The Safewards Model and Its Originating Domains
Discuss about the Evidence Based Nursing Research Mental Health Services.
Conflict and containment are the two events that occur in the mental health services and are the important matters in the nursing practice and hospital management. The self-harm, aggression, absconding, medication refusal and alcohol or substance abuse are the conflicts and containments are the coerced intramuscular medication, required medication, annual restraint, seclusion and special observation. These two events of conflict and containment increases the rate of self-harm, violence and absconding that threatens the patients and the medical staffs in the mental hospital wards. To avoid these events, The Safewards Model provide a powerful and simple way to make changes and provide safety to the patients and staffs in the mental hospital wards (Bowers 2014). It reduces the conflict and a safe, clinical model that is under trail in several mental health services in Victoria, Australia. It addresses the causes of the behavior that occur in the mental health settings that give rise to situations and flashpoints where conflicts could occur. Therefore, the following essay deals with the research background, significance of the research, research questions and sub-questions.
In mental health units, violent incidents occur that cause serious harms to the patients and staffs and in many cases, there are suicidal events and absconding. The use of coercion and force that are related to containment raises the staff ambivalence, results in unintended injury to the patients, and affects the patient-staff relationships (Bowers et al. 2015). The events like self-harm, aggression and absconding can be grouped as conflict and for the management of these events; containment is used like seclusion, required medication or manual restraint. This Safewards model is an attempt to fill this gap where the restrictive practices could be reduced and reduction in conflict events. This research is important as to study the Safewards model implementation and effectiveness in the mental health units.
This model has six originating domains that influence the rates of conflict and containment in the mental health units. The patient characteristics, patient community, staff team, regulatory framework, the physical environment, and the outside the hospital are the domains (Parish 2016). These domains give rise to events of flashpoints trigger the containment or conflict. This model provides description of the patient and medical staff modifiers that influence the origin of these domains, capacity to give rise to the flashpoints and the connection between the conflict with containment and flashpoints. This model is primarily applied to the acute mental health units that provide limited time care in admissions and severely and acutely mentally ill people in the community.
Reduction of Conflict and Containment through Safewards Model
The Safewards model in its simple form illustrates the influencing factors for the rate of conflict and containment events that occur in the mental health units and difference in the number of these events than others (Paton et al. 2016). The originating domains are the physical and social locations that separate the mental health patients from the normal residences to mental health care for 24/7 on a basis of legal coercion and mixed voluntary to a degree that can influence the containment and conflict. The staff modifiers are the staff features that work as teams and individuals where the staffs act in the management of the patients and the physical environment. It also encompasses initiates or responses with the patients that influence the conflict or containment frequency. Patient modifiers are the ways in which the patients behave with each other that have an influence on the frequency of the containment or conflict and the susceptibility of the staffs influence. The psychological and social situations arise in different domains, preceding imminent, signaling and conflict behaviors called flashpoints. The patient behaviors that threaten and harm the patients along with the medical staffs like suicide, absconding or violence or aggression is called conflict. The last domain is the containment that includes the activities that the mental health units staffs do to prevent the conflict from occurring or minimize the violent situations like special observation, required medication or seclusion.
The above domains explained by the model indicates that the originating conflicting factors give rise to flashpoints that trigger conflicts that results in containment. This model also gives an indication that there is a dynamic relationship between the conflict and containment (Mustafa 2015). It is reciprocal in nature where containment use can give rise to conflict events instead of preventing it. The staffs are the ones who can influence the conflict rates and containment in the acute mental health units at every level. The reduction or eradication of the factors that originate conflict, prevention of flashpoints and cutting of the link between conflict and flashpoint can help to reduce the conflict events in the ward. When the patient modifiers are influenced where the staffs do not use containment, it ensures that containment does not lead to conflict events.
