Use of Safewards Model in Mental Health-Free-Samples for Students

Question: Has using the Safewards Model in acute Mental health units improved Client engagement in promoting recovery? Answer: Background and Potential Benefits of Study Background The need to reduce conflict and containment has been a disturbing issue for many years. Many interventions and models have been attempted to solve this issue albeit unworking. The absconding by patients, rule breaking, manual restraint, attitude to containment, compulsory detention and attitude of nurses to patients with mental disorders have been the backdrops against which these models and intervention have been tried. Other researchers have also focused their studies on understanding Safewards Model through aggression, absconding, substance use, medication refusal, suicide, special observations, coerced medication, manual restraint, seclusion and mechanical restraint. The overarching finding from these studies point towards the need for a much stronger model and design a much stronger interventions for the people to utilize. It is upon this backdrop that many researchers have recommended the use of Safewards Model in order to reduce the conflict and containment for effective and smooth recovery process. The researchers have used Safewards Model and subsequently produced various ideas for intervention that clearly appreciates the benefits of this model when used in wards to assist the ward staff decrease levels of containment and conflicts thereby making their wards safer placers. This is because the studies have shown that Safewards interventions have generated a significant decrease in the rate of conflict and reduce the containment rate. The conflict (self-harm, aggression, absconding, self-harm, medication refusal, substance use) and containment (as required medication, seclusion, special observation, coerced intramuscular, manual restraint and secular) put patients and staff at risk of severe harm. The frequency of such events differ across wards, yet there are few explications as to why this is so, alongside a coherent model is really lacking. This essay thus proposes a comprehensive critical systematic review of literature that address the use of Safewards Model in Mental Health to give a detailed explanatory model of these variations, and sketch the implication for the mechanisms for decreasing risks alongside coercion on the inpatient wards to inform the required changes in education, healthcare practice and future research. Professor Len Bowers and colleagues developed the Safewards Model in the United Kingdom. This model particularly scrutinizes events referred to as conflict (events which may threaten staff as well as consumers like self-harm, absconding, suicide and aggression) alongside containment (interventions implemented by staff to avoid a conflict between them and consumers. These may include increased observation, utilization of medication, as well as using restrictive interventions). Conflict and containment events can be categorized together (Bowers 2013). This is because patients that might display one type of the conflict behavior could further display another. The conflict as well as containment can differ substantially between various wards and nationally as well as internationally, and types of methods of containment can further differ significantly. Thus, this Model seeks to offer an explanation on the differing rates of both containment and conflict as well as provide interventions w hich are designed to lessen the risk of the conflict as well as containment incidences taking place. The model has six domains (see appendix (figure 1 and 2)) that are; outside hospital, physical environment, patient community, staff team, regulatory framework, and patient characteristics (Bowers 2013). These 6 domains give rise to flashpoints that are defined as social as well as psychological context emerging out of the features of originating domains, signaling as well as proceeding imminent conflict behavior. Such flashpoints could trigger conflict that might lead to containment. The use of containment could cause conflict. The purpose of this model is to reduce such undesirable interventions (Bowers 2013). The staff interventions can effectively modify these process by decreasing the conflicts-emerging factors: preventing flashpoints from emerging; cutting link between flashpoints and conflict; selecting not to utilize containment; and making sure that containment utilization does not culminate in further conflicts. It is upon this backdrop that this review will be important as the model will be systematically described in detail; and clearly shown how it can be utilized in devising strategies that effectively help promote patient and staffs safety. Potential Benefits (Significance) This study seeks to evaluate whether using the Safewards Model in acute mental health units has improved client engagement in promoting recovery. Answering this research question will have potential implication towards the implementation, modification and even development of new models to boost the client engagement in the recovery promotion among the patients in acute mental health units (Price, Burbery, and Leonard Doyle 2016). If the research finds out that the