Nurse pioneer champions model of conflict resolution that can be implemented on any ward
Posted 09 October 2020 - 11:00
Safewards model offers ten interventions to reduce conflict and has transformed mental health nursing practice
- Safewards sets out interventions to reduce conflicts that can be implemented on any ward
- Star Wards provides practical ideas and inspiring examples from and for mental health ward staff
- Geoff Brennan, member of the Safewards and Star Wards teams, has won the Mental Health Nursing category of the 2020 RCNi Nurse Awards
Three decades of encouraging and supporting mental health nurses worldwide to improve wards has seen a pioneering nurse win a prestigious award.
Geoff Brennan, a member of the Safewards team at King’s College London’s Institute of Psychiatry, Psychology and Neuroscience and executive director for Star Wards, has been named winner of the Mental Health Nursing category of the 2020 RCNi Nurse Awards.
Safewards is a model of conflict resolution, offering ten interventions to reduce conflict that can be implemented on any ward.
Star Wards and Safewards have helped transform mental health nursing practice
Star Wards, a project of social justice charity Bright, provides 75 practical ideas and inspiring examples from and for mental health ward staff on its website and supports wards to develop their own solutions to problems through visits.
RCNi Nurse Awards judge and London South Bank University professor of mental health science Patrick Callaghan says: ‘Geoff is a pioneering mental health nurse, embedded in clinical practice, research and leadership.
‘He has played a crucial role in Safewards, arguably the most important piece of research on mental health nursing by nurses in the past 30 years.
‘Together with Star Wards, Safewards has helped to transform mental health nursing practice, with a positive impact on service users in the UK and overseas.
‘Geoff Brennan continues to be the architect behind many of these developments.’
A culture built on mutual respect, communication and joint activities
Mr Brennan says both projects create ideas for ‘the human community’ of a ward – the staff and the patients – that help bring out the best in them without demanding huge funding or retraining.
‘Using our ideas, nurses and those they care for together create a culture built on mutual respect, good communication and joint activities, and recognise patients as positive agents with their own skills, ideas and experience.’
Ways you can improve your ward
Improving inpatient experience doesn’t require a huge investment of time or money, says Geoff Brennan.
‘In the small spaces of free time nurses have they can look at what the ward is like for patients.
‘Patients are away from their families and bored. We can do something about that as we are there in that space with them. Staff are full of ideas. It is about creating the environment where they can turn them into reality.’
Look at what you have and talk to patients
The first step, he says, is look at what you already have and talk to patients. ‘On my first ward, I wanted to make it better, so I asked the patients what they thought would improve it,’ Mr Brennan recalls.
‘I was expecting something dramatic but the answer was it would be nice if the Monopoly board had dice. They were right – the games were unusable and all the jigsaws had pieces missing.’
Look at your team’s interests – can you bring it into the ward?
If the service user likes gardening buy them some pots, he says. ‘You grow from the first small thing and start coming up with bigger ideas.
‘Look at your team’s interests – do you like gardening, photography? Can you bring it into the ward? Do you like films? – create a film night with popcorn.
‘One nurse who loved making jewellery got his trust to buy some materials. He shares those skills and patients make lovely jewellery for their parents and friends.
‘Access to animals and nature can make such a difference. Where a bird box has been successful, why not provide some bird books?’
Filling empty moments can have an amazing effect
One ward has created a popular bath night with donated bath products and relaxing lighting.
Mr Brennan recently learned of a ward that had replaced ‘as required’ PRN medication. ‘Instead of medication they were offering a selection of herbal teas.’
There is sometimes a mistaken belief that patients’ mental health rules out activities, he says. ‘For example we have been told that a photography group is impossible “because patients are too psychotic” but we know a trust where a mindful photography group has been really successful.’
Filling empty moments can have an amazing effect, he adds. ‘In one ward, a DJ looking for something to do walked around the ward asking people their favourite songs.
‘Nurses can create moments when people connect on a very human level and they stop being nurses and patients’
Geoff Brennan
‘When he played the playlist he had created, they all started to talk about why the song meant something.
‘The ward has to be a clinical space but nurses can create moments when people connect on a very human level and they stop being nurses and patients. It’s the sign of a good ward.
‘And whatever ideas nurses have, we can show them how to make them a reality – or introduce them to someone who has already done it. It helps make environments become more healing and therapeutic. It is what nurses want to do and it is where we really shine.’
Wards are ‘better’ with less aggression, seclusion and restraint, and more satisfaction, pride and fun
Every nurse can find something in the Safewards interventions and Star Wards projects that will change and improve their ward, he says, adding: ‘It is all within the nurse’s skill set.
‘And they make wards “better” with less aggression, seclusion and restraint and more satisfaction, pride and fun.
‘There are papers on their effectiveness from the UK, Australia and Denmark. Wards all over the world are enthused with what they offer.’