The above background study of the research shows that the Safewards model helps in reducing the events of conflict and containment. This aids in developing better relationships between the patients and staffs who are able to provide active patient support and manage them. The staff modifiers in the Safewards model domain are related to the acquiring and development of healthy relationship between the patients and staffs (Cox, Campbell and Dalton 2016). There is development of active patient support by the staffs that help in managing and regulating the conflict events. It also offers the opportunities for modifications that would lead to the conflict behavior in the mental wards. This domain also explains that the staff presence and good relationships with the patients helps to develop interventions at the earlier stages when the potential arguments and diplomatic negotiation that can avert irritations resulting into aggressive behavior. The background also poses a way for the evaluation of the model as a multimodal intervention so that it would be implemented in the acute mental health units to reduce the events of conflict and containment (Bowers 2013).
Significance of the Model: Patient-Patient Interactions, Staff Capacity, Patient Safety
The significance of this model study and research helps to bring many considerations to the forefront. Firstly, there are patient-patient interactions which are seriously considered and the included explanations for the conflict and containment events. The patient symptoms and characteristics are widely used as the basis for the conflict events and containment. However, the Safewards model is beneficial as it identifies the safe and effective treatments strategies and also identifies the responses of the staffs to the patient characteristics. This has the significant impact on the staffs’ capacity to the events of conflict and containment. It incorporates the influence on the wards and the patients’ behavior and physical environment that provides recommendations of quality improvement and patient-staff relationship and patient safety (Price et al. 2016).
There are many significance and contributions of this model for the reduction of conflict and containment. The obvious significance of this model is that it brings about a change in the psychological understanding, emotional regulation and moral commitments. There is also teamwork skill, technical mastery, effective ward structure and building of positive appreciation that reduces the events of conflict and containment (Ryan 2016). There is positive projection of these values that would also be helpful in instructing other staff members to edge towards change and review care for the patients. This approach also identifies the flashpoints that are the social locations that would trigger the events for the conflict and enhance the patient-staffs relationships through the establishment, re-affirming, demonstration and instantiation of the ward structure. There is a connection between the containment and structure that is greatly mediated by aggression and violent behavior.
The denial of the patients’ requests or limiting of the setting leads to containment. However, is a frustrated, belittled or confused patient who responds with anger is met with irritation or anxiety by the staffs can result in use of containment in the eventful events. The cutting of this cycle by the understanding of the model can result in the reduction of the events of conflict and containment (Cockerton, O’Brien and Oates 2015). The physical environment of the hospital including the resources, managers and organization also plays an important role in the events of conflict and containment. The environment quality is also an important factor that contributes to the events of self-harm, aggression or absconding events. The staff modifiers in the model study can modify the environment that interacts with the patient behavior. The physical environment that comprises the external factors in the Safewards model also triggers the threatening events in the hospital wards. The inpatient care emphasizes on the thinking, attention and action of the patient that also influences the behavior in the ward.
Contributions and Positive Impact of Safewards Model
The Safewards model’s objective is to create better relationships between the patients and staffs. This would reduce the conflict and the use of containment. This model greatly welcomes and proposes that the conflict within an acute mental health ward arises when the patient is faced with situations when their emotional distress is increased or gives rise to flashpoints (Tuck 2017). This model focuses on the staff actions and what they can do before a situation reaches a flashpoint. This would greatly trigger potential situations for conflict and containment. This model also acts as a guide for the mental health unit staffs to develop the best method to reduce the conflict or the best containment method for the conflict situation. This model provides a collaborative approach to work with the patients in reducing the conflict and containment and make the units a peaceful and therapeutic place.
The research question is the is the Safewards model and its implementation in the acute mental health units can help to create better relationships between the patient and staffs that promotes recovery. This question can be explored in a way that when the events of conflict and containment are reduced, it would help to promote better understanding between the patients and staffs that result in the better recovery of the patients in the acute mental health units. The subquestions associated with the implementation of this model are whether the model is capable of explaining the relationship between the conflict and containment events. Another question arises whether the model is able to identify the opportunities for the interventions. The question also arises that whether this model also generates the ideas that require change for the potential reduction of the conflict and containment in the acute mental health units. The Safewards model is an approach that categorizes the risk scenarios or behaviors and pairs that with the appropriate mechanism like de-escalation, isolation or containment (Riding and Riding 2016). This model attempts to work beyond the mechanisms that are traditional like outburst and instead, formulate a set of responses for the reduction of these behaviors.
