuals these traumas occur at a developmentally vulnerable time with the perpetrator often in a caregiving role; thus the trauma incorporates a betrayal of trust. Disclosure can be a problem particularly with complex trauma such as sexual abuse or domestic violence, and is often incremental as trust with the clinician is formed. Patients who have experienced complex trauma should be assessed for the core symptoms of PTSD. In addition, patients should be assessed for disturbances in the three domains of emotional dysregulat...
Fatal accident inquiries in Scotland are similar to coroners' inquiries in England, Northern ... more Fatal accident inquiries in Scotland are similar to coroners' inquiries in England, Northern Ireland, and Wales. Justine McCulloch and Alastair Hull explain more about them and give some survival tips if you are ever called on as a witness
Got a career or related problem that needs answering? Can't find the right person to point yo... more Got a career or related problem that needs answering? Can't find the right person to point you in the right direction? Log on to the Advice Zone (www.bmjcareers.com/advicezone) for reliable medical careers advice. You can post a question or see if one of our 300 advisers has already answered a similar question. Here is a selection of questions and answers posted on the site.
Background: Interventions to support psychological recovery after critical illness, including inf... more Background: Interventions to support psychological recovery after critical illness, including information provision via an intensive care unit (ICU) diary or discharge summary, have been widely adopted in some regions, albeit without strong empirical evidence. Objective: To examine the feasibility and acceptability, for patients, family members and clinicians, of information provision via an ICU diary or discharge summary to support psychological recovery for critical illness survivors. Methods: A pilot, partially randomized patient preference study in a mixed ICU in a tertiary hospital in Australia. Eligible patients were in ICU>24 hours and able to converse in English. Interventions were ICU Diary or Discharge Summary compared to usual care. Feasibility was assessed throughout the study process, with acceptability assessed 3 and 6 months after hospital discharge, with data analysed descriptively and thematically. Results: Sixty-one patients were recruited, 45 completed 3 month follow-up (74%) and 37 (61%) 6 month followup. Participants were medical (39%), surgical (30%) and trauma (31%) patients; age 55 [interquartile range, IQR:36-67] years; and stayed in ICU 7 [IQR:3-13] days and hospital 23 [IQR:14-32] days. Within the partially randomised framework, 34 patients chose their intervention-4 chose usual care, 10 ICU Diary and 20 Discharge Summary. The remaining 27 patients were randomised-9 usual care, 10 ICU Diary and 7 Discharge Summary. The majority (>90%) considered each intervention helpful during recovery, however a significant proportion of patients reported distress associated with reading the ICU Diary (42%) or Discharge Summary (15%). Clinicians reported they were hesitant to make diary entries. Conclusions: When given choice, more patients chose a Discharge Summary over the ICU Diary or usual care. Participants considered both interventions acceptable. Given the reports of distress associated with information provision, clear empirical evidence is required to determine effectiveness, optimal timing, support needed and for whom they should be used.
Much of the theoretical focus in post-traumatic stress disorder has been on the role of the amygd... more Much of the theoretical focus in post-traumatic stress disorder has been on the role of the amygdala, the hippocampus and the prefrontal cortex. Crucially, in unresolved traumatic experiences that underlie clinical presentations, this focus misses the brain areas key to the defence responses of fight, flight and freeze-and the associated affects of anger, fear and grief. The periaqueductal gray in the midbrain, with the hypothalamus, is essential for these somatic and emotional responses to traumatic experiences. We argue that when treatment approaches thought to work at the
BackgroundFindings from neuroimaging studies complement our understanding of the wide-ranging neu... more BackgroundFindings from neuroimaging studies complement our understanding of the wide-ranging neurobiological changes in trauma survivors who develop post-traumatic stress disorder (PTSD).
Family members could play an important role in preventing and reducing the development of deliriu... more Family members could play an important role in preventing and reducing the development of delirium in Intensive Care Units (ICU) patients. This study sought to assess the feasibility of design and recruitment, and acceptability for family members and nurses of a family delivered intervention to reduce delirium in ICU patients. A single centre randomised controlled trial in an Australian medical/surgical ICU was conducted. Sixty-one family members were randomised (29 in intervention and 32 in non-intervention group). Following instructions, the intervention comprised the family members providing orientation or memory clues (family photographs, orientation to surroundings) to their relative each day. In addition, family members conducted sensory checks (vision and hearing with glasses and hearing aids); and therapeutic or cognitive stimulation (discussing family life, reminiscing) daily. Eleven ICU nurses were interviewed to gain insight into the feasibility and acceptability of imple...
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