model has improved consumer engagement, it would be recommended for mental health units as this will be beneficial since it will have helped decrease any form of conflict and restrictive containment methods that only serve to derail the recovery process of the patients in acute mental health units (Price, Burbery, Leonard and Doyle 2016). On the other hand, the research will have potential benefits by identifying some key limitations of Safewards and suggest the required adjustment or modification that will boost its usage for promoting recovery (Parish 2013). The research might also reach a finding that the Model itself is effective as it is but the process of implementation may have not been well understood and hence focus on the ways to improve Safewards for better outcomes (Price, Burbery, Leonard and Doyle 2016). Finally, the study will be of great potential where it reaches a conclusion that Safewards is not the best Model in this context and goes on to recommend the implementation of new Model to substitute Safewards Model (Price, Burbery, Leonard and Doyle 2016). Aim: The real aim is to critically review the literature that addressed the use of the Safewards Model in Mental Health. The comprehensive critical review of literature is done to understand the usefulness of Safewards Model in mental health. To do this, the focus will be on whether the reviewed literature highlight the effectiveness of limitation of this model on the basis of implementation and usage. The success of this model in clinical health will be examined on the basis of whether it has enhanced patient engagement and the corresponding effect of such an engagement to recovery process. This well provide effective recommendations relating to its implementation, modification or a new Model that will help effectively engage patients in acute mental units for better recovery. Purpose: The main purpose of this study is to evaluate the success of Safewards Model in terms of its ability to engage the patients in acute mental units by looking at how the issues of conflict and containment are either reduced or increased even after the implementation of the Safewards Model. This will be beneficial in informing the future Model or the implementation and modification necessary to make Safewards Model to be more effective (Price, Burbery, Leonard Doyle 2016). By so doing, a recommendation will be offered that will propose the adoption and implementation of the Safewards Model so as to promote consumer engagement and hence better recovery. Research Question Has using the Safewards Model in acute mental health units improved client engagement in promoting recovery? Systematic Critical Review The researcher used the critical review to appraise various articles in the literature. The aim of the critical-review was to validate that the researcher had lengthily investigated the literature as well as critically evaluated the quality of such literature. The critical review extends beyond the mere description to include the analysis degree as well as the conceptual innovation. Unlike traditional literature reviews that merely introduces a topic, summarize the main ideas and providing certain illustrative instance which lacks reliability, critical systematic review guarantees reliability by recording how primary studies were sought as well as selected and how such studies were analyzed to generate their conclusions. It helps the readers to be able to judge whether each of the relevant literature is probably to have been found as well as how the quality of a given study is assessed. The systematic review remains transparent regarding they generate conclusions. This is important b ecause it avoids misrepresentation of knowledge base by evaluating each study to make clear its relevance and quality. It helps confirms that the review authors have taken the necessary steps to decrease distortions and inaccuracies. The systematic review also uses a protocol that sets out how the review is conducted prior to actual review to reduce bias by minimizing the influence the results might have over the being overly influenced by review procedures. The systematic review also entails exhaustive searches to obtain as much as feasible of the relevant study to reduce bias by ensuring that conclusions are never overly influenced by most reachable study. The methods of systematic review are also made explicit to allow users of review to know if they can trust the findings of the review as readers can easily judge how well the review has been undertaken. The systematic review also involves potential users of the systematic review to ensure that the research is relevant by setting advisory cohorts are set up with representation from all user groups. The findings of the systematic review remains solid as the results of sound research are synthesized effectively. This helps generate clear as well as easily reachable messages regarding the reliable evidence existing on a topic. This is done by appraisal of each study and pooling its results which imply that conclusions can be effectively drawn regarding the direction of the evidence in its entirety. Search, Retrieval, and Selection The researcher used the critical review process to search for the relevant articles about Safewards