The research questions are the evaluation of the effectiveness of the implementation of the Safewards model in the mental health wards. The question also arises that is the Safewards model is specific to the inpatients and requires a heavy amount of resources. This might act as weakness and barrier in the implementation of the Safewards model in the acute mental health units. Another question arises that will the mental health unit staffs are willing to change their attitude or behavior towards the implementation of this model. This working model greatly explains to fill the gap between the risks for coercion and promote a safe, working environment in the mental health units that promotes recovery of the mental health patients (Bowers et al. 2014). The model also acknowledges the addressing of the conflict that occurs in the mental health units by the medical staffs before the triggering of the flashpoints or conflict events.
The effectiveness of the Safewards model is under trail in Victoria in collaboration with the Victorian Department of Health. The Centre for the Psychiatric Nursing is also trailing for the implementation of the Safewards model in the mental health units. The Safewards Model provides a powerful and simple way to make changes and provide safety to the patients and staffs in the mental hospital wards. This Safewards model is an attempt to fill this gap where the restrictive practices could be reduced and reduction in conflict events. The staff modifiers in the model study can modify the environment that interacts with the patient behavior. This modification is important in establishing the healthy relationship between the patients and staffs that would promote their recovery.
Bowers, L., 2013. The safewards model and cluster RCT. International Journal of Mental Health Nursing, 22, p.1.
Bowers, L., 2014. Safewards: a new model of conflict and containment on psychiatric wards. Journal of psychiatric and mental health nursing, 21(6), pp.499-508.
Bowers, L., Alexander, J., Bilgin, H., Botha, M., Dack, C., James, K., Jarrett, M., Jeffery, D., Nijman, H., Owiti, J.A. and Papadopoulos, C., 2014. Safewards: the empirical basis of the model and a critical appraisal. Journal of psychiatric and mental health nursing, 21(4), pp.354-364.
Bowers, L., James, K., Quirk, A., Simpson, A., Stewart, D. and Hodsoll, J., 2015. Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial. International journal of nursing studies, 52(9), pp.1412-1422.
Cockerton, R., O’Brien, A. and Oates, J., 2015. Implementing positive and proactive care: Rachel Cockerton and colleagues describe how a mental health trust is empowering patients by reducing the use of restrictive practices on acute psychiatric wards. Mental Health Practice, 19(4), pp.36-39.
Cox, L., Campbell, C. and Dalton, J., 2016. Teaching the safewards model in a bachelor of nursing program. Australian Nursing and Midwifery Journal, 23(11), p.49.
Mustafa, F.A., 2015. The Safewards study lacks rigour despite its randomised design. International journal of nursing studies, 52(12), pp.1906-1907.
Parish, C., 2016. Len Bowers: the man behind the Safewards model: The professor of nursing, whose approach to care has found worldwide popularity, talks to Colin Parish about his experiences along a career path he could not have predicted. Mental Health Practice, 19(5), pp.37-40.
Paton, F., Wright, K., Ayre, N., Dare, C., Johnson, S., Lloyd-Evans, B., Simpson, A., Webber, M. and Meader, N., 2016. Improving outcomes for people in mental health crisis: a rapid synthesis of the evidence for available models of care. Health Technologyl Assessment, 20(3).
Price, O., Burbery, P., Leonard, S.J. and Doyle, M., 2016. Evaluation of safewards in forensic mental health: Analysis of a multicomponent intervention intended to reduce levels of conflict and containment in inpatient mental health settings. Mental Health Practice, 19(8), pp.14-21.
Riding, T. and Riding, T., 2016. Exorcising restraint: reducing the use of restrictive interventions in a secure learning disability service. Journal of Intellectual Disabilities and Offending Behaviour, 7(4), pp.176-185.
Ryan, K., 2016. Integrated care is every nurse's business. Australian Nursing and Midwifery Journal, 23(11), p.49.
Tuck, J.A., 2017. A new approach to team clinical supervision on an acute admissions unit. Mental Health Practice, 20(5), pp.24-27.
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