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To promote the Royal College's core principles of sustainable psychiatry, Junior Doctors at Ayrshire Central Hospital formed the Sustainability and Well-being Committee. The principle aim through 2022, following the COVID-19 pandemic, was to maximise junior well-being - knowing a sustainable workforce is one that feels supported and fulfilled by work and working conditions.
Through meetings with junior doctors, qualitative information on factors impacting well-being in the work place was gathered, and three targets for improvement were identified.
The following domains and interventions were implemented:
1. Improve working environment: The doctor's office was sized for 2 staff maximum - despite staffing levels consistently in excess of 20 junior doctors. Additionally, there was no natural light. We obtained a new significantly larger office space, with natural light.
2. Comfort break area – Doctors identified that having an area with comfort seating to take breaks and socialise away from patients and visitors would be beneficial. We obtained a seating area and a coffee machine, maintained by the junior doctors.
3. Access technology – Absence of desktops and IT issues with older laptops was impairing productivity and morale. We obtained 4 new desktop computers, and personal laptops for core trainees.
A digital questionnaire was used to collect quantitative data retrospectively, from doctors currently working in the department, or who had done so in the last 6 months.
Likert scales were used to assess pre and post-intervention levels of well-being, and ranking intervention impact on this. Doctors also identified future areas of intervention going forward into 2023.
A total of 16 responses were obtained, and 100% of these agreed that feeling supported and good working conditions was important to maintaining wellness and productivity. Pre-intervention average wellness was rated 5.2 (with 1 being extremely poor, and 10 being extremely good), this increased to 8.1 post-intervention. Improved working environment had the most significant impact on well-being.
Respondents identified environmental sustainability as target for improvement in 2023, potentially through improved recycling, reducing meat consumption and car sharing. Further well-being interventions e.g., walks, promotion of Balint group and social events were also suggested.
Interventions from the trainee-led Sustainability and Well-being Committee through 2022 improved working environment and subjective well-being. This demonstrates that junior staff can successfully initiate and lead projects to promote and improve sustainability in psychiatry. Results indicate that junior staff are willing to actively participate in interventions to improve well-being, and environmental sustainability in 2023.
Medical Emergencies in A Mental Health Setting (MEAMS) was a proposed high-fidelity simulation training course specifically designed for the mental health multidisciplinary team (MDT). A team of resus officers, mental health nurses and psychiatric doctors worked to create scenarios reflecting the emergencies encountered in mental health. It aimed to gives staff simulated experience in approaching and managing a verity of complex emergencies, including physical health, as well as communication scenarios. Specifically the aims were: (1) Determine if course was perceived to benefit staff, (2) Determine if course subjectively increased staff knowledge and confidence in mental health emergencies, (3) Review for continued areas of improvement
The full day sessions were carried out in the Electroconvulsive therapy (ECT) suite, with it being modified into an immersive environment similar to wards or clinics. The faculty of medical resus officers, mental health nurses and psychiatric consultants ran the courses, with participants joining from across the MDT including nursing staff, junior doctors, consultants, students and nursing assistants.
The morning program, run by resus officers, provided education in life support, initial assessment of the unwell patient and intraosseous access. The afternoon contained various scenarios, including for example managing neuroleptic malignant syndrome. Scenarios were observed via video link by faculty, with constructive feedback and debriefs provided.
Quantitative data of knowledge and confidence was obtained pre and post sessions using Likert scales. Qualitative information regarding future proposed scenarios, areas of improvement and areas of notable value was gathered.
36 staff attended the program, run over 4 days. Average knowledge and confidence (scored out of 10) improved from 4.9 pre-session to 8.1 post-session. All 36 staff felt the session was beneficial. Particular positive feedback on scenario realism, MDT working, safe/ supportive teaching and the resus faculty teaching was highlighted.
Areas for improvement highlighted included running sessions more often, widening accessibility to more staff and teaching on resus medications and fluids. A variety of further scenarios were suggested, for example management of withdrawal seizure.
MEAMS was felt to achieve its aims, and demonstrated clear subjective increase in staff knowledge and confidence regarding common emergencies seen in mental health settings. Further sessions and wider accessibility to the mental health MDT is anticipated to continually benefit staff. Taking on qualitative feedback, the faculty aims to continually adapt the program to provide the best possible training and education, adapting and creating new relevant scenarios.
Within NHS Ayrshire and Arran for psychiatric inpatient admissions, the admitting clinician is to directly handover clinical details and relevant aspects of mental state, risk and management plan to the inpatient duty doctor. Over 2022, there was concerns this process was not being followed, resulting in prescription errors, difficulty in assessing risk at admission and difficulty in prioritising workload. The aim of the project was to first assess pre-intervention rates of handover for inpatient admissions. Then with these data, look for interventions. The final aim was to re-asses post-intervention, analysing if interventions improved rates of handover.
