Search

The high prevalence of trauma among people with HIV (PWH) and its negative impact on HIV outcomes underscore the need for Ryan White-funded HIV clinics (RWCs) to implement trauma-informed care (TIC) inclusive of crisis prevention and response. As part of a mixed-methods study of TIC practices employed by RWCs, we conducted qualitative interviews with 36 administrators, providers, and staff from Southeastern RWCs exploring crisis prevention and response strategies. Interviews were guided by the Substance Abuse and Mental Health Services Administration TIC framework and analyzed using a framework-driven, qualitative thematic approach. Crisis prevention strategies included: using electronic medical records to identify patients at risk for experiencing crisis, peer navigators to help patients bypass clinic public spaces, protocols to ensure perpetrator-victim pairs were not concurrently scheduled, and social workers to help patients identify crisis triggers and develop safety plans, plus dedicating safe spaces for patients with extensive trauma histories. Crisis response included patient referral to onsite and community crisis intake, trauma support, and mental health services and having onsite security personnel and alarm systems. Several participants requested additional training in response protocols. Study findings highlight the need for RW network-wide TIC training and sharing of best practices in crisis prevention and response. [ABSTRACT FROM AUTHOR]

A gap in research on family interventions is the understanding of long‐term effects on hypothesized mechanisms of effect regarding children's processes of responding to family stressors. This study assessed the long‐term effects of an intervention designed to improve interparental and family conflict resolution on adolescents' emotional insecurity about interparental conflict. Emotional insecurity about interparental conflict has long been linked with adolescents' risk for adjustment problems. These findings have motivated the development of several family‐based preventive interventions, one of which is the focus of this study. A community sample of 225 adolescents and their parents participated in an RCT‐based study of an intervention designed to reduce adolescent's emotional insecurity about interparental conflict. The intervention's effect on patterns of change in adolescents', mothers', and fathers' reports of the three components of adolescents' emotional insecurity (emotional reactivity, behavioral dysregulation, and cognitive representations) from posttest through the 3‐year follow‐up were examined using multilevel modeling. Results suggested that the intervention predicted immediate (pre to posttest) and long‐term linear decreases in emotional reactivity, as well as long‐term quadratic change in behavioral dysregulation. These findings support the beneficial effects of a brief intervention on multiple components of emotional security. The results also underscore the importance of considering the potential of long‐term (including nonlinear) patterns of change that may occur as a function of family‐based interventions, as well as that the impact of family‐based interventions may vary as a function of reporter and component of emotional insecurity. [ABSTRACT FROM AUTHOR]

Purpose: Brief Admission by self-referral (BA) is a standardized crisis-management intervention for individuals with self-harm and risk for suicide. This study explored relatives' experiences of BA. Relatives' perspectives may contribute to an increased understanding of the effects of BA given the relatives' role as support and informal caregivers as well as being co-sufferers. Methods: Fourteen relatives to adults with access to BA within one Swedish region participated in focus groups analysed with reflexive thematic analysis. Results: We generated themes evolving around three meaning-based concepts: access (A low threshold to a safe back-up is crucial and obstacles may easily break faith), independence (Trust in their ability with care and respect), and recovery (The rest and relational recovery we all get are needed and invaluable). Conclusions: BA brings considerable value to users and relatives, by supporting them to take care of themselves and each other. Communication and involvement of relatives may enhance users' ability to overcome obstacles to accessing BA. Implementation and adherence may be strengthened by supervision of BA staff and education of emergency care staff. Resources are needed to improve access. Mapping hurdles to BA, support through peers and targeted psychoeducation may improve recovery for BA users and their relatives. [ABSTRACT FROM AUTHOR]

Purpose: Sisu refers to extraordinary internal strength in the face of adversities. Although originally a Finnish concept, it can be a universally useful concept for studying managerial well-being and performance during difficult or even emergency periods. Previous research on sisu categorizes it into beneficial and harmful sisu and suggests that these two dimensions of sisu are useful when studying determination and resoluteness in crisis situations. This study applies the concept of sisu to examine managers' well-being in times of crisis. Methodology: Interviews were conducted with 15 managers in the hotel, manufacturing and retail industries in Finland. Results: The beneficial effects of sisu seem to dissolve when it is used too often. The study also highlighted the paradoxical tension involved in the decision to stop or continue actions in a difficult situation and contributes to sisu research by discussing collective sisu. Conclusion: The results of this study suggest that beneficial sisu helps to overcome adversity, while harmful sisu causes distortions in thinking that are detrimental to managers. Understanding one's own tendency towards beneficial or harmful sisu in difficult situations can help in managerial work. Collective sisu is an excellent resource for overcoming difficult situations in workplaces. [ABSTRACT FROM AUTHOR]

Previous studies have reported that patients with borderline personality disorder (BPD) often have negative experiences in psychiatric inpatient care. To address this issue, a novel intervention known as patient‐initiated brief admission (PIBA) has been developed. PIBA offers a constructive approach to crisis management in situations of heightened anxiety, as well as during instances of self‐harm and suicidal ideation. The intervention allows patients to directly contact the psychiatric ward to initiate a brief admission lasting 1–3 days. This easily accessible care option during a crisis has the potential to prevent harm to the patient and reduce the need for prolonged hospital stays. The aim of the present study is to investigate the effects of PIBA on psychiatric care consumption among patients diagnosed with BPD. This retrospective register‐based study includes data from both inpatient and outpatient care registries for patients diagnosed with BPD. Data were extracted from the National Board of Health and Welfare in Sweden. The study period encompasses 2013–2020, with the PIBA intervention occurring between 2016 and 2019. The sample included 107 patients in the PIBA group and 5659 matched controls. Data were analysed using a difference‐in‐differences (DiD) approach through ordinary least squares (OLS) regression and ordinal logistic regression. Throughout the 3‐year follow‐up, both groups exhibited a reduction in the number of days of utilisation of psychiatric inpatient care services. The DiD analysis indicated an additional decrease of 1.5 days at the 6‐month mark for the PIBA group (β = −1.436, SE = 1.531), expanding to 3 days fewer at the 12‐month follow‐up (β = −3.590, SE = 3.546), although not statistically significant. For outpatient care, the PIBA group displayed an increase in the number of visits, averaging to half a visit more every 6 months (β = 0.503, SE = 0.263) compared with the controls. Statistically significant differences were observed for two out of six measurements at the 12‐month (β = 0.960, SE = 0.456) and 18‐month follow‐up period (β = 0.436, SE = 0.219). The PIBA group had a statistically significant lower odds of experiencing extended lengths of inpatient care days after the index date than the controls (OR 0.56, 95% CI: 0.44–0.72). In conclusion, PIBA was associated with a significant reduction in the length of individual hospital stays, but not in the overall number of inpatient care days. PIBA may be linked to a shift from longer inpatient care utilisation to outpatient care utilisation. These findings suggest that PIBA may reduce the risk of prolonged hospitalisations for patients who have access to the intervention. Future research should explore the impact of PIBA on healthcare costs and cost‐effectiveness, both in relation to health care for the individual and cost‐effectiveness in relation to recovery and health. [ABSTRACT FROM AUTHOR]

Hate crime victimization targeting the victim's religious identity poses a serious problem for individuals, communities, and societies. This systematic review describes countermeasures to such victimization, aiming for broad descriptive inclusion by canvassing personal adaptations, collective programs, and institutional-governmental policies. Targeting peer-reviewed articles published between 2002 and 2022, we found 44 articles describing measures related to religion-based victimization prevention. We classified the studied measures into 12 main types. The most salient personal adaptations included camouflage-type blending in to avoid victimization, using religion as a source of resilience, and changing routines to deflect risk. At the collective level, mobilizing community resilience, stereotype reduction, and place-based solutions were often researched. The relatively few institutional-level studies addressed measures to enhance the connection between victims and authorities by various means. The experimental studies heavily concentrated on experiments supporting the efficacy of changing people's perceptions as a means of prevention. The review concludes with a discussion about research and policy implications. [ABSTRACT FROM AUTHOR]

