Explore the vast range of titles available.

Background Several international studies suggest that the feedback that emergency ambulance service (EMS) personnel receive on the care they have delivered lacks structure, relevance, credibility and routine implementation. Feedback in this context can relate to performance or patient outcomes, can come from a variety of sources and can be sought or imposed. Evidence from health services research and implementation science, suggests that feedback can change professional behavior, improve clinical outcomes and positively influence staff mental health. The current study aimed to explore the experience of EMS professionals regarding current feedback provision and their views on how feedback impacts on patient care, patient safety and staff wellbeing. Methods This qualitative study was conducted as part of a wider study of work-related wellbeing in EMS professionals. We used purposive sampling to select 24 frontline EMS professionals from one ambulance service in the United Kingdom and conducted semi-structured interviews. The data was analyzed in iterative cycles of inductive and deductive reasoning using Abductive Thematic Network Analysis. The analysis was informed by psychological theory, as well as models from the wider feedback effectiveness and feedback-seeking behavior literature. Results Participants viewed current feedback provision as inadequate and consistently expressed a desire for increased feedback. Reported types of prehospital feedback included patient outcome feedback, patient-experience feedback, peer-to-peer feedback, performance feedback, feedforward: on-scene advice, debriefing and investigations and coroners’ reports. Participants raised concerns that inadequate feedback could negatively impact on patient safety by preventing learning from mistakes. Enhancing feedback provision was thought to improve patient care and staff wellbeing by supporting personal and professional development. Conclusions In line with previous research in this area, this study highlights EMS professionals’ strong desire for feedback. The study advances the literature by suggesting a typology of prehospital feedback and presenting a unique insight into the motives for feedback-seeking using psychological theory. A logic model for prehospital feedback interventions was developed to inform future research and development into prehospital feedback.

Background Healthcare staff deliver patient care in emotionally charged settings and experience a wide range of emotions as part of their work. These emotions and emotional contexts can impact the quality and safety of care. Despite the growing acknowledgement of the important role of emotion, we know very little about what triggers emotion within healthcare environments or the impact this has on patient safety. Objective To systematically review studies to explore the workplace triggers of emotions within the healthcare environment, the emotions experienced in response to these triggers, and the impact of triggers and emotions on patient safety. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, four electronic databases were searched (MEDLINE, PsychInfo, Scopus, and CINAHL) to identify relevant literature. Studies were then selected and data synthesized in two stages. A quality assessment of the included studies at stage 2 was undertaken. Results In stage 1 , 90 studies were included from which seven categories of triggers of emotions in the healthcare work environment were identified, namely: patient and family factors, patient safety events and their repercussions, workplace toxicity, traumatic events, work overload, team working and lack of supervisory support. Specific emotions experienced in response to these triggers (e.g., frustration, guilt, anxiety) were then categorised into four types: immediate, feeling states, reflective, and longer-term emotional sequelae. In stage 2 , 13 studies that explored the impact of triggers or emotions on patient safety processes/outcomes were included. Conclusion The various triggers of emotion and the types of emotion experienced that have been identified in this review can be used as a framework for further work examining the role of emotion in patient safety. The findings from this review suggest that certain types of emotions (including fear, anger, and guilt) were more frequently experienced in response to particular categories of triggers and that healthcare staff's experiences of negative emotions can have negative effects on patient care, and ultimately, patient safety. This provides a basis for developing and tailoring strategies, interventions, and support mechanisms for dealing with and regulating emotions in the healthcare work environment.

Background Healthcare professionals are experiencing unprecedented levels of occupational stress and burnout. Higher stress and burnout in health professionals is linked with the delivery of poorer quality, less safe patient care across healthcare settings. In order to understand how we can better support healthcare professionals in the workplace, this study evaluated a tailored resilience coaching intervention comprising a workshop and one-to-one coaching session addressing the intrinsic challenges of healthcare work in health professionals and students. Methods The evaluation used an uncontrolled before-and-after design with four data-collection time points: baseline (T1); after the workshop (T2); after the coaching session (T3) and four-to-six weeks post-baseline (T4). Quantitative outcome measures were Confidence in Coping with Adverse Events (‘Confidence’), a Knowledge assessment (‘Knowledge’) and Resilience. At T4, qualitative interviews were also conducted with a subset of participants exploring participant experiences and perceptions of the intervention. Results We recruited 66 participants, retaining 62 (93.9%) at T2, 47 (71.2%) at T3, and 33 (50%) at T4. Compared with baseline, Confidence was significantly higher post-intervention: T2 (unadj. β =  2.43, 95% CI 2.08–2.79, d  = 1.55, p  < .001), T3 (unadj. β =  2.81, 95% CI 2.42–3.21, d  = 1.71, p  < .001) and T4 (unadj. β =  2.75, 95% CI 2.31–3.19, d  = 1.52, p  < .001). Knowledge increased significantly post-intervention (T2 unadj. β =  1.14, 95% CI 0.82–1.46, d  = 0.86, p  < .001). Compared with baseline, resilience was also higher post-intervention (T3 unadj. β =  2.77, 95% CI 1.82–3.73, d  = 0.90, p  < .001 and T4 unadj. β =  2.54, 95% CI 1.45–3.62, d  = 0.65, p  < .001). The qualitative findings identified four themes. The first addressed the ‘tension between mandatory and voluntary delivery’, suggesting that resilience is a mandatory skillset but it may not be effective to make the training a mandatory requirement. The second, the ‘importance of experience and reference points for learning’, suggested the intervention was more appropriate for qualified staff than students. The third suggested participants valued the ‘peer learning and engagement’ they gained in the interactive group workshop. The fourth, ‘opportunities to tailor learning’, suggested the coaching session was an opportunity to personalise the workshop material. Conclusions We found preliminary evidence that the intervention was well received and effective, but further research using a randomised controlled design will be necessary to confirm this.

