Reflective supervision and reflective practice in infant mental health: A scoping review of a diverse body of literature.

Reflective practice is a core component of Infant Mental Health (IMH) training and work in the form of reflective supervision/consultation (RS/C). RS/C supports and facilitates relationship-based practice, and is considered to help prevent burnout and promote work satisfaction. In response to an identified gap in empirical research on RS/C, this scoping review aimed to give an overview of the broad range of study designs and outcomes by systematically charting empirical studies on RS/C in IMH-based work with children and families. Searches of Academic Search Complete, CINAHL, MEDLINE, APA PsychArticles, APA PsycInfo, and Web of Science were supplemented with a Google Scholar search and citation searching. Following title/abstract screening (n = 233) and full-text review (n = 168), 35 reports met criteria for inclusion. Key findings were organized into four categories: Essential components and processes of RS/C; Experiences and outcomes of RS/C; Emerging issues in RS/C literature; and Measuring, researching, and reporting on RS/C. Results describe the components and experience of engaging in quality RS/C, and show that practitioners generally experience RS/C as supportive and beneficial. The existing literature has some methodological limitations and further empirical research is needed on outcomes of RS/C. Practice implications and potential future research directions are discussed.

La práctica con reflexión es un componente central del entrenamiento y trabajo en el campo de Salud Mental Infantil (IMH), en forma de una supervisión/consulta con reflexión (RS/C). RS/C apoya y facilita la práctica que tiene como base la relación y se considera que ayuda a prevenir el agotamiento y a promover la satisfacción en el trabajo. Como respuesta a un identificado vacío en la investigación empírica sobre RS/C, esta revisión de los antecedentes se propuso presentar una visión general de la amplia gama de diseños y resultados de estudios por medio de un trazado sistemático de estudios empíricos sobre RS/C en el trabajo basado en IMH con niños y familias. La búsqueda en Academic Search Complete (Completa Búsqueda Académica), en CINAHL, MEDLINE, APA, PsychArticles, APA PsycInfo y Web of Science (Red de la Ciencia) se suplementó con una búsqueda en Google Scholar y una búsqueda de citas anotadas. Después de seguir la detección de título/resumen (n = 233) y una revisión del texto completo (n = 168), 35 reportes reunieron los criterios para ser incluidos. Los resultados claves se organizaron en 4 categorías: Componentes y procesos esenciales de RS/C; Experiencias y resultados de RS/C; Asuntos incipientes en la literatura sobre RS/C; y Medir, investigar y reportar sobre RS/C. Los resultados describen los componentes y experiencias de participar en RS/C de calidad, y muestran que los profesionales de la práctica generalmente experimentan RS/C como un proceso de apoyo y beneficioso. La literatura existente tiene algunas limitaciones metodológicas y se necesita una mayor investigación empírica sobre los resultados de RS/C. Se discuten las implicaciones en la práctica y las potenciales directrices para la futura investigación.

"You go in heavy and you come out light": An interpretative phenomenological analysis of reflective practice experiences in an Irish infant mental health setting.

Reflective practice (RP) is a core component of infant mental health (IMH); however, there is limited published empirical research on IMH practitioner experiences of RP. This two-stage, qualitative, multimodal study explored Irish IMH practitioners' experiences of RP spaces. Visual and verbal data from seven individual interviews and a participatory arts-based focus group with seven participants (eight participants in total, all white Irish females) were analyzed using Interpretative Phenomenological Analysis. Five group experiential themes (Just get on with it; What should I be bringing to this space?; Who are my "hands"?; Taking a step back; and You go in heavy and you come out light) were generated by the analysis. These were used to construct a developmental and experiential model of learning in an RP space. The themes portray how a practitioner's RP experience can change over time: influenced by prior experiences and practice development stage, practitioners move from initial uncertainty, anxiety, and perceived pressure in a busy workload to developing the trust and ability to be vulnerable in an RP space. Through relationships (supervisor/facilitator or group members), a shared safe space can be created, which addresses practitioners' needs for containment, allowing for experiential learning through a process of transformational moments.

