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  • Mental health and other factors associated with work productivity after injury in the UK: multicentre cohort study

    Morriss, Richard K. (2021)
    Introduction Mental health conditions are a major contributor to productivity loss and are common after injury. This study quantifies postinjury productivity loss and its association with preinjury and postinjury mental health, injury, demographic, health, social and other factors.Methods Multicentre, longitudinal study recruiting hospitalised employed individuals aged 16–69 years with unintentional injuries, followed up at 1, 2, 4 and 12 months. Participants completed questionnaires on injury, demographic factors, health (including mental health), social factors, other factors and on-the-job productivity upon return to work (RTW). ORs were estimated for above median productivity loss using random effects logistic regression.Results 217 adults had made an RTW at 2, 4 or 12 months after injury: 29% at 2 months, 66% at 4 months and 83% at 12 months. Productivity loss reduced over time: 3.3% of working time at 2 months, 1.7% at 4 months, 1% at 12 months. Significantly higher productivity loss was associated with preinjury psychiatric conditions (OR 21.40, 95% CI 3.50 to 130.78) and post-traumatic stress avoidance symptoms at 1 month (OR for 1-unit increase in score 1.15, 95% CI 1.07 to 1.22). Significantly lower productivity loss was associated with male gender (OR 0.32, 95% CI 0.14 to 0.74), upper and lower limb injuries (vs other body regions, OR 0.15, 95% CI 0.03 to 0.81) and sports injuries (vs home, OR 0.18, 95% CI 0.04 to 0.78). Preinjury psychiatric conditions and gender remained significant in analysis of multiply imputed data.Conclusions Unintentional injury results in substantial productivity loss. Females, those with preinjury psychiatric conditions and those with post-traumatic stress avoidance symptoms experience greater productivity loss and may require additional support to enable successful RTW.No data are available.
  • A case management occupational health model to facilitate earlier return to work of NHS staff with common mental health disorders: a feasibility study

    Griffiths, Amanda (2021)
    Background: The NHS is the biggest employer in the UK. Depression and anxiety are common reasons for sickness absence among staff. Evidence suggests that an intervention based on a case management model using a biopsychosocial approach could be cost-effective and lead to earlier return to work for staff with common mental health disorders. Objective: The objective was to assess the feasibility and acceptability of conducting a trial of the clinical effectiveness and cost-effectiveness of an early occupational health referral and case management intervention to facilitate the return to work of NHS staff on sick leave with any common mental health disorder (e.g. depression or anxiety). Design: A multicentre mixed-methods feasibility study with embedded process evaluation and economic analyses. The study comprised an updated systematic review, survey of care as usual, and development of an intervention in consultation with key stakeholders. Although this was not a randomised controlled trial, the study design comprised two arms where participants received either the intervention or care as usual. Participants: Participants were NHS staff on sick leave for 7 or more consecutive days but less than 90 consecutive days, with a common mental health disorder. Intervention: The intervention involved early referral to occupational health combined with standardised work-focused case management. Control/comparator: Participants in the control arm received care as usual. Primary outcome: The primary outcome was the feasibility and acceptability of the intervention, study processes (including methods of recruiting participants) and data collection tools to measure return to work, episodes of sickness absence, workability (a worker’s functional ability to perform their job), occupational functioning, symptomatology and cost-effectiveness proposed for use in a main trial. Results: Forty articles and two guidelines were included in an updated systematic review. A total of 49 of the 126 (39%) occupational health providers who were approached participated in a national survey of care as usual. Selected multidisciplinary stakeholders contributed to the development of the work-focused case management intervention (including a training workshop). Six NHS trusts (occupational health departments) agreed to take part in the study, although one trust withdrew prior to participant recruitment, citing staff shortages. At mixed intervention sites, participants were sequentially allocated to each arm, where possible. Approximately 1938 (3.9%) NHS staff from the participating sites were on sick leave with a common mental health disorder during the study period. Forty-two sick-listed NHS staff were screened for eligibility on receipt of occupational health management referrals. Twenty-four (57%) participants were consented: 11 (46%) received the case management intervention and 13 (54%) received care as usual. Follow-up data were collected from 11 out of 24 (46%) participants at 3 months and 10 out of 24 (42%) participants at 6 months. The case management intervention and case manager training were found to be acceptable and inexpensive to deliver. Possible contamination issues are likely in a future trial if participants are individually randomised at mixed intervention sites. Harms: No adverse events were reported. Limitations: The method of identification and recruitment of eligible sick-listed staff was ineffective in practice because uptake of referral to occupational health was low, but a new targeted method has been devised. Conclusion: All study questions were addressed. Difficulties raising organisational awareness of the study coupled with a lack of change in occupational health referral practices by line managers affected the identification and recruitment of participants. Strategies to overcome these barriers in a main trial were identified. The case management intervention was fit for purpose and acceptable to deliver in the NHS.
  • Vocational rehabilitation to enhance return to work after trauma (ROWTATE): protocol for a non-randomised single-arm mixed-methods feasibility study