The aim of this quality improvement was to develop a sustainable nurse-led ‘See and Treat’ service in a regional plastic surgery unit in England for patients requiring plastic surgery under local anaesthetic following traumatic injury.Trauma-related injuries are a substantial part of the workload in the plastic surgery department in question; with people with the most minor injuries requiring surgery under local anaesthetic accounting for 17%. COVID-19 threatened the continuation of any minor surgery service, but the initial crisis-driven response to the pandemic provided the opportunity to develop a new, more effective, nurse-led service for this patient group.The Model for Improvement was used and four ‘Plan, Do, Study, Act’ cycles deployed over an 8-week period, involving 102 patients. Routine quantitative and qualitative data in the form of a semistructured patient feedback proforma were used to guide the improvement process, optimising the new service design and delivery.The results demonstrated that 98% (n=100) of patients received same-day surgery via the new ‘See and Treat’ service. Staff and patient satisfaction remained high throughout; all patients preferred same-day surgery. No negative unintended consequences, for example, postoperative infections, were identified. One positive unintended consequence was the reduction in carbon footprint achieved by decreasing clinical waste and patient travel.Improvement methodology was successfully used by a nurse-led team to enable the continuation and enhancement of surgical services for trauma patients during COVID-19-driven service disruption. This service transformation has resulted in the retention of the revised service delivery model as the ‘new normal’ approximately 2 years later. The COVID-19 pandemic challenged the resilience of the trauma surgery service but led to a positive long-term legacy that sustainably improved waiting times and patient experience while maintaining safety.

Digital health is redefining nursing and midwifery practice, fuelled by national and international priorities for health improvement and workforce planning. Developing digitally enabled healthcare systems can help enable universal health coverage and improve safety outcomes while offering solutions to workforce shortages. However, research suggests that nursing/midwifery leaders are often absent from the strategic planning, design, and implementation of digitally enabled healthcare service models and the associated technological systems that directly impact practice. This paper presents the protocol for a sequential, multi-method exploration of digital health policy implementation and its impact on practice. This investigation from the perspective of national nursing/midwifery leaders, will increase understanding of the impact these professions have on national decision-making, which will be used to inform digital healthcare policy implementation and development across Europe and beyond. A purposive sample of national nursing/midwifery leaders across the WHO European region will be recruited. In Phase 1, individuals will be invited via email to participate in an anonymous online survey, with findings used to inform the topic guide for online focus groups in Phase 2. Descriptive statistical analysis of the survey dataset will be used to understand the range of countries, roles, contexts, participant experiences, and perceptions on which the findings are based. Where possible, analysis will be undertaken, e.g., by country, and participant role to identify any patterns, gaps, and key areas for further exploration during Phase 2. Survey respondents will be offered the opportunity to participate in an online focus group. Free text questions from the survey and data from focus groups will be transcribed verbatim and analysed using a reflexive thematic approach. The study outlined within this paper will generate empirical data on to what extent and how national nursing/midwifery leaders influence the progress of digital healthcare, based on their experiences implementing key European policy. In gaining a better understanding of this policy implementation, and the role played by nursing and midwifery leaders, the factors that facilitate or hinder this process can be identified and better managed, to maximise the benefits of digital healthcare for population outcomes moving forward. Ethical approval for this study was granted on 10.12.25 by Anglia Ruskin University [ID ETH2425-0725].

