Adult Inpatient Services Research Articles

Improving the standardisation, timeliness and efficiency of the occupational therapy admission process in an older adult inpatient service

Occupational therapists (OTs) are at the forefront of providing recovery-oriented care for older people through timely assessments of patient’s engagement in daily living activities among many other interventions. This aids...

Adult Inpatient Services in Pediatric Hospitals: A National Mixed Methods Study.

Some pediatric institutions have developed adult inpatient services to enable quality care of hospitalized adults. Our objectives were to understand the characteristics of these adult inpatient services in pediatric hospitals, barriers and facilitators to their creation and sustainability, and patient and system needs they addressed. An explanatory mixed methods study was conducted using a distribution of an electronic survey followed by targeted semi-structured interviews of directors (or designates) of adult inpatient services in US pediatric hospitals. The survey identified institutional demographics, service line characteristics, and patient populations. An interview guide was created to explore survey findings and facilitators and barriers in the creation of adult inpatient services. Interviews were conducted after survey completion. A codebook was created using an inductive thematic approach and iteratively refined. Final themes were condensed, and illustrative quotes selected. Ten institutions identified as having an adult inpatient service. Service staffing models varied, but all had dually trained internal medicine and pediatrics physicians. All participants voiced their respective pediatric institutions valued that these services filled a clinical care gap for hospitalized adults adding to whole-person care, patient safety, and health system navigation. Adult inpatient services in pediatric institutions have been present for >15 years. These services address clinical care gaps for adults hospitalized in pediatric institutions and use specialized internal medicine and pediatrics knowledge. Demonstrating return on investment of these services using a traditional fee for service model is a barrier to creation and sustainability.

“It's not just about the numbers”: Inside the black box of nurses' professional judgement in nurse staffing systems in England and Wales: Insights from a qualitative cross-case comparative study

BackgroundWhether implicit or explicit, professional judgement is a central component of the many nurse staffing systems implemented in high-income countries to inform workforce planning and staff deployment. Whilst a substantial body of research has evaluated the technical and operational elements of nurse staffing systems, no studies have systematically examined the role of professional judgement and its contribution to decision-making. ObjectiveTo explore nurses' use of professional judgement in nurse staffing systems in England and Wales. MethodsA cross-case comparative design centred on adult in-patient services in three University Health Boards in Wales and three National Health Service Trusts in England. Data generation was undertaken between January 2021 and March 2023 through stakeholder interviews, observations of staffing meetings, and analysis of documents and artefacts. Observations were undertaken in clinical areas but limited to three cases by COVID-19 restrictions. Analysis was informed by translational mobilisation theory. FindingsTwo kinds of professional judgement were deployed in the nurse staffing systems: the judgement of clinical nurses and the judgement of senior nurse managers. The research highlighted the reflexive relationship between professional judgement and data, and the circumstances in which organisations placed trust in people and when they placed trust in numbers. Nurses' professional judgement was central to the generation of data, its interpretation and contextualisation. Healthcare organisations relied on the professional judgements of clinical nurses and senior nurse managers in making operational decisions to mitigate risk, where real-world understanding of the status of the organisation was privileged over formal data. Professional judgement had attenuated authority for the purposes of workforce planning, where data was a master actor. Nurses expressed concerns that strategic decision-making prioritised safety and efficiency, and formal measurement systems did not capture important aspects of care quality or staff wellbeing, which made it difficult to articulate their professional judgement. ConclusionsThe implementation of staffing systems is resource intensive. Given limited evidence on which to recommend any specific methodology, the priority for future research is to optimise existing systems. If nurses are to deploy their professional judgement to proactively influence the conditions for care, as well as responding to the challenges of risk mitigation, there is a need for robust systems of nursing measurement aligned with agreed standards of care and a vocabulary through which these judgements can be articulated. Tweetable abstractHealth systems depend on nurses' professional judgement for operational staffing decisions, but data is privileged over professional judgement for workforce planning.

