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Title: Overcoming barriers to change in acute mental health wards : the effects of staff perceptions
Author: Laker, Caroline Jane
ISNI:       0000 0004 6423 114X
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2017
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Background: Capturing how nursing staff perceive barriers to change may clarify why, despite investments to improve mental health wards, change has been problematic. Given changes are disruptive and wards are frequently volatile, detrimental effects such as worsened perceptions, reduced work satisfaction and burnout are likely. However, there are currently no measures of perceptions of barriers to change for use in mental health wards. Aims: i. Undertake a qualitative investigation into how nursing staff conceptualise barriers to change; ii. Develop a measure of perceptions of barriers to change; iii. Psychometrically test the measure; iv. To explore baseline factors which affect perceptions of barriers to change; v. To explore the relationships between staff perceptions of barriers to change, ward climate, work satisfaction and burnout; vi. To explore whether participation in an intervention worsens perceptions of barriers to change and to consider the influence of ward climate; vii. To explore whether perceptions of barriers to change worsen work satisfaction and burnout across time, in the context of participation in an intervention. Methods: Perceptions of barriers to change were examined using mixed methods and by adopting a model of stakeholder involvement. Interviews were undertaken, and then thematically analysed, to produce VOCALISE: a measure of perceptions of barriers to change. Following psychometric testing, VOCALISE was used in a randomised controlled trial introducing intensive changes. This allowed cross-sectional and longitudinal relationships (between VOCALISE, ward climate, work satisfaction and burnout) to be examined, using multi-level regression modelling. Results: VOCALISE had promising psychometric properties. Three subscales were identified capturing themes of resistance including powerlessness, low confidence and demotivation. At baseline, VOCALISE was predicted by ward climate, incidents and temporary staff. Staff with more negative perceptions of barriers to change had increased burnout and reduced work satisfaction. At baseline and follow up, younger and direct care staff had worse VOCALISE scores than older and more senior staff. At follow up, the impact of change and baseline ward climate led to poorer perceptions of barriers to change in the intervention group than in the control group. Negative baseline VOCALISE scores predicted work dissatisfaction, and this effect was greater in the intervention group. Discussion: As change had a detrimental impact on perceptions (particularly for direct care and younger staff), future research should consider how to reduce the burden of innovation in challenging work environments, like acute wards. This may improve how staff respond to changes, and increase work satisfaction and the quality of care offered to service users.
Supervisor: Cella, Matteo ; Wykes, Til H. M. ; Callard, Felicity Jane Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available