Browsing by Person "Rattray, Janice"

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A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial
(2014-01-29) Ramsay, Pamela; Salisbury, Lisa; Merriweather, Judith L.; Huby, G.; Rattray, Janice; Hull, Alastair M.; Brett, Stephen J.; Mackenzie, Simon J.; Murray, Gordon D.; Forbes, John F.; Walsh, Timothy S.
Increasing numbers of patients are surviving critical illness, but survival may be associated with a constellation of physical and psychological sequelae that can cause ongoing disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period. This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness. The intervention is currently being evaluated in a randomised trial (ISRCTN09412438; funder Chief Scientists Office, Scotland). Methods The intervention was developed using the Medical Research Council (MRC) framework for developing complex healthcare interventions. We ensured representation from a wide variety of stakeholders including content experts from multiple specialties, methodologists, and patient representation. The intervention construct was initially based on literature review, local observational and audit work, qualitative studies with ICU survivors, and brainstorming activities. Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline (No. 83), publicly available patient stories (Healthtalkonline), a stakeholder event in collaboration with the James Lind Alliance, and local piloting. Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant (GRA) role. Several rounds of external peer review during successive funding applications also contributed to development.
Extending the assessment of patient-centredness in health care: Development of the updated Valuing Patients as Individuals Scale using exploratory factor analysis
(Wiley-Blackwell, 2017-07-03) Jones, Martyn; Williams, B.; Rattray, Janice; MacGillivray, S.; Baldie, Deborah; Abubakari, R.; Coyle, J.; Mackie, Susan; McKenna, Eileen
Aims and objectives To update and re-validate the Valuing Patients as Individuals Scale for use as a patient appraisal of received healthcare. Background Healthcare in the United Kingdom and beyond is required to deliver high quality, person-centred care that is clinically effective and safe. However, patient experience is not uniform, and complaints often focus on the way patients have been treated. Legislation in United Kingdom requires health services to gather and use patients' evaluations of care to improve services. Design This study uses scoping literature reviews, cognitive testing of questionnaire items with patient and healthcare staff focus groups, and exploratory factor analysis. Methods/Setting/Participants Data were collected from 790 participants across 34 wards in two acute hospitals in one National Health Service Health Board in Scotland from September 2011-February 2012. Ethics and Research and Development approval were obtained. Results Fifty six unique items identified through literature review were added to 72 original Valuing Patients as Individuals Scale items. Face validity interviews removed ambiguous or low relevance items leaving 88 items for administration to patients. Two hundred and ninety questionnaires were returned, representing 37% response rate, 71 were incomplete. Thus 219 complete data were used for Exploratory Factor Analysis with varimax orthogonal rotation. This revealed a 31 item, three factor solution, Care and Respect; Understanding and Engagement; Patient Concerns, with good reliability, concurrent and discriminant validity in terms of gender. A shortened 10 item measure based on the top 3 or 4 loading items on each scale was comparable. Relevance to clinical practice The short scale version is now being routinized in real-time evaluation of patient experience contributing to this United Kingdom, National Health Service setting meeting its policy and legislative requirements. What does this paper contribute to the wider global clinical community? -The updated Valuing Patients as Individuals Scale; -Is a reliable and valid measure specifically designed to capture the issues that matter most to people receiving secondary care. -Has been developed based upon current conceptualisations of person-centred care and the clinical practices required to deliver this. -May be used within service improvement work as a trigger to ensure person-centred care delivery.