Objective: Shared Individual Formulation Therapy (SIFT) is a brief, hybrid psychotherapy intervention that uses shared formulation and psychodynamic psychotherapy techniques to help participants expand their understanding of their difficulties. It was used in a pilot study for 29 adults with functional neurological disorder (FND). This analysis explores the experiences of participants using qualitative methods. Method: Participants underwent semistructured interviews about their experiences of SIFT, which were analysed using reflexive thematic analysis from a critical realist standpoint. Findings were triangulated with the previously published quantitative results. Results: Participants experienced SIFT as providing a safe space to help them explore and make sense of their FND. The resulting self‐knowledge was experienced as promoting recovery and growth, but some participants experienced the process as challenging and were ambivalent about it. Conclusion: The findings support SIFT's potential value for treating adults with FND. The psychodynamic aspects are an important component of SIFT for many, but not all, participants. [ABSTRACT FROM AUTHOR]

Introduction: When providing health information in a diverse society and during health crises, it is crucial that nurses can adapt their communication to immigrants, as this may have an impact on their health outcomes. This study seeks to identify how nurses experienced and assessed their communication and information work with immigrants during COVID-19 and to discuss measures to improve practice. Method: The study has an interpretive and explorative qualitative design, analyzing 10 semi-structured interviews with nurses from the municipal health service in Norway. Results: Three themes were created as follows: multilingual infection control teams and cooperation with volunteers, challenges when providing COVID-19 information, and the nurses' suggestions for improvements in the event of a new pandemic or other health crisis. Discussion: Nurses' cultural competence and their knowledge of immigrants' health literacy can help them understand how immigrants think and behave during illness. It is important that nurses use discretion during health crises. [ABSTRACT FROM AUTHOR]

Anxiety is one of the most prevalent psychological conditions in the pediatric population, and its associated impairments often persist into adulthood. Pediatricians are in a unique position to screen, briefly intervene, and facilitate treatment to prevent long-term impacts. However, they often do not have adequate training to do so. The current study addressed this gap by providing a brief online educational workshop aimed to promote: (1) screening for anxiety and (2) follow-up with appropriate evidence-based interventions. Fifty-three providers participated, and 38 completed surveys pre- and post-training. Findings indicate acceptability of the training to providers, improved knowledge related to anxiety, and increased readiness to manage anxiety during a medical visit. This study supports the utility of a brief, online training on screening and provision of evidence-based treatment for anxiety in pediatric primary care. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had a well-evidenced impact on adolescents, who are especially sensitive to pandemic disruptions given the critical role of socialization in their development. In Chile too, evidence shows increases in mental health complaints among adolescents over the lockdown period. Our study aimed at exploring the experiences of Chilean adolescents regarding their mental health during the lockdown and school closure (March 2020-December 2021), and during the return to on-site education (2022) as informed by adolescents and school staff, with a focus on family, school, and social sources of risk and support for adolescents' wellbeing during these periods. Methods: Using a qualitative approach, we conducted semi-structured interviews with 19 adolescents and 16 staff members from schools in an urban area of Chile. Results: Through thematic analysis, we generated five themes: [1] Adolescents in a mental health crisis, comprising a range of distressing experiences and mental health problems. This crisis was fueled by alterations in the functioning of adolescents' systems: [2] Broken support systems (peers and school); [3] The school agenda must go on, reflecting schools' strict compliance with the educational curriculum; and [4] Blurred boundaries between home and school life and within the family. Finally [5], Development will (try to) find its way describes how most participants experienced a bouncing back to wellbeing in the course of the school year upon return, and how some developmental milestones took place despite the abnormal conditions, providing evidence for resilience amid pandemic adversity. Conclusions: The findings give insight into how the exchanges between the adolescent and the social systems they are embedded in were interfered. The results help us understand the challenges for mental health during and after the pandemic, and highlight adolescents' capacity to thrive as normality was restored. The results also underscore the importance of upholding stability across adolescents' systems and routines, in order to mitigate impacts on wellbeing amid abnormal circumstances. The findings are relevant for development-informed initiatives in policy design in the aftermath of the pandemic and in future crisis management responses. [ABSTRACT FROM AUTHOR]

Previous disaster research exploring mental health consequences has been conducted after a single disaster. Community mental health nurses offer critical support in the aftermath of a disaster through complex assessments, psychosocial education and treatment. This research examines help-seeking behaviors in a Greater Houston community struggling with two simultaneous disasters, a historic winter freeze amidst the COVID-19 pandemic. Three Mental Health Crisis clinics, staffed by an interdisciplinary team, offered walk-in crisis services. The study characterizes adults who accessed services and describes those who accepted follow-up, subsidized behavioral health therapy or case management, including populations experiencing health disparities. Statistical analysis included descriptive and inferential statistics. Those who recognized the need for behavioral health care and accessed episodic care differed from those who accepted follow-up care. The population that was more likely to accept follow up care largely consisted of females, individuals without a previously existing mental health condition, those who reported trauma exposure, and young adults of Hispanic/Latino origin. Nurses can leverage female support to inspire male adults to seek care and advocate for increased resources and training to support culturally relevant care. Nurses and the interdisciplinary team need to assess for trauma exposure, as it influences care decisions. [ABSTRACT FROM AUTHOR]

Social psychologists interested in interaction have demonstrated that help‐seeking is a fruitful area for understanding how people relate to one another, but there is insufficient knowledge on how people navigate emotional involvement in help activities. Drawing on discursive psychology and conversation analysis, this article examines third‐party calls to a crisis helpline, with emergency calls as a point of comparison, to see how participants manage emotional involvement related to callers' concerns for others. The analysis unpacks how participants orient to helplessness—callers' uncertainty and inability to move forward—as justifying a focus on the at‐risk person or on the caller's emotions. While dispatchers at emergency centres work to get pertinent information to send help, call‐takers at the crisis helpline are trained to offer emotional support. In the latter case, a caller's displays of helplessness may be treated as a sign of danger for the person at‐risk, but it can also be taken as a disposition to worry, warranting a focus on the caller's emotional state. Showing how participants manage this challenge as they navigate 'whom to help', the paper contributes to research on the accomplishment of subjectivity and objectivity and demonstrates the utility of this framework in suicide prevention. [ABSTRACT FROM AUTHOR]

Assess the changes in post‐traumatic stress disorder (PTSD), burnout, anxiety, depression, jobstrain, and isostrain levels over time among healthcare workers in emergency departments (EDs) after successive outbreaks of COVID‐19. A prospective, multicenter study was conducted in 3 EDs and an emergency medical service. Healthcare workers who participated in our previous study were invited to participate in a follow‐up 16 and 18 months and completed the questionnaires to assess symptoms of PTSD, burnout, anxiety, depression, jobstrain, and isostrain. Among the 485 healthcare workers asked to participate, 211 (43.5%) completed the survey at inclusion (122 were followed up at 3 months) and 59 participate to the follow‐up study. At 16 months, 10.9% of healthcare workers had symptoms of PTSD and 17.4% at 18 months. At inclusion, 33.5% and 11.7% of healthcare workers had symptoms of anxiety and depression, respectively. A decrease in anxiety between inclusion and 16 months (p = 0.02) and an increase between 16 and 18 months (p = 0.009) was observed. At inclusion, 40.8% of all healthcare workers had symptoms of burnout. There was an increase in symptoms of burnout between inclusion and 18 months (p = 0.006). At inclusion, 43.2% and 29.5% of healthcare workers were exposed to jobstrain and isostrain, respectively. Jobstrain were higher among paramedics and administrative staff compared to physicians (p = 0.001 and p = 0.026, respectively). Successive outbreaks of COVID‐19 led to long‐term mental health consequences among ED healthcare workers that differed according to occupation. This must be taken into account to rethink the management of teams. [ABSTRACT FROM AUTHOR]