La práctica con reflexión (RP) es un componente central de la salud mental infantil (IMH), sin embargo, existe una limitada investigación empírica publicada sobre las experiencias de RP de los profesionales de la práctica de IMH. Este estudio multimodal, cualitativo, en dos etapas, exploró las experiencias de los espacios de RP de profesionales irlandeses en la práctica de IMH. Se analizó la información visual y verbal de siete entrevistas individuales y un grupo de enfoque participativo con base artística de siete participantes (ocho participantes en total, todas mujeres blancas irlandesas) usando el Análisis Fenomenológico Interpretativo. El análisis generó cinco temas de la experiencia de grupo (Manos a la obra; ¿Qué debo aportar a este espacio?; ¿Quiénes son mis 'manos'?; Dar un paso atrás; y Se comienza pesado y se termina liviano). Estos temas se usaron para construir un modelo de desarrollo y experimental de aprendizaje dentro de un espacio de RP. Los temas describieron cómo la experiencia de RP de un profesional de la práctica puede cambiar a lo largo del tiempo: influida por experiencias previas y un estado de desarrollo práctico, los profesionales de la práctica pasan de la incertidumbre inicial, la ansiedad y la percibida presión dentro de una ocupada carga de trabajo a desarrollar la confianza y la habilidad de ser vulnerable dentro de un espacio de RP. A través de relaciones (supervisor/facilitador o miembros de grupo), se puede crear un espacio seguro compartido, el cual aborda las necesidades de contención de los profesionales de la práctica, permitiendo el aprendizaje experimental a través de un proceso de momentos transformacionales.

Self-Efficacy Among Caregivers of Children With Food Allergy: A Cohort Study.

OBJECTIVE: The prevalence of pediatric food allergy (FA) is increasing and, due to early disease onset, requires significant caregiver management that is associated with psychosocial burden. Caregiver perception of how they cope and handle FA-related events (self-efficacy) has been linked to psychosocial outcomes in racially/geographically homogenous samples. This study explores FA-related caregiver self-efficacy and associations with FA-related caregiver quality of life (QoL) in a diverse cohort. METHODS: Caregivers of children, diagnosed with IgE-mediated FA who identified as non-Hispanic Black or White, were recruited from U.S. academic allergy clinics. Caregivers completed demographic and medical questionnaires, the Food Allergy Self-Efficacy Scale for Parents (FASE-P), Food Allergy Independent Measure-Parent Form (FAIM), and the Food Allergy Quality of Life-Parental Burden (FAQL-PB). Bivariate and multivariate associations estimated relationships between study variables. RESULTS: Caregivers of 365 children (Mage = 5.8 years, 62.2% male, 31.1% Black) were enrolled. Caregivers reported high FA self-efficacy (M = 82.06/100), moderate perceptions of risk/FA severity (FAIM: M = 3.9/7), and some limitations on the FAQL-PB (M = 3.9/7). Self-efficacy was related to lower perceptions of risk/FA severity across all demographic groups (r = -.42, p < .001). Caregivers who reported higher self-efficacy reported better QoL, particularly Black caregivers (r = .67). CONCLUSIONS: In this sample of caregivers of children with FA, greater self-efficacy was related to improved QoL regardless of sociodemographic factors. Caregivers' perception of risk was lower for those with greater self-efficacy. Future research into the impact of FA management on QoL among diverse caregivers is needed.

Does empowerment enhance nurses' organizational commitment?

AIM: We examined whether psychological empowerment was significantly associated with the organizational commitment of licensed practical nurses. BACKGROUND: Healthcare organizations face unprecedented staffing challenges. This study provides insight into potential ways to ameliorate these issues. METHODS: In early 2010, we distributed a 45-item questionnaire, based on established measures of psychological empowerment and organizational commitment, to the entire population of active, full-time licensed practical nurses throughout a Midwestern US state. Our sample consisted of 1165 respondents. RESULTS: The results of our data analysis suggest that even after controlling for a range of potentially confounding variables, three subscales (meaning, self-determination and impact) were positively and associated with organizational commitment. However, one subscale (competence) was negatively related to the outcome. CONCLUSIONS: The psychological empowerment dimensions of impact, meaning and self-determination are associated with increased organizational commitment among licensed practical nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Considering the profound staffing challenges facing the nursing profession-exacerbated by the current global pandemic and retirements-our findings provide nurse administrators with critical information to use in stemming the wave of nurses leaving the profession.

Food allergy-related bullying and associated peer dynamics among Black and White children in the FORWARD study.