Ten interventions by Safewards
- Mutual expectations: staff and patients work together to agree acceptable conduct and display it on ward posters
- Soft words: ‘Message of the day’ posters and postcards give staff communication tips to avoid patient confrontations
- Talk down: different de-escalation techniques are displayed and role-modelled by a designated ‘Talk Down’ champion
- Positive words: during handovers, nurses use positive language about patients
- Bad news mitigation: proactively watch out for signs of distress and follow them up
- Know each other: create a folder of information about staff and patients to help build a therapeutic relationship and promote engagement
- Mutual help meetings: hold morning meetings of staff and patients, preferably daily, to build community and identify and resolve potential conflicts
- Calm down methods: have equipment to comfort agitated patients before ‘as required’ or PRN medication is offered
- Reassurance: discuss ward incidents openly with patients and reassure them to prevent anxiety and suspicion
- Discharge messages: give hope by displaying messages from discharged patients
Ask patients and staff what they want to change and for their ideas
Nurses commit to the projects, says Mr Brennan, because they have a positive appreciation of what they deliver, despite being under-resourced and under-valued.
‘Wards are difficult places, with people managing terrible internal battles – alien thoughts, overwhelming fear through believing people want to harm you, horrific flashbacks to abuse, strong feelings of shame, guilt and pain, powerful impulses to end it all,’ says Mr Brennan.
‘Many have risen above the challenges to create healing spaces inclusive for all – and these are the people we serve’
Geoff Brennan
‘But wards are also full of skills, compassion. Many have risen above the challenges to create healing spaces inclusive for all – and these are the people we serve.’
Star Wards will visit wards if requested. ‘There might be a problem, but we don’t tell people what to do,’ says Mr Brennan.
‘We ask the patients and staff what they want to change and for their ideas. We empower them so when we leave they continue to do it.’
Mr Brennan was nominated for the award by South West London and St George’s Mental Health NHS Trust head of nursing Catherine Gamble for being ‘a catalyst for change through inspiring, collecting and disseminating best practice in inpatient care’.
Ms Gamble, who is also RCN professional lead for mental health, says: ‘One minute Geoff can be in rural Northumberland sharing his expertise, the next he will be travelling the world disseminating these interventions.’
Mr Brennan is delighted and proud to be recognised, but stresses that any success is due to collaboration with other nurses and mental health staff, patients and experts by experience.
‘There have been so many who have inspired, helped and guided me’
‘Recognition from a profession I love is a huge thing,’ he says. ‘There have been so many who have inspired, helped and guided me.
‘I have worked extremely hard for a long time to make mental health wards better, in my own practice and when involved in the projects.
‘Patients deserve the best we can offer – so many of them have and continue to inspire me.
‘There are more challenges to face, more wards to reach, more nurses to enthuse, more patients to engage’
Geoff Brennan
‘But I cannot separate out my contribution to Star Wards and Safewards from the huge and inspirational team involved over the years.
‘It would be a bit like a single player accepting the FA Cup – I hope they can see it is their accolade.’
The award has further energised him. ‘There are more challenges to face, more wards to reach, more nurses to enthuse, more patients to engage. We can do even better for our patients. We are not finished yet.’
Positive and Safe Care Team’s ‘Talk 1st’ approach
A team from Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust was shortlisted for the mental health category of the RCNi Nurse Awards for its restraint reduction strategy ‘Talk 1st’.
Unaware of his own nomination, Geoff Brennan nominated the ‘phenomenal’ positive and safe care team.
Mr Brennan says team members have taken forward the ideas of Safewards and Star Wards over the trust’s 63 wards, with a challenging client group.
Unlocking local solutions to local issues
‘They get service users and carers involved in everything and have a fantastic ex-patient as part of their team,’ he says.
Some wards appoint patient leads to the core team that decides how the ward will try to reduce restraint.
Talk 1st, developed by two senior nurses, supports ward teams to develop their own restraint reduction strategies and share good practice with peers through cohort days with follow-up ward-based support.
‘They unlock local solutions to local issues,’ says Mr Brennan.
Best possible service user and carer experience
Positive and safe care team deputy director Ron Weddle says: ‘Talk 1st is introducing innovations that support the best possible service user and carer experience through promoting a person-centred and trauma-informed approach to restraint reduction.
‘Safewards interventions, Star Ward ideas and live data make up the core components of each ward’s unique action plan – a plan that is live and developing every day.’
Over the past two years this has seen reductions in the use of restraint by 23% and assaults on staff by 18%, with particular decreases in 2018 and 2019.
Prone restraint has reduced by 38%, seclusion by 35% and rapid tranquilisation injections by 37%.
Mr Weddle says the positive and safe care team was honoured to have been nominated, and that the nomination was by Mr Brennan ‘adds to the feeling of accomplishment’.
‘It is a positive affirmation of the efforts of thousands of nurses and other healthcare professionals across our organisation to reduce the use of restrictive interventions,’ says Mr Weddle.
‘The team has encouraged wards not to compare themselves with others but to use data to improve their own service in its unique context’
Ron Weddle
‘We still have some way to go – changing cultures is complex and requires long-term commitment.’
For Mr Brennan the team’s biggest challenge was how to lead without dictating solutions. ‘The cohort days mean small groups have been able to learn from each other while creating unique solutions to the issues they face.
Team encourages wards to use data to improve their own service in its unique context
‘From this the team has been able to create pockets of excellence in CAMHS [child and adolescent mental health services], forensic, learning disability, older adult, neurology and substance misuse services as well as general psychiatry.
‘Each specialty area is faced with complex idiosyncrasies as well as more general issues.
‘The team has encouraged wards not to compare themselves with others but to use data to improve their own service in its unique context.’
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