Use of an Information Pack to Improve Relative’', Friend’' and Carer’' Satisfaction With the Admission Process in an Older Adult Inpatient Service: A Quality Improvement Project

AimsWe performed a Quality Improvement Project in an inpatient Old Age Adult ward to increase patients’ relatives, friends and carers’ (RFCs’) knowledge about important aspects of hospital admission, through the provision of an information pack. By increasing this knowledge, we aimed to improve RFC satisfaction surrounding the admission process. Previously published evidence has shown that increasing the perception of involvement of RFCs in a patient's admission promotes greater satisfaction within this group. Adequate information provision is regarded as an important part of promoting perceived involvement; conversely, a lack of information provision and communication has been associated with dissatisfaction with hospital admissions among RFCs.MethodsUsing a survey directed towards members (n=9) of the ward MDT, we identified several topics relating to hospital admission that were regarded as high priority for inclusion in an information pack. MDT members were also asked about their perception of RFC satisfaction in the admission process. RFCs (n=8) were asked how well-informed they felt about these topics with a separate survey, and their level of satisfaction with the admission process. An information pack was created based on the results of these surveys and distributed to RFCs. The RFC survey was then repeated to assess improvements in RFC knowledge and satisfaction.ResultsPerceived RFC satisfaction among staff members prior to the publication of the information pack was lower than actual RFC satisfaction. RFC satisfaction with and knowledge about the admission process increased following the distribution of the care pack.ConclusionAdmission information packs can be used on inpatient old age wards to improve patient family, friend and carer knowledge and satisfaction.

Co-producing a physical activity intervention in two forensic psychiatry settings in the UK: The IMPACT study

IntroductionIn the UK there are 3500 individuals detained in medium secure forensic psychiatry units. Service users in such settings have complex and serious mental illness (SMI), often with co-morbid physical health problems and a life expectancy of at least 10 years shorter than the general population. They often have low levels of physical activity. There is little evidence about physical activity interventions for medium secure service users in the United Kingdom.ObjectivesOur objective is to co-produce, with medium secure service users, the content and delivery of an intervention to increase physical activity. We shall assess feasibility, acceptability and pilot data collection methods for outcomes relevant for a future randomised controlled trial.MethodsThis is a 24-month mixed-methods project that will follow the Medical Research Council (MRC) framework Developing and Evaluating Complex Interventions. The study has 4 phases.- Phases 1-2 will gather information required to co-develop an evidence based intervention in Phase 3.- Phase 4 will assess the intervention in a feasibility study, evaluating and testing the intervention for a future pilot study.Study settings: Two NHS Medium Secure In-Patient Psychiatric Hospitals in the UK.ResultsThis paper presents the findings from the Phase 1 questionnaire and focus groups with service users and hospital staff that identified the barriers and facilitators to physical activity in such settings. The results are then discussed in relation to the Phase 2 qualitative results that explored stakeholders’ and service users’ opinions into how to increase physical activity among medium secure service users by identifying potential elements for inclusion in a physical activity intervention, to gain insight into how we can establish engagement of this group with the intervention, maintain commitment, avoid drop-out and develop the intervention design. All findings are presented using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model), which is widely used to identify what needs to change for a behaviour change intervention to be effective.ConclusionsThe findings of Phases 1-2 are allowing the team to move forward with Phase 3 that is currently developing an intervention to increase physical activity for adult inpatient service users in the medium secure units. This phase will be guided by the MRC framework and the COM-B model to define the target behaviours and select the most suitable intervention components (functions and techniques) and implementation approach.Disclosure of InterestNone Declared

Documentation quality of patient-directed discharge and early warning interactions in an adult inpatient service.