Teen-to-teen (t2t) crisis lines are a special type of crisis service where youth volunteers help their peers. Although prior research has examined the experience of adult crisis line responders, no research has examined the experience of adolescents who do this work. In collaboration with two of the largest t2t lines in the U.S., this pilot study is the first examination of t2t crisis line work. Volunteers (ages 14–20) reported: their primary motivation for joining the crisis lines was to help others and give back to the community; responding to a range of peers' problems on the t2t crisis line, including high-risk suicide contacts; and a range of ways the crisis line work impacted their lives. Findings provide preliminary information about the experience of adolescents engaging in t2t crisis line work. Additional research is needed in larger and more diverse samples to understand the impact of crisis line work for youth. [ABSTRACT FROM AUTHOR]

This cross-sectional survey study describes characteristics of mobile crisis teams (MCTs) in the United States. Mobile crisis teams (MCTs) are increasingly recognized as essential responders to help those experiencing mental health crises get urgent and appropriate care. Recent enhanced federal funding is designed to promote adoption of MCTs, but little is known about their current structure and function and whether teams meet new Medicaid rules governing their utilization. Survey participants (N = 554) are a convenience sample of MCT representatives recruited through professional organizations, listservs, and individual email contacts from October 2021 – May 2022. Respondents most frequently identified themselves as MCT program director/manager (N = 237, 43%). 63% (N = 246) of respondents reported billing insurance for services provided (including Medicaid), while 25% (N = 98) rely on state or county general funds only. Nearly all respondents (N = 390, 98%) reported including behavioral health clinicians on their teams, and 71% (N = 281) reported operating on a 24/7 basis, both of which are required by Medicaid's enhanced reimbursement. Just over half of respondents (N = 191, 52%) reported being staffed with 11 or more FTE staff members, our estimated number required for adequate 2-person coverage on a 24/7 basis. MCTs are a popular policy initiative to reduce reliance on law enforcement to handle mental health emergencies, and enhanced federal funding is likely to expand their utilization. Federal rule makers have a role in establishing guidelines for best practices in staffing, billing, and outcomes tracking, and can help ensure that stable financing is available to improve stability in service delivery. [ABSTRACT FROM AUTHOR]

Purpose : This study aimed to determine the effectiveness of end-of-life care debriefing as an intervention to reduce moral distress among intensive care unit (ICU) nurses after end-of-life care. Methods : This quasiexperimental study included 104 nurses (46 in the control group and 58 in the intervention group) working in three medical ICUs and two surgical ICUs. The data collection period was from September 1, 2017, to January 31, 2018, and end-of-life care debriefing in the intervention group was implemented over three months. Debriefings were conducted in groups or individually, with eight people participating in three or more debriefings. Comparisons of end-of-life care stress, end-of-life care attitudes, and wellness between the two groups were performed using an ANCOVA. Satisfaction with the debriefing was analyzed using descriptive statistics. Results : End-of-life care stress and wellness did not differ between the groups, but there was a significant difference in end-of-life care attitudes. Overall, 50% of the participants were satisfied with the debriefing. Conclusion : Based on the finding that end-of-life care debriefing has a positive impact on ICU nurses' attitudes toward end-of-life care, it can be used as an effective measure to reduce nurses' moral distress. An institutional debriefing system should be established and operationalized. [ABSTRACT FROM AUTHOR]

This article explores the meanings and uses of a hospital corridor through 98 diary entries produced by the staff of an English specialist hospital during the early stages of the COVID‐19 pandemic. Drawing on Lefebvre's (1991, The production of space. Blackwell) threefold theorisation of space, corridors are seen as conceived, perceived and lived spaces, produced through and enabling the reconfiguration and reinterpretation of social interactions. The diaries depict two distinct versions of the central hospital corridor: its 'normal' operation prior to the pandemic when it was perceived as a social and symbolic space for collective sensemaking and the 'COVID‐19 empty corridor' described as a haunting place that divided hospital staff along ostensibly new social and moral boundaries that impacted negatively on lived work experiences and staff relationships. The mobilisation of the central hospital corridor in the daily social construction of meaning and experience during a period of organisational and societal crisis suggests that corridors should not be only seen as a material backdrop for work relationships but as social entities that come into being and are maintained and reproduced through the (lack of) performance of social relations. [ABSTRACT FROM AUTHOR]

Engaging the public and community organizations in local health actions greatly assists disease prevention and control. However, it remains unclear how organization-public relationships (OPR) and communication networks within communities contribute to community health actions. To fill this gap, a survey was conducted among community members in Shanghai, China, who were challenged by the Omicron wave of the COVID-19 pandemic. Results revealed that integrated connectedness to a storytelling network (ICSN) was a significant predictor of residents' community engagement. Trust, control mutuality, commitment, and ICSN were positively associated with community engagement intentions through the sense of community and organizational efficacy. This study is a step toward understanding how organizations and members collectively respond to health crises at the community level. [ABSTRACT FROM AUTHOR]

Background. Considering the importance of psychological first aid, which is the first priority when a disaster occurs, developing a web‐based simulation training program for nurses and confirming its effectiveness is necessary. Aim. This study aimed to develop an interactive simulated education program as a psychological first aid program for nurses and verify its effectiveness. Participants. Nurses working in hospitals and the community who had not participated in psychological first aid training in the last year were recruited. Methods. A web‐based interactive simulated educational program for psychological first aid was developed. To verify its effectiveness, a randomized controlled trial design was used. The experimental group participated in a web‐based educational program, while the control group was provided self‐learning data in the form of e‐books. The program's effects on disaster response core competencies, problem‐solving abilities, and self‐leadership capacity were measured. We used descriptive statistics to analyze the general characteristics, and independent t‐tests were used to analyze the differences before and after the intervention. Results. The core competencies for disaster response (t = −2.239, p < 0.05, Cohen's d = 0.59), problem‐solving abilities (t = −2.753, p < 0.01, Cohen's d = 0.72), and self‐leadership capacity (t = −2.073, p < 0.05, Cohen's d = 0.54) showed a statistically significant difference between groups. Conclusions. The web‐based simulation education program for psychological first aid training developed in this study effectively enhanced nurses' ability to respond to disasters and improved their problem‐solving abilities and self‐leadership capacity. Thus, nurses can use the educational program as a tool to learn psychological first aid. This trial is registered with KCT0008965. [ABSTRACT FROM AUTHOR]

Describe clinical practice, inter-disciplinary clinical pathway and core principles of care within a mild traumatic brain injury (mTBI) rehabilitation team. An observational study examined inter-disciplinary practice, nested within an observational trial investigating team-based mTBI rehabilitation. Data were collected to describe clinical service over 12 months. Activity data quantified clinical sessions per participant, mode of service delivery and content of sessions using custom-designed codes. The clinical team gathered narrative data to confirm the inter-disciplinary clinical pathway and individual discipline practice. 168 participants entered the rehabilitation program during the 12 months. A single Allied Health Screening Assessment identified patient priorities. Occupational Therapy (OT) and Physiotherapy (PT) provided the majority of clinical sessions; the team also comprised Social Work, Rehabilitation Medicine, Speech Pathology and Clinical Psychology. Telehealth was the most common service delivery mode (54%). Median session numbers per participant ranged 1–4 for all disciplines; mean/maximum occasions of service were highest for PT (6.9/44) and OT (6.8/39). A small proportion of participants received much higher number of sessions, consistent with intractable issues after mTBI. High attendance rates indicate the predominantly telehealth-delivered model was feasible. The clinical approach included early prioritizing of discipline input and follow-up after discharge. [ABSTRACT FROM AUTHOR]