BACKGROUND: The experiences of Black children with food allergy (FA) are not well characterized, particularly with respect to bullying victimization and other psychosocial outcomes. OBJECTIVE: To evaluate bullying experiences of Black and White children with FA, including associations with peer relationships, anxiety, and school policies. METHODS: Surveys were administered to parents of 252 children with physician-diagnosed FA enrolled in the multisite FORWARD cohort. The surveys assessed demographics, atopic disease, bullying victimization, and school FA management practices and policies. Descriptive statistics of bullying by race were compared by χ2 tests. Multiple logistic regression analyses adjusting for race, age, parental education, household income, child sex, and multi-FA compared adjusted probabilities of bullying victimization by school policies. RESULTS: Nearly 20% of school-aged children were bullied for FA with no substantial racial differences overall, though for children ages 11 years and up, White children reported higher rates of bullying. However, Black children experienced non-FA-related bullying twice as frequently as White children (38.6% vs 17.7%; P = .002). Most of the caregivers (85.7%) who intervened in their child's bullying reported that it was helpful. Among parents, 17.3% reported that they were teased or bullied owing to their child's FA. More than half of the respondents (54.8%) reported that some allergens are banned from their child's school, most typically peanut. In schools banning peanuts, FA-related bullying was less frequently reported by all students who have food allergy. CONCLUSION: Bullying owing to FA is common, and caregivers, medical professionals, and school administrators can help reduce bullying by screening for bullying and supporting and educating school policies.

AAAAI Mast Cell Disorders Committee Work Group Report: Mast cell activation syndrome (MCAS) diagnosis and management.

Our current recommendations for diagnosing and treating primary mast cell (MC) activation syndrome make use of the latest studies and consensus guidelines for clinically recognizing systemic anaphylaxis in real time, regardless of whether allergen-triggered or other pathways are involved; our current understanding of the biomarkers secreted by activated MCs that best discriminate this disorder from other conditions; and the therapeutic drugs that might selectively affect those mediators or MCs themselves. Finding familial or somatic mutations of genes that cause MCs to be hyperactivatable would extend our diagnostic tools and potentially indicate new therapeutic interventions, targeting either the mutated gene product or the associated molecular pathway. In conclusion, we trust that the clinical, laboratory, and therapeutic criteria for primary MC activation syndromes described herein will provide clinicians with practical criteria of sufficient sensitivity and specificity to diagnose most cases without overdiagnosing the disorder in patients who likely have other conditions.

Organizational Trust, Psychological Empowerment, and Organizational Commitment Among Licensed Practical Nurses.

In this study, we examine the influence of organizational trust on organizational commitment among licensed practical nurses (LPNs). Guided by prior research and theory, we also consider whether psychological empowerment mediates the influence of organizational trust on organizational commitment. To accomplish these tasks, we examine data from our survey of all registered LPNs in a Midwestern US state on their levels of organizational trust, psychological empowerment, and organizational commitment. Using path decomposition procedures, we isolate the net effect of organizational trust on organizational commitment into total, direct, and indirect effects. Our findings suggest that organizational trust is positively associated with higher levels of organizational commitment. Furthermore, more than a fifth of this relationship is mediated through one's level of psychological empowerment. These findings provide some insight into antecedents of organizational commitment among LPNs. The results of this investigation are especially timely considering the extant issues associated with staffing levels in facilities employing LPNs in the United States.

Grief, Tragic Death, and Multiple Loss in the Lives of Irish Traveller Community Health Workers.

Recent data on the inequities in mortality, health, and access to health services experienced by the Traveller community in Ireland show higher rates of death by suicide and other sudden causes among members of this marginalized minority group than in the general population. Psychological literature on bereavement suggests that traumatic deaths and multiple deaths within a close network may be more likely to lead to complicated grief reactions. The aim of this study is to add to our understanding of the effects of the differential mortality rate by exploring how grief is experienced within the Traveller community in the context of bereavement from multiple deaths or sudden deaths (including suicide). Data from three semistructured focus group interviews with a total of 10 Traveller Community Health Worker participants (nine female and one male) were analyzed using Interpretative Phenomenological Analysis. Two master themes organized the salient phenomenological aspects of the grief experience: Living with Tragic Loss and Communicating Tragic Loss. A picture emerged of individual and community-level loss that is extensive, profound, and enduring. The sequelae of deaths by suicide include difficulties in coping, a search for meaning, and a pervasive sense of fear. Silence, the embodied act of giving voice to tragic loss, and strategies for managing disclosure of tragic deaths with children were all strong themes which emerged from the analysis. This study uses interpretative phenomenological analysis to generate a vivid picture of the lived psychological experience of grief as it is experienced by members of a minority group with above average rates of sudden and early deaths. This contributes to understanding the burden of health inequality in an underresearched population. Findings in relation to challenges in communicating with children about tragic deaths can be integrated into bereavement support resources.

