Appropriate medical referral is more likely when adequate assessment is undertaken and when a pharmacist is directly involved in the consultation. This highlights the need for pharmacies to ensure that processes are in place for patients to access the pharmacist.
This survey was designed to investigate levels of stress, anxiety and depression, and to identify factors exacerbating or relieving stress in anaesthesia trainees within the Australian and New Zealand College of Anaesthetists training scheme. In addition, the survey investigated levels of personal healthcare, some working conditions, and reports of bullying and reported discrimination along with stigmatisation of mental health issues in this cohort. Psychological distress was assessed using the Kessler psychological distress scale (K10). An electronic survey was sent to 1310 randomly selected trainees, and 417 (32%) responses were received. The majority of respondents (67%) reported being satisfied or very satisfied with their job and training. However, 31% had K10 scores indicating high or very high levels of distress. Eleven percent reported being currently on treatment for anxiety and/or depression. Major stressors were examinations, job prospects, critical incidents and fear of making errors. Forty-five percent of respondents reported having experienced bullying during anaesthesia training, 25% discrimination and 7% sexual harassment. Twenty-six percent reported an excessive workload and 21% reported that they felt their workload compromised patient safety. Forty-two percent reported that they would avoid seeking help for anxiety or depression and 50% reported that they thought revealing mental health problems would jeopardise their careers. The results of this survey demonstrate a high incidence of psychological distress, and high levels of bullying and discrimination, as well as stigmatisation of mental ill health among respondents. Appropriate education, a review of assessment tools, effective management of bullying and discrimination, a review of working conditions, and destigmatisation of mental illness appear to be indicated.
Previous studies have established that bullying is a pervasive problem in healthcare. However, most investigations of bullying in anaesthesia use self-labelled survey questions in which respondents’ subjective perceptions of bullying are central in defining prevalence. This study applied the validated revised Negative Acts Questionnaire (NAQ-r) for a more objective assessment of bullying prevalence and types of negative behaviours experienced by anaesthesia trainees in Australia and New Zealand. An online questionnaire was distributed by the Australian and New Zealand College of Anaesthetists (ANZCA) Clinical Trials Network to 990 randomly selected ANZCA trainees. Bullying prevalence was assessed using both a self-labelled survey tool and the NAQ-r, which requires respondents to select from a list of negative acts, with validated cut-offs that define bullying. Sources of bullying, impact on recipients and barriers to reporting were also examined. This design allowed comparison of the two methods for evaluating bullying prevalence. Twenty-six percent of trainees surveyed completed both bullying survey instruments. Thirty percent of these respondents self-labelled as having experienced bullying in the previous six months, with 8% reporting bullying at least monthly. With the NAQ-r, most respondents (96%) reported experiencing at least one negative act in the prior six months, with 54% reporting these on a monthly basis. The most frequent behaviours described were humiliation and intimidation. Using NAQ-r cut-offs, 36% of respondents experienced occasional bullying and 10% were victims of severe workplace bullying. The NAQ-r provides a more nuanced and objective insight into bullying faced by ANZCA trainees than do self-labelled surveys. The results of the present study provide a valuable baseline for ongoing assessment.
Although neat preparations of intravenous iron do interfere with spectrophotometric analysis of haemoglobin, concentrations likely to be seen post iron infusion do not significantly interfere with haemoglobin measurement.
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