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The Human Issues :

The Human Issues :. -Why Exposures Happen -Responding to Reduce Distress Barbara Wren, C.Psychol. Occupational Health Psychologist Royal Free Hampstead NHS Trust. Why Do Exposures Happen?. Individual Level Explanations: Knowledge Confidence Skill/Competence Stress/anxiety

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The Human Issues :

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  1. The Human Issues: -Why Exposures Happen -Responding to Reduce Distress Barbara Wren, C.Psychol.Occupational Health PsychologistRoyal Free Hampstead NHS Trust

  2. Why Do Exposures Happen? • Individual Level Explanations: • Knowledge • Confidence • Skill/Competence • Stress/anxiety • Internal factors- inattention, forgetfulness, carelessness • Fatigue • Solution=teach, train, motivate, (punish) • Person – centred approach suits management agenda (isolate cause=no change)

  3. Problems with Individual Level Explanations • The best people can make the worst mistakes • Errors are not random but fall into recurrent patterns • Local human error = last, least easily managed part of casual sequence

  4. Why Do Exposures Happen? (2) • Team/group level explanation • Communication • Leadership • Modelling safe practice • Team-working • Role clarity • Learning Culture of team • Solution= teach, train, motivate,( punish)

  5. Why Do Exposures Happen?(3) • System Level Explanations • Errors = result of “upstream systemic factors” Organisational strategy, culture, management attitudes to risk and uncertainty • Organisational Culture: safety vs. blame • Information as a Learning Resource • Integration of risk management into management structure

  6. How Human Error Contributes to System Failure • All organisations create barriers btwn source of hazard and potential victims/losses • Human elements weaken or strengthen by • Active failures “unsafe acts” • Latent conditions arise from fallible decisions often taken by those not directly in the workplace, lie dormant, combine with trigger event = incident.

  7. Latent Conditions • High workload and fatigue • Inadequate knowledge, ability,experience • Poor equipment design • Inadequate supervision & instruction • Rapid change

  8. Latent Conditions (ctd) • Poor morale • Macho culture • Poorly expressed rules • Lack of integrated safety culture

  9. Active Failures and Latent Conditions • Active failures hard to predict • Latent conditions are always present, can be identified and removed BUT • Call for change in culture or management attitudes and beliefs

  10. Culture Change to Reduce Error • Raise awareness of cost of risk • Educate clinicians about their role in risk management • Focus on near misses as well as actual incidents • Ensure concerns can be reported without fear

  11. Culture Change to Reduce Risk (ctd) • Use external input to stimulate learning • Effective communication & feedback to frontline staff • High profile lead and personal commitment of senior clinicians • A strong organisational culture for dealing with the findings of reviews of adverse events

  12. The Way Forward • Unified mechanisms for reporting and analysis of mistakes and near misses. • A more open learning culture • Mechanisms to translate learning into practice • Wider appreciation of the value of the systems approach An Organisation With a Memory, DoH, 2000

  13. Factors influencing Distress after Exposure • Whose responsibility? (guilt, anger with self/others) • Immediate/longer term consequences for self: • anxiety • uncertainty • health, • career, • relationships, • the “hoped for” future

  14. Factors influencing Distress after Exposure (ctd) • Immediate and longer term consequences for others: partner family • Ability to manage anxiety & uncertainty • Tolerance of side effects of prophylaxis

  15. Providing Initial Psychological Support • Listen to fears • Communicate understanding • Normalise reactions • Check for information needs

  16. Providing Initial Psychological Support • Prepare for emotional impact, & for physical side effects of treatment • Challenge thinking e.g, catastrophising • Discuss stress/anxiety management

  17. Possible Emotional Impact • High emotion – eg tearfulness • Hyperarousal • Rumination • Nightmares • Shock and disbelief • Irritability • Emotional numbing • Avoidance • Guilt • Anger

  18. Issues to Consider in Planning Support • Current life situation • Previous coping style • Social support • Personal and social resources • Psychological resources • Current psychological state • Impact on, and likely reaction of, partners, family etc.

  19. Factors Influencing Coping • Understanding and interpretation of the threat (appraisal, assumptions and beliefs) • Ongoing stressors • Coping strategies used • Availability of social support • Self-efficacy

  20. What helps? • Providing information sensitively • Supporting problem solving, positive re-appraisal, & information-seeking coping • Promoting self-efficacy • Help to access opportunities to discuss fears and feelings • Linking support provided to “the meaning of the exposure” for the individual

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