Interpersonal Conflict and Organizational Commitment Among Licensed Practical Nurses.

The shortage of nursing professionals in the United States is unquestionable. This shortage, which is predicted to continue into the foreseeable future, is a particularly salient problem within the nursing profession. This is especially true for long-term care facility administrators who not only are faced with the challenge of increasing numbers of aging residents but also regularly struggle with turnover among more cost-effective nursing staff, such as licensed practical nurses (LPNs). The primary purpose of this study was to examine whether perceived interpersonal conflict influences organizational commitment among LPNs. To accomplish this, we analyzed responses from 1165 LPNs throughout a Midwestern state who were queried on their perceptions of interpersonal conflict and organizational commitment in their work settings. Considering a wide range of potential confounding influences such as age and years working as an LPN, for example, we found that higher perceived interpersonal conflict was associated with significantly lower levels of organizational commitment. The implications of these findings, along with recommendations for nurse administrators to reduce LPN turnover, are discussed in the article.

Risk of obstructive sleep apnea in African American patients with chronic rhinosinusitis.

BACKGROUND: It is widely known that patients with chronic rhinosinusitis (CRS) commonly experience sleep disruption. Many of these patients have the associated diagnosis of obstructive sleep apnea (OSA). However, little is known about the risk factors for developing OSA in the CRS population. OBJECTIVE: To identify the risk factors for OSA in CRS to determine who should be screened for OSA among patients with CRS. METHODS: We evaluated a large cohort of patients with confirmed diagnostic criteria for CRS. Patient medical records were reviewed to identify those with OSA confirmed by overnight polysomnography. Records were further reviewed for demographic information (age, sex, race, and ethnicity), body mass index, and medical history, including the presence of nasal polyps, asthma, aspirin-exacerbated respiratory disease, allergic rhinitis, and eczema. The number of endoscopic sinus operations, duration of CRS, presence of subjective smell loss, and computed tomography Lund-Mackay score were also ascertained. RESULTS: A total of 916 patients with CRS were included in the study. Implementation of a multivariable regression model for identifying adjusted risk factors revealed that African American patients had a significantly higher risk for OSA than white patients, with an adjusted odds ratio of 1.98 (95% confidence interval, 1.19-3.29). Furthermore, patients with CRS without nasal polyps were at higher risk for OSA, with an odds ratio of 1.63 (95% confidence interval, 1.02-2.61) compared with patients with CRS with nasal polyps. CONCLUSION: African American patients with CRS were at higher risk for OSA compared with white patients, and this patient group needs to be screened for OSA.

Staying Awake and Aware: The Importance of Sleep in Psychiatric Nursing Practice.

Given that approximately 70 million Americans suffer from sleep-wake disorders and their under-recognized role in practice, psychiatric nurses may see, or may be already seeing, patients with undiagnosed sleep disorders. Assessment of sleep-wake disorders can and should be a part of psychiatric nursing education and practice. Many practicing clinicians lack formal training regarding sleep-wake issues and treatment. Even as sleep disturbances are common concerns among psychiatric populations, sleep-wake issues may go unrecognized. The article presents a stylized progression of care to enable clinicians to identify, address, and treat underlying sleep-wake disorders in psychiatric settings. The article recommends instituting screening procedures for sleep-wake issues and follow-up assessments, particularly overnight pulse oximetry and polysomnograms. Just as clinicians already screen for physical conditions that would affect psychiatric care, practitioners can evaluate patients for potential sleep-wake disorders as part of their existing practice and intake procedures. Further, the piece details implications for psychopharmacology as well as evidence from clinical practice. Psychiatric nurses should stay awake to the importance of sleep medicine and aware of how sleep-wake disorders can affect psychiatric populations.

Prevalence of allergic rhinitis and asthma in patients with chronic rhinosinusitis and gastroesophageal reflux disease.