Documentation quality of patient-physician discussion, assessment, and intervention at the time of patient directed discharges (elopement and 'against medical advice' discharges) is found to be poor in available studies, and importantly, may be a proxy for quality of care delivered. Less is known about the patient-physician interactions and documentation at the time a patient vocalizes the desire to leave early ('early warning interaction') prior to a patient directed discharge. This was a cohort study comprising a retrospective chart review of patients leaving 'against medical advice' from an inpatient internal medicine - infectious disease service at a tertiary medical center from 07/01/2020 to 09/24/2021. Documentation quality was assessed using 11 extractable factors detailing patient-physician conversation elements from the AIMED framework, plus related interventions pertinent to patient safety and care optimization. Descriptive statistics were mainly utilized with inferential statistics and regression models as appropriate. 52 patients left against medical advice and 49 eloped; 11% had an early warning interaction. Aggregate documentation quality scores at early warning interaction (13%), 'against medical advice' discharge (42%), and at elopement (31%) were low. Half of suggested documentation elements were recorded in no patients. Documentation quality overall was poor, suggesting the need for further training and interventions to facilitate more thorough documentation.

Improving family engagement in an adult inpatient mental health service using an action research framework

AbstractFamily involvement in mental health treatment has been shown to improve outcomes for service users. This project used a whole system‐focused action research framework and involved service users, family members and healthcare professionals to develop ways to improve family engagement in an adult inpatient mental health service. Focus groups were conducted with two service users, two family members and four healthcare professionals to discuss their experiences of family involvement and develop initial ideas. A problem‐solving group, involving service users, family members and professionals, was used to develop the solutions. The project identified context‐specific solutions to improve family engagement, which included specific training for professionals working on the inpatient wards, questionnaires to facilitate conversations with families, and sharing information about mental health and the inpatient mental health service with families. These may be helpful for other adult inpatient services.

Can inpatient pharmacists move the needle on smoking cessation? Evaluating reach and representativeness of a pharmacist-led opt-out smoking cessation intervention protocol for hospital settings.

Hospitalization affords an opportunity to reduce smoking, but fewer than half of patients who smoke receive evidence-based cessation treatment during inpatient stays. This study evaluated a pharmacist-led, electronic health record (EHR)-facilitated opt-out smoking cessation intervention designed to address this need. Analyses of EHR records for adult patients who smoked in the past 30 days admitted to an academic medical center in the upper Midwest were conducted using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. The reach of a pharmacist-led, EHR-facilitated protocol for smoking cessation treatment was assessed by comparing patients' receipt of nicotine replacement therapy (NRT) and tobacco quitline referral before and after implementation. χ2 tests, t tests, and multiple logistic regression models were used to compare reach across patient demographic groups to assess treatment disparities and the representativeness of reach. Adoption of the program by hospital services was also assessed. Of the 70 hospital services invited to implement the program, 88.6% adopted it and 78.6% had eligible admissions. Treatment reach increased as rates of delivering NRT rose from 43.6% of eligible patients before implementation to 50.4% after implementation (P < 0.0001) and quitline referral rates rose from 0.9% to 11.9% (P < 0.0001). Representativeness of reach by sex and ethnicity improved after implementation, although disparities by race and age persisted after adjustment for demographics, insurance, and primary diagnosis. Pharmacists addressed tobacco use for eligible patients in 62.5% of cases after protocol implementation. Smoking cessation treatment reach and representativeness of reach improved after implementation of a proactive, pharmacist-led, EHR-facilitated opt-out smoking cessation treatment protocol in adult inpatient services.

Mapping transitional care pathways among young people discharged from adolescent forensic medium secure units in England.

This study tracked young offenders transitioning from national adolescent forensic medium secure units to adult services in the UK within a six-month period. We used a mapping exercise to identify eligible participants moving during the study period from all national adolescent forensic medium secure units in England. Young people older than 17.5 years or those who had turned 18 years (transition boundary) and had been referred to adult and community services were included. Of the 34 patients identified, 53% moved to forensic adult inpatient services. Psychosis was the most prevalent symptom among males (29%), and emerging personality disorder symptomatology was commonly reported among females (18%) followed by learning disability (24%). The mean time for transition to adult mental-health services and community settings was eight months. There were no shared transition or discharge policies, and only two hospitals had discharge guidelines. The findings highlight the need for consistency between policy and practice among services along with the development of individualised care pathways. Future qualitative research is needed to understand and reflect on young people’s and carers’ experiences to improve transition service delivery.