Aim: To identify insights for supporting people at risk of suicide in the community based on primary healthcare workers' experiences. Design: Qualitative descriptive design. Methods: Semi‐structured interviews were conducted with fifteen primary healthcare workers employed by Japanese municipalities between August and October 2019. The data were subjected to qualitative descriptive analysis. Results: The analysis revealed eleven subthemes, clustered under the following three themes: (1) fostering 'opportunities for discovery' for people at risk of suicide by encompassing strategies such as increasing access to services and promoting a holistic understanding of the life cycle; (2) fostering 'meaningful connections' by searching for channels to reach the heart and taking approaches from different objectives; and (3) engaging in 'risk management', by understanding and coping with real‐life struggles and implementing timely crisis intervention. Conclusion: Not only direct care targeting suicide prevention but also holistic care that includes atypical perspectives such as 'approaches from different objectives' may provide important insights for supporting people with suicide risk. Implications for Practice: Beyond the limitations of existing suicide risk screening methods, this study highlights the importance of a holistic approach that sees people at risk of suicide in the context of their daily lives and aims to alleviate the difficulties in their lives that have brought them to the point of considering suicide. Impact: By describing support focused on the difficulties that people at risk of suicide face in their daily lives, this study identified insights for supporting people at risk of suicide in communities where screening and intervention are difficult. These findings will contribute to the relief of people at risk of suicide by stimulating suicide prevention measures in primary healthcare settings. Reporting Method: This study complied with the COREQ guidelines. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Given the enormous scale of the COVID-19 pandemic affecting the healthcare sector, limited human resource capacity, and efforts to prevent the spread of COVID-19, occupational health protection could not escape changes. The aim was to identify and compare the regulations regarding the provision of medical occupational check-ups (MOCs) during the pandemic in all European Union member states (EU MS). The study employed the Delphi method, involving experts from EU MS to assess MOC regulations between January 2020 and May 2021. Experts were queried regarding the existence and specifics of MOC regulations, particularly for entrance and periodic MOCs at hazardous and non-hazardous workplaces. Out of the 27 EU MS surveyed, 13 EU MS did not regulate MOCs, while 14 EU MS (51.6%) regulated the provision of MOCs. The regulations were changes in the way MOCs were provided, modifications (postponement in time, alternative provision, e.g. using telemedicine or online connection, or replacing the medical certificate of fitness to work based on the MOC with a declaration by the worker), or interruption without compensation, even for hazardous works. The regulations were in effect for different lengths of time and varied in some countries during the study period. The cumulative duration of MOC interruptions in all EU MS during the study period was 137 months (7.5% of the cumulative study period of 1836 months). Given the different approaches to the provision of MOCs in EU MS, it has proved appropriate to develop an optimal unified framework plan for future similar situations. [ABSTRACT FROM AUTHOR]

Background: Poor sleep is an unrecognized problem among cancer survivors that affects quality of life. However, screening for sleep disorders is not routine in cancer care. To fill this gap, a self-paced online training program was designed for RNs to screen patients for sleep disturbance and provide brief intervention or referral for treatment (Sleep-SBIRT). Method: A three-phase evaluation pilot study included the following steps: (a) develop an online training program with in situ simulation; (b) implement the program with RNs at a comprehensive cancer center; and (c) evaluate module and quiz completion rates and focus group thematic analysis. Results: Of the 22 RNs participating, 17 completed online modules and in situ simulation. The RNs were satisfied (M = 4.74/5, SD = 0.42) and self-confident (M = 4.45/5, SD = 0.45) with the learning. Focus group themes were learning new knowledge, learning online effectively, applying learning to in situ simulation, and intending to implement. Conclusion: The RNs gained knowledge applying Sleep-SBIRT, but future larger studies are warranted. [J Contin Educ Nurs. 2024;55(8):387–392.] [ABSTRACT FROM AUTHOR]

Background: Sex trafficking of persons, a pervasive public health issue disproportionately affecting the most marginalized within society, often leads to health as well as social consequences. Social service provision to meet the resulting needs is critical, however, little is known about the current pandemic's impact on providers' capacity to deliver requisite care. Method: To examine social service providers' perspectives of care provision for domestically sex-trafficked persons in Ontario, Canada, during the COVID-19 pandemic, we conducted semi-structured interviews with 15 providers and analyzed these using Braun and Clarke's analytic framework. Results: Impacts of the COVID-19 pandemic on social service care provision were connected to individuals' increased vulnerability to trafficking, difficulties safely and effectively providing services to sex-trafficked persons amid pandemic restrictions, and reduction in in-person educational activities to improve providers' capacity to serve this client population. Securing safe shelter was particularly difficult and inappropriate placements could at times lead to further trafficking. Conclusion: The pandemic created novel barriers to supporting sex-trafficked persons; managing these sometimes led to new and complex issues. Future efforts should focus on developing constructive strategies to support sex-trafficked persons' unique needs during public health crises. [ABSTRACT FROM AUTHOR]

Background Resilience of national health systems in Europe remains a major concern in times of multiple crises and as more evidence is emerging relating to the indirect effects of the COVID-19 pandemic on health care utilization (HCU), resulting from de-prioritization of regular, non-pandemic healthcare services. Most extant studies focus on regional, disease specific or early pandemic HCU creating difficulties in comparing across multiple countries. We provide a comparatively broad definition of HCU across multiple countries, with potential to expand across regions and timeframes. Methods Using a cross-country federated research infrastructure (FRI), we examined HCU for acute cardiovascular events, elective surgeries and serious trauma. Aggregated data were used in forecast modelling to identify changes from predicted European age-standardized counts via fitted regressions (2017–19), compared against post-pandemic data. Results We found that elective surgeries were most affected, universally falling below predicted levels in 2020. For cardiovascular HCU, we found lower-than-expected cases in every region for heart attacks and displayed large sex differences. Serious trauma was the least impacted by the COVID-19 pandemic. Conclusion The strength of this study comes from the use of the European Population Health Information Research Infrastructure's (PHIRI) FRI, allowing for rapid analysis of regional differences to assess indirect impacts of events such as pandemics. There are marked differences in the capacity of services to return to normal in terms of elective surgery; additionally, we found considerable differences between men and women which requires further research on potential sex or gender patterns of HCU during crises. [ABSTRACT FROM AUTHOR]

Bystanders play a crucial role in assisting and rescuing victims of intimate partner violence (IPV) or sexual assault, thereby preventing further harm. Consequently, an increasing amount of research has focused on improving bystander interventions in such situations. While many existing scales that measure bystanders' willingness to intervene and their behaviors are likely tailored to Western settings and primarily focused on preventing sexual assaults, pursuing diversity to make these scales applicable to a variety of contexts is necessary. This study aimed to develop and validate a scale from South Korean samples that measure the likely level of bystander engagement in witnessed IPV situations, named the Bystander Engagement Scale for Witnessed Intimate Partner Violence (BESW-IPV). Preliminary items, developed to describe various IPV situations that a bystander might witness, underwent content validity testing through expert review and cognitive focus group interviews. Afterward, the scale was administered to 311 participants from the target population in South Korea. The scale's factor structure was assessed through exploratory factor analysis (EFA) and confirmed through confirmatory factor analysis (CFA). The reliability and validity were rigorously assessed. The final version of the BESW-IPV comprised 28 items. Through EFA, "direct IPV indicators" and "indirect IPV indicators" were identified. Together, these factors accounted for 76.10% of the total variance. CFA affirmed that the final model offers an acceptable fit. The scale's convergent and discriminant validities were also well established. The Cronbach's alpha and the McDonald's omega values were 0.98 and 0.99, respectively. In contrast to many existing tools that measure bystander intervention predominantly within the confines of Western educational settings, we believe that the BESW-IPV can be applied in broader contexts, especially in patriarchal environments. Further research is required to translate and validate this tool in different cultural contexts. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic placed unprecedented demands on hospitals around the globe, making timely crisis response critical for organizational success. One mechanism that has played an effective role in health care service management during large-scale crises is the Hospital Incident Command System. Purpose: The aim of this article was to understand the role of HICS in the management of a large academic medical center and its impact on relationships and communication among providers in the delivery of services during a crisis. Methodology: This mixed methods study was based on meeting observations, document reviews, semistructured interviews, and two measures of team performance within an academic medical center in the Northeast during the COVID-19 pandemic. Descriptive and bivariate analyses were applied, and qualitative data were coded and analyzed for themes. Results: HICS provided a systematic information-sharing and decision-making process that increased communication and coordination among team members. Analyses indicate a correlation between dimensions of relational coordination and organizational mindfulness. Qualitative data revealed the importance of shared meetings and huddles and the evolution of HICS across multiple waves of the crisis. Conclusion: HICS facilitated organizational improvements during the crisis response and generated opportunities to maintain specific coordination practices beyond the crisis. The prolonged implementation of HICS during the COVID-19 pandemic created challenges, including the disruption of the routine leadership structure. Practical Implications: Applying relational coordination and organizational mindfulness frameworks may allow hospitals to leverage communications and relationships within a high-stakes environment to improve service delivery. [ABSTRACT FROM AUTHOR]

