The Egagemet Model ad its implemetatio Ja Sitvast, PhD, MA, RN, lecturer at Uiversity of Applied Scieces Hogeschool Utrecht Maikel Haket, urse practitioer (studet)
AIMS Report o the Egagemet Model ad how it has bee implemeted o acute wards of a metal health care hospital i the cotext of efforts aimed at reducig seclusio ad restrait
What is Egagemet? The Egagemet model teaches caregivers how to egage i cotact with cliets i such a way that patiets experiece safety, warmth, trust ad hospitality. This furthers a active ivolvemet betwee cliets, family ad caregivers.
Visio of GGNet (a provider of metal health services i the Easter provice of The Netherlads) stregtheig cliet s resiliece must play a cetral role i treatmet ad support. the use of seclusio ad restrait may be cosidered at odds with stregtheig cliets resiliece 2016 Ambitio: abolishig seclusio i 5 years time
Ispiratio The Egagemet Model is based o the exemplary work of Murphy ad Beigto- Davies (2005) who reformed metal health services i e.g. Salem Hospital, Orgeo. Kevi A Huckshor s six core strategies for reducig seclusio ad restrait (2005)
Priciples of the Egagemet Model Offerig a safe ad hospitable eviromet Havig attetio for the impact of stressful evets whe patiets are take i A approach ad way of workig that gives priority to collaboratio with the cliet. The cotact must be based o equivalece Utilisig experietial expertise Ispirig leadership
What does this mea i practice? Make use of experietial expertise of cliets Actively ivolve family recogizig that they form parters i a treatmet triad Experieces of traumatizatio i the past are give due attetio The ward must be a healig eviromet The ward must have facilities to reduce tesio whe cliets are harassed by icreasig agitatio, for istace a comfort room The seclusio room becomes a retreat
Features of Trauma Iformed Care Iclude perspective of the cliet Recogize that coercive iteractios cause retraumatizatio Realize that metal health settigs ofte are coercive overtly ad covertly Recogize that most metal health staff are uiformed about the effects of trauma
Welcomig Admissio process as a opportuity for egagemet Cosider the circumstaces Offer ameities Early egagemet TAKES time Early egagemet SAVES time
Risk Assessmet History of triggerig evets What happeed to you Bloom, 1997
Risk Assessmet History of violece ad trauma History of exposure to childhood abuse History of seclusio or restrait History of stigmatizatio History of forced hospitalizatio or medicatio History of catastrophic medicatio side effects
A Healig Eviromet Starbucks approach to physical space Cliets otice whe staff are t there People otice whe staff members treat oe aother well It is the relatioship that heals
Alteratives to Coercio Empathy Hope Commuity Expectatios Respect Compassio Service Skillful predictio, early idetificatio ad prevetio
Becomig Healers Trauma-iformed Less coercio meas more time for therapy The relatioship is healig for everyoe Whe hope is preset, egagemet begis
How we set about Expert pael of professioals is asked to discuss a cocept referece text cocerig the Egagemet Model The referece text was adjusted ad fie-tued i a couple of rouds of discussio ad dialogue Operatioalisatio of 12 factors ito cocrete strategies ad directives Desigig a uiform set of criteria o a 5-poits scale for assessig model fidelity Progress of implemetatio was moitored i a PDCA-cycle (Pla-Do-Check-Act) of improvig care
All 12 factors Orgaisatio ad maagemet 1. Trasparet ad coheret visio 2. Committed ad ethousiast leadership 3. Visibility ad availability of data 4. Deploymet of experietial experts Expertise ad staff attitude 5. Implemetatio of the best practice The First Five Miutes 6. Trauma-iformed treatmet 7. Hospitality ad cliët approach 8. Motivatioal iterviewig techiques 9. Cotiuous team reflectio Housig 10. Comfort rooms 11. Healig eviromet, atmosphere, warmth 12. Family participatio
Research ito the implemetatio process 2010-2017 Apart from measurig the progress of implemetatio we measured the effect of Egagemet o rates of seclusio ad restrait. I what ways did actios udertake i implemetig the Egagemet Model cotribute to a reductio of rates of seclusio ad restrait?
Ackowledgemet A umber of slides are copied from a Power Poit Presetatio by Maggie Beigto- Davies, MD
Implemetatio Egagemetmodel Maikel Haket The HU Uiversity of Applied Scieces Utrecht
Itroductio Bachelor of Nursig GGNet: Itesive Care Uit, Warsveld, The Netherlads, 2009-2014 20 beds (6 HIC beds) Staff: 4 4-2 >2010 Expert Nurse ad traier agressio maagemet The HU Uiversity of Applied Scieces Utrecht: Nurse Practioer i traiig metal health, 2017-2019
Egagemetmodel Mai goal: abolishig seclusio! 1 Havig a clear ad vissible visio 2 Orgaisatio ad Egaged ad ethusiastic leadership 3 maagemet Visibility of digits 4 Use experietial expertise 5 1 st 5 miutes-model 6 Trauma-iformed 7 Kowledge ad Hospitality 8 attitude employees Traiig of employees 9 Reflectio (coachig, itervisio, traiig) 10 Family participatio 11 Comfortrooms Housig 12 Healig eviromet
Comfortroom
Housig
Kowledge ad attitude Traiig, coachig, traiig, coachig 1st 5 miutes The call Hospitality, service Participatio of family ad frieds PTSD Cotact: stress maagemet, verbal skills ad self-defese techiques
Maagemet Visio Leadership Digits, mothly results
Results More satisfied patiets More satisfied staff More relaxed atmosphere to recover ad work Less agressive icidets Less use of seclusio rooms (umber of patiets ad hours)
Difficulties ad challeges Temporary psychiatrists (kowledge, takig risks, resposability) Resistace amog ursig staff (fear, here we go agai) Not everyoe is suitable for this work Droppig out of experiece experts (lack of educatio, relaps) Leadership (succes could ot be maitaied) Moey