The impact on redeployed nurses of working in critical care during the COVID-19 pandemic: a cross-sectional study
(Wiley, 2025-06-25) Mccallum, Louise; Dixon, Diane; Pollard, Beth; Miller, Jordan; Hull, Alastair; Scott, Teresa; Salisbury, Lisa; Ramsay, Pam; Rattray, Janice
Background Many nurses with little critical care experience were redeployed to critical care units during the COVID-19 pandemic to assist with the increased numbers of critically ill patients. The impact of this redeployment on nurses and their employing organization merits detailed assessment. Aims To (a) measure the impact on redeployed nurses of working in critical care during the COVID-19 pandemic and identify the predictors of that impact, (b) identify any differences between redeployed and critical care nurses and (c) measure the organizational impact. Study Design A cross-sectional study of redeployed (n = 200) and critical care nurses (n = 461) within the United Kingdom's National Health Service between January 2021 and March 2022. A survey measured components of the Job Demand-Resources Model of occupational stress. Free text questions enabled nurses to describe their experiences of being redeployed to critical care during the pandemic. Results Survey data indicated high levels of health impairment; 70% of redeployed nurses met the threshold for psychological distress, 52% for burnout and 35% had clinically significant symptoms of posttraumatic stress. When job demands (emotional load, mental load, pace and amount of work and role conflict) were high, health impairment was worse and when job resources (staffing, focus on well-being and learning opportunities) were low, work engagement was reduced. Free text comments illustrated both the stress and distress experienced by redeployed nurses. Conclusion Many redeployed nurses experienced significant negative consequences and potentially enduring sequelae of working in critical care during the pandemic. These may continue to affect individual and organizational outcomes. Relevance to Clinical Practice Nurses' well-being should be monitored, and appropriate services provided. Improvements in ongoing and meaningful communications with senior management alongside prioritization of ongoing professional development are required.
Increased Hospital-Based Physical Rehabilitation and Information Provision After Intensive Care Unit Discharge
(2015-04-13) Walsh, Timothy S.; Salisbury, Lisa; Merriweather, Judith L.; Boyd, Julia A.; Griffith, David M.; Huby, G.; Kean, Susanne; Mackenzie, Simon J.; Krishan, Ashma; Lewis, Stephanie C.; Murray, Gordon D.; Forbes, John F.; Smith, Joel; Rattray, Janice; Hull, Alastair M.; Ramsay, Pamela
Importance Critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. Objective To evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post-intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. Design, Setting, and Participants A parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. Interventions During the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. Main Outcomes and Measures The Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). Results Median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, -0.2 [95% CI, -1.3 to 0.9; P-=-.71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, -0.1 [95% CI, -3.3 to 3.1; P-=-.96]; and in the Mental Component Summary score, 0.2 [95% CI, -3.4 to 3.8; P-=-.91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. Conclusions and Relevance Post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery.
"Intensive care unit survivorship" - a constructivist grounded theory of surviving critical illness
(2017-10-30) Kean, Susanne; Salisbury, Lisa; Rattray, Janice; Walsh, Timothy S.; Huby, G.; Ramsay, Pamela
Aims and objectives To theorise intensive care unit survivorship after a critical illness based on longitudinal qualitative data. Background Increasingly, patients survive episodes of critical illness. However, the short- and long-term impact of critical illness includes physical, psychological, social and economic challenges long after hospital discharge. An appreciation is emerging that care needs to extend beyond critical illness to enable patients to reclaim their lives postdischarge with the term 'survivorship' being increasingly used in this context. What constitutes critical illness survivorship has, to date, not been theoretically explored.
“Like fighting a fire with a water pistol”: A qualitative study of the work experiences of critical care nurses during the COVID ‐19 pandemic
(2023-07-28) Miller, Jordan; Young, Ben; Mccallum, Louise; Rattray, Janice; Ramsay, Pam; Salisbury, Lisa; Scott, Teresa; Hull, Alastair; Cole, Stephen; Pollard, Beth; Dixon, Diane
Aim: To understand the experience of critical care nurses during the COVID‐19 pandemic, through the application of the Job‐Demand‐Resource model of occupational stress. Design: Qualitative interview study. Methods: Twenty‐eight critical care nurses (CCN) working in ICU in the UK NHS during the COVID‐19 pandemic took part in semi‐structured interviews between May 2021 and May 2022. Interviews were guided by the constructs of the Job‐Demand Resource model. Data were analysed using framework analysis. Results: The most difficult job demands were the pace and amount, complexity, physical and emotional effort of their work. Prolonged high demands led to CCN experiencing emotional and physical exhaustion, burnout, post‐traumatic stress symptoms and impaired sleep. Support from colleagues and supervisors was a core job resource. Sustained demands and impaired physical and psychological well‐being had negative organizational consequences with CCN expressing increased intention to leave their role. Conclusions: The combination of high demands and reduced resources had negative impacts on the psychological well‐being of nurses which is translating into increased consideration of leaving their profession. Implications for the Profession and/or Patient Care: The full impacts of the pandemic on the mental health of CCN are unlikely to resolve without appropriate interventions. Impact: Managers of healthcare systems should use these findings to inform: (i) the structure and organization of critical care workplaces so that they support staff to be well, and (ii) supportive interventions for staff who are carrying significant psychological distress as a result of working during and after the pandemic. These changes are required to improve staff recruitment and retention. Reporting Method: We used the COREQ guidelines for reporting qualitative studies. Patient and Public Contribution: Six CCN provided input to survey content and interview schedule. Two authors and members of the study team (T.S. and S.C.) worked in critical care during the pandemic.
