Evolution of an innovative approach to the delivery of in-person training in the responsible conduct of research.

The responsible conduct of research (RCR) Center is an innovative, workshop-based approach to research ethics education at the University of Pittsburgh. A flexibly scheduled program of workshops combines the benefits of traditional case-based discussion and in-person instruction with greater accessibility and a broader disciplinary reach. Essential features of the program include a rotating schedule of independent workshops with separate registration, expert speakers, and a dedicated program director position. At an institutional level, this novel response to National Institutes of Health-mandated training requirements increases access to a wide range of interactive RCR training programs and promotes interdisciplinary conversations on research ethics that involves investigators, trainees, and the research community at large.

A survey of pedagogical approaches and quality mechanisms used in education programs for mental health professionals.

The provision of high-quality education and training that is responsive, relevant, accessible and evidence based is critical if the vision for quality mental health services presented in recent policy initiatives in Ireland is to be fulfilled. This paper reports the findings related to pedagogical approaches and quality assurance mechanisms utilized within mental health education. The study involved canvassing all Higher Education Institutions in Ireland. A total of 227 courses in 31 educational institutes were identified and 149 questionnaires were returned from 129 Course Coordinators. Various quality processes were identified in existing programs; however, formal feedback from service providers, service users and carers was seldom reported. Ongoing evaluation and quality assurance strategies are a key element of governance and there is a need to develop strategies that explore the impact of education programs on mental health education and health outcomes. Recommendations are made in terms of future interprofessional mental health education and practice.

Student psychiatric nurses' approval of containment measures: relationship to perception of aggression and attitudes to personality disorder.

Difficult and challenging behaviour by inpatients is a feature of acute psychiatric ward life. Different methods are used to contain these behaviours, and there is international variation in which are approved of or used. Previous research suggests that staff attitudes to patients may affect their willingness to use, or choice of, method. The aim of this study was to explore the relationship between approval of containment measures, perception of aggression and attitude to personality disorder. A survey of student psychiatric nurses was conducted, and using three attitudinal questionnaires related to aggression and containment. An association was found between positive attitude to patients and the approval of containment methods that involved nurses being in personal contact with patients. There was evidence that students' attitudes to patients deteriorated over time. The results highlighted the importance of (and linkage between) staffs' feelings of anger and fear towards patients, and their preparedness to use containment measures.

International variation in containment measures for disturbed psychiatric inpatients: a comparative questionnaire survey.

BACKGROUND: Disturbed psychiatric inpatients are managed using a range of containment measures (e.g. seclusion, mechanical restraint) whose use differs by country. Little is known about why these differences exist, or about how staff choose between the different methods available to them. AIMS: To compare psychiatric professionals attitudes to containment measures between countries with different practices, and to discover what factors have the greatest impact on preparedness to use a containment method. METHOD: Surveys of psychiatric professionals in the United Kingdom, the Netherlands, Finland, and Australia, using the Attitude to Containment Measures Questionnaire. RESULTS: Relative approval of different containment measures broadly matched what we know about different practices, with some notable differences. Staff in Finland expressed the highest level of approval of containment, staff in the UK the least, with those in the Netherlands in between. Individuals' preferences for different containment measures were largely determined by whether they considered it (i) safe for the patients undergoing it, (ii) prevented them from injuring others, and (iii) quickly calmed them. CONCLUSION: Future evaluation research on containment measures should use time taken to calm the patient, injury to patients and others, as primary outcomes. National clinical audit and injury reporting systems would also enable the identification of methods that are truly physically injurious to patients, aiding in the rational selection of appropriate containment measures.

Does anticipation training affect drivers' risk taking?

Skill and risk taking are argued to be independent and to require different remedial programs. However, it is possible to contend that skill-based training could be associated with an increase, a decrease, or no change in risk-taking behavior. In 3 experiments, the authors examined the influence of a skill-based training program (hazard perception) on the risk-taking behavior of car drivers (using video-based driving simulations). Experiment 1 demonstrated a decrease in risk taking for novice drivers. In Experiment 2, the authors examined the possibilities that the skills training might operate through either a nonspecific reduction in risk taking or a specific improvement in hazard perception. Evidence supported the latter. These findings were replicated in a more ecological context in Experiment 3, which compared advanced and nonadvanced police drivers.

Changes in attitudes to personality disorder on a DSPD unit.

