Safewards Bad News Mitigation Refresher Explanationinformation Role modelling

Safewards Bad News Mitigation Refresher

Explanation/information, Role modelling, Patient education, Removal of means, Presence & presence+ Staff Modifiers Denial of request, Staff demand, Limit setting, Bad news, Ignoring Flashpoints Staff anxiety & frustration, Moral commitments, Psychological understanding, Teamwork & consistency, Technical mastery, Positive appreciation Staff Modifiers A, , IC Rules, Routine, Efficiency, Clean/tidy, Ideology, Custom & practice Internal Structure Staff Team ics s s, ne c ti blo rs g rou tive ifie ckin erna od e, Che dy, Alt ff M isitiv & Ti Sta & inqu, Clean spect t oin de, shp litu Exit Fla ecy, Soshock, r Sec ission ked m Ad CONTAINMENT ork Anxiety management, Mutual support, Moral commitments, Psychological understanding, Technical mastery rist hy , Male, g cte p ed un ara ogra. , Abusall. s, Yo Ch em nhib s, H nt & d y/disi lusion tie Pa ptomsritabiliitght, De , Ir ns Symtraits sion, I s rs , PD re oia s, Dep an Par /drug Alc Patient Modifiers al f E r Ap ame xter pe wo n Re als, Prork, Natal Stru gul io s ato ecutionnal polcture ic s, ry Fra Hospitya, Comp la lp me w olicy ints, & sis ifie od erapy al analyns ff M coth ction entio Sta. Pharmya & fun& interv rap ort the upp cho g s ts Psy ursin N or al E sic t U Re ce ilan enan ices, PIC vig t n, cho gly Main sio nts rin Ca cor, es eclu poi Dé tur ity, S ture Fea plex , Liga om ooms , C t lity ory r en ua s , Q sen nm ked rt/ iro loc omfo nv C Do y Ph Leg Flashpoints Assembly/crowding/activity Queuing/waiting/noise Staff/pt turnover/change Bullying/stealing/ prop. damage oin s; y shp tion ntit Fla rba ide e c ce/ ty Exa nden everi s e ep ity/ Ind Acu CONFLICT C Fla Ad omp shp uls m o Co mp ission ory d ints l a tre int , App eten atm de ti e en nied al ref on, D t, E , En usa Ho ue p S t x pe l a it r f f , roc efu orce , Leg Infor ess, J f M sed d m o u Co itima atio stice dif nsi cy, n g , R ier ste e i nt Comp ving, spec s po licy ensa Supp t for , Fl tor ort righ exi y a bili uto to ap ts, p ty, n Re omy eal, spe , ct ie ctiv mil in e p y th volv rs ati era em en en t su py t pp F o l r Ba a t d n sh Los ew po s o s, H in acc f rela ome ts om tio cri Arg mod nship sis, um atio or en n, t Ou ito tsid De rs, Re pe e. H nd lative en osp cy s & f Str & i am ita e s nst i l itu ly ten sors tio na sions lisa tio , Pros n, De pecti ma ve Sta nd –ve Ca s& rer ff M /re ho move lat od me i F ve if a A Vis Patient Community Patient – patient interaction Contagion & discord

Background People can be affected greatly by unwelcome news, and may want to leave the unit to seek familiar support or escape the cause of the news. Being given no choice to leave the unit when distressed, people may express feelings in an unsafe way. Bad news from outside hospital can also cause conflict. Examples can include: death in the family, relationship breakdown, loss of tenancy, burglary, illness in the family, childcare issues, financial issues. The resulting distress can cause increased irritability, aggression, violent incidents and absconding

Bad news mitigation Receiving bad news can be common during an inpatient stay. This intervention is about providing support during the delivery of news or afterwards, to mitigate the risk of flashpoints. Key messages: • Bad news can create confusion and hinder understanding. Be respectful of a person’s views. • Being aware of occasions when people might get upsetting news. • Identify a proactive way to reach out to people before there is a reactive need to.

Bad news mitigation and the Safewards Model Staff modifier: Staff modifiers Mitigate bad news Patient modifiers Originating domains • Originating Outside hospital domains • Regulatory framework Flashpoint: Flashpoints receiving bad news Conflict Containment

Task: Bad news scenarios • What have you found helpful when working with people who have received bad news? • What has not been helpful? Why?

Bad News Mitigation in practice • Handover • Before news is delivered • After news is received • Ongoing support

Bad News Mitigation in practice Approach • Find a quiet place, give the person time to express their feelings. • Acknowledge their feelings, express empathy. • Answer any questions honestly, giving time, attention and respect. • Show you are receptive to concerns - use listening techniques. • Be responsive and respectful of a person’s views. • Support the person to understand decisions and acknowledge feelings. This can improve relationships and make aggression, self-harm and absconding less likely.

Delivering Bad News Video https: //www. youtube. com/watch? v=ju. KAMBh 9 J 54 Source: The Irish Hospice Foundation, Youtube

Role of the intervention lead Make sure these two questions are considered by the team at handover: 1. Has anyone received any bad news over the past shift? If they have, how can we support them? 2. Is anyone likely to receive bad news during the coming shift, and if so, how are we going to manage that?

Bad news mitigation fidelity Bad news mitigation IS NOT = ≠ • A proactive way to reach out to people before there is a reactive need to • Keeping staff aware and looking for occasions when people might get upsetting news and delivering emotional support quickly • Giving patients enough information so they can determine whether it’s bad news or not • A way of protecting patients from life or threatening them with consequences or assuming how they will feel • Attaching the phrase ‘I am sorry to let you know’ when we tell patients they cannot have something they desperately want

Bad news mitigation adjustments CAMHS None, but understanding for meaning and relevance to age group Forensic None Older people None, but understanding for meaning and relevance to age group