BACKGROUND: An association between chronic rhinosinusitis (CRS) and gastroesophageal reflux disease (GERD) has been previously reported; however, the underlying factors linking CRS and GERD remain to be elucidated. OBJECTIVE: To assess the association of GERD and CRS using prospective and retrospective approaches. METHODS: The retrospective study comprised a large cohort of CRS cases, whereas the prospective arm evaluated a series of CRS cases and controls. RESULTS: In the retrospective arm of the study, of the 1066 patients with CRS, 112 (10.5%) had GERD. Among patients with CRS, GERD was associated with higher body mass index, older age, and female sex. The odds ratios (ORs) for asthma and allergic rhinitis in the CRS group with GERD compared with the CRS group without GERD were 2.89 (95% confidence interval [CI], 1.905-4.389) and 2.021 (95% CI, 1.035-3.947). Furthermore, GERD was associated with a greater duration of CRS. Ninety patients with CRS and 81 controls were enrolled in the prospective arm of the study. In the CRS group, GERD was associated with asthma (OR, 4.77; 95% CI, 1.27-18.01). Patients with CRS and GERD had a longer duration and a younger age at onset of CRS. In controls, no association was found between GERD and asthma (OR, 0.67; 95% CI, 0.09-5.19) or allergic rhinitis (OR, 0.35; 95% CI, 0.05-2.59). CONCLUSION: Patients with CRS and GERD are more likely to have atopic conditions and asthma when compared with patients with CRS but without GERD. One of the potential explanations of this link is that comorbid GERD and atopic disease are potential risk factors for development of CRS.

Clinical Psychopharmacology Update: What's in a Name? Confusion Prompts Change for Vortioxetine's Brand Name.

Similar names between two unrelated drugs have led the FDA to issue warnings about and now approve a name change for vortioxetine, which was branded as Brintellix® until recently. While the trade name had been screened prior to the product's launch, the FDA received numerous reports of prescribing and dispensing errors, specifically with regard to the anti-coagulant drug Brilinta® (ticagrelor). Starting 1 June 2016, vortioxetine will be marketed under the name Trintellix™ in an effort to reduce confusion. Clinicians are advised that while the name and National Drug Code number with this product will change, it will retain the same formulation, indication, and dosage information. To the extent possible, clinicians can and should take actions to identify and reduce potential medication errors in prescriptions, especially when using electronic records and e-prescription systems.

Anaphylactic Shock at the End of Hemodialysis.

Allergic reactions to epoetin alfa, including anaphylaxis, have been described but desensitization in the setting of an IgE-mediated reaction has not been reported. We present a case of a hemodialysis patient who developed symptoms of an IgE-mediated allergic response to epoetin alfa that occurred after each administration. These reactions progressed to a single episode of anaphylaxis with generalized pruritus, urticaria, oropharyngeal edema, and hypotension that prompted its discontinuation. Intradermal skin testing confirmed an allergic response to this agent. The patient then underwent a desensitization procedure to epoetin alpha after which she was able to tolerate it without further problems.

Clinical Psychopharmacology Update: Additional Safety Concerns for Using Varenicline (Chantix) for Smoking Cessation Treatment.

Smoking cessation remains a positive therapeutic goal and should be encouraged for the millions of individuals who continue to smoke and struggle to quit. While psychiatric nurses should encourage patients to start or continue smoking cessation therapies, they must be aware of the additional safety concerns relating to the use of varenicline (Chantix). Research published subsequent to the last clinical update in this journal (Tobin, 2007 ) has prompted additional warnings from the Food and Drug Administration concerning varenicline for smoking cessation therapy. In particular, clinicians need to be aware of increased concerns about varenicline's association with neuropsychiatric side effects, seizures, and alcohol interactions.

In vitro evaluation of intestinal epithelial TLR activation in preventing food allergic responses.

Alterations in the gut microbiota composition are associated with food allergy. Toll-like receptors (TLRs) respond to microbial stimuli. We studied the effects of the ligation of TLRs on intestinal epithelial cells (IECs) in preventing an allergic effector response. IEC monolayers (T84 cells) were co-cultured with CD3/28-activated PBMCs from healthy controls or atopic patients and simultaneously apically exposed to TLR2, TLR4 or TLR9 ligands. The barrier integrity of T84 cell monolayers was significantly reduced upon co-culture with PBMCs of food allergic subjects compared to healthy subjects. Apical exposure of IECs to a TLR9 ligand prevented PBMC-induced epithelial barrier disruption. Using PBMCs from food allergic subjects, apical TLR9 activation on IECs increased the IFN-γ/IL-13 and IL-10/IL-13 ratio, while suppressing pro-inflammatory IL-6, IL-8 and TNF-α production in an IEC-dependent manner. Hence, the activation of apical TLR9 on IECs, potentially by microbiota-derived signals, may play an important role in the prevention of allergic inflammation.