#EndPJParalysis; what is our baseline in acute adult in-patient services?

#EndPJParalysis; what is our baseline in acute adult in-patient services?

Mentorship Called Key to Bringing Diversity to Psychiatric Workforce

Mentorship Called Key to Bringing Diversity to Psychiatric Workforce

Outpatient workload in the NHS: A new challenge for the burn services?

The aim of this study was to evaluate the impact of outpatient care on activities at the Adults’ Regional Burns Centre and the Children's Regional Burns Unit, Mid Yorkshire Hospitals NHS Trust UK, where outpatient and inpatient responsibilities are shared between the nursing staff.Data for all inpatient and outpatient interactions (all care related activities with the presence of a Registered Nurse (RN)) was collected prospectively by the attending RN for two consecutive months (October and November 2014). We also retrospectively collected data related to daily RN staffing levels, and Centre/Unit admissions and discharges. We compared our results with the staffing standard recommended by the National Burn Care Review 2001 and the National Burn Care Standards 2013.In the two months analysed we recorded a total number of 1232 interactions: 240 for the adult inpatient service, 385 for the adult outpatient service, 155 for the paediatric inpatient service, 452 for the paediatric outpatient service.Considering this burden and collating it with daily RN staffing levels, we highlighted an understaffing in 42.6% (26/61) of the days for the Adult Regional Burn Centre and in 100% (61/61) of the days and nights for the Children Regional Burn Unit.The impact of outpatients on the activities of a Burns Centre/Unit is a factor that should be taken into account when evaluating staffing needs and planning services. This is a variable not currently considered in any guideline for safe staffing.

Fatores relacionados ao absenteísmo por doença entre trabalhadores de Enfermagem

ObjetivoAvaliar a associação do absenteísmo por doença com o perfil sociodemográfico e relacioná-lo ao trabalho dos profissionais de Enfermagem.MétodosEstudo descritivo exploratório, que analisou atestados médicos de até 15 dias de afastamento do trabalho apresentados por 994 profissionais de enfermagem de um hospital universitário. A fonte de dados foi o sistema de frequência da instituição.ResultadosA maioria dos trabalhadores era do sexo feminino, casada e técnica de Enfermagem. A idade média foi de 41,9 anos e um terço atuava no serviço de internação de adultos. Dos 994 profissionais, 645 apresentaram pelo menos um dia de atestado médico.ConclusãoO absenteísmo por doença teve fatores complexos e multifatoriais. Os fatores associados a ele foram: grupo etário, escolaridade, função, turno de trabalho, tempo na instituição e local de trabalho.

Sleeping at Home: A New Model for a Hospital Teaching Service

The traditional marriage between teaching hospitals and residents pivots on a central prenuptial agreement: residents offer their hospitals round-the-clock patient care, and, in exchange, hospitals provide an experiential learning modality. This long-held covenant may require an update due to 3 significant changes: the increased spotlight on protecting resident education from excessive service demands; the development of hospital medicine as a specialty; and the need to provide more experiential learning in ambulatory care settings for primary care programs, including family medicine. The rapid growth of hospitalist care—84% of all teaching hospitals in the United States have at least 3 hospitalists1—has been sparked in part by pressure placed on primary care doctors to increase outpatient visits and on hospitals to reduce length of stay.2 The desire to have better work/life balance coupled with fewer inpatient admissions and increased financial demands have resulted in a decline in family medicine physicians who provide both inpatient and outpatient care. Many hospitals are moving to hospitalist care, citing improved care and decreased cost.,3,4 In 2006, the year before we implemented our new model of inpatient teaching, 62.5% of our program's new graduates entered into practice without an inpatient component. We describe a unique adult inpatient teaching service in a family medicine residency program that integrates resident teaching with hospitalist care. The novelty stems from the use of hospitalists, not residents, as the primary workforce in the hospital. By uncoupling the educational experience of teaching residents how to care for hospitalized patients from the service demands of the hospital, it is possible to achieve both of these goals and comply with duty hour limits. The added advantage of our system is that residents are able to spend more time in the outpatient setting. This gain in ambulatory training aligns with most of our residents' postgraduation plans to work as primary care physicians in the outpatient setting.