    das Nair, Roshan; Morriss, Richard K. (2021)
    BACKGROUNDTraumatic injuries are common amongst working-age adults. Survivors often experience physical and psychological problems, reduced quality of life and difficulty returning to work. Vocational rehabilitation improves work outcomes for a range of conditions but evidence of effectiveness for those with traumatic injuries is lacking. This study assesses feasibility of delivering a vocational rehabilitation intervention to enhance return to work and improve quality of life and wellbeing in people with at least moderate trauma to inform design of a definitive randomised controlled trial (RCT).METHODSNon-randomised, single-arm, multi-centre mixed-methods feasibility study with nested case studies and qualitative study. The case studies comprise interviews, observations of clinical contacts and review of clinical records. The qualitative study comprises interviews and/or focus groups. Participants will be recruited from two UK major trauma centres. Participants will comprise 40 patients aged 16-69 with an injury severity score of > 8 who will receive the intervention and complete questionnaires. Interviews will be conducted with 10 patients and their occupational therapists (OTs), clinical psychologists (CPs), employers and commissioners of rehabilitation services. Fidelity will be assessed in up to six patients by observations of OT and CP-patient contacts, review of patient records and intervention case report forms. OT and CP training will be evaluated using questionnaires and competence to deliver the intervention assessed using a team objective structured clinical examination and written task. Patients participating in and those declining participation in the study will be invited to take part in interviews/focus groups to explore barriers and facilitators to recruitment and retention. Outcomes include recruitment and retention rates, intervention fidelity, OT and CP competence to deliver the intervention, experiences of delivering or receiving the intervention and factors likely to influence definitive trial delivery.DISCUSSIONEffective vocational rehabilitation interventions to enhance return to work amongst trauma patients are urgently needed because return to work is often delayed, with detrimental effects on health, financial stability, healthcare resource use and wider society. This protocol describes a feasibility study delivering a complex intervention to enhance return to work in those with at least moderate trauma.TRIAL REGISTRATIONISRCTN: 74668529 . Prospectively registered on 23 January 20.
  • Menopause and work: An overview of UK guidance

    Griffiths, Amanda (2018)
    Background: Recent evidence suggests that some women experience menopausal symptoms that impact on their working lives, and that work environments can impact upon the experience of menopause. As a result, guidance for employers and other key stakeholders about this potential occupational health issue has emerged. To date there has not been a review of these documents to identify their main recommendations for policy and practice. Aims: To provide a narrative overview of such guidance and summary of content. Methods: Documents published in the UK and available in a major UK trade union library were searched systematically to identify guidance on the topic of menopause and work. An inductive thematic analysis was performed to identify the main themes addressed. Results: Twenty-five relevant documents, on average eight pages long, were identified. A minority indicated that the use of scientific evidence informed the content. Five overarching themes were identified: (i) legislation; (ii) policy; (iii) information and training needs; (iv) workplace support; and (v) the physical work environment. Conclusions: This overview of UK guidance revealed common areas of concern about reducing and managing difficulties experienced by working menopausal women. Possible areas for action were identified. Some recommendations were common across much of the guidance, whereas others were exclusive. Future guidance might include consideration of all these issues, while making reference both to the evidence base and sources of further information.
  • The effectiveness of analytically informed team supervision in reducing sickness absence rates

    Ijomah, Geoffrey; Sleight, Victoria (2016)
    Introduction/Aims Psychoanalytic literature documents how staff are impacted by the toxic emotional states and behaviours that are generated through treating patients with severe long-term psychological problems and working in a high secure forensic setting. This study evaluates the outcome of providing analytically informed reflective supervision to a department team in such a setting. Methods Participants; A team consisting of art therapists, music therapists, assistants and departmental manager. The Intervention; Analytically Informed Reflective Practice. Duration: 90 minutes, delivered in a group format by a facilitator external to the department. Focus: emotional impact of work, team relationships, systemic issues and institutional culture. Frequency: monthly for a minimum of one year. Quantitative measures; Pre-post comparison of the pattern of sickness absence for12 months prior and during team supervision. Management records were used to determine the quantity of sickness absence days. Qualitative measures; Semi structured interview of the participants about the experience of supervision, conducted by an independent interviewer. Results Sickness absence rates were on the increase prior to team supervision. Rates of sickness continued to increase for the initial few months before beginning to reduce. By month nine the sickness absence pattern had changed and most months were free of sickness absence. At interview the participants reported the experience of supervision being beneficial in terms of: - sharing a common experience - gaining an understanding of others - learning about assumptions made about others. Conclusions/Comments Team supervision delivered in this way was associated with improved staff sickness absence patterns. The time-scale for improvement was consistent with the mode of action of group psychotherapy. The improvement can be detected by the ninth month through staff management records. Staff found team supervision beneficial and improved their understanding of team relationships. The treatment was cost-effective in terms of cost saved through reducing staff sickness. Other benefits include improved efficiency in terms of the team maintaining an increased caseload.
  • Does talking about work place emotional stresses reduce sickness and improve well-being?

