Substitutes for leadership in anaesthesia teams and their impact on leadership effectiveness

In this study we aim to increase our understanding of leadership in anaesthesia teams by investigating the relationship between substitutes for leadership, leadership behaviour, and team performance in situations with varying levels of routine and standardization. The present study relied on video recordings of 12 anaesthesia teams in a simulated setting with the occurrence of a nonroutine event. Clinical team performance was measured by the speed of adequate team reaction to this event. The leadership behaviours observed were coded either as content oriented (e.g., information transmission) or structuring (e.g., assigning tasks). Results showed that leadership behaviour changed depending upon the level of routine of a situation, the degree of standardization, and, to some extent, on the experience of team members. Leadership tends to be positively related to team performance during nonroutine and low standardized situations but negatively related to team performance in routine and highly standardized situations. Furthermore, leadership is only slightly related to team member experience. This study improves our understanding of influences of substitutes for leadership on successful leadership behaviour in anaesthesia teams. The findings also lead to suggestions for both further research and the enhancement of team leadership in critical care.     

Demands,resources, and work ability: A cross-national examination of health care workers

Understanding work ability, with the goal of promoting it, is important for individuals as well as organizations. It is especially important to study work ability in health care workers, who face many work-related challenges that may threaten work ability. We studied various job demands, job resources, and interactions of demands and resources relating to work ability using the Job Demands–Resources model as a framework. Acute care health care workers from six nations (US, Australia, UK, Brazil, Croatia, and Poland) completed a survey. Role demands related to work ability in the Australia sample only, and supervisor support related to work ability in the Australia sample only. Yet, high levels of supervisor support significantly moderated (buffered) negative relationships between physical demands and work ability in the US sample, along with negative relationships between role demands and work ability in both the Croatia and UK samples. Skill discretion related to work ability in every nation sample, and therefore appears to be particularly important to work ability perceptions. In addition, skill discretion moderated (buffered) a negative relationship between role demands and work ability in the Australia sample. We therefore recommend that interventions to help preserve or improve work ability target this important job resource.     

Faith in welfare: the origins of the Open Home Foundation

This article analyses the origins of the Open Home Foundation (OHF), a Christian social service provider that commenced in New Zealand in 1977. It interprets the Foundation’s appeal, paying particular attention to the role of religious values and spirituality within the organisation. The article argues that OHF emerged and flourished from the late 1970s due to a confluence of personal, social, political and religious factors. Specifically, it reflected and benefited from post-war concerns about family life, renewed emphasis on policies of deinstitutionalisation, and a mobilisation of disparate conservative Christian interests. The latter factor concerning the religious context is particularly significant. On the one hand, it helps to explain the values and ethos of the organisation, and the social implications of a particular set of spiritual commitments. On the other, it complicates commonly held interpretations of conservative Christian engagement with social issues during this period.     

The integrative attitude–a personal journey

The origins of clinical psychotherapy date from the beginning of last century and the development of broadly four foundational schools–psychoanalytic, cognitive-behavioural, humanistic and transpersonal psychologies. The imperative to integrate these schools, however, is relatively recent and in the last 25 years a professional integration movement has developed, exemplified by the formation of SEPI and the UKAPI, and ‘integrative psychotherapist’ is now the most popular nomenclature used in the profession. This article gives a brief history of the integration movement, reviews some issues raised by developments so far, and discusses the personal dilemma that integration evokes in the would-be integrative practitioner. Using my own journey I espouse an integrative attitude that is based on the nature of integration as an evolving personal process rather than an ideal, fixed, profession-wide position. I describe three interweaving modalities of integration I call constructive, complicit and contiguous integration, which form a developmental framework that aims to encourage the individual activity of questioning, inventing, researching and interrogating the discipline within its philosophical, professional and social context. In concluding, this article exhorts the profession to see integration as a personal journey, as a way of being that is constantly becoming and unfolding in relation with the therapist's training, experience and interaction with peers and clients. The result is indefinable and unnameable, and perhaps represents the soul of integrative psychotherapy.     

