Security Competencies:1. Physical Procedural & Relational Security

2. Searching People & Spaces

© Training Innovations Ltd 2014

Last updated: 07.07.15

Candidates will cover:

• Guiding literature including ‘SEE, THINK, ACT’, Department of Health (DoH), and

• National Institute for Clinical Excellence (NICE) guidance• Key concepts in relation to searching people, spaces and property• Observing & Escorting Patients• Legal, ethical and risk perspectives, including searching with or

without consent• Systemic searching of people, spaces and property• Creating and maintaining sterile area for people who have been

searched• Documentation, pro-forma and record keeping in relation to search

procedure

By the end of the course Candidates will be able to:

• Comprehend the legal, ethical and risk considerations when carrying out searches

• Understand and deploy search procedures for people, spaces and property

• Complete and maintain all local search pro forma and records in accordance with local policy

• Course Criteria: PASS/FAIL

Assessment

• Part 1 Course Criteria: PASS/FAIL• You will be assessed on your professional

attitude and ability to confidently and competently undertake search procedures

• Part 2: Written Workbook

Definition & Context

• Security: the state of being free from danger or threat (dictionary definition)

• Secure clinical environments are tasked with providing detention and treatment of patients who have more often than not have a criminal convictions and are detained under the Mental Health Act and have

• Complex needs and present risks and challenges

Historical

• Until very recently secure clinical environments have focussed largely on containment over care and recovery

• Reliant on ‘Experience’, ‘Incident’ or ‘Inquiry-based practice’ (see Nursing in Secure Environments, UKCC, 1999)

• Large asylums have all but closed,• a growing number of purpose built, hospitals or

units developed, especially in the private sector

Striking a Balance!?!

• Containment versus Care• Reactive versus Proactive Practice

Types of Security

• Relational• Physical• Procedural

Relational Security

• What is relational security?• ‘the balance between intrusiveness and openness;

trust between patients and professionals’• ‘the staff-to-patient ratio and amount of time spent

in face-to-face contact’• “Relational security 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”.

Relational Security

• Secure mental health settings are complex and they place unique demands on staff. We expect staff to manage serious risks and maintain the right balance between care and security.

• All health services carry risk, but when a serious incident occurs in a secure mental health service, it can have devastating consequences.

• How much would this cost?• When these types of incidents have happened in

services, they have often been found to be rooted in poor ‘relational security’

Situation Awareness

• “being aware of what is happening around you to understand how information, events, and your own actions will impact your goals and objectives, both now and in the near future”

• “knowing what is going on so you can figure out what to do”

• High information flow where decisions can have serious consequences

SEE THINK ACT

Physical Security

• Describes security measures that are designed to deny unauthorized access to facilities, equipment and resources, and to protect personnel and property from damage or harm (such as espionage, theft, or terrorist attacks).

• Physical security involves the use of multiple layers of interdependent systems which include CCTV surveillance, security guards, protective barriers, locks, access control protocols, and many other techniques.

Physical Security

• Deterrents: physical barriers, natural surveillance, security lighting

• Intrusion detection & Electronic Surveillance: alarm systems and sensors, video surveillance

• Access Control: mechanical & electronic control systems

• Identification systems and access policies• Security personnel

Procedural Security

• Procedural security controls are security controls that mitigate identified risks by way of policies, procedures or guidelines. As opposed to other controls, procedural controls rely on users to follow rules or perform certain steps that are not necessarily enforced by technical or physical means.

Procedural Security

• Systemic, Operational and Strategic Policy guidance on practice which outline, authority, roles responsibilities of organisation and staff in relation to safety and security

• Compliance assurance with governmental, legal and professional standards

• Control, Prevention, Contingency, Review, Reporting and Emergency Management Systems

• Regular staff training

Purpose

• Relational, Physical & Procedural Security interventions may have elements of:

• Prevention• Detection• Correction

Searching People & Spaces

• Can be a contentious issues and problematic with detained patients

• Sensitivity around Human Rights: Article 3 - Prohibition of inhuman or degrading treatment

• May re-traumatise patients who have been previously abused

• May inflame litigious patients, delusional or paranoid patients

• May cause heightened anxiety or arousal

Exercise

• Lets imagine you are a patient on a ward at Glenhurst. The staff have informed you that they are going to conduct personal and room searches.

• Discuss your thoughts and feelings as a patients, BEFORE, DURING and AFTER the searches.

Searching People & Spaces

• The National Institute for Health and Clinical Excellence (NICE) both recognise that the undertaking of necessary and lawful searches of both patients and visitors can make an important contribution to the effective management of aggression and violence.

• Provisions are made for searching patients and their property both in the Mental Health Act and the Code of practice which specify that providers must have relevant policies and procedures

• There must be a lawful reason!• Both routine and when required

Searching People & Spaces

• It is important not to take the decision in isolation• Assess all information at hand• Discuss and plan before implementation• Identify: roles (searcher; observer/ recorder), sterile

area, documentation, debriefing and reporting• Established that the patient has capacity and

consent has been sought or that pressing reasons exist for the search to take place immediately without consent.

Personal Searches

• Keep in mind:• Who should conduct the search?• Safety (PPE)• Systematic procedure• Clarity in Communication• Engage to occupy• Maintain Respect & Dignity• Prompt Self-searching

Exercises

• The Night Club Search• The ‘PAT Down’ search• Body Map• Commonly used hiding places• Common mistakes

Further Action?

• Removed Clothing Searching• Searching Intimate Areas/ Cavity Searches• Again advice must be sought from other

professionals primarily RC• Patient Support• Documentation• Alerting other agencies

Searching Spaces

• Different systems and considerations:• Creating a Sterile area• Sectors and quadrants• Clockwise/ Anticlockwise• Dismantling objects/ electrical items• Using room maps• Checking property lists/ ‘Volumatic’ controls• Hazards?

Pitfalls

• Staffing• Interruptions and distractions• Fatigue• Object/ goal blindness• Information & Task Drift• Patient resistance

Again, Keep in mind

• Who should conduct the search?• Safety: PPE• Systematic procedure• Clarity in Communication• Maintain Respect & Dignity• Observe patient for anxiety • Documentation & Reporting• Prompt Self-searching

Escorting Patients

• How do search procedures impact upon patient escorts?

Learning Action Plan

• Complete Workbooks• Consult relevant policies• Change in practice• Storage and volumatic control • Patients counting cutlery supervision• More proactive rather than reactive• Written procedure• Documentation