Hi Mat,

You reminded me of my first presentation at a Trust conference held in Tameside General Hospital. And yes, I was dreadfully nervous too. Dry mouth, wobbly voice and reading from a prepared script in my case,. It took me some time to get used to doing it. Hard to believe I got from there to feeling so comfortable with it now.

Good luck with the Safewards implementation in Forensics. I think you are right about it's time coming soon. I hope to present about Safewards at several forensic nursing conferences nationally and internationally next year - fingers crossed.

Len

One of our ideas was that the issue of Conflict & Containment on wards is akin to Newton's Third Law of Motion (every action has an equal and opposite reaction), i.e a patients conflict results in our containment measures, and our containment can trigger patient conflict. By exploring our ward procedures (our 'actions') and identifying areas where restrictions can be eased, we can reduce potential flashpoints (reactions), thereby reducing the potential for conflict. Anyway, hope to catch you at one of your presentations one day - keep me posted!

Mat, thanks for this. There does seem to be a real appetite in forensic care –,you and Dario have bought into it with so much energy, for example. I am very interested in if forensic services feel they can adopt the model and interventions "as is" or if there are felt to be modifications to be considered. As the debate continues, it would be really good to track any such comment or opinion. As what I would term our "expert in the field", and taken your previous comments, can I just ask if you and your colleagues and the audiences you have spoken too have expressed any such views.

I send this with trepidation as I know you are talking to others while also working on your own ward – but you have a very special view of safewards that would be very interesting to hear. In a recent team discussion we thought that the position on forensics care (as perhaps in other specialities) would be that Safewards would have “fit”, but there may be caveats or special considerations in terms of flashpoints for example or the need to adapt interventions such as discharge messages (given the slower flow through services).

Hi Geoff,
As far as Discharge Messages goes, there is a delay to add to it - our Pathway is 18 months so we could be waiting a while! It may be useful for us to ask patients to add to it in advance whilst we wait for it to gather momentum. We could introduce this through the Mutual Help Meetings or perhaps run a group on Preparing for Discharge that includes reflecting on their stay in hospital and messages that would have helped them on admission.
Potential flashpoints that may be specific to secure environments includes our 'Restrictive and Prohibited' lists - this can include things like plastic carrier bags that patients may not initially understand or tolerate.
As mentioned previously, we do need to double check that items for the Calm Down Box are up to 'secure specification' (the £300 bean bag!).
On the whole though, we are finding that Safewards does fit 'as is'. If there are any specific areas you would like feedback on let me know.
Matt

Thanks Matt.
Your comments on Discharge Messages are very useful and seem to fit with other areas that have less of a flow through their services. In discussion with these, some of the things suggested are as you say, gathering messages for people while they are still there and likely to be there for some time longer. The caveat to this is that in the trial and implementation, there are incidents when patients who are particularly unwell /agitated/annoyed can show this by in some way upsetting the discharge message display. One solution seems to be to keep the original and make a copy for the tree/display.

As people, like your good, self deal with these, believe me when I say we would be interested in any problem solving you do.
Thanks for your posts Matt – they are exactly what the forum is for!

First time I've taken a look at the Secure Units section of this, and strangely I had thought today about writing a post about difficulties with the discharge messages tree when we have more disturbed patients in - our leaves seem to make excellent roaches for roll ups, and a very disturbed young man has been nicking them off the tree! We hadn't previously found this, and as he's been in seclusion, we haven't got round to talking to him about Safewards, and what the discharge message tree is all about. On the plus side, this is the first time the tree has been interfered with!

Sian