Background: Healthcare workers are ranked among one of the top occupations for musculoskeletal disorder (MSD) injuries that affect the muscles, the bones, the nervous system and due to repetitive motion tasks (Centers for Disease Control and Prevention, 2017). Numerous high-risk patient handling tasks such as lifting, transferring, ambulating and repositioning of patients cause injuries that can be prevented when evidence-based solutions are used for safe patient handling and mobility (SPHM) tasks. Purpose: The purpose of this quality improvement project was to evaluate the knowledge and attitudes of orthopedic nurses regarding the use of SPHM algorithms as the standard of care when transferring patients. Theoretical Framework. Lewin’s Theory of Change Methods. A quasi-experimental pretest-post-test design was utilized in this evidenced-based practice project. Results. Descriptive statistics that evaluated pre and post questionnaires of the orthopedic nurses noted nurses displayed behavioral and attitudinal intent to use the SPHM algorithms as the standard of care to improve patient outcomes by decreasing falls. Although the behavioral beliefs and attitudes reflected acknowledgement of SPHM skills and knowledge, nursing did not improve in their documentation of SPH fall risk as two separate tools were required on each patient. Conclusions: SPHM evidenced-based standards do guide staff to critically examine how to safely transfer and mobilize a patient. Patient fall rates did decrease during educational sessions, prompting the need for on-going education of all staff on the unit that transfers patients. The findings from this quality project may encourage future practice approaches to use of the safe patient handling (SPH) fall risk assessment tool for all patients to prevent patient falls.

The present thesis was carried out in part fulfilment of the Doctorate in Clinical Psychology at the University of Edinburgh. It is presented in portfolio format, comprising of two individual papers although a total thesis abstract provides an overview of the entire thesis. The first paper is a systematic review of existing empirical research. It explores the predictive validity of risk assessment tools for imminent (short-term) violence and aggression in forensic psychiatric settings. The second paper is an empirical study exploring how frontline nursing staff both predict and emotionally cope with experiencing violence and aggression in a high-security setting. Paper one was prepared for Aggression and Violent Behavior and paper two for The International Journal of Forensic Mental Health; so, follow their respective author guidelines. Mental health, and forensic mental health nurses have been identified as being at particular risk of experiencing patient perpetrated violence and aggression (PPVA). There is relatively little research investigating how nursing staff predict and cope with more immediate, imminent inpatient violence and aggression, specifically within secure (forensic) settings. Negative outcomes of PPVA are widely accepted and demonstrated within empirical literature, including increased anxiety and stress for staff, fractures to the therapeutic relationship between patients and staff, and difficulties with staff retention and absenteeism for the organization. Due to the extensive negative outcomes associated with PPVA, a wealth of research has focused on developing the area of violence risk assessment. Despite this, there remains limited understanding regarding the utility of existing risk assessment tools for predicting and assessing violence risk over brief time frames (i.e. days to weeks). Therefore, a systematic review was conducted to explore the predictive validity of violence risk assessment tools for imminent, short-term risk in inpatient forensic psychiatric settings. Findings demonstrated that multiple tools had decent predictive validity, however quality scores were impacted by small sample sizes. The Dynamic Appraisal of Situational Aggression- Inpatient Version was the most effective tool with the highest mean quality score. The main limitations were the small number of studies assessing some of the included tools and the level of ambiguity between studies regarding the definition of imminent, short-term violence. Developing a shared understanding of what constitutes short-term risk and improving the number and quality of studies on the largely neglected tools, should therefore be research priorities. How nurses actually recognize and predict inpatient violence and aggression in forensic psychiatric settings, and how they emotionally cope with the aftermath, are poorly explored and understood processes. A social constructivist grounded theory approach was used to analyze the transcripts from 12 interviews with frontline nursing staff from an inpatient high-security setting. A model was constructed integrating nurses' beliefs and assumptions about subtypes of violence, their efforts to use observation skills in order to aid risk prediction, and their resultant emotional experiences following PPVA. Nurses emotional coping seemed to be affected by several factors relating to the culture of the organization and the accessibility of support. Seemingly, knowing the patient helped nurses to better identify underlying needs leading to violent behavior. This understanding helped nurses to implement targeted, needs-led interventions to address these unmet needs, and so reduce recurrent and cyclical violence. Recommendations are made to build upon, and utilize nursing skills in risk prediction and management, and to help better support the emotional impact of experiencing PPVA within forensic psychiatric settings.

Health risk assessment tools compute an individual’s risk of developing a disease. They are potentially useful in chronic disease prevention mediated by family physicians. We sought to learn family physicians’ awareness, and perspectives on the usefulness, usability and feasibility of implementation of risk assessment tools. Focus groups, discussion with key informants, and usability testing with an EMR-embedded risk assessment tool were conducted with family physicians (n=30) from academic and community-based practices. Analysis following grounded theory methodology was used to generate categories and themes. Our findings indicate that participants are aware of the implications of risk assessment calculations though very few tools are used regularly. Tool integration with EMR systems was felt to be essential in assisting tool usability, uptake and efficiency of use. Results provide insight into current risk assessment tool use and the facilitation of wider implementation of risk assessment tools in family practice settings.