Model. To begin my search, I first identified the key terms and phrases that could help me get the required and relevance articles. Some of the key terms identified were: Safewards Model; Implementation of Safewards Model; Importance of Safewards Model; Success of Safewards Model; Conflicts and Restrictive Containment Application of Safewards Model; and Challenges to Safewards Model Implementation. After this identification of key terms, I brainstormed on specific search engines that could helped me get the required articles. I came up with a list of few search engines including Google, Yahoo and Bing. Further, I selected some data bases that could enable me get the required information and came up with a list of key databases: The York Research Database; PubMed; Cochrane Library; Popline; TOXNET; CINAHL Plus and EMBASE to enable me obtain the relevant articles and retrieved (Goulet, L arue Dumais 2017). The inclusions and exclusion criteria was based on a number of considerations. First, I was looking at the current and updated articles. Based on this criteria, only the peer-reviewed article published between 2010 and 2017 would be included and any article published before 2010 was excluded. The other criteria was based on whether the article was academic article (peer reviewed) journal. Thus once I had gotten an article, I had to check whether it is a peer-reviewed before including it or discarding it. Another inclusion and exclusion criteria was based on the relevance of the article to my topic. I had to read through the conclusion and recommendation sessions of each article to grasp and a glance whether it would help me advance the aim of this study. Only those articles that helped me understood the use, success and importance of Safewards Model were included. Based on the above exclusion and inclsion criteria, I managed to identify only seven key important articles and selected them for the review out of the thirty articles that were retrieved and appraised effectively. The articles then formed the basis for my literature review which then informed the findings and subsequent evidence-based discussion of this paper. Critical Appraisal The tool chosen for this critical appraisal was CASP systematic review checklist. CASP approaches research in three steps: (is the study valid); what are the results; and (iii) are the results useful. Is the study valid? The 1st step is to decide whether the study was not biased via the evaluation of its methodological quality. Various criteria for articles validity are utilized for various kinds of questions. Based on the validity of the article, the appraiser can categorize it within a scale of evidence levels besides degrees of recommendations. What are the results? Where it is decided that the article is valid, we can then proceed to look at results. At this stage, a consideration is made whether the results of the study are important. A consideration of how much uncertainty exist regarding the results, as expressed in terms of p-values, sensitivity analysis and confidence intervals. Are the results useful? After a decision is made that the evidence is valid and significant, the appraiser need to think about how it apples to the study question. The critical appraisal skills avails a basis within which to consider such issues in the explicit and transparent manner. CASP tools ranges from CASP systematic review checklist, CASP randomized controlled trial checklist, CASP diagnostic checklist, CASP economic evaluation checklist, CASP qualitative checklist, CASP case control checklist, CASP cohort study checklist and CASP clinical prediction rule checklist. However, for this critical review of literature, CASP systematic review checklist was chosen. It was chosen since my project was based on a literature review and hence I was convinced it would enable me critically appraise the articles in a systematic manner. The questions asked in the systematic review were also appropriate in helping me arrive at the best articles. The systematic review is also important because unlike the traditional unsystematic and subjective methods of collecting data, analyzing and interpreting results that are marred with issues of bias, and overestimation of value of the study, systematic critical appraisal has a defined method of collecting and analyzing study results to reduce bias. It is a higher level of review which is very important tool for my research. It enabled me effectively evaluate the evidence using clearly formulated topics which utilizes both organized and explicit methods for identifying, selecting as well as critically appraising relevant s tudy. It was also important in helping me to solve the controversies between the conflicting findings and provided a reliable foundation for making a decision on what articles to use. Summary of Outcomes From the critical appraisal, summary of the outcome was established. It was established that of the thirty articles that were retrieved, seven of the articles met the criteria set for the appraisal. These criteria included; relevance, current (published between 2010 and 2017), and peer-reviewed. In terms of relevance, the article would only be included if it directly contributed to the understanding of the problem being studied. For