A model of occupational stress to assess impact of COVID-19 on critical care and redeployed nurses: a mixed-methods study
(NIHR Journals Library, 2024-12-18) Rattray, Janice; Miller, Jordan; Pollard, Beth; McCallum, Louise; Hull, Alastair; Ramsay, Pam; Salisbury, Lisa; Scott, Teresa; Cole, Stephen; Dixon, Diane
Objective: To use the job demands−resources model of occupational stress to quantify and explain the impact of working in critical care during the COVID-19 pandemic on nurses and their employing organisation. Design: Two-phase mixed methods: a cross-sectional survey (January 2021–March 2022), with comparator baseline data from April to October 2018 (critical care nurses only), and semistructured interviews. Participants: Critical care nurses (n = 461) and nurses redeployed to critical care (n = 200) who worked in the United Kingdom National Health Service (primarily Scotland) between January 2021 and March 2022. The 2018 survey was completed by 557 critical care nurses (Scotland only). Survey response rate in Scotland was 32% but could not be determined outside Scotland. Forty-four nurses were interviewed (critical care = 28, redeployed = 16). Methods: A survey measured job demands, job resources, health impairment, work engagement and organisational outcomes. Data were compared to 2018 data. Regression analyses identified predictors of health impairment, work engagement and organisational outcomes. Semistructured interviews were conducted remotely, audio-recorded and transcribed. Data were analysed deductively using framework analysis. Findings: Three-quarters of nurses reached threshold for psychological distress, approximately 50% reached threshold for burnout emotional exhaustion and a third clinically concerning post-traumatic stress symptoms. Compared to 2018, critical care nurses were at elevated risk of probable psychological distress, odds ratio 6.03 (95% CI 4.75 to 7.95); burnout emotional exhaustion, odds ratio 4.02 (3.07 to 5.26); burnout depersonalisation, odds ratio 3.18 (1.99 to 5.07); burnout accomplishment, odds ratio 1.53 (1.18 to 1.97). There were no differences between critical care and redeployed nurses on health impairment outcomes, suggesting elevated risk would apply to redeployed nurses. Job demands increased and resources decreased during the pandemic. Higher job demands predicted greater psychological distress. Job resources reduced the negative impact of job demands on psychological distress, but this moderating effect was not observed at higher levels of demand. All organisational outcomes worsened. Lack of resources predicted worse organisational outcomes. In interviews, staff described the pace and amount, complexity, physical and emotional effort of their work as the most difficult job demands. The sustained high-demand environment impacted physical and psychological well-being, with most interviewees experiencing emotional and physical exhaustion, burnout, and symptoms of post-traumatic stress disorder. Camaraderie and support from colleagues and supervisors were core job resources. The combination of sustained demands and their impact on staff well-being incurred negative organisational consequences, with increasing numbers considering leaving their specialty or nursing altogether. Dissemination events with a range of stakeholders, including study participants, identified staffing issues and lack of learning and development opportunities as problematic. Critical care nurses are concerned about the future delivery of high-quality critical care services. Positive aspects were identified, for example, reduced bureaucratic systems, increased local autonomy and decision-making, recognition of the critical care nurse skill set. Conclusions: The National Health Service needs to recognise the impact of COVID-19 on this staff group, prioritise the welfare of critical care nurses, implement workplace change/planning, and support them to recover from the pandemic. The National Health Service is struggling to retain critical care nurses and, unless staff welfare is improved, quality of care and patient safety will likely decline.