BACKGROUND: Psychiatric professionals tend to have poor attitudes towards people who suffer from personality disorder. Previous studies suggest that such attitudes are influenced by sufferer behaviours, organizational factors and the characteristics of individual professionals, but do similar considerations apply outside health services? AIM: To identify what events, experiences and factors in the course of daily work with personality-disordered people influence the attitudes and beliefs of prison staff. METHOD: Semi-structured interviews were conducted with prison officers working in a pilot "Dangerous and Severe Personality Disorder" Unit within a UK prison. Open questions were asked about any changes in their attitudes to or beliefs about personality-disordered inmates. RESULTS: Positive influences on attitude were: development of greater understanding of personality disorder and prisoners as individuals; improvement in inmate behaviours; education; the staff counselling programme; staff sharing support and skills; the challenge and purpose of the new role and having their views listened to. Negative influences were: delays in establishing the treatment programme; some inmate behaviours; fear and concern over their new roles and negative portrayal as a profession in the media. CONCLUSIONS: In order to maintain a high overall positive attitude among staff to working with people with personality disorder, units should have: consistency of direction and timely implementation of anticipated developments; clear philosophy and treatment regime; substantial investment in staff training programmes and effective programmes for the provision of clinical supervision to frontline staff.

Cultures of psychiatry and the professional socialization process: the case of containment methods for disturbed patients.

Acute mental disorder necessitating admission to hospital is often accompanied by disturbed behaviour that threatens the health of the person concerned or that of those around them. A range of containment methods are used by psychiatric professionals to keep patients and staff safe. These strategies are strongly emotive and attract strong moral valuations, yet differ sharply between countries. This paper reports a study to investigate the relationship between attitudes to these containment methods, and exposure to psychiatric education and practice. It was hypothesized that the culture of psychiatry in the study country would socialise students' views towards the locally dominant pattern of relative evaluations. Nine cohorts of student psychiatric nurses at different stages of their training at one UK University were asked to complete ratings on 11 containment methods. Containment methods fell into five groups, with mechanical restraint and net beds attracting the most severe disapproval. Neither the relative evaluation of methods, nor the intensity of those evaluations, changed systematically with duration of training. The findings support the interpretation that the relative evaluations of psychiatric containment methods are a property of wider national cultures, rather than an isolated tradition of professional psychiatric practice.

Patient-staff conflict: results of a survey on acute psychiatric wards.

BACKGROUND: Disruptive behaviours of acute psychiatric inpatients have typically been studied separately, as have the methods used to contain them. There are indications that behaviours and containment methods are systematically related. AIMS: The aim of this study was to assess the frequency and relationship between the differing conflict behaviours of patients, and explore the relationship between professional containment measures and those conflict behaviours. METHODS: A cross-sectional survey of conflict behaviours and containment of 238 two-week admissions to 12 acute psychiatric wards in London, UK was carried out. RESULTS: Factor analysis revealed seven patterns of conflict behaviours, with aggression being separately associated with absconding and medication refusal. Neither substance misuse nor self-harm were associated with aggression. Aggressive behaviour attracted the widest range of containment measures, including the use of special observation. CONCLUSIONS: The conflict behaviours of patients form complex patterns, and should be studied together rather than separately.

Psychiatric nurses' views on criteria for psychiatric intensive care: acute and intensive care staff compared.

AIM: To explore and investigate differences between the views of qualified nurses working in psychiatric intensive care units (PICUs) and acute care wards on which patients are appropriate for PICU care. BACKGROUND: Previous research on the area of psychiatric intensive care highlights the great differences that exist in all aspects of service provision, from unit size and staffing levels to treatment approaches and physical environment. One of the most common areas of controversy is the type of client behaviour that warrants admission to the PICU. METHOD: Structured interviews of 100 qualified nursing staff (in the London area, England) working on either acute or PICU wards were used to gather data on appropriate and inappropriate referral to PICUs. Comments made during the course of the interviews were also collected and subjected to content analysis. FINDINGS: There was evidence to support the hypothesis that acute ward staff considered patients suitable for PICU care at a lower level of risk than PICU staff thought appropriate. In comparison to acute ward nurses, those working in PICUs attended to a broader range of factors when considering suitability for admission to PICU. Appropriate reasons for transfer fell into five groups: risk to others; risk of intentional harm to self; risk of unintentional harm to self; therapeutic benefit from the PICU environment; and legitimate acute ward care problem. Inappropriate reasons for transfer fell into four groups: low risk to others and/or self; illegitimate acute admission care problems; patient belongs elsewhere; policy issues. CONCLUSION: The study opens up a range of issues not previously studied in relation to the use of PICUs and the intricate relationship of this use with the available acute care wards and other services. These findings and their implications for the care of acute and disturbed psychiatric patients are discussed.