Health risk assessment tools compute an individual’s risk of developing a disease. They are potentially useful in chronic disease prevention mediated by family physicians. We sought to learn family physicians’ awareness, and perspectives on the usefulness, usability and feasibility of implementation of risk assessment tools. Focus groups, discussion with key informants, and usability testing with an EMR-embedded risk assessment tool were conducted with family physicians (n=30) from academic and community-based practices. Analysis following grounded theory methodology was used to generate categories and themes. Our findings indicate that participants are aware of the implications of risk assessment calculations though very few tools are used regularly. Tool integration with EMR systems was felt to be essential in assisting tool usability, uptake and efficiency of use. Results provide insight into current risk assessment tool use and the facilitation of wider implementation of risk assessment tools in family practice settings.

Actuarial risk assessment tools have been part of the initial security classification process in Canadian prisons since the 1990s. Developed initially on a white, homogenous male prison population (Hannah-Moffat, 2015b), actuarial instruments have been championed by researchers in the field of corrections and psychology as an “objective” instrument that can standardize the classification procedure (Andrews et al., 1990; Barnum & Gobeil, 2012). However, the universal application of such tools has been met with resistance, criticized for having not been validated on an Indigenous prison population and thus culturally inappropriate for use (Martel et al., 2011; Monture-Angus, 1999; Webster & Doob, 2004). This thesis intends to examine how Correctional Service Canada (CSC) has legitimated the use of actuarial tools in its initial security classification and penitentiary placement procedure. Guided by the theoretical framework of governmentality (Foucault, 1991) and the logic of elimination (Wolfe, 1994; 2006), this study undertakes a qualitative content analysis of seven CSC research documents that evaluated the empirical validity and reliability of the Custody Rating Scale (CRS), a 12-item structured instrument that calculates a prisoner’s recommended security classification level. I put forth the argument that, in the process of legitimating actuarial instruments by appealing to justifications grounded in an actuarial rationality, CSC simultaneously facilitates the ontological erasure of Indigenous people in prison that is consistent with a logic of elimination inherent in settler colonial societies.

<p>The medication errors associated with intravenous (IV) administration may cause severe patient harm. To address this issue, smart infusion pumps now include a built-in dose error reduction system (DERS) to help ensure the safety of IV administration in clinical settings. However, a drug limit alert triggered by DERS may be overridden by the practitioners which can potentially cause patient harm, especially for high-risk medications. Most analytical measures used to estimate the associated risk of harm are frequency-based and only consider the overall drug performance rather than the severity impact from individual alerts. Unlike these other measures, the IV medication harm index attempts to quantify risk of harm for individual alerts. However, it is not known how well these measures describe the risk associated with alert-overridden scenarios. The goal of this research was (1) to quantitatively measure the risk for simulated individual alert-overridden infusions, (2) to compare these assessments against the risk scores obtained among four different analytical methods, and (3) to propose better risk quantification methods with a higher correlation to risk benchmarks than traditional measures, such as the IV Harm index. </p> <p>In this study, 25 domain experts (20 pharmacists and 5 nurses) were recruited to assess the risk (adjusted for risk benchmarks) for representative scenarios created based on hospital alert data. Four analytical methods were applied to quantify risk for the scenarios: the linear mixed models (Method A), the IV harm index (Method B), Huang and Moh’s matrix-based ranking method matrix-based method (Method C), and the analytical hierarchy process method, adjusted by linear mixed models (Method D). Method A used seven alert factors (identified as key risk factors) to build models for risk prediction, and Methods B and C used two out of seven factors to obtain risk scores. Method D used pairwise comparison surveys to calculate the risk priorities. The quantified scores from the four methods were evaluated in comparison to the risk benchmarks.</p> <p>Risk assessment results from the domain experts indicated that overdosing scenarios with continuous and bolus dose field limit types had significantly higher risks than those of bolus dose rate type. About the soft limit type, the expected risk in the group with a large soft maximum limit was significantly higher than the group with a small soft maximum limit. This significant difference could be found in the adult intensive care unit (AICU), but not in adult medical/surgical care unit (AMSU). The comparisons between four analytical methods and risk benchmarks showed that the risk scores from Method A (<i>ρ</i> = 0.94) and Method D (<i>ρ </i>= 0.87) were highly correlated to the risk benchmarks. The risk scores derived from Method B and Method C did not have a positive correlation with the benchmarks.</p> <p>This study demonstrated that the traditional IV harm index should include more risk factors, along with their interaction effects, for increased correlation with risk benchmarks. Furthermore, the linear mixed models and the adjusted AHP method allow for better risk quantification methods where the quantified scores most correlated with the benchmarks. These methods can provide risk-based analytical support to evaluate alert overrides of four high-risk medications, propofol, morphine, insulin, and heparin in the settings of adult intensive care unit (AICU) and adult medical/surgical care unit (AMSU). We believe that healthcare systems can use these analytical methods to efficiently identify the riskiest medication-care unit combinations (e.g. propofol in AICU), and reduce medication error/harm associated with infusions to enhance patient safety.</p> <p> </p>