Background Providing feedback to healthcare professionals and organisations on performance or patient outcomes may improve care quality and professional development, particularly in Emergency Medical Services (EMS) where professionals make autonomous, complex decisions and current feedback provision is limited. This study aimed to determine the content and outcomes of feedback in EMS by measuring feedback prevalence, identifying predictors of receiving feedback, categorising feedback outcomes and determining predictors of feedback efficacy. Methods An observational mixed-methods study was used. EMS professionals delivering face-to-face patient care in the United Kingdom’s National Health Service completed a baseline survey and diary entries between March-August 2022. Diary entries were event-contingent and collected when a participant identified they had received feedback. Self-reported data were collected on feedback frequency, environment, characteristics and outcomes. Feedback environment was measured using the Feedback Environment Scale. Feedback outcomes were categorised using hierarchical cluster analysis. Multilevel logistic regression was used to assess which variables predicted feedback receipt and efficacy. Qualitative data were analysed using content analysis. Results 299 participants completed baseline surveys and 105 submitted 538 diary entries. 215 (71.9%) participants had received feedback in the last 30 days, with patient outcome feedback the most frequent ( n  = 149, 42.8%). Feedback format was predominantly verbal ( n  = 157, 73.0%) and informal ( n  = 189, 80.4%). Significant predictors for receiving feedback were a paramedic role (aOR 3.04 [1.14, 8.00]), a workplace with a positive feedback-seeking culture (aOR 1.07 [1.04, 1.10]) and white ethnicity (aOR 5.68 [1.01, 29.73]). Feedback outcomes included: personal wellbeing (closure, confidence and job satisfaction), professional development (clinical practice and knowledge) and service outcomes (patient care and patient safety). Feedback-seeking behaviour and higher scores on the Feedback Environment Scale were statistically significant predictors of feedback efficacy. Solicited feedback improved wellbeing (aOR 3.35 [1.68, 6.60]) and professional development (aOR 2.58 [1.10, 5.56]) more than unsolicited feedback. Conclusion Feedback for EMS professionals was perceived to improve personal wellbeing, professional development and service outcomes. EMS workplaces need to develop a culture that encourages feedback-seeking to strengthen the impact of feedback for EMS professionals on clinical decision-making and staff wellbeing.

BackgroundExtensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital emergency care has been relatively neglected. Exploratory work suggests that enhancing feedback and follow-up to emergency medical service (EMS) staff might provide staff with closure and improve clinical performance. Our aim was to summarise the literature on the types of feedback received by EMS professionals and its effects on the quality and safety of patient care, staff well-being and professional development.MethodsA systematic review and meta-analysis, including primary research studies of any method published in peer-reviewed journals. Studies were included if they contained information on systematic feedback to emergency ambulance staff regarding their performance. Databases searched from inception were MEDLINE, Embase, AMED, PsycINFO, HMIC, CINAHL and Web of Science, with searches last updated on 2 August 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Data analysis followed a convergent integrated design involving simultaneous narrative synthesis and random effects multilevel meta-analyses.ResultsThe search strategy yielded 3183 articles, with 48 studies meeting inclusion criteria after title/abstract screening and full-text review. Interventions were categorised as audit and feedback (n=31), peer-to-peer feedback (n=3), postevent debriefing (n=2), incident-prompted feedback (n=1), patient outcome feedback (n=1) or a combination thereof (n=4). Feedback was found to have a moderate positive effect on quality of care and professional development with a pooled effect of d=0.50 (95% CI 0.34, 0.67). Feedback to EMS professionals had large effects in improving documentation (d=0.73 (0.00, 1.45)) and protocol adherence (d=0.68 (0.12, 1.24)), as well as small effects in enhancing cardiac arrest performance (d=0.46 (0.06, 0.86)), clinical decision-making (d=0.47 (0.23, 0.72)), ambulance times (d=0.43 (0.12, 0.74)) and survival rates (d=0.22 (0.11, 0.33)). The between-study heterogeneity variance was estimated at σ2=0.32 (95% CI 0.22, 0.50), with an I2 value of 99% (95% CI 98%, 99%), indicating substantial statistical heterogeneity.ConclusionThis review demonstrated that the evidence base currently does not support a clear single point estimate of the pooled effect of feedback to EMS staff as a single intervention type due to study heterogeneity. Further research is needed to provide guidance and frameworks supporting better design and evaluation of feedback interventions within EMS.PROSPERO registration numberCRD42020162600.

