Taking the action to seclude patients in Forensic Services can have a traumatic effect on both staff and patients.
Whilst in some cases, this may be necessary to maintain levels of safety for other patients and the clinical team, seclusion brings with it some degree of stigma for the patient and can significantly damage the overall therapeutic relationship.
Harry Tupsy, Ward Manager of Fir Ward , at The Chichester Centre a Low Secure Unit within Sussex Partnership NHS Foundation Trust, was determined to look into the practice of using seclusion as an intervention in the management of violence, with a view to developing strategies that would lead to a reduction in seclusion episodes.
Harry, along with the multi-disciplinary team, looked at various situations that could potentially lead to an episode of seclusion within the context of ‘Relational Security’ – that is, the knowledge and understanding staff have of a patient and of the environment; and the translation of that information into appropriate responses and care. From this, he arrived at some key interventions that would become part of Fir Ward’s philosophy and clinical functioning.
Examples included making one-to-one time with patients more effective and involving greater liaison with multi-disciplinary colleagues. Harry was also keen to ensure that there were many opportunities for communication, including frequent supervision and employing reflective practice to encourage continuing improvements.
Training, particularly in the areas of de-escalation and conflict management, was set in motion as was building a greater understanding of attachment theory and boundaries.
Other improvements included improving the clinical environment, making sure assessment was a team exercise and developing collaborative care planning designed around the needs of the patient. Some of the more subtle, intuitive areas of intervention included what Harry calls “noticing the small stuff” such as noticing small changes in patient routine and behaviour.
Gary Davies-Ebsworth, Nurse Consultant, Secure and Forensic Services, who put forward the nomination said: “Harry is a very committed individual who often goes beyond what is required of his role to improve the care of patients on Fir Ward. He is frequently seen on the unit beyond his hours of duty, by doing so showing that he demonstrates the 6Cs in areas such as Care, Commitment, and Compassion and leads his team to improve and maintain high standards of care.
Harry has demonstrated courage in his challenge of the traditional beliefs around the use of seclusion in secure services and to put this challenge to the Service Leadership Team in the form of a thought provoking presentation called Less is More”.
The outcome of Harry’s work has been shared with the wider care group and further discussions have taken with colleagues at the Service’s academic meeting in early August.
Gary added: “The improvements Harry has put in place are making a significant improvement in our practice within this area. Less seclusion equals fewer traumas and reduced damage to therapeutic relationships. It also has the potential to save on the need for additional staffing in avoided seclusion episodes.
Harry has demonstrated the value of the 6Cs within this a process and in particular how effective communication can make such a difference and an improvement in patient care and experience.”
Marie Batey, Head of Acute and Lead for Compassion in Practice, said: “Nursing in Forensic Services presents its own unique challenges. Having reviewed the work Harry has undertaken, which is making real change and uncovering useful insights into patient care, it is clear that they have had a measurable impact on reducing the need to seclude patients from care, while ensuring their safety and dignity is protected.
This is a case of Harry putting the patient at the centre of care, showing he had the compassion and courage to implement change, while making sure everyone is involved and understands what those changes mean. These attributes certainly embody the 6Cs approach have delivered tangible and sustainable improvements for patients and the multi-disciplinary team.”