Violence occurs daily in the ACT’s hospital wards; many nurses and midwives fear they will be assaulted. But the trial of Safewards, a program to make wards safer for staff and patients alike, could offer a solution.
“It’s a system approach to ensuring patient and staff safety through understanding how people interact with one another,” said ACT Minister for Health, Rachel Stephen-Smith, at the program’s launch on Friday.
Safewards will be trialled in four public hospital wards over the next six months. The program helps staff to recognise triggers and emotional distress “flash points” – behaviour in staff and patients that may result in harm – and to defuse charged situations.
“Safewards gives staff the tools to de-escalate conflict and to build positive relationships with each other and their patients,” Ms Stephen-Smith said.
Those tools include setting clear mutual expectations with patients; visual signs about sensitive and respectful communication; a display of positive notes written by patients and their carers before discharge; and creating a box of items patients can use to feel calmer and more relaxed.
“Safewards aims to support staff and clients to work together to make facilities and wards more peaceful and friendly, and therefore safer for everyone,” Ms Stephen-Smith said. “This isn’t just about keeping staff safe; it’s about keeping staff safe in a way that’s better for patient outcomes as well.”
The approach was developed by Len Bowers, Professor of Psychiatric Nursing at King’s College London, to reduce the risk of conflict (events that threaten staff and patient safety, such as self-harm, suicide, aggression, absconding) and of containment (things staff do to prevent or reduce harm to staff and patients, such as increased observation, extra medication, or restrictive interventions).
The Minister said Safewards has already been successfully implemented in other Australian states and territories. It has been found to reduce conflict in wards, particularly in adult and youth mental health wards, and to make staff and patients feel safer and happier.
Victoria essayed the world’s largest and most systematic trial of Safewards in 2014; by 2019 it was being used in all the state’s patient wards. Macquarie Hospital, Sydney, found it reduced incidents relating to seclusion and restraint. Similarly, Rockingham, Western Australia, was able to reduce seclusion by 69% and ‘Code Black’ (personal threats) by 50%. Queensland, Tasmania, and the Northern Territory have also introduced the program.
While attacks on healthcare workers may seem unlikely in prosperous Canberra, nurses and midwives are the largest health care group exposed to occupational violence and aggression, the government states.
More than 600 nurses and frontline health staff reported incidents of physical assault in the ACT in 2019; a male nurse was stabbed in the Canberra Hospital carpark (April 2019); and nurses have been punched, kicked, beaten, and scratched at the Dhulwa Mental Health Unit, a secure facility for people involved with the criminal justice system.
“We still have incidents reported to us of serious assaults,” Matthew Daniel, secretary of the Australian Nursing & Midwifery Foundation, ACT Branch, said.
“[Violence] is a daily occurrence … That’s not inconsistent with healthcare nationally and internationally. This is a real problem for healthcare. We’re looking at what we can do to change it for nurses and midwives, understanding that [this] can be applied broadly to other health workers as well,” he said.
The ACT Government intends to implement Safewards across ACT public health services by June 2021, Ms Stephen-Smith said. The program will first be trialled in Canberra Hospital’s General Medical Ward 7B and the Adult Acute Mental Health Unit, and Calvary Public Hospital’s General Medical Ward 4B and Older Person Mental Health Inpatient Ward. The program will then be tweaked before the general rollout.
The Safewards trial is part of the Nurses and Midwives: Towards a Safer Culture strategy, which aims to decrease violence and aggression in public health workplaces.
In September, the government launched a communication awareness campaign, “Be kind and respectful to our nurses and midwives”. The government has also developed challenging behaviour guidelines, designed to avoid aggression and violence; drafted a risk management framework for isolated and remote workers; and developed a fact sheet setting out staff rights to a safe workplace.
Ms Stephen-Smith expects reporting of occupational violence and risks will increase, once healthworkers start to feel safer.
“It is really important they report those incidents so that we understand what’s going on across hospitals, and so that we can manage and reduce the incidence of violence in collaboration with staff and with consumers. Safewards is a key part of that.”
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