relevance, I was looking for the themes coming from these studies in relation to success, implementation of Seaward Model and the challenges with implementation of the of the Seawards Model. For the peer-reviewed, I chose this criteria because the information would be more credible, valid, and viable and verified because they have been tested and the evidence proven. This will, therefore, help me to have information that can be generalizable to inform the use of this Model. For the timeline or date of publication (2010 to 2017), I chose this because of the need to be current. I was convinced that this timeline captures updated states and these could have corrected errors and omission that could have been made in the ancient studies published before year 2010. These seven articles were, therefore, selected on the basis of this inclusion and exclusion criteria as advanced in the search retrieval and selection section above and reviewed using the critical review method to inform the completion and the final compilation of the current study. The summary of the outcome was given in terms of three common themes: Safewards Model has immensely decreased the conflicts; Safewards have immensely eliminated the use of restrain and rapid tranquilization; and Model is more inclusive. Critical Summary Table Source Research question presented Use of right type of study Design minimize bias Analysis accuracy Conclusion drawn from data and analysis Contribution of study to problem understanding Bowers (2013) The research question well-presented and explanation given why research was needed Interventions and hence RCT used well The design well-chosen and minimized bias Analysis was accurate The conclusion is strictly as per data and analysis The study highly contributed the Safewards Model understanding (Bowers, (2013)) Bowers (2014) The research question well-presented. It explained for research RCT was effectively applied The biased was minimized based on good choice of design The accuracy of analysis was above board The analysis and data well informed the conclusion The source gave more details of Model thereby boosting its understanding Bowers et al (2014) Research question well aligned to need for study The study correctly used the RCT type of study The biased was extremely minimized by use of right design Analysis of finding was so accurate The conclusion drawn from the investigations relates to analysis and data This study led to increased understanding of Safewards Model implementation and benefits Kinner (2016) Presentation of research question was performed and acknowledged the significance of study Randomized Control Trial was used effectively No form of biasedness recorded due to right design The analysis was precise and informed the conclusion effectively The deduction drawn from the review is a clear reflection of data and analysis More understanding of Safewards Model was attributed to this study Mustafa (2015) Correct research question presented and recognized the need for Safewards Model The study was about therapy and hence the author correctly used RCT There was no biasness in the investigation due to right design Truthful and factual analysis was done The deduction was on the basis of data and analysis Much comprehension of Safewards Model application including its potential benefits to reduce conflicts were presented correctly () Price et al. (2016) Precise research question presented RCT correctly applied The degree of bias was highly minimized Accuracy of analysis was guaranteed based on facts and reviewed literature Authors drew correct conclusion from data and analysis The authors presented clear understanding of Safewards Model as a result of this study Well et al. (2015) A clear and explorative question presented Being a therapy, Randomized Control Trial was applied effectively Authors prevented any form of bias Accuracy was ensured during the analysis arising from factual data The conclusion was built from data and analysis of the information gathered on Safewards Model One can really get to understand the Safewards Model from this study and hence greatly contributed to the understanding of the Model (Well et al. (2015)) The table above presents the summary of the critical appraisal done for the seven articles included for this study. It uses six criteria to appraise each articles. These included research question presentation, contribution (relevance), use of correct design (correct study type), whether the design eliminates/minimize bias, accurate analysis and whether the conclusion arise from data and analysis. Each of the seven sources are listed in the first column with subsequent columns highlighting each of the above criteria for each source Summary Findings Increased Uptake of Safewards Model The review revealed an increasing success in the implementation of Safewards Model as many facilities are embracing it and integrating it in their facilities. The increasing Safewards Model is wholly organized by the mental health service staff and this is a typical evidence of value put on Safewards by staff engaged with its implementation (Kinner et al. 2016). Across the seven studies, this theme was evident as many mental health facilities embrace Safewards for effective engagement between