Safewards Outside Hospital Patient Community Staff Team Patient Characteristics Regulatory Framework Physical Environment Patient patient interaction Contagion amp discord Patient Modifiers ID: 1030854
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1. Clear mutual expectations Refresher Safewards
2. Outside HospitalPatient CommunityStaff TeamPatient CharacteristicsRegulatory FrameworkPhysical EnvironmentPatient – patient interactionContagion & discordPatient ModifiersAnxiety management, Mutual support, Moral commitments, Psychological understanding, Technical masteryStaff ModifiersExplanation/information, Role modelling, Patient education, Removal of means, Presence & presence+FlashpointsAssembly/crowding/activity Queuing/waiting/noise Staff/pt turnover/change Bullying/stealing/prop. damageSymptoms & demographyParanoia, PD traits, Irritability/disinhib., Abused, Male, Alc/drugs, Depression, Insight, Delusions, Hall.s, YoungStaff ModifiersPharmacotherapyPsychotherapy & functional analysisNursing support & interventionsFlashpointsExacerbations;Independence/identityAcuity/severityFlashpointsBad news, Home crisis, Loss of relationship or accommodation, ArgumentStaff ModifiersCarer/relative involvementFamily therapyActive patient supportStressorsVisitors, Relatives & family tensions, Prospective –ve moveDependency & institutionalisation, Demands & homeFlashpointsCompulsory detention, Admission, Appeal refusal, Complaint denied, Enforced treatment, Exit refusedStaff ModifiersDue process, Justice, Respect for rights, Hope, Information giving, Support to appeal,Legitimacy, Compensatory autonomy,Consistent policy, Flexibility, RespectExternal StructureLegal framework, National policy, Complaints,Appeals, Prosecutions, Hospital policyInternal StructureRules, Routine, Efficiency, Clean/tidy, Ideology, Custom & practiceStaff ModifiersStaff anxiety & frustration, Moral commitments, Psychological understanding, Teamwork & consistency, Technical mastery, Positive appreciationFlashpointsDenial of request, Staff demand, Limit setting, Bad news,IgnoringFeaturesDoor locked, Quality, Complexity, Seclusion, PICU, ICA, Comfort/sensory rooms, Ligature pointsStaff ModifiersCaringly vigilant & inquisitive, Checking routines, Décor, Maintenance, Clean & Tidy, Alternative choices, RespectFlashpointsSecrecy, Solitude, Admission shock, Exit blockedCONFLICTCONTAINMENT&
3. Background and aimsBackgroundSome flashpoints, and therefore conflict, are due in part to unclear expectations, lack of clarity or inconsistency on the unit.AimsCreate a more egalitarian social unitMutual holding to accountSet clear standards for both staff and patients Build consistency and predictability while allowing flexibilityEnsure patients and staff understand their obligations to each other
4. FlashpointsConflictContainmentPatient modifiersStaff modifiersOriginating domainsStaff modifier: Sharing expectations, finding mutual agreementPatient modifiers: Sharing expectations, finding mutual agreementClear mutual expectations and the Safewards modelOriginating domains:Patient CommunityStaff TeamPatient CharacteristicsPhysical environment
5. What are the benefits of having clear expectations?What expectations can be unclear? Task: Examples of clear expectations
6. Lack of consistency and clarity is annoying for almost everyone. It may particularly affect those who:aren't thinking clearlyare distracted by distressing thoughts or emotions, or are preoccupiedhave difficulty interpreting communicationexperience changes in mood have a distorted, or different, view of world and othershave a history of traumaLack of consistency and clarity can cause problems
7. Mutual expectations for considerationGeneral expectationsStaffExcluded itemsPropertyPlaces
8. Role of the clear mutual expectations lead Ensure clear mutual expectations meetings occurCommunicate meeting results in a visible manner e.g. posters Ensure the clear mutual expectations are discussed:If you're the admitting nurse, show the information/poster and explain its contentsIf you are on duty when a person is admitted, remind the admitting nurse to refer to the clear mutual expectationsAt handover, ask whether the poster has been shown and explained to new patients
9. Clear mutual expectations fidelityCodifying rules for patients so staff have an easier time telling patients what to doA pretty poster or mission statement to point to when things get trickyClear mutual expectationsIS=Clear mutual expectationsIS NOT ≠Sharing expectations across the community for consistency and high standards of behaviourFacilitating public conversation about how different groups sharing one space can respect one another
10. Clear mutual expectations adjustmentsCAMHS NoneForensic NoneOlder people None, usable by all