Reducing the Use of Seclusion and Restraint in Psychiatric Emergency and Adult Inpatient Services— Improving Patient-Centered Care

The reduction of seclusion and restraint (S/R) use has been given national priority by the US government, The Joint Commission, and patient advocacy groups. It is associated with high rates of patient and staff injuries and is a coercive and potentially traumatizing intervention. The New York City Health and Hospitals Corporation (HHC) is the largest municipal health care system in the country, with 11 HHC facilities operating psychiatric emergency services and inpatient psychiatric services. HHC operates 1117 adult inpatient psychiatric beds with an average length of stay of 22.2 days that generated over 19,000 discharges in 2009. In 2009, there were over 36,000 psychiatric emergency services visits. HHC's Office of Behavioral Health provides strategic leadership, planning, and support for the operations and quality objectives of these services. In January 2007, the corporate office initiated the Seclusion and Restraint Reduction Initiative, with a sequenced, intensive series of interventions and strategies to help focus the behavioral health leadership and staff on the need for continued culture change toward a more patient-centered and safe system of psychiatric emergency and adult inpatient care. From 2007 to 2009, there was a substantial decline in HHC's overall rate of S/R incidents in inpatient units. The more substantial impact was in the reduced overall time spent in S/R; the reduced frequency of use of S/R; and the reduced likelihood of patient injury from S/R use.

P02-183 - Impact of a new approach “acute care model” on detained patients in adult psychiatry wards in England

IntroductionAcute Care Model introduced in 2006 in UK has revolutionised the way Adult inpatient services are provided. Here, we look at the impact of this model on detained patients, which might serve as a service evaluation tool.ObjectivesOur objective is to study the effect of the acute care model on the application of the 1983 Mental Health Act (MHA) in Adult Psychiatry Wards at Clatterbridge Hospital, England.AimsOur aim is to measure any difference in the number and duration of detentions, use of tribunal hearings after the inception of this new model.MethodData on Section 2 (for assessment) and Section 3 (for treatment) were collected retrospectively from the Register at the hospital MHA Office. As the Acute Care Model was implemented on 6th June 2007, the data were collected from 6th March 2006 to 5th Oct 2008. From these data, the number and duration of stay of detained patients were calculated.ResultsThe number of people who were detained in hospital before and after the introduction of acute care did not change (n=122). However, the average duration of detention under Section 3 reduced significantly from 81.44 days to 46.25 days (43.21% reduction). There had also been a 55% decrease in the utilisation of tribunal hearings after the new model (45 tribunals before vs 18 tribunals after).ConclusionThe Acute Care Model in Adult Psychiatry seems to have had a significant positive impact on detained patients in reducing their in-patient stay and the need for tribunal hearings.

