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SAFEWARDS: Improving safety in mental health wards

SAFEWARDS Project Officer, Tracy Tabvuma 

Working in a mental health inpatient unit can be challenging. Faced with conflict, distress and even aggression, staff sometimes need to use methods such as transferring patients to a more secure unit, restraint or seclusion. However, the implementation of the research-based SAFEWARDS program aims to reduce the use of these methods to make mental health wards safer for both staff and patients.

Clinical Nurse Specialist and SAFEWARDS Project Officer, Tracy Tabvuma, has spent the past 10 months working with nine mental health units across South West Sydney mental health facilities to implement SAFEWARDS. She explains that the program, which was initially developed in the U.K., has 10 nurse-related interventions which have been shown in a  randomised controlled trial to reduce conflict and constraint.

Although seemingly simple, the ten interventions, such as “know each other” and use “positive words” have far reaching implications for the safety of both patients and staff.

Tracy explains that forming connections is vital within the mental health unit. The “Know each other” intervention has resulted in the creation of folders which display a page for each nurse and patient listing a few “non-controversial, personal” things about them such as their favourite food. This intervention has provided another avenue for building rapport between patients and nurses who, by viewing these folders, are able to identify common interests with each other.

Another intervention is to “Clear Mutual expectations”. In this intervention, staff and patients work together to develop a set of agreed-upon behaviours they expect from each other. This list is then displayed on the walls to remind both staff and patients of these mutual expectations.

Some of the agreed mutual expectations included, for patients: “When staff are busy, we understand we have to wait,” and for staff: “to respond in a timely manner.”

“Setting up mutual expectations helps clarify what is deemed as appropriate behaviour on a mental health unit. Mental health units have a different set of expectations because we are usually working with people who may have an altered mental capacity,” explains Tracy.

While the project seems straightforward enough, there were challenges with its implementation. Nurses had to complete and submit an evaluation form at the end of each shift. For some wards, this proved difficult.

“We found that some wards had better results implementing the evaluation form than others. We wondered what influenced that success and theorised that maybe the level of support and involvement of the direct manager led to better results,” said Tracy.

The project was evaluated throughout its implementation using two outcome measures as well as focus groups/ interviews. The two outcome measures included a patient-staff conflict checklist which was introduced as routine practice and completed by the nurse in charge after each shift (three times a day). The checklist indicates the number and types of conflict (behaviours that result in harm to patients and staff) as well as containment (restrictive practices) events.

Additionally, with the ward climate scales, the first iteration of the surveys; pre-implementation were completed and they are currently collecting the post-implementation surveys. Once these have been collected, analysis will elicit if there are changes in perceptions about the ward therapeutic atmosphere.

Tracy’s role in the program’s implementation has spurred her desire to pursue a career in research and project management.

“This role allowed me to have a foot in the clinical space, working with nurses and patients, while also working in project management and research. It was a role that gave me access to the best of both worlds,” says Tracy.