19 research outputs found

    Implementation of the Safewards model in public mental health facilities: a qualitative evaluation of staff perceptions

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    Background: The Safewards model is gaining increasing acceptance in the mental health field in Australia and overseas. One of the most important goals of inpatient psychiatric services is to provide a safe and therapeutic environment for both patients and staff. However, this goal can be difficult to achieve if staff-patient interaction is not conducive to preventing violence and aggression. Objective: The purpose of this study was to explore nursing staff perceptions of the factors impacting on their capacity to establish Safewards in acute adult inpatient wards. Design: This study was guided by a phenomenological approach to develop a rich understanding of staff perceptions using semi-structured interviews. Setting and sample: The setting was three acute mental health wards attached to general hospitals; one in a large provincial hospital and two in metropolitan hospitals in south-east Queensland. Interview participants were a purposive sample of fifteen registered nurses across each of the three wards. Method: Semi-structured interviews were conducted at 12 months post-implementation of Safewards. The study was underpinned by Michie's integrative framework of behaviour change that helped identify target areas in order to enhance successful implementation of this model. Results: Content analysis of interview transcripts highlighted a range of factors including failure to address the difficulties encountered by some staff in engaging with Safewards interventions, lack of support from management, poor use of nurse educator time, the ‘language’ of Safewards, high acuity on the study wards, and staff and patient turnover. Conclusion: This study highlights some difficulties with implementing Safewards and maintaining fidelity of the Safewards interventions in busy acute inpatient wards. Although these findings are from a qualitative study consisting of only 15 staff, our results indicate that efforts to implement Safewards need to address challenges faced by staff in engaging with the interventions, ensure buy-in from management, ensure adequate training and support during implementation and review training materials to ensure they fit with the local (i.e. Australian) context. Safewards provides an opportunity for a change in attitudes and development of a more therapeutic ward environment

    A clinical improvement project to develop and implement a decision-making framework for the use of seclusion

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    The use of seclusion within acute psychiatric settings is contentious. As evidenced by its use in practice, seclusion continues to be supported by mental health-care professionals. However, there is a growing evidence base that indicates that it is viewed negatively by patients and causes symptoms of severe distress. In Australia and several other countries, the use of restraint and seclusion is now being questioned, and there are now policy directives to reduce or abandon these practices. Despite mental health-care professionals' awareness of the potential detrimental effects of seclusion, the practice is strongly embedded in Australian mental health settings. This paper describes an improvement project to develop and implement a clinical decision-making framework around the use of seclusion. The setting was an acute mental health-care facility servicing a large health district in south east Queensland, Australia. The impetus for this project was driven by concerns expressed by consumers of the service and our own need to reduce the incidence of seclusion and the length of time of seclusion events to below 4 hours' duration. This improvement project employed practice development and action research principles to engage colleagues in the development of the framework. The project duration was 6 months, and resulted in two decision-making frameworks around the use of seclusion: the decision to seclude and the decision to release

    The safewards program in Queensland public hospital acute mental health settings

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    Aggression during psychiatric hospitalisation is frequent, problematic, and a major challenge for nurses and mental health services more generally. An important protective factor that can limit the likelihood of aggression is the strength of the therapeutic alliance between nursing staff and consumers
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