Between the street and the consulting room: The role of therapeutic frame in working with homeless clients

This paper explores the context of psychotherapy with people who are homeless and the kinds of dynamics and challenges that typically arise in this work. The paper specifically considers the process of therapy as it takes place with clients who have been recurrently homeless and who have difficulties with sustaining shelter that has its roots in deficits in early containment. Clinical case material from psychotherapy conducted with two homeless men is presented and the implications of the approach adopted are explored both in relation to policies around the provision of services for homeless people and the more specific issue of psychotherapy intervention.

It is argued that a clear, well-articulated set of expectations has to be developed around this work in order to protect it and to provide it with the greatest opportunity for providing the kind of safety that is required for the development of this work. It is argued that the most important issue here relates to the provision of a consistent therapeutic framework and a care around the development of the specific psychotherapeutic frame within, and in relation to, the other frames present in the person's life.     

The spiritual care of sick children: reflections from a pilot participation project

The authors are a multi-disciplinary team of chaplains, one with a counselling qualification, and an academic with a research background in spirituality and youth work. A pilot participation project undertaken at Birmingham Children’s Hospital (UK) focused on increasing the understanding of the spiritual needs of sick children and young people and involving children and young people in improving the service and provision of spiritual and religious care to them. Views from children, young people and parents were sought with the intention of developing resources and training that help facilitate the meeting of spiritual and religious needs of children and young people in hospital. Within the wider chaplaincy team are chaplains from the six major world faiths and this project considers spiritual needs of children and young people who perceive themselves as belonging to a faith group or not. Reflections from the pilot include identifying ten principles and practices to inform the spiritual care of sick children and proposing the concept of interpretive spiritual encounters as a tool for spiritual care. The pilot study indicated that being more proactive in offering spiritual care enhanced the quality of service offered by Chaplaincy.     

The relationship between forgiveness and history of suicide attempt

The sentiment of forgiveness in relationship to suicide attempts/completions has been mostly examined through studies of suicide notes and the experiences of survivors and therapists – not attempters. In a cross-sectional sample of 304 consecutive primary care patients, we examined sentiments about forgiveness using the Forgiveness Scale, comparing those individuals with versus without past suicide attempts. According to findings, individuals with past suicide attempts (N?=?55; 19.1%) evidenced significantly lower composite scores on the Forgiveness Scale. As for individual items, compared to participants without past suicide attempts, those with past suicide attempts were significantly less believing of forgiveness by others, were less likely to forgive themselves, and to a lesser degree, were less forgiving of others. There were no between-group differences with regard to confession of wrongdoing or existential forgiveness by God. Findings may offer some salient avenues of therapeutic inquiry and endeavour in the psychological healing of individuals with past suicide attempts.     

Issues in using interpreters in therapeutic work with refugees. What is not being expressed?

‘Interpreting’ could be thought about as a legal equal opportunities or human rights issue. Whereas interpreters are likely to focus on the linguistic issues, and will be aware of the technical complexities of their work. Clinicians may worry about the impact on the therapeutic relationship of the interpreter's presence, how this will be managed and how it may depend on the match or mismatch of such factors as the client's gender, age and first or other language. This paper considers the issue on each of these levels to reveal the complexities and dilemmas of effective clinical work with interpreters, but also what can be achieved: the multiple layers of meaning concerning the client's experience and communication which can be elicited through effective working between interpreter and clinician.     

Integrating different types of knowledge in supervision

The present article examines ways to integrate two, often contradictory, types of knowledge in supervision, which are sometimes represented either by supervisors or supervisees, and sometimes by different parts in the supervisee. These types of knowledge are in a dialectic relationship: they may define each other and at the same time influence and shape each other, yet remain two separate sources for understanding the therapeutic experience. One type is the primary, vague, and intuitive knowledge about patients and therapist–patient interactions, derived from actual participation in the therapeutic relationship. The other type is knowledge derived from theory, experience acquired mainly outside of the specific therapy, and dialog with colleagues.