With a Woman's Voice: A Writer's Struggle for Emotional Freedom

Back to table of contents Previous article Next article Book ReviewsFull AccessWith a Woman's Voice: A Writer's Struggle for Emotional FreedomEllen B. Tabor M.D.Ellen B. Tabor M.D.Search for more papers by this authorPublished Online:1 May 2006https://doi.org/10.1176/ps.2006.57.5.734AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail If the unexamined life is not worth living, what, then, about the overexamined life? The life that Lucy Daniels heaps upon the page in With a Woman's Voice is examined as closely as an anorexic might measure her food. No detail is too insignificant to be retold, and no event took place that the author does not use to hammer home her point. Her childhood, privileged on the outside, is barren, abusive, and traumatic on the inside, the secret place that only she knows. As she force feeds the reader the minutia of her thoughts, this reader pushed away the overloaded plate of words and said, "Enough!" Lucy Daniels describes her mother as cold, more concerned with appearances than with love, and fearful of her daughter, a rival for the attention of her father, who is a boisterous, sexual, and menacing man. She describes herself as the victim of their insufficient efforts to nurture or destroy her. So she acts out their emotional starvation and sexual intrusiveness by becoming anorexic. And she repays them by stuffing her readers to the point of bursting. The author's language is redolent with sexuality and heavy-curtained secrecy, in the fashion of many Southern authors, yet her writing lacks art and, for this reader, sympathy.The title of the book would be better stated "With a Child's Voice," because Dr. Daniels continues to be the bitter, hungry, and frightened child who is seemingly unchanged despite years of psychotherapy, psychoanalysis, and her professional development as a psychologist. She maintains this tone until the coda of the book, which comes after more than 300 pages of anger and pain. Most of this book is tiresome, whiny, and utterly lacking in evidence of working through the author's issues. This woman is angry, furious, and enraged and insists that the reader share her worldview. Eventually, the author finds an analyst who can bear her pain and understand her traumas and yearnings, and through psychoanalysis she manages to restore herself to a life of writing, of hope, and even, it seems, of joy.At some point, a psychotherapist must request that the patient take the insights gained from therapy and put them to work in her life; insight alone is an insufficient goal of psychotherapy. Yet until the very last few pages, Dr. Daniels does not demonstrate any appearance of growth as a human being. Forgiving her parents may be too much to ask of a person who feels so injured, but why not understanding that leads to rapprochement? All I hear from this author is "I survived!" In fact, the first sentence of the coda chapter is "I still exist."The author courageously shares her dreams and other content from her analytic hours. She shares experiences, events, thoughts, and the most painful fantasies. Somehow the author's rage prevents much empathy from developing until the end. Yet Dr. Daniels, as she states herself, has remained demanding: "my man would have to be pretty remarkable to fit with the standards I've internalized from Dr. Howie [the analyst]." She does not realize that her standards also limit her relationships with her children and grandchildren. She seems gratified to note that "needs can be roots of power." What she does not seem to have learned is that to get along with others one must sometimes sublimate one's needs for theirs. Hers is a sad story indeed, and one that, for all her success, remains sad today.With a Woman's Voice is not a pleasant book, and it is not a good book. I cannot recommend it for any reader. Curiously, the book was printed in Iceland. Dr. Daniels seems to have inhabited a land of ice herself, and she resists thawing. Dr. Tabor is medical director of the adult inpatient service at Kings County Hospital Center in Brooklyn, New York, and assistant professor of psychiatry at the State University of New York Downstate Medical Center. FiguresReferencesCited byDetailsCited byNone Volume 57Issue 5 May, 2006Pages 734-735PSYCHIATRIC SERVICES May 2006 Volume 57 Number 5 Metrics PDF download History Published online 1 May 2006 Published in print 1 May 2006