Patient and carer experience of hospital-based rehabilitation from intensive care to hospital discharge: mixed methods process evaluation of the RECOVER randomised clinical trial
(2016-08-01) Ramsay, Pamela; Huby, G.; Merriweather, Judith L.; Salisbury, Lisa; Rattray, Janice; Griffith, David M.; Walsh, Timothy S.
Objectives: To explore and compare patient/carer experiences of rehabilitation in the intervention and usual care arms of the RECOVER trial (ISRCTN09412438); a randomised controlled trial of a complex intervention of post-intensive care unit (ICU) acute hospital-based rehabilitation following critical illness. Design: Mixed methods process evaluation including comparison of patients' and carers' experience of usual care versus the complex intervention. We integrated and compared quantitative data from a patient experience questionnaire (PEQ) with qualitative data from focus groups with patients and carers. Setting: Two university-affiliated hospitals in Scotland.
Polypharmacy and emergency readmission to hospital after critical illness: A population-level cohort study
(Elsevier, 2020-10-31) Turnbull, Angus J.; Donaghy, Eddie; Salisbury, Lisa; Ramsay, Pamela; Rattray, Janice; Walsh, Timothy; Lone, Nazir
Polypharmacy is common and closely linked to drug interactions. The impact of polypharmacy has not been previously quantified in survivors of critical illness who have reduced resilience to stressors. Our aim was to identify factors associated with preadmission polypharmacy and ascertain whether polypharmacy is an independent risk factor for emergency readmission to hospital after discharge from a critical illness. A population-wide cohort study consisting of patients admitted to all Scottish general ICUs between January 1, 2011 and December 31, 2013, whom survived their ICU stay. Patients were stratified by presence of preadmission polypharmacy, defined as being prescribed five or more regular medications. The primary outcome was emergency hospital readmission within 1 yr of discharge from index hospital stay. Of 23 844 ICU patients, 29.9% were identified with polypharmacy (n=7138). Factors associated with polypharmacy included female sex, increasing age, and social deprivation. Emergency 1-yr hospital readmission was significantly higher in the polypharmacy cohort (51.8% vs 35.8%, P<0.001). After confounder adjustment, patients with polypharmacy had a 22% higher hazard of emergency 1-yr readmission (adjusted hazard ratio 1.22, 95% confidence interval 1.16-1.28, P<0.001). On a linear scale of polypharmacy each additional prescription conferred a 3% increase in hazard of emergency readmission by 1 yr (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.03, P<0.001). This national cohort study of ICU survivors demonstrates that preadmission polypharmacy is an independent risk factor for emergency readmission. In an ever-growing era of polypharmacy, this risk factor may represent a substantial burden in the at-risk post-intensive care population.
Predicting risk of unplanned hospital readmission in survivors of critical illness: A population-level cohort study
(2018-04-06) Lone, Nazir; Lee, Robert J.; Salisbury, Lisa; Donaghy, Eddie; Ramsay, Pamela; Rattray, Janice; Walsh, Timothy S.
Background Intensive care unit (ICU) survivors experience high levels of morbidity after hospital discharge and are at high risk of unplanned hospital readmission. Identifying those at highest risk before hospital discharge may allow targeting of novel risk reduction strategies. We aimed to identify risk factors for unplanned 90-day readmission, develop a risk prediction model and assess its performance to screen for ICU survivors at highest readmission risk. Methods Population cohort study linking registry data for patients discharged from general ICUs in Scotland (2005-2013). Independent risk factors for 90-day readmission and discriminant ability (c-index) of groups of variables were identified using multivariable logistic regression. Derivation and validation risk prediction models were constructed using a time-based split. Results Of 55 975 ICU survivors, 24.1% (95%CI 23.7% to 24.4%) had unplanned 90-day readmission. Pre-existing health factors were fair discriminators of readmission (c-index 0.63, 95%-CI 0.63 to 0.64) but better than acute illness factors (0.60) or demographics (0.54). In a subgroup of those with no comorbidity, acute illness factors (0.62) were better discriminators than pre-existing health factors (0.56). Overall model performance and calibration in the validation cohort was fair (0.65, 95%-CI 0.64 to 0.66) but did not perform sufficiently well as a screening tool, demonstrating high false-positive/false-negative rates at clinically relevant thresholds. Conclusions Unplanned 90-day hospital readmission is common. Pre-existing illness indices are better predictors of readmission than acute illness factors. Identifying additional patient-centred drivers of readmission may improve risk prediction models. Improved understanding of risk factors that are amenable to intervention could improve the clinical and cost-effectiveness of post-ICU care and rehabilitation.