    Ijomah, Geoffrey; Sleight, Victoria; Fairlie, Deborah (2018)
    BACKGROUND & AIMS Reflective practice meetings are recommended for supporting the well-being of organisations and mental health practitioners but few evaluations have been conducted. This pilot study evaluates the outcome of introducing a forum to discuss the psychological and emotional impact of providing patient care in a high secure hospital setting. METHODS A mixed methods observational study. Participants; A team consisting of art therapists, music therapists, assistants and departmental manager, n=8. Intervention; Reflection on team relationships, re-organisations, organisational culture and the emotional impact of work. Duration; 90 minutes, monthly using a group psychotherapy model. OUTCOME MEASURES & ANALYSIS Sickness records; Comparisons of Pre-treatment and Post-intervention levels of sickness absence. CORE-OM (Clinical Outcomes in Routine Evaluation) at 3, 10 and 15 months post-intervention. Semi-structured interviews and thematic analysis of the experience of reflective practice. RESULTS Statistically significant reductions in sickness absence days (Two sample t test p=0.034) Staff wellbeing improved as the intervention was continued. At interview the participants reported the experience of reflective practice meetings as being beneficial and developing interpersonal learning, especially in improving understanding of others roles, impact of behaviour on others and ability to talk directly rather than letting issues bubble under the surface. CONCLUSIONS/COMMENTS Reflective practice meetings delivered in this way were associated with improvements in staff wellbeing, team relationships and a reduction in sickness absence. The treatment was cost effective in terms of costs saved through reducing staff sickness levels, increased resilience and productivity in terms of adaptation to an increased workload. Success of the initial evaluation led to the expansion and adoption of the model by the wider department encompassing approximately 120 staff.
  • Vicarious traumatization: Implications for the mental health of health workers?

    Sabin-Farrell, Rachel (2003)
    It has been suggested that a unique feature of some mental heath practitioners' work is exposure through their role as therapists to clients' descriptions of and reactions to trauma, and that these experiences may actually indirectly cause distress and traumatization to the therapist. This proposed phenomenon has been termed "vicarious traumatization" (VT) and is the focus of the current review. The concept of VT, together with other related concepts such as "burnout," "compassion fatigue," "secondary traumatic stress" (STS), and "work stress" are appraised. Psychological mechanisms that might be theoretically involved in VT are considered. The measurement of VT is reviewed alongside the limited research evidence supporting its existence. Factors such as direct trauma exposure and the personal attributes of mental health workers, which have been suggested to be associated with VT, are also assessed. It is concluded that the evidence to support the existence of VT is meager and inconsistent. Future research needs to be directed at distinguishing VT from other sources of distress arising within the workplace. Finally, the organizational relevance of VT and its possible implications for the management of mental health workers are critically appraised.;
  • EMAS recommendations for conditions in the workplace for menopausal women

    Griffiths, Amanda (2016)
    Women form a large part of many workforces throughout Europe. Many will be working throughout their menopausal years. Whilst the menopause may cause no significant problems for some, for others it is known to present considerable difficulties in both their personal and working lives. During the menopausal transition women report that fatigue and difficulties with memory and concentration can have a negative impact on their working lives. Furthermore, hot flushes can be a source of embarrassment and distress. Some consider that these symptoms can impact on their performance. Greater awareness among employers, together with sensitive and flexible management can be helpful for women at this time. Particular strategies might include: fostering a culture whereby employees feel comfortable disclosing health problems, allowing flexible working, reducing sources of work-related stress, providing easy access to cold drinking water and toilets, and reviewing workplace temperature and ventilation. Copyright © 2016. Published by Elsevier Ireland Ltd.
  • Why do they fail? A qualitative follow up study of 1000 recruits to the British Army Infantry to understand high levels of attrition

