The Relationship of Mentorship to Career Outcomes in Academic Psychiatry and Psychology: a Needs Assessment.

OBJECTIVE: Faculty development is designed to facilitate career advancement of junior faculty but there is limited empirical evidence on how to design an effective program. METHODS: As a first step in the design of an effective program, a needs assessment was conducted. Participants were faculty members of an academic psychiatry department. Participants completed a quantitative and qualitative survey assessing their experience with mentors, academic self-efficacy, career burnout and satisfaction, academic productivity, and perceived barriers to scholarship. RESULTS: Eighty percent (N = 104) of eligible faculty members completed the study survey (54% female; 81% White, 10% underrepresented in medicine). Less than half of the respondents (44%) reported having a current mentor. Number of mentors (r = .33; p < .01), mentorship meetings (r = .35; p < .01), and mentorship quality (r = .33; p < .01) were significantly correlated to a standardized measure of academic self-efficacy. Self-efficacy was significantly associated with academic productivity (r = .44; p < .001) and career satisfaction (r = .29; p < .05). The top barriers to scholarship productivity were time and lack of access to resources. Faculty members without a mentor endorsed more barriers to scholarship (p < .001) than those with a mentor. Themes that emerged from the qualitative data suggest that mentorship supports career advancement through coaching and professional development, invitations to collaborate and resource share, networking, and active teaching. CONCLUSION: Based on the relationship of mentoring to career outcomes, a robust faculty development program needs a formal academic mentorship program to improve career satisfaction and academic productivity.

Delayed Signs and Symptoms of Extended Release Guanfacine Overdose in Two Adolescent Patients: Implications of Monitoring on the Psychiatry Unit.

Guanfacine is a selective alpha-2a adrenoreceptor agonist that with overdose can cause symptoms ranging from mild sedation to coma, respiratory depression, hyporeflexia, hypotonia, bradycardia, and hypotension. Despite a well-defined and predictable toxidrome, variations can be seen based on multiple factors including age, quantity ingested, organ functions, coingestions, time since ingestion, and specific dosage form. Here, we describe two cases of delayed presentation of extended release guanfacine toxicity and highlight the variations encountered in the toxidrome presentation. These cases bring to attention the importance of maintaining a high suspicion for such atypical presentations, keeping in mind the limitations of managing these complications on an inpatient psychiatric unit.

Risk Factors for Assault and Physical Aggression Among Medically Hospitalized Adult Patients Who Had a Behavioral Emergency Call: A Descriptive Study.

BACKGROUND: Health care settings are a primary location for workplace violence that involves clients, but risk factors for behavioral emergencies in medical settings are largely unknown. AIM: This study proposed to identify risk factors for assault and physical aggression among medically hospitalized patients who needed a behavior emergency response team. METHOD: This descriptive study, conducted at a large Midwestern academic medical center, used univariable and multivariable logistic regression to assess relationships between demographic, medical, mental health, and contextual variables with assault and physical aggression. Predictive ability was summarized using area under the receiver operating characteristic curve. RESULTS: Among patients who received a behavior emergency response (N = 820), 86 (10%) were assaultive. Physical aggression was the most significant predictor of assault. Physical aggression was predicted by older age, male gender, and verbal threats to others. Conversely, internalizing mental health conditions of anxiety, depression, and suicidal ideation were significant for decreased risk of assault and/or physical aggression. Contextual factors, identified as wanting to smoke or leave the hospital, were significantly associated with decreased risk of both assault and physical aggression. CONCLUSION: Health care providers are encouraged to (1) consider the demonstration of physical aggression as a sign to urgently implement precautionary measures for safety, (2) avoid predicting violent situations based on particular medical or mental health conditions alone, and (3) understand that not all disruptive behavior leads to violent situations.

Implementation of a Preparedness Program to Address Violent Situations in Healthcare.

Workplace violence is one of the most complex and dangerous occupational hazards facing hospital healthcare workers today. The United States Occupational Safety and Health Administration recommends that all hospitals have a violence prevention program. The purpose of this article is to describe the development and implementation of a preparedness program to address violent situations in healthcare as an essential component of workplace safety. The foundational program elements are leadership involvement, policy development, organization assessment, response personnel deployment, education, data repository and culture shift. A triad leadership from patient safety, security and nursing led the program. Key implementation lessons involved coordination of change within and across multiple sites.

