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Working in medical profession is stressful, and stress can affect performance, indirectly affecting patient care. Mindfulness has shown to decrease stress, which may improve patient care. At the East Tennessee State University Family Physicians of Bristol, there are no resources for learning mindfulness, so our goal was to educate all the medical professionals in our practice to learn mindfulness and evaluate the effect on their stress levels. First, a stress survey (Perceived Stress Scale) was administered to clinic providers. We presented instruction to clinic providers how to engage in mindfulness meditation. The technique of mindfulness meditation was taught by an expert through an audio clip. Six weeks after implementing the mindfulness meditation program, the Perceived Stress Scale was administered to the providers again to determine if their stress level had been reduced. Statistical analysis consisted of a t test. Higher scores on the Perceived Stress Scale indicate higher levels of experienced stress. The mean score in the pre-meditation condition was 16.71, and the mean score for the post-meditation condition was 12.62. The t test indicated that this difference was statistically significant, t(1,32)=2.14, p<05. The results of this study demonstrate that teaching healthcare providers skills regarding mindfulness meditation can significantly reduce their feelings of stress in the workplace. Future research should focus on examining if reducing stress has a measurable effect on patient outcomes.

Wellness is an integral component of the helping professions (Myers & Sweeney, 2005; Witmer, 1985). Specifically, wellness is included in ethical codes, suggestions for practice, and codes of conduct throughout counseling, psychology, and social work fields (see American Counseling Association Code of Ethics, 2014; American Psychological Association Ethical Principles of Psychologists and Code of Conduct, 2010; National Association of Social Workers Code of Ethics, 1996). Even so, wellness in helping professionals is a difficult construct to measure. Thus, the purpose of the research investigation was to develop the Helping Professional Wellness Discrepancy Scale (HPWDS) and examine the psychometric features of the HPWDS in a sample of helping professionals and helping professionals-in-training. A correlational research design was employed for this investigation (Gall, Gall, & Borg, 2007). Specifically, the researcher examined: (a) the factor structure of the HPWDS with a sample of helping professionals; (b) the internal consistency reliability of the HPWDS; (c) the relationship between HPWDS scores and Counseling Burnout Inventory (CBI) scores; (d) the relationships between helping professionals' HPWDS scores and their reported demographic data; and (e) the relationship between HPWDS factor scores and the Marlowe-Crowne Social Desirability Scale-X1 (MCSDS-X1). The research questions were examined using: (a) Factor Analysis (FA), (b) Cronbach's alpha, (c) Spearman Rho correlation, (d) Multiple Linear Regression (MLR) and (e) internal replication analysis. A review of the literature is provided, discussing theoretical and empirical support for all the items on the initial model of the HPWDS (n = 92) as well as for all the items included on the final HPWDS exploratory model (n = 22). The researcher investigated helping professionals' perceived levels of wellness, aspirational levels of wellness, and the discrepancy between perceived and aspirational levels of wellness. The data was collected via online, mail out, and face-to-face administration to increase methodological rigor. The sample size for the investigation was 657, with 88 coming from Face-to-Face sampling, 87 from mail out sampling, and 484 from online/email sampling. Data analysis resulted in a five-factor exploratory HPWDS model that accounted for 69.169% of the total variance. Model communalities were considered acceptable with only three communalities below the recommended .5 value. Factor 1 represented Professional & Personal Development Activities and accounted for 32.605% of the variance, Factor 2 represented Religion/Spirituality and accounts for 13.151% of the variance, Factor 3 represented Leisure Activities and accounted for 9.443% of the variance, Factor 4 represented Burnout and accounted for 7.198% of the variance, and Factor 5 represented Helping Professional Optimism and accounted for 6.773% of the variance. In addition to a literature review, the research methodology and research results are provided. Results of the research investigation are discussed and areas for future research, limitations of the study, and implications for the helping professions are presented. Some implications of the findings include: (a) a theoretically and methodologically sound instrument for assessing wellness discrepancies in helping professionals is important; (b) helping professionals should be aware of both the personal and professional activities they are engaging in to increase their knowledge and self-efficacy, as well as their leisure activity engagement; (c) it is advantageous for researchers to use the scale development procedures, rigorous sampling methodologies, and FA guidelines outlined throughout Chapters 3 and 4 when developing new assessments for evaluating helping professionals; and (d) a five factor wellness assessment allowing helping professionals to evaluate themselves in Professional & Personal Development Activities, Religion/Spirituality, Helping Professional Optimism, Leisure Activities, and Burnout arenas is integral in assessing wellness discrepancies in helping professionals.

