Evaluating the Introduction of the Safewards Model to a Medium- to Long-Term Forensic Mental Health Ward

Maguire, Tessa; Ryan, Jo; Fullam, Rachael; McKenna, Brian

doi:10.1097/jfn.0000000000000215

Cited by 27 publications

(139 citation statements)

References 23 publications

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“…Participants overall reported feeling safer, and participants who rated the model and interventions as excellent reported one of the key changes was that the ward felt calmer, which led to them feeling safer. This finding concurs with reports of consumers from a forensic mental health ward who stated that the ward was calmer and they felt safer after the implementation of Safewards (19).…”

Section: Discussionsupporting

confidence: 89%

“…Respect from staff for participants and between the consumers was important in the feedback provided and mirrors the findings of Maguire et al (19), who reported that both consumers and staff felt increased respect between the two groups (30). Participants in our study reported that Clear Mutual Expectations and the Mutual Help Meetings played a part in increasing the feeling of respect from staff for participants.…”

Section: Discussionsupporting

confidence: 74%

“…Subsequent evaluation of Safewards in Australia and internationally has reported mixed success. Maguire and colleagues (19) reported high implementation fidelity and fewer conflict events alongside improved ward atmosphere in a forensic mental health ward in Australia. Their study gathered consumer and staff perspectives regarding Safewards during fidelity checks, highlighting positive practice change, enhanced safety and more respectful relationships.…”

Section: Introductionmentioning

confidence: 99%

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Consumer Perspectives of Safewards Impact in Acute Inpatient Mental Health Wards in Victoria, Australia

et al. 2019

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Background: Inpatient mental health wards are reported by many consumers to be custodial, unsafe, and lacking in therapeutic relationships. These consumer experiences are concerning, given international policy directives requiring recovery-oriented practice. Safewards is both a model and a suite of interventions designed to improve safety for consumers and staff. Positive results in reducing seclusion have been reported. However, the voice of consumers has been absent from the literature regarding Safewards in practice. Aim: To describe the impact of Safewards on consumer experiences of inpatient mental health services. Method: A postintervention survey was conducted with 72 consumers in 10 inpatient mental health wards 9–12 months after Safewards was implemented. Results: Quantitative data showed that participants felt more positive about their experience of an inpatient unit, safer, and more connected with nursing staff. Participants reported that the impact of verbal and physical aggression had reduced because of Safewards. Qualitatively, participants reported increased respect, hope, sense of community, and safety and reduced feelings of isolation. Some participants raised concerns about the language and intention of some interventions being condescending. Discussion: Consumers’ responses to Safewards were positive, highlighting numerous improvements of importance to consumers since its implementation across a range of ward types. The findings suggest that Safewards offers a pathway to reducing restrictive interventions and enables a move toward recovery-oriented practice.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

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Consumer Perspectives of Safewards Impact in Acute Inpatient Mental Health Wards in Victoria, Australia

et al. 2019

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“…Problems with implementation have included low adherence (fidelity) and lack of staff acceptance of the model (33, 34). This contrasts with high fidelity to the model in some settings, resulting in reduction in conflict events (35) and reduction in the use of forced sedation (36). Hence, high fidelity to the model is important to its outcomes.…”

Section: Introductionmentioning

confidence: 99%

Safewards Impact in Inpatient Mental Health Units in Victoria, Australia: Staff Perspectives

et al. 2019

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Introduction: Mental health professionals working in acute inpatient mental health wards are involved in a complex interplay between an espoused commitment by government and organizational policy to be recovery-oriented and a persistent culture of risk management and tolerance of restrictive practices. This tension is overlain on their own professional drive to deliver person-centered care and the challenging environment of inpatient wards. Safewards is designed to reduce conflict and containment through the implementation of 10 interventions that serve to improve the relationship between staff and consumers. The aim of the current study was to understand the impact of Safewards from the perspectives of the staff. Methods: One hundred and three staff from 14 inpatient mental health wards completed a survey 12 months after the implementation of Safewards. Staff represented four service settings: adolescent, adult, and aged acute and secure extended care units. Results: Quantitative results from the survey indicate that staff believed there to be a reduction in physical and verbal aggression since the introduction of Safewards. Staff were more positive about being part of the ward and felt safer and more connected with consumers. Qualitative data highlight four key themes regarding the model and interventions: structured and relevant; conflict prevention and reducing restrictive practices; ward culture change; and promotes recovery principles. Discussion: This study found that from the perspective of staff, Safewards contributes to a reduction in conflict events and is an acceptable practice change intervention. Staff perspectives concur with those of consumers regarding an equalizing of staff consumer relationships and the promotion of more recovery-oriented care in acute inpatient mental health services.

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“…One such programme is the Safewards model, providing 10 interrelated interventions (Bowers 2014;Bowers et al 2014). Although several studies on Safewards showed significant reductions in conflict events, no cost-effective studies were performed (Bowers et al 2015;Fletcher et al 2017;Maguire et al 2018;Baumgardt et al 2019). Depending on the available staff capacity, costs in terms of money and budget may be smaller or larger than the costs we estimated in this analysis.…”

Section: Discussionmentioning

confidence: 93%

The incidence and economic impact of aggression in closed long-stay psychiatric wards

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Hazewinkel

Bogers

et al. 2020

International Journal of Psychiatry in Clinical Practice

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Objective: Aggressive behaviour is highly prevalent in long-term psychiatric inpatient care. We aimed to estimate the overall incidence of aggression, the time staff took to handle aggression incidents, and the weighted average financial costs thereof. Methods: A random sampling procedure was conducted at long-term psychiatric inpatient care facilities. Nurses were asked to recall all incidents (i.e., verbal, physical towards objects, self, or others) of their shift. For the time spent on each type of incident, staff were monitored in real-time. Estimated costs were calculated by the time spent multiplied by hourly wages in addition to material-related costs. Results: Incidence rates were 90 incidents per patient year. The average time spent per incident was 125 min but differed for each type of incident. Almost 80% of this time was consumed by nursing staff. The average cost per aggression incident was e78; extrapolated per patient year, the total costs were approximately e7000. Conclusions: The current study found a high rate of aggression incidents in closed long-stay psychiatric wards. Reports of aggression on these types of wards are scarce. Nevertheless, aggression seems to have a severe impact on invested time and related costs, which suggests a need for aggression-prevention and de-escalating programs. KEY POINTS Aggression incidents are highly prevalent and are accompanied by high costs. The effect of aggression incidents on the workload for staff members is high, especially for nursing staff. Studies across countries on the incidence and the costs of aggression among psychiatric inpatients are needed to help model the effects of (new) strategies for aggression reduction.

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Evaluating the Introduction of the Safewards Model to a Medium- to Long-Term Forensic Mental Health Ward

Cited by 27 publications

References 23 publications

Consumer Perspectives of Safewards Impact in Acute Inpatient Mental Health Wards in Victoria, Australia

Consumer Perspectives of Safewards Impact in Acute Inpatient Mental Health Wards in Victoria, Australia

Safewards Impact in Inpatient Mental Health Units in Victoria, Australia: Staff Perspectives

The incidence and economic impact of aggression in closed long-stay psychiatric wards

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