Derscheid, Della J.

A strong organizational culture begins with leadership who create systems and structures to support safety and well-being of staff. The purpose of this article is to provide direction for nursing leaders on resources and actionable items to support staff who have been involved in challenging encounters with patient behavior. Staff needs are impacted not only by the situation but also by available on-the-job support and leadership respect for staff’s individual judgment. Postsituation support from both leaders and peers offer a protective effect against negative outcomes from adverse experiences. Ultimately, staff preferences for specific resources are individual and best determined through private conversation with their leadership. Given the unique nature of each situation, taking into account patient intentions and staff perceptions, it is important to offer flexible and actionable measures for staff managing challenging patient behaviors.

AbstractThe aim of this study was to identify hospital‐based workplace violence (WPV) risk factors with the Haddon Matrix Model (HMM) to determine its potential utility to conceptualize multiple risks for WPV events. This descriptive study utilized two independent convenience samples Data from behavioral emergencies (2014–2015) for patient violence (N = 192) and from health care staff (N = 380) 12‐month violence survey responses (2015) in a Midwestern academic hospital were analyzed. Logistic regression examined patient features associated with physical violence. Survey questions pertained to employee, environment, and cultural factors associated with WPV; responses were examined with Chi‐square and two‐sample t‐tests. Violence risk factors populated the 4 Haddon Matrix domains at pre‐event time frames as Host (worker)‐age/demographics, Agent (patient)‐age/gender, Physical Environment‐door/window structure, and Social Environment‐worker safety. Risks at event time frames populated for Agent—behavior/delirium, and Physical Environment—event medication/patient identification. The Haddon Matrix identification of hospital violence risks indicates its utility as a comprehensive approach to workplace violence.

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.

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.

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.