Background: Unintended pregnancies can adversely affect maternal health, preventable through timely postpartum contraception. During the COVID-19 pandemic, family planning services were constrained by policies that curtailed outpatient visits. We investigated the prevalence of postpartum contraceptive initiation at King Chulalongkorn Memorial Hospital (KCMH) during January to June 2020, comparing with the same period in 2019, and identified factors associated with such initiation. Methods: We reviewed the medical records of 4506 postpartum women who delivered at KCMH during the study period. Logistic regression was conducted to test the association between early COVID-19 phase deliveries and post-partum long acting reversible contraception (LARC) initiation including copper intrauterine devices, levonorgestrel intrauterine systems, contraceptive implants, and progestogen-only injectable contraceptives. Results: A total of 3765 women (83.6%), of whom 1821 delivered during the pandemic and 1944 during the historical cohort period, were included in this study. The proportion of women who initiated non-permanent modern contraceptives at six weeks postpartum was comparable between the COVID-19 (73.4%) and historical cohort (75.3%) (p = 0.27) periods. The proportion of women who initiated LARC at six weeks postpartumwas comparable between the historical cohort period (22.5%) and the COVID-19 (19.7%) (p = 0.05) period. Accessing a six-week postpartum check-up was independently associated with LARC initiation, of which the adjusted odds ratio (OR) (95% confidence interval) was 3.01 (2.26 to 4.02). Conclusions: Our findings demonstrated that accessing postpartum care significantly associate with the use of LARC. The data suggest the strong influence of postpartum check-ups in facilitating the adoption of effective contraception, emphasizing the need for accessible postpartum care to sustain maternal health during health crises. Plain language summary: In this study, we looked at how often new mothers used birth control methods after giving birth during the COVID-19 pandemic in Thailand. We also wanted to find the factors that influenced their decision to use birth control. We reviewed the medical records of 4,506 women who had recently given birth at King Chulalongkorn Memorial Hospital. Out of these, 3,765 women were included in the study. Some gave birth during the pandemic, and others gave birth before the pandemic. We found that a similar number of women started using birth control about six weeks after giving birth, whether it was during the pandemic or before it. However, slightly fewer women chose very effective methods of birth control during the pandemic compared to before it. One important factor we found was that women who went for a check-up six weeks after giving birth were more likely to use highly effective birth control. This means that getting regular check-ups after childbirth can help women make better choices about birth control. In summary, our study showed that receiving postpartum care is closely linked to using LARC. This underlines how important it is for new mothers to have their check-ups after giving birth, to help them start using effective birth control if they choose. [ABSTRACT FROM AUTHOR]

The Paycheck Protection Program (PPP) was passed during the COVID-19 pandemic to assist small and medium-sized organizations. However, only a fraction of eligible nonprofits applied for and received loans. Using a contract failure lens, we posit that nonprofits are more likely to have higher per-employee loan amounts and use funds for payroll than for-profits. Analyzing a sample of 174,496 first-draw loans across human service sub-fields, results suggest differences by size, particularly among single-employee organizations, and by nonprofit and for-profit recipients. Single-employee organizations represent nearly half of HSO recipients, suggesting an unintended consequence of prioritizing short processing times over more scrutiny. During times of crisis, policy makers should consider oversight along with speed during policy implementation to discourage and detect self-motivated behavior. Organizations who successfully used adaptive tactics during the crisis included large organizations with more than 200 paid staff and nonprofit ownership structure. Managers of large nonprofit organizations in competitive subfields demonstrated resilience to competition and commercialization pressures by focusing on employee retention. [ABSTRACT FROM AUTHOR]

Background: Medical interventions have a place in crisis support; however, narrow biomedical and risk‐driven responses negatively impact people seeking crisis care. With increasing shifts towards involving people with lived experience (service users) in designing services, foregrounding people's desired responses is critical. Accordingly, the aim of the study was to explore the wished‐for crisis responses from the perspective of people who have experienced crisis and accessed crisis care. Method: Using a hermeneutical phenomenological approach, in‐depth interviews were conducted to determine the desired crisis responses of 31 people who self‐reported experiencing mental health crises and accessed crisis services at ED, phone lines and/or crisis alternatives. Results: The findings identified wished‐for responses that gave a felt and embodied sense of their own safety influenced by a human‐to‐human response, emotional holding, a place of safety and choice within holistic care. For such responses to be possible, participants identified organising principles, including recognising crisis as meaningful and part of our shared human experience, understanding risk as fluid and a whole‐of‐community responsibility for responding to crises. Conclusion: This paper proposes how insights from people who have experienced crises can be translated into more beneficial crisis care. Patient or Consumer Contribution: Most authors are in identified lived experience roles. The first author engaged with participants during the recruitment and interviews and was explicit regarding their lived experience. Service users were involved as advisors, providing input throughout the study. [ABSTRACT FROM AUTHOR]

The nurse role on an Assertive Community Treatment (ACT) team requires a specialized set of skills in psychiatric community-based care. While the ACT model has existed for fifty years, no nationally recognized standard curriculum to train ACT nurses has been developed. The ACT Nursing Project described in this paper aimed to create a competency-based on-board training program using the Developing a Curriculum (DACUM) method. Eight ACT nurses from three states served as the expert panel to create a DACUM chart detailing the full set of nine duties and 127 tasks required of ACT nurses. To verify the DACUM results, 57 ACT nurses from four states completed a survey and confirmed that 80% of the tasks identified by the expert panel were also performed by the validation sample of ACT nurses. This paper describes how the DACUM duties and tasks provided the framework to develop onboard training curriculum for ACT program nurses. The next step is to pilot the onboard training curriculum to newly hired ACT nurses to ensure they are equipped to meet the complex needs of people living with serious mental illness, and to increase their competency, job satisfaction and decrease the high annual turnover rate among ACT nurses. [ABSTRACT FROM AUTHOR]

Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated by RTs. A qualitative descriptive study design guided data collection through one-on-one interviews, dyadic interviews, and focus groups. We recruited active RTs across Canada, advertising on professional practice networks and social media platforms and using snowball sampling. Forty-nine RTs representing seven Canadian provinces participated. The four overarching themes developed using thematic analysis were (1) navigating uncertainty along with ever-changing practices, policies, and attitudes, (2) morphing roles within a constrained system, (3) witnessing patients suffering and experiencing moral distress, and (4) recognizing the personal toll of the pandemic on self and others, as well as lessons learned. Our study demonstrated that many RTs suffered moral distress, poor mental health, and some from challenging financial situations, especially those in the private sector. They also expressed a resilient attitude in response to these stressors. Implications in the future include identifying promising communication strategies that could act as protective factors, addressing workforce constraints and diminishing resources through innovative models of care. [ABSTRACT FROM AUTHOR]