nurses and patients. Safewards Enhance Mental Health culture and Atmosphere There was a consensus throughout these seven articles regarding the above theme. The evaluation of the use of Safewards suggests that the model can contribute immensely in enhancing the culture as well as atmosphere in the mental health service (Kinner et al. 2016). Unlike before where mental health services witnessed high levels of conflict events including violence, aggression as well as absconding. These cases are no longer experienced with full implementation of Safewards (Mustafa 2015). Nurses no longer need to use the restrictive practices as Safewards has improved the safety for everyone including the mental health staff, visitors as well as consumers (Bowers 2013). It appears from the review that the both staff and consumers of this Model reported that it reduces conflict as well as enhanced communication. The model also impacts on the decrease of the utilization of restrictive interventions (Hallett and Dickens 2015). The implementation of the Model has improved the local se rvice delivery. Safewards Decrease Conflicts It was a common theme from the seven articles this model has greatly reduced conflicts between nurses and mentally ill patients. It is for this reason that the model is being promoted through the social media as a new set of intervention to nurses that have been proved to greatly decrease the conflict within the inpatient environment. The new Safewards Model is anchored on the years of research by Len Bowers (Bowers 2015). The findings, presentations, training aids as well as guidance remain freely available (Bowers et al. 2014). The Safewards Model is built on the backdrop of a research that examined the potential harmful events including the aggression, rule breaking substance utilization, medication refusal, absconding as well as self-harm alongside the identified most effective means of containing such negative events (Kinner et al. 2016). Whereas acknowledging that there is never a single response that certain variables are outside any persons control, the Safewards Model identi fies 10 possible interventions that are the most efficient as well as effective means of controlling such adverse events and have been proved to really make a difference (Kinner et al. 2016). Safewards have immensely eliminated the use of restrain and rapid tranquilization It was also a common them from the literature that such interventions as simple as establishing precise mutual prospects, utilizing soft-words, bad-news mitigation, and mutual assistance as well as growing the mutual-understanding, utilizing calm-down approaches as well as the provision of reassurance-strategies nurses utilize in their routine activities (Kinner et al. 2016) were effective in improving client engagement. Together with increasing the utilization of these techniques, it was found that using Safewards Model interventions reduced many the most disliked intervention like restraint, rapid tranquilization and hence the outcome is that conflict on wards declined by over 14.60% and containment activities declined by 23.60%. Such findings remain substantially significant and the nurses are increasingly becoming keen to encourage the service providers including, ward managers as well as the broader team to adopt the Safewards Model and apply it to their individual wards. All th e evidence points towards Safewards beneficial importance to both staff and also consumers (Kinner et al. 2016). Discussion: Under this section, I will discuss the following main points: how Safewards Model is more inclusive as it explicates conflicts behavior and containment mechanism; and what is needed to be done for effective implementation of Safewards Model; How Safewards Model is more inclusive as it explicates conflicts behavior and containment mechanism; The Model Seeks to explicate all the conflict behaviors as well as all containment mechanisms together. Safewards model is hence more all-inclusive compared to disjointed models for absconding and aggression among others and recognizes the presently firmly empirically-proven correlation between them (Kinner et al. 2016). Safewards depicts the bidirectional connection between containment and conflict and hence indicates that the utilization of containment inspired by the urge to bar upcoming conflict is able, to certain incidence, cause such a conflict (Long, Afford, Harris and Dolley 2016). The Model, hence, permits discrete interventions that decrease containment without having to influence the rates of the conflicts like the several seclusions as well as limit reduction initiatives in many economies globally. In deriving the difference between the originating-domains as well as the flashpoints, Safewards Model outlines the pressures generated by regular operations of the inpatient units which are in fact the very intrinsic to it, as well as illustrating how such results are more focused and time-located flashpoints (Long, Afford, Harris and Dolley 2016). The standalone originating domains identification as well as flashpoints permits clearer ideas regarding what can and cannot be altered by the clinical-staff working in such wards, and hence facilitate the production of philosophies for rational alteration which have