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Safewards: a new model of conflict and containment on psychiatric wards
ACCESSIBLE SUMMARY: Rates of violence, self-harm, absconding and other incidents threatening patients and staff safety vary a great deal by hospital ward. Some wards have high rates, other low. The same goes for the actions of staff to prevent and contain such incidents, such as manual restraint, co...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BlackWell Publishing Ltd
2014
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237187/ https://www.ncbi.nlm.nih.gov/pubmed/24548312 http://dx.doi.org/10.1111/jpm.12129 |
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author | Bowers, L |
author_facet | Bowers, L |
author_sort | Bowers, L |
collection | PubMed |
description | ACCESSIBLE SUMMARY: Rates of violence, self-harm, absconding and other incidents threatening patients and staff safety vary a great deal by hospital ward. Some wards have high rates, other low. The same goes for the actions of staff to prevent and contain such incidents, such as manual restraint, coerced medication, etc. The Safewards Model provides a simple and yet powerful explanation as to why these differences in rates occur. Six features of the inpatient psychiatric system have the capacity to give rise to flashpoints from which adverse incidents may follow. The Safewards Model makes it easy to generate ideas for changes that will make psychiatric wards safer for patients and staff. ABSTRACT: Conflict (aggression, self-harm, suicide, absconding, substance/alcohol use and medication refusal) and containment (as required medication, coerced intramuscular medication, seclusion, manual restraint, special observation, etc.) place patients and staff at risk of serious harm. The frequency of these events varies between wards, but there are few explanations as to why this is so, and a coherent model is lacking. This paper proposes a comprehensive explanatory model of these differences, and sketches the implications on methods for reducing risk and coercion in inpatient wards. This Safewards Model depicts six domains of originating factors: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. These domains give risk to flashpoints, which have the capacity to trigger conflict and/or containment. Staff interventions can modify these processes by reducing the conflict-originating factors, preventing flashpoints from arising, cutting the link between flashpoint and conflict, choosing not to use containment, and ensuring that containment use does not lead to further conflict. We describe this model systematically and in detail, and show how this can be used to devise strategies for promoting the safety of patients and staff. |
format | Online Article Text |
id | pubmed-4237187 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BlackWell Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-42371872014-12-15 Safewards: a new model of conflict and containment on psychiatric wards Bowers, L J Psychiatr Ment Health Nurs Original Articles ACCESSIBLE SUMMARY: Rates of violence, self-harm, absconding and other incidents threatening patients and staff safety vary a great deal by hospital ward. Some wards have high rates, other low. The same goes for the actions of staff to prevent and contain such incidents, such as manual restraint, coerced medication, etc. The Safewards Model provides a simple and yet powerful explanation as to why these differences in rates occur. Six features of the inpatient psychiatric system have the capacity to give rise to flashpoints from which adverse incidents may follow. The Safewards Model makes it easy to generate ideas for changes that will make psychiatric wards safer for patients and staff. ABSTRACT: Conflict (aggression, self-harm, suicide, absconding, substance/alcohol use and medication refusal) and containment (as required medication, coerced intramuscular medication, seclusion, manual restraint, special observation, etc.) place patients and staff at risk of serious harm. The frequency of these events varies between wards, but there are few explanations as to why this is so, and a coherent model is lacking. This paper proposes a comprehensive explanatory model of these differences, and sketches the implications on methods for reducing risk and coercion in inpatient wards. This Safewards Model depicts six domains of originating factors: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. These domains give risk to flashpoints, which have the capacity to trigger conflict and/or containment. Staff interventions can modify these processes by reducing the conflict-originating factors, preventing flashpoints from arising, cutting the link between flashpoint and conflict, choosing not to use containment, and ensuring that containment use does not lead to further conflict. We describe this model systematically and in detail, and show how this can be used to devise strategies for promoting the safety of patients and staff. BlackWell Publishing Ltd 2014-08 2014-02-19 /pmc/articles/PMC4237187/ /pubmed/24548312 http://dx.doi.org/10.1111/jpm.12129 Text en © 2014 Crown copyright. This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland. |
spellingShingle | Original Articles Bowers, L Safewards: a new model of conflict and containment on psychiatric wards |
title | Safewards: a new model of conflict and containment on psychiatric wards |
title_full | Safewards: a new model of conflict and containment on psychiatric wards |
title_fullStr | Safewards: a new model of conflict and containment on psychiatric wards |
title_full_unstemmed | Safewards: a new model of conflict and containment on psychiatric wards |
title_short | Safewards: a new model of conflict and containment on psychiatric wards |
title_sort | safewards: a new model of conflict and containment on psychiatric wards |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237187/ https://www.ncbi.nlm.nih.gov/pubmed/24548312 http://dx.doi.org/10.1111/jpm.12129 |
work_keys_str_mv | AT bowersl safewardsanewmodelofconflictandcontainmentonpsychiatricwards |