Tessa Maguire Rachel Gwyther Lisa Spong Conflict Containment M odels working definition of conflict and containment Events that threaten staff or patient safety including verbal abuse physical aggression to others self harm ID: 775562
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Safewards aVictorian perspectiveTessa MaguireRachel Gwyther Lisa Spong
Slide2Conflict
Containment
Model’s working definition of conflict and containment
Events that threaten staff or patient safety, including verbal abuse, physical aggression to others, self- harm,
suicide and absconding
Things staff do in order to prevent events from occurring or
minimising
the harmful
outcomes, including
the use of extra sedating medication, special observation,
restraint and seclusion
Slide3Key Aims of the Safewards Model
1. Explain the relationship between conflict and containment
2. Identify opportunities where nurses can intervene
3. Generate ideas for change that have the potential to reduce conflict and containment
“Positive and proactive care: Reducing the need for restrictive interventions”
Slide4Safewards identifies six areas or domains which can influence or trigger conflict
6. Outside Hospital
Flashpoint
5. Physical Environment
4. Staff Team
3. Regulatory Framework
2. Patient Characteristics
1. The Patient Community
Flashpoint Definition
Social and psychological situations arising out of features of the originating domains, signaling and preceding imminent conflict behaviours
Domains
Slide5PHYSICAL ENVIRONMENT
OUTSIDE HOSPITAL
PATIENT COMMUNITY
PATIENT CHARACTERISTICS
REGULATORY FRAMEWORK
STAFF TEAM
Patient-patient interaction
Contagion & discord
Internal Structure
Rules; Routine; Efficiency; Clean/tidy;
Ideology; Custom & practice
Features
Door locked; Quality; Complexity; seclusion;
PICU; ICA; comfort/sensoryrooms; ligature points
Symptoms& demography
Paranoia, PD traits; Irritability/disinhib; Abused; male;
Alc/drugs; Depression; insight; delusions; hall.s; young
Stressors
Visitors; Relatives & family tensions; Prospective –ve move
Dependency & Institutionalisation; Demands & home
External structure
Legal framework; National policy; Complaints;
Appeals; Prosecutions; Hospital policy
Staff modifiers
Staff anxiety & frustration; Moral commitments;
Psychological understanding; Teamwork & consistency; Technical mastery; Positiveappreciation
Staff modifiersExplanation/information; Role modelling;Patient education; Removal of means;Presence & presence+
Staff modifiersCaringly vigilant & inquisitive; Checking routines, Décor, Maintenance; Clean & tidy; Alternative choices; Respect
Staff modifiersCarer/relative involvementFamily therapyActive patient support
Staff modifiersPharmacotherapyPsychotherapy & functional analysis;Nursing support & intervention
Patient modifiersAnxiety management; Mutual support; Moral commitments; Psychological understanding; Technical mastery;
FlashpointsDenial of request; Staffdemand; Limit settingBad news;ignoring
FlashpointsAssembly/crowding/activityQueuing/waiting/noiseStaff/pt turnover/changeBullying/stealing/prop. damage
FlashpointsSecrecy; Solitude; Admission shock;Exit blocked
FlashpointsExacerbations;Independence/identityAcuity/severity
FlashpointsCompulsory detention;Admission; Appeal refusal; Complaint denied;Enforced treatment; Exit refused
FlashpointsBad news; Home crisis; Loss of relationship oraccommodation; Argument
CONFLICT
CONTAINMENT
&
Staff modifiers
Due process; Justice; Respect for rights; Hope;
Information giving; Support to appeal;Legitimacy; Compensatory autonomy;Consistent policy; Flexibility; Respect
Slide6Victorian Safewards trial
RRI 12 month projectTrain the trainer model (theory/implementation)CustomisationEvaluation CoP Complexities
Slide7Safewards interventions
Are a set of specific prevention and intervention strategies, developed to correspond to diverse flashpoints identified in the model
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