Safewards intervention refresher: Positive words

Background and aims
Background
At handover the focus is often on behaviour that is difficult or presents risks to the patient or others. Focusing on this behaviour may promote a negative perception of patients, rather than a balanced view of strengths and ways of working with a person. 

Aims
•	Balance the budget – know the strengths as well as the problems
•	Set an optimistic start to every shift
•	Change staff relationship assumptions
•	Even out the implied power and status differential

Safewards approach to handover
•	Balance the natural tendency to focus on issues and negative aspects of patient behaviour
•	Say something positive about each patient at handover
•	When difficult or disruptive behaviour is described, offer a possible psychological explanation  
•	Overall, promote a positive appreciation of patients to reduce the likelihood of further conflict
•	Refer to the document ‘Understanding unsafe and risky patient behaviours’ which can help in the construction of these psychological explanations

Task: How has using positive words changed your handovers?
Task: Positive words
Why did you come into your profession?  
Why are you still in your profession? 

Task: Understanding the function of the behaviour
What are some of the psychological explanations for the following:
•	aggression and violence
•	self-harm
•	manipulative behaviour
•	absconding
•	medication refusal

Task: How would you hand this over?
Using positive words how would you hand over these examples:

Positive words – long-term implementation
•	Aim for balanced communication to become part of professional communication
•	Renew by switching the focus of communication to other professionals (pharmacists, doctors, etc.)
•	Rotate the focus over longer time periods to reinforce the underlying impetus 
•	Consult with consumer groups or patients on the ward to expand and identify strengths and positive features of patients that staff can use in implementing this intervention
•	Discharge reviews with an external facilitator could identify strengths the ward staff missed.
Positive words fidelity
Positive words adjustments
CAMHS		None
Forensic		None
Older people		None, links to life story work, life 	story work applied to patient 	behaviours