Hand-intensive work significantly correlates with the increased risks of developing Distal upper-extremity (DUE) Work-related musculoskeletal disorders (WMSDs), such as carpal tunnel syndrome and tendinitis. Many studies have investigated the physical risk factors and their contribution to the occurrence of the DUE WMSDs. These factors include but are not limited to hand force, level of hand movement repetition, and non-neutral hand-wrist postures. Several observational-based risk assessment methods have emerged from these studies to control these risk factors and reduce the DUE WMSDs' development. In this regard, The RAMP Tool's Hand Model (RAMP's HM) has been developed recently by the Ergonomics Division at KTH Royal Institute of Technology as a new model within the RAMP Tool .The aim with RAMP's HM is to fulfill the need for an observational-based, preventive, research-oriented, and systematic method of risk management targeting the elevated risks of DUE occupational injuries associated with hand-intensive tasks. Moreover, the RAMP's HM seeks to investigate and combine a more significant number of ergonomic risk factors than those covered by existing DUE observational-based risk assessment methods. This master's thesis project evaluated the latest prototype of RAMP's HM for reliability, usability, and face validity. A group of ten ergonomists and ergonomics coordinators, all working at Scania AB, had volunteered to participate in this evaluation study. They assessed eight video records of hand-intensive work tasks across various industries using RAMP's HM. The raters assessed the model's inter-rater and intra-rater reliability by evaluating eight video records of hand-intensive work tasks in two assessment sessions, which were separated by a 21-day gap. The ergonomists also used the 2018 ACGIH® Hand Activity Level (HAL)– Threshold Limit Value (HAL Tool) to assess the same video-recorded tasks in the two sessions to evaluate the reliability of RAMP's HM in comparison (the inter-method reliability). Seven of the ten ergonomists volunteered to complete a quantitative questionnaire using a 5-Likert scale to assess the usability and face validity of the new RAMP model. The evaluation showed that the RAMP Tool's Hand Model has fair inter-rater and moderate intra-rater reliability. The reliability test also showed a similar level of reliability for the two methods, with no significant differences between the reliability results of RAMP's HM and HAL. The reliability results of the RAMP's HM may have been adversely influenced by statistical factors, and factors related to the observation process, raters' experience and background, and pre-test training. The categories of the resulting ratings for overall risk levels on the task level using RAMP's HM and the HAL Tool agreed in over 75% of ratings. According to the ergonomists, RAMP's HM is usable; it supports the systematic risk management approach, and their answers indicated that it has been designed in a user-centered way. Furthermore, the evaluation results indicated a strong face validity for RAMP's HM. Raters perceived the new model as a practical tool for systematically managing DUE WMSDs and the corresponding risk factors across various work environments and industries. Based on the results of this study, it is recommended that comprehensive education and practical training on RAMP's HM are provided before conducting further evaluations, i.e., on the complete RAMP 2.0 version. Furthermore, it is recommended to include more participants and tasks in such evaluations. Additionally, it may be valuable to consider using other reliability parameters besides the weighted Cohen's kappa.

Studien är en källstudie vars syfte är att undersöka huruvida SARA B-SAFER fungerar som riskbedömningsinstrument och om brottsutvecklingen för våld mot kvinnor i nära relationer har ökat eller minskat under tidsperioden, åren 2000-2012. Urvalet för studien är Kalmar polismyndighet och Södertörn polismästardistrikt. Underlaget för studien är tidigare forskning från hur Polisen har arbetat med SARA B-SAFER och offentlig statistik på antalet anmälda brott från Brottsförebyggande rådet (BRÅ). Resultaten i studien visar på en ökning av antalet anmälda brott för våld mot kvinnor i nära relationer, samtidigt som anmälningarna ligger på en förhållandevis jämn nivå. Vidare indikerar studien på att det finns en komplexitet kring SARA B-SAFER som riskbedömnings-instrument, då det finns indikationer på att instrumentet har en prediktiv validitet. Åtgärder för att skydda brottsoffren hamnar i skymundan och SARA B-SAFER fungerar då inte preventivt, vilket kan förklara antalet ökade anmälningar för att instrumentet predicerar rätt. / This study aims to appose if the SARA B-SAFER are successful as a risk-assessment tool and if the crime development for spousal against women have risen or declined between the years 2000-2012. Kalmar Police County and Södertörn Manor are participating and statistics over crimes for spousal violence against women are studied in these areas. The material for the study is earlier research and statistics from Brottförebyggande rådet (BRÅ). The result in the study show that the crimes for spousal violence against women have increased but lay on a stable level. Further there is a complexity about SARA as a risk-assessment tool, when it seems to work on a predictive level, but not as much on a preventive stage, as wishes. The predictive factor on SARA can explain the increased numbers of crimes.