Pre-intervention quantitative data were gathered over a three week period in April 2022, with Junior Doctors noting for admissions to Woodland View Psychiatric Hospital whether handover had been received, or if the Duty Doctor had been alerted at all to the admission prior to patient's arrival on the ward.
Qualitative data were also gathered, specifically asking what factors admitting clinicians found impacted ability to handover.
Data were presented at the monthly division of psychiatry meeting, and subsequently interventions were discussed in a meeting with Hospital bed managers, Hospital co-coordinators and the clinical director for inpatient care. The outcome resulted in change to the local hospital admission protocol, with bed managers prompting the importance of handover, and transferring admitting clinician's phone calls to the duty doctor at the time admissions are accepted by bed managers.
Post-Intervention, the same criteria assessed in April 2022 was reassessed in January 2023.
Pre-intervention, of 25 admissions, a handover was provided for 32% of patients. Duty doctor was alerted to 52% of admissions prior to the patient's arrival on the ward. Post-intervention, this increased to 71% and 82% respectively for 17 patients admitted in January 2023.
Qualitative themes thought to impact ability of handover were admitting clinicians feeling there was already a number of calls made when admitting, and one with duty doctor could be neglected. Secondly the clinicians thought another member of the team would alert duty doctor of admissions.
The project met its aims, showing pre-intervention rates of handover as low, and post-intervention rates rising after the admission process was changed, taking on the feedback from admitting clinicians. Given rates remain still significantly below 100%, there is still further work to be done. Results are due to be shared again with bed managers and at division to discuss further interventions.
New light is shed on the song culture of Sankt Gallen almost a century before its earliest notated sources through consideration of the poetic section of a manuscript copied at the Abbey shortly after the year 800, i.e. the second part of Leiden, Universiteitsbibliotheek Vossianus Lat. Q. 69. The predominantly Merovingian accentual Latin verse (rhythmi) and metrical verse by the late-antique poet Prudentius (his Liber Cathemerinon and Liber Peristephanon) were written out in song forms. It is newly proposed that Prudentius’ verse from the Liber Peristephanon was arranged into a liturgical cycle. The poetic section of the Leiden manuscript is accordingly understood as a collection of songs, which prompts reflection on the way in which earlier sung versus at Sankt Gallen may have provided models for the later Liber ymnorum. Witnesses to the song culture of Sankt Gallen in the first half of the ninth century are re-examined and a leading role during this period for the nearby Abbey of Reichenau is proposed. Finally, it is suggested that Iso’s advice to Notker that singulae motus cantilenae singulas syllabas debent habere was at least partly informed by the existing tradition of sung versus at both abbeys.
One of the earliest surviving accounts of Christian liturgy is a report of Sunday Eucharist written at Rome around AD 150 by Justin Martyr:
And on the day named for the sun there is an assembly in one place for all who live in the towns and in the country; and the memoirs of the Apostles and the writings of the Prophets are read as long as time permits. Then when the reader has finished, he who presides speaks, giving admonishment and exhortation to imitate those noble deeds. Then we all stand together and offer prayers. And when, as we said above, we are finished with the prayers, bread is brought, and wine and water, and he who presides likewise offers prayers and thanksgiving, according to his ability, and the people give their assent by exclaiming Amen. And there takes place the distribution to each and partaking of that over which thanksgiving has been said, and it is brought to those not present by the deacon.
A description of a solemn mass as celebrated at Rome some six centuries later runs to several thousand words. The account of the introit, cited here in abbreviated form, is in itself longer than the entirety of Justin Martyr's earlier description.
Then [the choir] rises up and passes in order before the altar, and the two rows arrange themselves in this manner: the men-singers on either side without the doors [of the presbytery], and the children on each side within. Immediately the precentor begins the anthem for the entry: and when the deacons hear his voice, they at once go to the pontiff in the sacristy. Then the pontiff, rising, gives his right hand to the archdeacon, and his left to the second [deacon], or whoever may be appointed: who, after kissing his hands, walk with him as his supporters . . . After this the pontiff passes on, but before he comes to the choir the bearers of the candlesticks divide, four going to the right and three to the left; and the pontiff passes between them to the upper part of the choir, and bows his head to the altar . . . Then turning towards the precentor, he signs to him to sing, Glory be to the Father, and to the Son etc.; and the precentor bows to the pontiff, and begins it . . .
For a large part of Western music history we are forced to interpret in the absence of signs. The appearance in the ninth century of a system of signs to represent music thus not only comes as something of a relief but also raises certain questions. How would the signs have been understood? How would something with no immediate history have been comprehended? Recent answers to such questions have placed notational signs within the context of oral history, positing a degree of continuity and interaction across oral and literate domains. Much insight has been gained through this awareness of oral issues, and it is not intended to challenge claims made in this area.
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