BackgroundAllied health professionals (AHPs) in inpatient mental health, learning disability and autism services work in cultures dominated by other professions who often poorly understand their roles. Furthermore, identified learning from safety incidents often lacks focus on AHPs and research is needed to understand how AHPs contribute to safe care in these services.MethodsA rapid literature review was conducted on material published from February 2014 to February 2024, reporting safety incidents within adult inpatient mental health, learning disability and autism services in England, with identifiable learning for AHPs. 115 reports/publications were included, predominantly consisting of independent investigations by NHS England, prevent future deaths reports and Care Quality Commission reports.FindingsMisunderstanding of AHP roles, from senior leadership to frontline staff, led to AHPs being disempowered and excluded from conversations/decisions, and patients not getting sufficient access to AHPs, contributing to safety incidents. A central thread ‘organisational culture’ ran through five subthemes: (1) (lack of) effective multidisciplinary team (MDT) working, evidenced by poor communication, siloed working, marginalisation of AHPs and a lack of psychological safety; (2) (lack of) AHP involvement in patient care including care and discharge planning, and risk assessment/management. Some MDTs had no AHPs, some recommendations by AHPs were not actioned and referrals to AHPs were not always made when indicated; (3) training needs were identified for AHPs and other professions; (4) staffing issues included understaffing of AHPs and (5) senior management and leadership were found to not value/understand AHP roles, and instil a blame culture. A need for cohesive, well-led and nurturing MDTs was emphasised.ConclusionUnderstanding and recognition of AHP roles is lacking at all levels of healthcare organisations. AHPs can be marginalised in MDTs, presenting risks to patients and missed opportunities for quality improvement. Raising awareness of the essential roles of AHPs is critical for improving quality and safety in inpatient mental health, learning disability and autism services.

BackgroundClinical performance feedback has been demonstrated to have positive effects on patient care in hospital and primary care settings (Ivers et al., 2012). Emerging evidence suggests that providing prehospital clinicians with feedback on their performance and patient outcomes may similarly improve patient care, patient safety and staff wellbeing (Wilson et al., 2022). The aim of this study was to describe the predictors and outcomes of feedback received by prehospital clinicians in the UK, and to identify situations where prehospital clinicians desired enhanced feedback.MethodsThis was an observational mixed-methods study involving online diary entries between March - August 2022. Eligible participants were emergency ambulance staff delivering face-to-face patient care, employed by NHS ambulance trusts in the UK. Baseline survey data was analysed using logistic regression and diary entries were analysed using multilevel modelling and content analysis. Feedback effects were categorised using hierarchical cluster analysis.ResultsThe baseline survey was completed by n=299 participants, a third of which (n=101) went on to submit n=956 diary entries. Patient outcome feedback was the most frequently received feedback type (n=226). Significant predictors for receiving feedback were paramedic role (p=0.024), workplace with good feedback-seeking culture (p=0.001) and white ethnicity (p=0.024). Categories of feedback effects were personal development (closure, confidence, job satisfaction), professional development (clinical practice, knowledge) and service outcomes (patient care, patient safety). Feedback on patient satisfaction was associated with positive effects on service outcomes (p=0.017), whilst patient outcome feedback was associated with positive effects on professional development (p=0.056). Feedback was most frequently desired for non-conveyed patients and those with neurological or cardiovascular conditions.ConclusionFeedback and follow-up to prehospital clinicians improves personal development, professional development and service outcomes. The results of this study highlight subsets of patients and staff that prehospital feedback should be enhanced for to improve clinical decision-making and staff wellbeing.

BackgroundEmergency ambulance staff have a strong desire to receive feedback, but the frequency and effects of prehospital feedback have not yet been explored quantitatively in the UK. Surveys on prehospital feedback prevalence have been conducted in the US, but are limited by retrospective data collection and a potential disconnect in recipients recognising that they were being provided with feedback (Cash et al., 2017; McGuire et al., 2021). Our study seeks to overcome these limitations by collecting data in real-time using a diary study design and providing a clear definition of prehospital feedback: ‘the provision of information to emergency ambulance staff regarding their performance within prehospital practice and/or patient outcomes’. The study aim will be to explore the extent, characteristics, mechanisms and effects of prehospital feedback in the UK from the recipients’ point of view and to describe individual differences in the desire for enhanced feedback.MethodsThis will be an observational mixed-methods study involving a baseline survey, diary entries and a follow-up survey. The emphasis of data collection is quantitative survey data, which is supported by qualitative open-ended survey items that will be integrated using triangulation. Data analysis will involve logistic regression (baseline survey), multilevel modelling (diary entries) and content analysis (qualitative data). The baseline survey includes questions on demographics, feedback frequency and the Feedback Environment Scale (Steelman et al., 2004). Participants will be asked to complete 10 diary entries for an event where feedback is received and 5 diary entries where feedback is desired but not received. Eligible participants will be NHS ambulance staff delivering face-to-face patient care. Power calculations suggest a sample size of n=325 participants.Results and ConclusionThe findings from this study will demonstrate how feedback characteristics, person and environment variables influence reported feedback effects in the prehospital setting and highlight missed opportunities for feedback.