Implementation of the Safewards model in public mental health facilities: A qualitative evaluation of staff perceptions

Higgins, Niall; Meehan, Tom; Dart, Nathan; Kilshaw, Michael; Fawcett, Lisa

doi:10.1016/j.ijnurstu.2018.08.008

Cited by 41 publications

(158 citation statements)

References 24 publications

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“…The fact that results regarding frequency and duration of coercive measures differ substantially between wards underlines these aspects. This phenomenon is well-known from previous reports where engagement with the Safewards Model varies between wards and even within wards (2). Reasons discussed for those differences on the level of wards are number, education, resilience, professional self-conception, professional experience, stress level, and personality of employees (59).…”

Section: Discussionsupporting

confidence: 65%

“…Managing conflict and violent situations such as self-harm, drug abuse, physical aggression, verbal abuse, or aggressive behavior towards others is part of acute inpatient psychiatric care. It has become a major focus for staff interventions in such units (1, 2). Coercive interventions are often used to contain such situations, even though they may cause harm to patients and staff (3).…”

Section: Introductionmentioning

confidence: 99%

“…There are promising research findings indicating a positive effect of the Safewards Model on conflict and containment in acute inpatient units in English-speaking countries (2, 32, 33). For example, a large-scale randomized controlled trial in the United Kingdom found a reduction in conflict by 15% and a reduction in containment by 25% in intervention versus control wards (34).…”

Section: Introductionmentioning

confidence: 99%

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Preventing and Reducing Coercive Measures—An Evaluation of the Implementation of the Safewards Model in Two Locked Wards in Germany

et al. 2019

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Introduction Aggression and violence are highly complex problems in acute psychiatry that often lead to the coercive interventions. The Safewards Model is an evidence-informed conflict-reduction strategy to prevent and reduce such incidents. The aim of this study was to evaluate the implementation of this model with regard to coercive interventions in inpatient care. Materials and Methods We evaluated outcomes of the implementation of the Safewards Model in two locked psychiatric wards in Germany. Frequency and duration of coercive interventions applied during a period of 11 weeks before and 11 weeks after the implementation period were assessed through routine data. Fidelity to the Safewards Model was assessed by the Organization Fidelity Checklist. Results Fidelity to the Safewards Model was high in both wards. The overall use of coercive measures differed significantly between wards [case-wise: χ 2 (1, n = 250) = 35.34, p ≤ 0.001; patient-wise: χ 2 (1, n = 103) = 21.45, p ≤ 0.001] and decreased post-implementation. In one ward, the number of patients exposed to coercive interventions in relation to the overall number of Patients decreased significantly [χ 2 (1, 281) = 6.40, p = 0.01]. Furthermore, the mean duration of coercive interventions overall declined significantly [ U (55,21) = −2.142, p = 0.032] with an effect size of Cohen’s d = −0.282 (95% CI: −0.787, 0.222) in that ward. Both aspects declined as well in the other ward, but not significantly. Discussion Results indicate that the implementation of the Safewards interventions according to the model in acute psychiatric care can reduce coercive measures. They also show the role of enabling factors as well as of obstacles for the implementation process.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preventing and Reducing Coercive Measures—An Evaluation of the Implementation of the Safewards Model in Two Locked Wards in Germany

et al. 2019

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“…Many of these components were recommended by patients included in the reviewed studies and/or identified as factors that improved their experience of detention. Difficulties implementing the safewards model have, however, included high staff turnover, 87 which patients in this review also highlighted as a barrier to building trusting relationships.…”

Section: Discussionmentioning

confidence: 98%

Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis

et al. 2019

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Background Understanding patient experiences of detention under mental health legislation is crucial to efforts to reform policy and practice. Aims To synthesise qualitative evidence on patients' experiences of assessment and detention under mental health legislation. Method Five bibliographic databases were searched, supplemented by reference list screening and citation tracking. Studies were included if they reported on patient experiences of assessment or detention under mental health legislation; reported on patients aged 18 years or older; collected data using qualitative methods; and were reported in peer-reviewed journals. Findings were analysed and synthesised using thematic synthesis. Results The review included 56 papers. Themes were generally consistent across studies and related to information and involvement in care, the environment and relationships with staff, as well as the impact of detention on feelings of self-worth and emotional state. The emotional impact of detention and views of its appropriateness varied, but a frequent theme was fear and distress during detention, including in relation to the use of force and restraint. Where staff were perceived as striving to form caring and collaborative relationships with patients despite the coercive nature of treatment, and when clear information was delivered, the negative impact of involuntary care seemed to be reduced. Conclusions Findings suggest that involuntary in-patient care is often frightening and distressing, but certain factors were identified that can help reduce negative experiences. Coproduction models may be fruitful in developing new ways of working on in-patient wards that provide more voice to patients and staff, and physical and social environments that are more conducive to recovery. Declaration of interest None.

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“…A further two evaluated the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) programme268 269 and both found significant clinical benefits in reducing seclusion and improving team functioning. One paper looked at the barriers and facilitators to implementing a Safewards intervention 270. With regard to policy, eight studies concerned safety policies related to: observation,271 272 risk assessment,273 274 treatment,275 safeguarding,276 security277 and ergonomic improvement 278.…”

Section: Resultsmentioning

confidence: 99%

Patient safety in inpatient mental health settings: a systematic review

et al. 2019

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ObjectivesPatients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology.DesignSystematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to ‘mental health’, ‘patient safety’, ‘inpatient setting’ and ‘research’. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model.ResultsOf the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control.ConclusionsPatient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice.PROSPERO registration numberCRD42016034057.

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Implementation of the Safewards model in public mental health facilities: A qualitative evaluation of staff perceptions

Cited by 41 publications

References 24 publications

Preventing and Reducing Coercive Measures—An Evaluation of the Implementation of the Safewards Model in Two Locked Wards in Germany

Preventing and Reducing Coercive Measures—An Evaluation of the Implementation of the Safewards Model in Two Locked Wards in Germany

Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis

Patient safety in inpatient mental health settings: a systematic review

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