    Repper, Julie (2015)
    Background: The British Army has over 100 career employment groups to which recruits may apply. The Infantry is one of these career employment groups; it accounts for 25% of the overall strength. It is of concern that Infantry recruit attrition within the first 12 weeks of training remains consistently above 30% . Poor selection methods that lead to the enlistment of unsuitable recruits have negative financial and personal consequences, but little is known about the personal experiences of those who fail.; Objective: The aim of this research was to understand why infantry recruits choose to leave and explore the personal experiences of those that fail.; Methods: This study draws on qualitative data from the second phase of a larger mixed method study. The foci of this paper are the findings directly related to the responses of recruits in exit interviews and their Commanding Officers' training reports. An exploratory qualitative, inductive method was used to generate insights, explanations and potential solutions to training attrition.; Results: What the data describes is a journey of extreme situational demands that the recruits experience throughout their transition from civilian life to service in the British Infantry. It is the cumulative effect of the stressors, combined with the recruit being dislocated from their established support network, which appears to be the catalyst for failure among recruits.; Conclusion: There are clearly defined areas where either further research or changes to current practice may provide a better understanding of, and ultimately reduce, the current attrition rates experienced by the Infantry Training Centre.;
  • Supported-employment practice in the UK: Evidence about an emerging occupational group

    Schneider, Justine (2008)
    Purpose: This paper reports the findings from a UK survey of 519 practitioners of employment support and rehabilitation for disabled people.; Method: A structured examination of where practitioners worked, who their clients were and what models they operated. It explored training needs, attitudes to disability and current practice in terms of an 'adherence scale' based on supported employment principles.; Results: Respondents were from a wide range of agencies, and the supported-employment model was common. The majority of respondents worked in the voluntary sector, where both perceived needs for training and adherence to supported-employment principles were relatively high. Staff subject to output targets were less optimistic about the potential of all disabled persons to work. There was a lack of confidence in dealing with benefits issues, changing structures and systems, and in delivering cognitive behaviour therapy, which has attracted much attention in the UK.; Conclusion: Our findings begin to remedy the lack of information about the individuals who deliver supported employment in the UK, and offer a comparator for similar enquiries in other countries. They raise questions concerning professionalisation and the role of government departments versus the role of the third sector; these issues call for further investigation.;
  • Association of quality of life and job stress in occupational workforce of India: Findings from a cross-sectional study on software professionals

    Rathnaiah, Mohanbabu (2016)
    Background: There is limited scientific evidence on the relationship of job stress with quality of life (QoL). Purpose: This study aims to explore different domains of job stress affecting IT/ITES professionals and estimate the levels of stress that these professionals endure to reach positive levels of QoL given that other determinants operating between these two variables are accounted for. Materials and Methods: We estimated levels of stress that software professionals would have endured to reach positive levels of QoL considering that other factors operating between these two variables are accounted for. The study participants comprised 1071 software professionals who were recruited using a mixed sampling method. Participants answered a self-administered questionnaire containing questions on job stress, QoL, and confounders. Results: All the domains (physical, psychological, social, and environmental) of QoL showed statistically significant positive associations with increasing stress domains of autonomy, physical infrastructure, work environment, and emotional factors. Conclusions: The respondents clearly found the trade-off of higher stress to be acceptable for the improved QoL they enjoyed. It is also possible that stress might actually be responsible for improvements in QoL either directly or through mediation of variables such as personal values and aspirations. «Yerkes-Dodson law» and stress appraisal models of Folkman and Lazarus may explain the plausible positive association. © 2016 Indian Journal of Occupational and Environmental Medicine. Published by Wolters Kluwer - Medknow.
  • Mentoring students: Exploring and managing incivil behaviour in community nursing placements

    Pitt, Margaret (2016)
    Students who demonstrate quiet incivility can be challenging and disrupt the learning that takes place in the community setting. Recognising incivility and acting to address this behaviour with students is difficult because the behaviour is not overt or obvious to others. The most important component in attempting to manage incivility is exploring the behaviour with the student to identify the potential cause, and negotiate a strategy to improve it. It is acknowledged that the behaviour may be due to personal, academic, or professional issues. If issues are not addressed, care activity and learning are affected, and this can result in failure to achieve in practice.;
  • The 3Rs: Are we asking the wrong questions?

    Ilott, Irene; Kenyon, Joan (2004)
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  • Sun safety knowledge and practice in UK postal delivery workers

    Griffiths, Amanda (2016)
    BACKGROUND: Postal delivery workers spend a large proportion of their work time outdoors, placing them at increased risk of skin cancer. To date, no studies have examined occupational sun safety knowledge and practice within this group in the UK.