potential for the reduction of containment and conflicts (Long, Afford, Harris and Dolley 2016). The Safewards Model further results in important novel regards to the fore. Patients-patient interactions, for first-time, are extremely regarded and added in the explications fir containment alongside conflict rates (Bowers 2014). Whereas patient physiognomies as well as symptoms have been broadly reported in the past as the triggers of conflict besides containment, the Model recognizes treatment as the operative and efficient safety-generating approach, and identifies that the manner staff respond to their corresponding consumers features will substantially influence on the capacity to result to actual conflict and containment incidences. The outside structure/regulatory framework alongside its corresponding characteristics are identified, for the first-time, as the originating-domain for both conflict alongside containment in such wards (Bowers 2014). What is needed to be done for effective implementation of Safewards Model? There are things that the staff can do when undertaking the implementation of such structures which have the significant potential to decrease the risk of conflict as well as containment. Nevertheless, Safewards Model further illustrates some actions capable of being taken at the uppermost policy degrees that can culminate in wars which are increasingly safer for consumers and staff (Cox, Campbell, and Dalton 2016). Furthermore, the Model integrates impacts on the behavior of the patients from the external environment thereby offering novel understandings hence new means of intervention (Bowers 2014). Whereas the significance of physical-environment has effectively been examined by the other researchers, the Model goes beyond the unsophisticated recommendations of development in quality to clearly describe physical characteristics of wards and the corresponding impacts on patient and staff safety. Implication: Under the implication, I will discusses the implication of Safewards to three different areas; healthcare practice, education and future research. The following subheading provides a detailed discussions on each of the three areas. Healthcare Practice The Model has clear and precise implication for conflict alongside containment reduction to staff. The unhidden implication to staff is that any intervention which may result in alterations to the psychological understanding, emotional regulation, increased commitment, teamwork skills, technical mastery, building positive appreciation as well as effective structure of wards is probably to account for the reduction of the conflict as well as containment rates (Bowers 2014). The option strategy is to stress on acknowledged flashpoints, obtaining better means to manage them effectively (Bowers 2014). The flashpoints remain the social-locations in wards which are highly probably to cause conflict, the interactions between staff and consumers whereby the ward-structure is created, reaffirmed, established as well as instantiated (Bowers 2014). Taking a modest illustration, rather than waiting for the patients to bump at office door, nurses can pre-empty requests by walking around the ward and subsequently enquiring patients what they require/ want prior. Education The implication to education calls for finding the best ways and competencies to understand the patient physiognomies. The dependable connections to younger age as well as male gender demonstrate that much conflict and resultant containment is around insurrection, power, and independence (Bowers 2014). All these remain greatly noticeable matters for men and/or the fledgling individuals. This points that education should be focused on finding proper ways to improve choices, freedom as well as avoiding control of consumers over their diagnosis will help in the reduction of both conflict alongside battles with staff hence better engagement (Bowers 2014). Attempts in education should focus on how to engage patients and nurses to accomplish a reciprocally respectful partnership between the duos as this will do much to prevent conflict arising from such matters (Bowers 2014). Future Research The future research should also be adjusted towards the appreciation of the link between conflict and containment to diseases and symptoms that further carries serious lessons. . The future research should inform the choices when responding to patients to make sure that only better responses are given to help in the enhancement of patients coping strategy to prevent adverse responses that will only increase the patients stress thereby eliciting yet more symptoms (Paton et al. 2016) which can be a barrier in the recovery process. References Bowers, L., 2013. The safewards model and cluster Rct. International Journal of Mental Health Nursing, 22, p.1. Bowers, L., 2014. A model of de-escalation: Len Bowers provides advice, based on the latest research, on the safest way for staff to deal with conflict and aggression. Mental Health Practice, 17(9), pp.36-37. Bowers, L., 2014. Safewards: a new model of conflict and containment on psychiatric wards. Journal of Psychiatric and Mental Health Nursing, 21(6), pp.499-508. Bowers, L., 2015. Safewards. 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