Background: Crisis Resolution Teams (CRTs) offer home-based care for people in mental health crisis, as an alternative to hospital admission. The success of CRTs in England has been variable. In response to this, the CRT Optimization and RElapse prevention (CORE) study developed and trialled a 12-month Service Improvement Programme (SIP) based on a fidelity model. This paper describes a qualitative evaluation of the perspectives of CRT staff, managers, and programme facilitators. We identify barriers and facilitators to implementation, and mechanisms by which service improvements took place. Methods: Managers and staff from six purposively sampled CRTs were interviewed, as well as six facilitators who were employed to support the implementation of service improvement plans. Semi-structured focus groups and individual interviews were conducted and analysed using thematic analysis. Findings: A majority of participants viewed all components of the SIP as helpful in improving practice, although online resources were under-used. Perceived barriers to implementation centred principally around lack of staff time and ownership. Support from both senior staff and facilitators was essential in enabling teams to undertake the work associated with the SIP. All participating stakeholder groups reported that using the fidelity model to benchmark their CRT work to best practice and feel part of a 'bigger whole' was valuable. Conclusion: CRT staff, managers and programme facilitators thought that a structured service improvement programme helped to increase fidelity to a best practice model. Flexibility (from all stakeholders) was key to enable service improvement actions to be manageable within time- and resource-poor teams. [ABSTRACT FROM AUTHOR]

Background and aims: Health inequities related to alcohol use exist for transgender individuals. While the Thailand Ministry of Public Health recently published a clinical guideline to implement a Screening, Brief Intervention and Referral to Treatment (SBIRT) in primary care, there has been no study regarding transgender women's (TGW) alcohol use and the acceptability of implementing SBIRT in a Thai context, a gap this study aimed to fill. Design: A mixed‐method approach was used. In the first phase, TGW service users and health‐care providers (HCPs) completed a survey on the acceptability of prospective implementation of SBIRT. TGW service users completed the Alcohol Use Disorder Identification Test‐Consumption (AUDIT‐C). In the second phase, TGW service users, HCPs, clinic administrators and national‐level alcohol, HIV and transgender health policymakers participated in in‐depth qualitative interviews. Setting: The Tangerine Clinic, a transgender‐led sexual health clinic in Bangkok, Thailand. Participants: In the first phase, TGW service users (n = 100) and HCP (n = 8) were surveyed. In the second phase, 22 stakeholders (n = 10 TGW service users; n = 8 HCP; n = 1 clinic administrator; n = 3 policymakers) were interviewed. Measurements Simple proportions were calculated for each survey item. Differences in acceptability by various demographic factors were calculated using univariate analysis. The qualitative data were coded using thematic analysis and a deductive approach. The results were mapped to the Consolidated Framework for Implementation Research domains and constructs. The quantitative and qualitative results were triangulated to expand understanding. Findings Fifty per cent of the TGW participants exhibited problematic drinking levels (AUDIT‐C ≥ 4). Implementing SBIRT was highly acceptable, as more than 95% of participants reported agreeing or completely agreeing to receive SBIRT for alcohol use. Barriers, such as complexity, time constraint and lack of knowledge and skills, were anticipated. Adaptability, such as tailoring the content of brief intervention to suit TGW health needs and SBIRT to fit with existing clinic procedures, might facilitate successful implementation. Conclusion: Screening, Brief Intervention and Referral to Treatment (SBIRT) for alcohol use has the potential to be successfully implemented in transgender‐led sexual health clinic settings, with some adaptations to overcome anticipated barriers. [ABSTRACT FROM AUTHOR]

Interdisciplinary collaboration is critical to address the multiple and varied needs of students with social/emotional and behavioral (SEB) challenges. Yet little is known about the nature of collaboration between two specialist groups who commonly support them: behavior analysts and mental health specialists. Considering expectations for collaboration, and the potential challenges unique to this partnership, we conducted a series of interviews in the U.S. state of Tennessee to explore these specialists' experiences and perspectives around collaboration. We used a qualitative description approach, which led to identifying themes related to (a) specialists' preparation to collaborate, (b) facilitators and barriers to effective collaboration, and (c) supports needed to collaborate more effectively in their current roles. Specialists from both groups felt their pre-service training inadequately prepared them to collaborate with one another. They identified several factors that impacted their ability to meaningfully collaborate and expressed needs for cross-discipline education, collaborative conversations, and training on "soft skills" to partner more effectively. We highlight distinct and overlapping perspectives within and across themes between behavior analysts and mental health specialists and discuss implications for improving the quality of these important partnerships. [ABSTRACT FROM AUTHOR]

Background: Since 2008, children in Catalonia (Spain) have suffered a period of great economic deprivation. This situation has generated broad-ranging health inequalities in a variety of diseases. It is not known how these inequalities have changed over time. The aim of the present study is to determine trends in inequalities over this period in ten relevant diseases in children according to sex and age. Methods: A retrospective cross-sectional population-based study of all children under 15 years old resident in Catalonia during the 2014–2021 period (over 1.2 million children/year) and of their diagnoses registered by the Catalan Health System. Health inequalities were estimated by calculating the relative index of inequality and time trends using logistic regression models. Interaction terms were added to test for the effects of sex on time trends. Results: Increasing significant temporal trends in inequalities were shown for both sexes in almost all the diseases or adverse events studied (asthma, injuries, poisoning, congenital anomalies, overweight and obesity), in mood disorders in boys, and in adverse birth outcomes in girls. Adjustment and anxiety and mood disorders in girls showed a decreasing temporal trend in inequalities. More than half of the diseases and adverse events studied experienced significant annual increases in inequality. Poisoning stood out with an average annual increase of 8.65% [4.30, 13.00], p ≤ 0.001 in boys and 8.64% [5.76, 11.52], p ≤ 0.001) in girls, followed by obesity with increases of 5.52% [4.15, 6.90], p = < 0.001 in boys and 4.89% [4.26, 5.51], p ≤ 0.001) in girls. Conclusions: Our results suggest that inequalities persist and have increased since 2014. Policy makers should turn their attention to how interventions to reduce Health inequalities are designed, and who benefits from them. [ABSTRACT FROM AUTHOR]

Mobile crisis teams (MCTs) deploy clinicians to assist individuals in acute crisis in the community. Little is known about the extent to which these teams provide evidence-based practices (EBPs) for suicide prevention nor the barriers they face. We surveyed 120 MCT clinicians across the United States about their: (1) use of suicide risk screening and assessment tools; (2) strategies used to address suicide risk (both EBPs and non-EBPs); and (3) perceived barriers to high-quality MCT services. Nearly all clinicians reported use of validated suicide screening tools and generic "safety planning." However, a sizeable minority also reported use of non-EBPs. Open-ended responses suggested many client/family-, clinician-, and systems-level barriers to MCT use of EBPs for suicide prevention. We identified several targets for future implementation efforts, including the need for de-implementation strategies to reduce use of ineffective and potentially harmful practices, and unique aspects of MCTs that require tailored implementation supports. [ABSTRACT FROM AUTHOR]

BACKGROUND: The current in-service Royal Naval Fitness Test has two elements to test the aerobic endurance and muscular strength of Service Personnel through generic field-based tests and a short job task simulation. However, in 2017 the Royal Navy (RN) identified a requirement to update their in-service fitness test to align with international best practice. OBJECTIVE: The purpose of this study was to conduct an Objective Job Task Analysis on critical, physically demanding tasks that could be undertaken by RN sailors during sea deployments METHODS: Twenty-one training exercises were observed across a range of contexts; Type 23 Frigates, Type 45 Destroyers and at shore-based training facilities. A total of 203 RN personnel (age 27.8±7.1 years) were observed undertaking 36 job related tasks (e.g., 'firefighting', 'damage control', 'abandon ship' and 'casualty handling'). Tasks were evaluated by cardiovascular response, primary functional movements and contextual factors to aid a Military Judgement Panel in task list down-selection. RESULTS: 14 Criterion Tasks (e.g., 'firefighting', 'two-person magazine stowage' and 'casualty handling') were selected to progress to the next stage of the process. Five tasks were selected based on cardiovascular responses and a further nine tasks selected based on task ergonomics and other factors. CONCLUSION: This research has identified and quantified the most physically demanding, critical roles undertaken by RN sailors on sea deployments and will inform the development of the RN Physical Employment Standard. [ABSTRACT FROM AUTHOR]

