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Safewards: a new model of conflict and containment on psychiatric wards
Article first published online: 19 FEB 2014
© 2014 Crown copyright. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Journal of Psychiatric and Mental Health Nursing
Volume 21, Issue 6, pages 499–508, August 2014
How to Cite
Bowers, L. (2014), Safewards: a new model of conflict and containment on psychiatric wards. Journal of Psychiatric and Mental Health Nursing, 21: 499–508. doi: 10.1111/jpm.12129
- Issue published online: 1 AUG 2014
- Article first published online: 19 FEB 2014
- Manuscript Accepted: 6 DEC 2013
- National Institute for Health Research (NIHR). Grant Number: RP-PG-0707–10081
- acute care;
- control and restraint;
- inpatient issues
- 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.
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.