Workforce

Introduction: There are abundant anecdotal reports of healthcare professionals undergoing strain, specifically moral distress, in advance care planning (ACP) related work. This study measured perceptions of morally challenging scenarios (MCS) faced by ACP facilitators and frontline clinicians. Method: An online survey, which is currently ongoing, was sent to the ACP community and also frontline clinicians in Singapore. Purposive and snowballing sampling approaches were employed. Result: Participants rated their opinions on 23 MCS in ACP-related work that were earlier identified from 30 interviews. Findings showed that the top three MCS perceived to go against one’s conscience were: (i) providing treatment not in concordance with wishes of patient, (ii) being uncertain if decisions by family members were driven by ulterior motives and (iii) taking the view of dominant family members as the final decision. Most commonly encountered MCS were dilemmas related to (i) perceived medical best interest, (ii) honouring of patient’s preferred place of death, and (iii) having to deal with collusion. Each of 14 MCS were encountered by at least 50% of our participants and 66% of all who had encountered at least one MCS agreed that their psychological health was affected. Guidance from mentors and support from peers were rated most favourably out of the 15 coping strategies to deal with moral dilemma in ACP work. Coping strategies were largely positive with only a minority favouring the use of alcohol or giving in to demands of patients and families. Conclusion: Findings show those who engaged in ACP-related work encountered a wide variety of MCS and perceived their psychological health as being affected. There is a pressing need to address the sources and risk factors of moral distress in such work, and to enhance the protective factors which can help ACP facilitators and frontline clinicians cope with moral distress successfully.

Introduction

The British Geriatric Society (BGS) highlighted the need for workforce improvement and development of a skilled multidisciplinary team (MDT) in older people’s healthcare in their 2024 roundtable, “Transforming care for older people”. This survey aimed to gather views from pharmacy professionals on career progression and how the BGS and UK Clinical Pharmacy Association (UKCPA) can support their advancement in this speciality.

Method

A Google Forms questionnaire was designed to collect data on demographics, education, working practices, and specialisation. Respondents were asked about the need for defined core competencies and an advanced curriculum for the speciality, as well as the support professional groups should provide. The survey was distributed through BGS and UKCPA communication channels.

Results

Thirty-eight pharmacy professionals responded, with pharmacists comprising the majority (n=37, 97%), working primarily in secondary (n=21, 55%) and primary care (n=12, 32%). Most respondents were female (n=31, 82%) and 61% (n=23) identified as white British. Over 80% (n=31) were at a senior level (band 8a or above), with 68% (n=26) having over 10 years’ experience. Many identified as specialists in care of older people (n=29, 76%). There was unanimous support for an advanced pharmacist curriculum specific to older people’s care for those seeking to credential at an advanced level, and 90% (n=34) agreed on the need for core competencies for all pharmacy staff in this area. Key themes to enable progression included structured support, mentorship, clear career pathways, accredited courses, and opportunities to share expertise.

Conclusion

The BGS and UKCPA are well-positioned to develop an advanced curriculum in older people’s healthcare, aligned with existing professional pathways already implemented by the Royal Pharmaceutical Society. Joint initiatives to provide structured development opportunities could enhance the specialist workforce, ensuring high-quality pharmacy services are provided routinely as part of multidisciplinary teams caring for older people.

Introduction

The number of older adults accessing the healthcare service far exceeds the available geriatric specialist services. It is recognised that for the foreseeable future most hospital inpatient contacts with older adults will be completed by doctors not specifically trained in Geriatric Medicine. To ensure the provision of adequate healthcare, it is imperative that all hospital doctors are trained in the minimum Geriatric Medicine competencies. Allowing for the broad, complex, and multidisciplinary nature of Geriatric Medicine, we conducted a group concept mapping (GCM) study to permit multiple stakeholders with various expertise to convey their thoughts on the competencies required by all hospital doctors caring for older adults.

Methods

GCM is a mixed methods approach utilising six phases to generate expert group consensus, enabling participants to organise and represent their ideas. We invited healthcare professionals, patient advocacy groups and clinical educators to participate in GCM via an online platform. Hierarchical cluster analysis and multi-dimensional scaling were utilised to analyse participant input regarding competencies required by doctors caring for older adults.

Results

Twelve competency domains were identified by participants as integral for all hospital doctors to care for older adults. Domains rated most important related to interpersonal communication skills, medicolegal concerns, recognition and management of delirium and medication management.

Discussion

The twelve competency domains indicate the diverse skillset required by all doctors to provide comprehensive care to older adults within a hospital setting. The emergence of interpersonal communication skills underscores the importance of effective- doctor patient and interprofessional communication. Furthermore, the emphasis on medicolegal issues highlights the potential complex ethical and legal aspects in treating older adults. Recognition of delirium and medication management underline the specific challenges associated with caring for this specific population.

Conclusion

This study identifies competencies that may serve as a foundational framework for ensuring quality healthcare for the ageing population. Future initiatives should consider incorporating these competencies to improve inpatient care provided by hospital doctors to older adults.

Introduction: There is growing awareness of the harms caused by racial abuse and discrimination from patients towards healthcare professionals, including anecdotal reports of patients ‘requesting a white doctor’ (Kline, BMJ Opinion, 2020); yet there is limited understanding of the impact in Geriatric settings. We conducted a survey in an inpatient Older Persons Service (OPS) on the prevalence, impact and actions taken in response to patient racism towards staff.

Methods: A cross-sectional survey (Total N=47; Black and Minority Ethnic (BME) staff: N=32; White staff: N=15) of staff experiences of racist behaviour from patients and carers (July 2021) in a tertiary level inpatient OPS in an ethnically diverse London borough, both in terms of patients and staff, in the United Kingdom. The survey was developed in collaboration with OPS staff and the BME network. The anonymous survey was offered to all nurses, doctors, allied healthcare professionals and non-clinical staff on two 26-bed wards.

Results: Sixty-nine percent (22/32) of BME staff had personally experienced racist behaviour from older patients, while witnessing racism towards colleagues was reported by 62% (18/29) of BME staff and 80% (12/15) of White Staff. Sixty-seven percent (30/45) of respondents had witnessed a patient request a different ethnicity of healthcare professional. The majority of racist incidents went unchallenged and unreported with only 39.1% challenging the patient or carer, 21.7% reporting to a senior and 8.7% reporting via the electronic incident reporting system. The impact of such incidents on staff well-being included self-reported depression (56%, n=11/21), anxiety about work (28%, n=6/21) and insomnia (14%, n= 3/21).

Conclusion: With an ageing population, staff recruitment and retention in Geriatrics is critical. Comprehensive policies that have a zero-tolerance approach to racism, support staff and encourage reporting are crucial. Future research that considers the impact of mental capacity and cognitive impairment would be beneficial.