Objective: Heterogeneous brief non-pharmacological interventions and guidelines exist to treat the burgeoning presentations to both emergency department and inpatient settings, for those in a crisis of mental ill-health. We systematically reviewed the literature to create a taxonomy of these brief non-pharmacological interventions, and review their evaluation methods and effectiveness. Method: We conducted a systematic review across Cochrane, CINAHL, DARE, Embase, MEDLINE, PsycINFO databases. Studies meeting quality criteria, using Joanna Briggs Institute tools, were eligible. Interventions were categorised, and outcomes synthesised. Results: Thirty-nine studies were included: 8 randomised controlled trials, 17 quasi-experimental, 11 qualitative studies, and 3 file audits. Taxonomy produced six coherent intervention types: Skills-focussed, Environment-focussed, Special Observation, Psychoeducation, Multicomponent Group and Multicomponent Individual. Despite this, a broad and inconsistent range of outcome measures reflected different outcome priorities and prevented systematic comparison of different types of intervention or meta-analysis. Few brief non-pharmacological interventions had consistent evidential support: sensory modulation rooms consistently improved distress in inpatient settings. Short admissions may reduce suicide attempts and readmission, if accompanied by psychotherapy. Suicide-specific interventions in emergency departments may improve depressive symptoms, but not suicide attempt rates. There was evidence that brief non-pharmacological interventions did not reduce incidence of self-harm on inpatient wards. We found no evidence for frequently used interventions such as no-suicide contracting, special observation or inpatient self-harm interventions. Conclusion: Categorising brief non-pharmacological interventions is feasible, but an evidence base for many is severely limited if not missing. Even when there is evidence, the inconsistency in outcomes often precludes clinicians from making inferences, although some interventions show promise. [ABSTRACT FROM AUTHOR]

Background: The COVID pandemic is an example of a crisis challenging healthcare systems worldwide. The impact of the pandemic on providing high-quality palliative care calls for a deeper understanding of specialist services during crises. This is essential in preparation for further crises. Aim: To develop a conceptual understanding of the impact of the pandemic on specialist palliative care as an example for arising future crises. Design: Qualitative interview study across Germany, following a constructivist grounded theory methodology. Setting/participants: Eleven semi-structured interviews with experts with overarching knowledge of structures and processes in specialist palliative care between 05–07/2020 and between 02–06/2021, 23 semi-structured interviews with healthcare professionals working in a specialist palliative care setting. Results: The complex system of palliative care provision during crises has properties that cannot be understood as separated parts of the care process. The pandemic led to unique structural and processual challenges characterized by interconnectedness, uncertainty, dynamic, underlying dilemmas, and unclear long-term goal. In response to the pandemic, teams experienced different phases, which enhanced adaption, innovation, and progress within complex care situations. Creative strategy approaches and dynamic responsiveness facilitated innovative development and could lead to long-lasting improvement within services. Availability of information, transparent communication, comprehensible instructions, participation in decision-making, and search for solutions contributed to teams' proactive development throughout the pandemic. Conclusion: Addressing the complex problems in specialist palliative care caused by crises requires system thinking and a learning mindset. This can facilitate teams to overcome the crisis and move forward rather than bounce back to normal. [ABSTRACT FROM AUTHOR]

Background: Intensive care units (ICUs) have been overwhelmed by the increasing number of coronavirus disease 2019 (COVID‐19) cases, causing psychological burdens, stress, and various types of conflict among nurses. Aim: To examine the occurrence, type, and intensity of conflict and preferred management styles among ICU nurses during the COVID‐19 pandemic. Study Design: This cross‐sectional descriptive study was conducted in a government hospital in Saudi Arabia using a convenience sample of 95 nurses from three ICUs. Data were collected using an e‐questionnaire comprising the Nursing Conflict Scale, Rahim Organizational Conflict Inventory‐II, and sociodemographic variables. Results: Most participants reported exposure to moderately (64.2%) or highly (34.79%) intense conflict during the pandemic. The competitive (2.23 ±.472) and intragroup (2.23 ±.385) types of conflict were the most frequently reported. The preferred conflict management style was collaborating (21.85 ± 5.49), followed by accommodating (18.39 ± 4.03). Pearson's correlation analysis showed that age, years of experience, and education were significantly associated with conflict type and management style. Preparedness to care for suspected or confirmed COVID‐19 cases was associated with interpersonal conflict (r =.20, p =.04). Conclusions: The participants experienced moderate‐ to high‐intensity conflict; however, they employed constructive rather than destructive management styles. Relevance to Clinical Practice: Nurse leaders, policymakers, and educators must initiate transformational intervention programmes to enhance and sustain nurses' competencies in constructive conflict management strategies. Interpersonal communication and crisis management training programmes should be formulated to raise nurses' awareness and enhance their competencies vis‐à‐vis taking a positive approach to overcoming various conflict types and levels, particularly during crises. [ABSTRACT FROM AUTHOR]

A robust field of research has elucidated when and why people are willing to offer help in times of crisis. Yet helping behaviour does not always occur when needed, and the absence of helping during crisis is less well studied. By broadly defining a crisis as an extremely difficult, disruptive and dangerous situation, which may result in possible harm to individuals, groups and societies, this article reviews research focused on the following general question: What factors (psychological, sociological, economic and legal) prevent people from helping others in times of collective crisis? The present work (a) integrates the helping literature, (b) presents new theoretical and empirical perspectives on novel findings concerning failures to help during crises, and (c) suggests recommendations that will enable professionals involved in emergency management to support the public in developing their own capacity to manage and overcome crises. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to describe the experience and practice of an intervention process for mental health crisis with 14,093 students living in a suddenly quarantined campus during the COVID‐19 pandemic. Methods: An expert committee of psychiatrists, psychologists and student counsellors was formed to manage the psychological crisis experienced by students. The committee provided online and onsite support, disclosed timely information, attended various online courses and facilitated various activities. Using the PHQ‐9, GAD‐7 and ISI scales, psychological weekly reports, student files and emergencies, students who were likely to have a crisis event were screened, and their degree of crisis was evaluated. A "one person–one case–one team" intervention was conducted for high‐risk students. Results: Of the 14,093 students, 11,121 finished all three online questionnaires. Based on the results of the screening tests, 732 students were placed in the prioritised attention group, 293 in the crisis group and 33 (10 [3.41%] male and 23 [7.85%] female) showed severe suicidal intentions. In total, 186 (3.26%) students declared poor sleep quality, while 610 (10.05%) students were found to have depression. The number of students affected with generalised anxiety was 650 (10.77%). Clinical intervention was successful with no untoward incidents. Conclusions: With strong support from the government, and the cooperation between multidisciplinary experts and the comprehensive intervention programme, the study obtained positive results. However, the limitations include the partial online survey responses and incomplete records of intervention. Nevertheless, the findings of this study could provide a foundation for further research. [ABSTRACT FROM AUTHOR]

Interaction has been recognised as an essential lens to understand how cognition is formed in a complex adaptive team such as a multidisciplinary crisis management team (CMT). However, little is known about how interactions within and across CMTs give rise to the multi-team system's overall cognitive functioning, which is essential to avoid breakdowns in coordination. To address this gap, we characterise and compare the component CMTs' role-as-intended (RAI) and role-as-observed (RAO) in adapting to the complexity of managing informational needs. To characterise RAI, we conducted semi-structured interviews with subject matter experts and then made a qualitative synthesis using a thematic analysis method. To characterise RAO, we observed multiteam interaction networks in real-time at a simulated training environment and then analysed the component CMTs' relative importance using node centrality measures. The resulting inconsistencies between RAI and RAO imply the need to investigate cognition in multiple CMTs through the lens of interaction. Practitioner summary: When a disaster occurs, multidisciplinary CMTs are expected to serve their roles as described in written or verbal guidelines. However, according to our naturalistic observations of multiteam interaction networks, such descriptions may be (necessary but) insufficient for designing, training, and evaluating CMTs in the complexity of managing informational needs together. [ABSTRACT FROM AUTHOR]