PReventing early unplanned hOspital readmission aFter critical ILlnEss (PROFILE): protocol and analysis framework for a mixed methods study
(2016-06-28) Walsh, Timothy S.; Salisbury, Lisa; Donaghy, Eddie; Ramsay, Pamela; Lee, Robert J.; Rattray, Janice; Lone, Nazir
Introduction: Survivors of critical illness experience multidimensional disabilities that reduce quality of life, and 25-30% require unplanned hospital readmission within 3 months following index hospitalisation. We aim to understand factors associated with unplanned readmission; develop a risk model to identify intensive care unit (ICU) survivors at highest readmission risk; understand the modifiable and non-modifiable readmission drivers; and develop a risk assessment tool for identifying patients and areas for early intervention. Methods and analysis: We will use mixed methods with concurrent data collection. Quantitative data will comprise linked healthcare records for adult Scottish residents requiring ICU admission (1 January 2000-31 December 2013) who survived to hospital discharge. The outcome will be unplanned emergency readmission within 90 days of index hospital discharge. Exposures will include pre-ICU demographic data, comorbidities and health status, and critical illness variables representing illness severity. Regression analyses will be used to identify factors associated with increased readmission risk, and to develop and validate a risk prediction model. Qualitative data will comprise recorded/transcribed interviews with up to 60 patients and carers recently experiencing unplanned readmissions in three health board regions. A deductive and inductive thematic analysis will be used to identify factors contributing to readmissions and how they may interact. Through iterative triangulation of quantitative and qualitative data, we will develop a construct/ taxonomy that captures reasons and drivers for unplanned readmission. We will validate and further refine this in focus groups with patients/carers who experienced readmissions in six Scottish health board regions, and in consultation with an independent expert group. A tool will be developed to screen for ICU survivors at risk of readmission and inform anticipatory interventions.
To survive and thrive – patients, staff and countries need healthy Critical Care Units [Editorial]
(Wiley, 2025-03-25) Rattray, Janice; Salisbury, Lisa; Hull, Alastair; McCallum, Louise
Work-related stress: The impact of COVID-19 on critical care and redeployed nurses: A mixed methods study
(BMJ, 2021-07-05) Rattray, Janice; McCallum, Louise; Hull, Alastair; Ramsay, Pam; Salisbury, Lisa; Scott, Teresa; Cole, Stephen; Miller, Jordan; Dixon, Diane
Introduction: We need to understand the impact of COVID-19 on Critical Care (CCNs) and redeployed nurses and NHS organisations. Methods and analysis: This is a mixed methods study (QUANT – QUAL), underpinned by a theoretical model of occupational stress, the Job-Demand Resources Model (JD-R). Participants are critical care and redeployed nurses from Scottish and three large English units. Phase one is a cross-sectional survey in part replicating a pre-COVID-19 study and results will be compared with this data. Linear and logistic regression analysis will examine the relationship between antecedent, demographic, and professional variables on health impairment (burnout syndrome, mental health, posttraumatic stress symptoms), motivation (work engagement, commitment), and organisational outcomes (intention to remain in critical care nursing and quality of care). We will also assess the usefulness of a range of resources provided by the NHS and professional organisations. To allow in-depth exploration of individual experiences, phase two will be one-to-one semi-structured interviews with 25 CCNs and 10 redeployed nurses. The JD-R model will provide the initial coding framework to which the interview data will be mapped. The remaining content will be analysed inductively to identify and chart content that is not captured by the model. In this way the adequacy of the JD-R model is examined robustly and its expression in this context will be detailed. Ethics and dissemination: Ethics approval was granted from the University of Aberdeen CERB2020101993. We plan to disseminate findings at stakeholder events, publish in peer reviewed journals and at present at national and international conferences.