I, Wabenzi

Back to table of contents Previous article Next article Book ReviewsFull AccessI, WabenziEllen B. Tabor M.D.Ellen B. Tabor M.D.Search for more papers by this authorPublished Online:1 May 2006https://doi.org/10.1176/ps.2006.57.5.735aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The memoir I, Wabenzi takes the reader on a wild ride. Its author, Rafi Zabor, née Joel Zaborowsky, takes us from Brooklyn to Woodstock, Turkey, England, Israel, Germany, California—and these travels do not begin to approach the travels the author has taken in his mind. The author, a nice Jewish boy from Brooklyn, reinvents himself through seeking and finding charismatic teachers from the Sufi branch of Islam, and by telling his tales he weaves threads into a complex and colorful tapestry. There are flights from family, reality, and perhaps sanity. Zabor can clang with the best of manics and invent words as pithy as any neologism. Is he crazy? Who cares? He escorts—nay, kidnaps—the reader for one wild magic carpet ride. Not long into the book, the reader becomes a willing accomplice, enjoying the contact high. The book is in essence a bildungsroman, the story of a young man's struggle to define himself. His mother is mentally ill, and one might say abusive—although the author would disagree. Yet his attachments to family, to Brooklyn, and to heritage never break, and he even refers to himself as the "too symbiotic son." He manages to integrate all that into his struggles and journeys and even finds that a member of the commune he visits in England is the brother of an old girlfriend, himself also much transformed. One of Zabor's struggles is with writer's block, and this rather weighty book is evidence that he has overcome it. The book reminded me of John Fowles' The Magus ( 1 ), in which the protagonist also takes a journey in which he learns the meaning of Eliot's ( 2 ) lines "And the end of all our exploringWill be to arrive where we startedAnd know the place for the first time." This excerpt could be the summary comment for I, Wabenzi as well. Zabor never rejects his past, exactly, nor does he return exactly to where he started. Instead, he manages to integrate his memories, traumas and experiences into a new whole: son, friend, author, mystic, Sufi, Jew, observer, participant. What is a Wabenzi, by the way? It's simply a person who owns a Mercedes, conjugated from the African. For more, read on.Dr. Tabor is medical director of the adult inpatient service at Kings County Hospital Center in Brooklyn, New York, and assistant professor of psychiatry at the State University of New York Downstate Medical Center.

I, Wabenziby Rafi Zabor; New York, Farrar, Straus, and Giroux, 2005, 472 pages, $26

Back to table of contents Previous article Next article Book ReviewsFull AccessI, WabenziEllen B. Tabor M.D.Ellen B. Tabor M.D.Search for more papers by this authorPublished Online:1 May 2006https://doi.org/10.1176/ps.2006.57.5.735aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The memoir I, Wabenzi takes the reader on a wild ride. Its author, Rafi Zabor, née Joel Zaborowsky, takes us from Brooklyn to Woodstock, Turkey, England, Israel, Germany, California—and these travels do not begin to approach the travels the author has taken in his mind. The author, a nice Jewish boy from Brooklyn, reinvents himself through seeking and finding charismatic teachers from the Sufi branch of Islam, and by telling his tales he weaves threads into a complex and colorful tapestry. There are flights from family, reality, and perhaps sanity. Zabor can clang with the best of manics and invent words as pithy as any neologism. Is he crazy? Who cares? He escorts—nay, kidnaps—the reader for one wild magic carpet ride. Not long into the book, the reader becomes a willing accomplice, enjoying the contact high. The book is in essence a bildungsroman, the story of a young man's struggle to define himself. His mother is mentally ill, and one might say abusive—although the author would disagree. Yet his attachments to family, to Brooklyn, and to heritage never break, and he even refers to himself as the "too symbiotic son." He manages to integrate all that into his struggles and journeys and even finds that a member of the commune he visits in England is the brother of an old girlfriend, himself also much transformed. One of Zabor's struggles is with writer's block, and this rather weighty book is evidence that he has overcome it. The book reminded me of John Fowles' The Magus ( 1 ), in which the protagonist also takes a journey in which he learns the meaning of Eliot's ( 2 ) lines "And the end of all our exploringWill be to arrive where we startedAnd know the place for the first time." This excerpt could be the summary comment for I, Wabenzi as well. Zabor never rejects his past, exactly, nor does he return exactly to where he started. Instead, he manages to integrate his memories, traumas and experiences into a new whole: son, friend, author, mystic, Sufi, Jew, observer, participant. What is a Wabenzi, by the way? It's simply a person who owns a Mercedes, conjugated from the African. For more, read on.Dr. Tabor is medical director of the adult inpatient service at Kings County Hospital Center in Brooklyn, New York, and assistant professor of psychiatry at the State University of New York Downstate Medical Center.

Residency Program Combines Child, General Psychiatry

Residency Program Combines Child, General Psychiatry