Aims: Ambulance pre-alerts are used to inform receiving emergency departments (EDs) of the arrival of critically unwell or rapidly deteriorating patients who need time-critical assessment or treatment immediately upon arrival. Inappropriate use of pre-alerts can lead to EDs diverting resources from other critically ill patients. However, there is limited guidance about how prealerts should be undertaken, delivered or communicated. We aimed to map existing pre-alert guidance from UK NHS ambulance services to explore consistency and accessibility of existing guidance. Methods: We contacted all UK ambulance services to request documentation containing guidance about pre-alerts. We reviewed and mapped all guidance to understand which conditions were recommended for a pre-alert and alignment with Association of Ambulance Chief Executives (AACE) and Royal College of Emergency Medicine (RCEM) pre-alert guidance. We reviewed the language and accessibility of guidance using the AGREE II tool. Results: We received responses from 15/19 UK ambulance services and 10 stated that they had specific pre-alert guidance. We identified noticeable variations in conditions declared suitable for pre-alerts in each service, with a lack of consistency within each ambulance service’s own guidance, and a lack of alignment with the AACE/RCEM pre-alert guidance. Services listed between four and 45 different conditions suitable for pre-alert. There were differences in physiological thresholds and terminology, even for conditions with established care pathways (e.g. hyperacute stroke, ST segment elevation myocardial infarction). Pre-alert criteria were typically listed in several short sections in lengthy handover procedure policy documents. Documents appraised were of poor quality with low scores below 35% for applicability and overall. Implications: There is a clear need for ambulance services to have both policies and tools that complement each other and incorporate the same list of pre-alertable conditions. Clinicians need a single, easily accessible document to refer to in a time-critical situation to reduce the risk of making an incorrect pre-alert decision. [ABSTRACT FROM AUTHOR]

The boundaries for whom the welfare state should protect during times of crisis are not necessarily obvious. Deservingness studies have identified unemployed people and immigrants as groups perceived as 'less deserving' of welfare state support than other groups in need during 'normal' times. These two groups have in recent years been subject to more conditional requirements and an incentivizing rationale. In this article, we compare the policy responses for 1) unemployed people and 2) immigrants during the COVID-19 pandemic in Norway form 2020–2022. We ask: Who deserves exceptions in times of crisis? We find that a cross-partisan parliament introduced extensive economic relief packages and temporary regulations to mitigate negative financial consequences for unemployed persons and furloughed workers. Politicians argued that individuals were not to blame for their unfortunate financial circumstances during the pandemic, and that the welfare state had to take the larger share of the burden. However, the government chose not to make temporary exemptions from economic requirements for permanent residence or family reunification. It was explicitly stated that there was no reason to deviate (temporarily) from the general economic requirements during the pandemic, referring to the potential strain on the Norwegian welfare state if immigrants were not self-sufficient. We argue that the political rationale of incentives underlying these requirements falls short during economic crises and that this non-policy response illustrate new forms of welfare state chauvinism. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed to examine the relationships between resilience and personal characteristics such as socio-economic status, employment, satisfaction with life, and anxiety, during the period of returning to routine life after mass vaccination for COVID-19. Method: 993 Israeli participants, 52% female and 48% male, with a mean age of 40 years (18 to 89 years old) responded to an online questionnaire during March 2021. We hypothesized that (1) unemployed individuals and those with a low SES would have lower resilience, lower satisfaction with life and higher anxiety, (2) individuals who were ill with COVID-19 would have lower resilience and satisfaction with life and a higher level of anxiety, and (3) a higher resilience would be related to a lower level of anxiety. Results: The findings showed that unemployed individuals had lower levels of resilience and satisfaction with life and higher levels of anxiety than employed individuals. Specifically, those who experience a large gap between their socio-economic and employment statuses are at a greater risk than others. In addition, differences were found between people who had experienced COVID-19 illness and those who had not, but only with their satisfaction with life. People who had been ill were more satisfied than those who had not been ill. Eventually, as expected, a higher resilience was related to a lower level of anxiety, specifically at the lower levels of resilience. Conclusions: The findings of this study can provide additional perspectives on the day after a crisis (COVID-19) and the need for the development of intervention programs to strengthen the resilience of individuals who experience a gap between their SES and employment statuses when returning to their routine life after a crisis. The study also shed light on the unique correlation between anxiety and resilience, implying that following a crisis, high-resilience individuals face their anxiety better than low-resilience individuals. [ABSTRACT FROM AUTHOR]

Crisis helplines provide important support for vulnerable individuals during the COVID-19 pandemic, which may also impact the helplines. We explored the challenges that the pandemic brought to Taiwan's national suicide prevention hotline and the hotline's responses. We interviewed 14 hotline workers and conducted data analysis using the framework method. The pandemic posed two new challenges to the hotline: potential service interruption and the adjustment of perceived role among hotline workers. The hotline's well-formulated response plan helped it sustain its services during the pandemic, although the workers also experienced stress and frustration resulted from role ambiguity. Our data highlighted the hotline workers' need for accurate COVID-19 information, relevant training, and timely support. [ABSTRACT FROM AUTHOR]

Emergency inpatient admissions of children and adolescents are more difficult if the patient is admitted involuntarily and/or the caregivers or custodians of institutional care are absent. The present study aimed to clinically characterize involuntary versus voluntary admissions by examining the reasons for presentation and associated factors. We retrospectively analyzed patients who presented to the emergency department of a hospital for child and adolescent psychiatry in Bavaria, Germany, and were admitted as inpatients for crisis intervention in the 4th quarter of 2014–2018. Reasons for presentation, clinical and sociodemographic characteristics, and type of admission (voluntary versus involuntary) were analyzed for 431 emergency inpatient admissions. A total of 106 (24.6%) patients were involuntarily admitted. In a binominal logistic regression, presentation due to alcohol consumption, deviant social behavior, and psychosocial burden was positively associated, whereas difficulties at school and depression were negatively associated, with the likelihood of involuntary admission. 58.5% of the 123 unaccompanied patients were admitted involuntarily. Reasons for the presentation of unaccompanied and voluntary inpatient admissions were suicidal thoughts, psychosocial burden, and externalized aggression. A substantial number of child and adolescent psychiatric admissions represent emergency admissions. Involuntarily admitted patients and unaccompanied children/adolescents represent a non-negligible proportion of clinical routine and the clinical and legal background factors need to be further clarified in future studies. This study is registered in the German Clinical Trials Register (24 September 2019, DRKS00017689). [ABSTRACT FROM AUTHOR]

Help‐line services provide a vital support to individuals experiencing mental or personal crisis. Recent years has seen a rise in both text‐based services as well as remote working conditions for those who offer help‐line services. Previous research has demonstrated positive and negative outcomes for individuals voluntarily offering support at crisis‐line services. However, few studies have focused on the mechanisms at work. The social identity approach offers one potential avenue for exploration. Specifically, individuals who meaningfully identify as a volunteer can unlock the benefits of the social cure. However, this pathway has not been tested for volunteers in remote working environments. The current study tested associations between identification with a crisis support organisation, well‐being outcomes, perceptions of social‐support, and self‐efficacy in remote text‐based services. This study collected data from 157 crisis‐support line volunteers in two remote‐working contexts. Results indicated a serial mediated indirect effect. Specifically, increased identification as a volunteer predicted increased perceptions of social support. In addition, social support predicted higher levels of self‐efficacy, resulting in increased levels of compassion satisfaction along with decreased levels of burnout, and secondary traumatic stress. Results emphasise the role of social identity and perceptions of social support in promoting positive outcomes for remote‐working volunteers. [ABSTRACT FROM AUTHOR]