Patient and Family Member Violent Situations in a Pediatric Hospital: A Descriptive Study.

PURPOSE: The intent of this study is to report on violent situations involving the pediatric patient and/or the patient's family member in the inpatient hospital setting. DESIGN AND METHODS: This descriptive study used two independent samples: Behavioral Emergency Response Team (BERT) recipients and surveyed pediatric healthcare staff at a pediatric hospital within a large urban Midwestern academic hospital in the United States. RESULTS: Per BERT recipients (N = 26) and staff survey respondents (N = 91), common physical patient behaviors were, respectively, hitting (60%, 77%) and kicking (53%, 82%). Fifteen (75%) patient BERT responses were for violent situations. The most common mental health condition among patients in violent situations was behavior dyscontrol (n = 8, 53%), which was absent among calls for non-violent situations (n = 5). Seizures, which was the most common medical condition among patients in BERT violent situations (n = 6, 40%), was proportionately slightly greater than among non-violent situations (n = 1, 20%). Staff who reported experience with violent situations (n = 64, 73%) were from general medical units (n = 48, 75%), and registered nurses (n = 53, 79%). CONCLUSIONS: This study helped illuminate demographic, medical and mental health clues about violent situations with patients and family members on pediatric inpatient hospital units. PRACTICE IMPLICATIONS: Pediatric patients and families may struggle to cope during hospitalization. Healthcare providers' knowledge about co-occurring conditions, stress related to hospitalization and use of BERT as a resource may help prevent violent situations.

Emotional Availability Scale Among Three U.S. Race/Ethnic Groups.

This study used a cross-sectional design to conduct a subgroup psychometric analysis of the Emotional Availability Scale among matched Hispanic ( n = 20), African American ( n = 20), and European American ( n = 10) English-speaking mother-child dyads in the United States. Differences by race/ethnicity were tested ( p < .05) among (a) Emotional Availability Scale dimensions with ANOVA, and (b) relationships of Emotional Availability Scale dimensions with select Dyadic Parent-Child Interaction Coding System variables with Pearson correlation and matched moderated regression. Internal consistency was .950 (Cronbach's α; N = 50). No significant differences in the six Emotional Availability Scale dimension scores by race/ethnicity emerged. Two Dyadic Parent-Child Interaction Coding System behaviors predicted two Emotional Availability Scale dimensions each for Hispanic and African American mother-child dyads. Results suggest emotional availability similarity among race/ethnic subgroups with few predictive differences of emotional availability dimensions by specific behaviors for Hispanic and African American subgroups.

Using high-fidelity simulation to develop nurse-physician teams.

BACKGROUND: This study was undertaken to determine whether interdisciplinary high-fidelity simulation training improves group cohesion in nurse-physician teams. In addition, perceptions of collaboration and satisfaction with patient care decisions were measured in nurse-physician participants. METHODS: Clinical scenarios relevant to the general surgical urology inpatient unit were conducted in an interdisciplinary high-fidelity simulation center. Participants included physicians and staff nurses. RESULTS: Participants reported a positive shift in group cohesion over time. In addition, the results suggested a positive shift in perceptions of collaboration and satisfaction with patient care decisions over time. The youngest participants (Millennial Generation, born in the 1980s and 1990s) showed the most significant growth in response to the training. CONCLUSION: This study provides evidence of benefits of high-fidelity simulation that extend beyond the training. Simulation training may be a strategy to build and strengthen relationships across nurse-physician teams. In addition, this type of training may positively affect collaboration and satisfaction with patient care decisions. When data were analyzed by generational grouping, the most significant growth occurred in the Millennial Generation participants. These influences need to be explored further.

Use of genomic assessments and interventions in psychiatric nursing practice.

The purpose of this study was to determine the impact of a genomic educational session by measuring participants' application of the class content to their nursing care. A sample of 65 psychiatric nurses participated in a staff development activity and completed a survey. Every respondent reported use of a genomic assessment or intervention with a patient from their clinical practice. The mean use of genomic assessment and intervention items was 5.5 out of the possible 10 which were identified and described in the educational session, providing evidence that nurses are able to include genomic assessments and interventions when caring for a patient with a psychiatric disorder.