Health care changes, including increased hospital admissions, an aging population and the chronicity of diseases and conditions have led to increased collaboration with unregulated professionals. Within the professions of occupational therapy and physiotherapy, there is a paucity of literature that addresses the perceptions of Occupational Therapist Assistants and Physiotherapist Assistants (OTAs and PTAs) with respect to their competence in clinical practice. This research study investigates the perceptions of clinical competence of OTA and PTA graduates from one Ontario community college. A phenomenological theoretical framework was used to explore the participants’ lived experiences. Eight individual in-depth interviews were used to gather data representing the graduate OTAs and PTAs’ perspectives. In addition, the viewpoints from a stakeholder focus group of eight participants comprised of occupational therapists, physiotherapists, and administration personnel from one Ontario hospital were used to triangulate the data.. Four themes emerged: 1) employing effective communication, 2) emerging knowledge, skills and competencies in clinical practice, 3) transitioning into clinical practice, and 4) developing confidence as an OTA and PTA. The Person Environment Occupation (PEO) model (Law et al., 1996) was used to organize the themes and to assist in determining the optimal fit between the themes. Confidence was articulated as a continuous concept that facilitated the graduates’ competence in their clinical skills. Proficiency in their roles, a supportive transition, and demonstrated competence were the presenting factors that empowered the graduate OTAs and PTAs to affirm their competence in clinical practice. This research study is foundational for future research related to OTAs and PTAs in the areas related to use of title, educational credentialing, and collaborative competency documentation. / Thesis / Master of Science (MSc) / Currently, there are changes in health care services that require modifications to the delivery of the treatment. Occupational Therapist Assistants and Physiotherapist Assistants (OTAs and PTAs) work within patient rehabilitation; however, their perceptions of competence have not been assessed. This study reviews the perceptions of the OTAs and PTAs when completing their role with patients by interviewing them and interviewing the staff that work with them. The data from this thesis will provide us with an enhanced understanding of the perceptions of OTAs and PTAs and the supports they believe enable them to be competent and confident health care professionals. This information will facilitate the identification of the next steps in research specific to OTAs and PTAs in the areas of competency and educational programs.

Medicines optimisation requires healthcare professionals to work collaboratively to meet the medication needs of patients. A grounded theory was produced which explains how doctors, nurses and pharmacists work to optimise the use of medicines in acute hospital settings in Northern Ireland. Seventeen semi-structured, one-to-one interviews were conducted with doctors, nurses and pharmacists. Concurrent data collection and analysis was carried out using coding, particular to grounded theory, adopting a constant comparative approach, writing memos and using theoretical sampling as described by Strauss and Corbin (1998). The core category was managing risk. Participants had an implicit understanding of the need to continually manage risk when working with the complex and the routine. They used personal and systemic checks and balances which could be viewed either as duplication of effort or indicative of a culture of safety. Multi-professional interdependencies and support for new, professional, non-medical roles were highlighted. Working together was a further strategy to ensuring each patient gets the right medicine. Establishing an agreed framework for working with medicines at ward level could support the safer use of medicines. It is anticipated that this theory will contribute to the design of systems involved in medicines use in acute hospitals in Northern Ireland. / Part-funded by: Northern Ireland Centre for Pharmacy Postgraduate Learning and Development (NICPLD), Western Health and Social Care Trust

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