Making Psychiatric Wards More Peaceful Places: Evaluating the Implementation of the Safewards Model in Acute Psychiatry Using a Pre–Post Mixed-Method Study Design

An analysis of the barriers and enablers to implementing the Safewards model within inpatient mental health services

“…Not all staff consented to Bower's study which increased this barrier. Staff declining to participate was also seen in Baumgardt et al (2020) due to participant identification codes not being 100% anonymous, a barrier to pre–post data matching. Manual data were also a design barrier where incorrect data entry and calculation can affect results and must be supported by two independent people (Baumgardt et al, 2020).…”

“…Studies reported on the two recommended tools: (a) fidelity checklist and (b) patient–staff conflict checklist (PCC). Barriers to the Safewards fidelity checklist were identified in several studies (Baumgardt et al, 2019, 2020; Bowers et al, 2015; Dickens et al, 2020). The most common barriers identified in these studies were that the tool only measures objective and visual evidence.…”

“…Staff turnover was identified as a barrier to Safewards implementation, this resulted in changes in leadership and staff participants (Baumgardt et al, 2019, 2020; Fletcher et al, 2017; Higgins et al, 2018; Lickiewicz et al, 2021). As well as turnover, lack of staff time for Safewards interventions was seen in the literature and was contributed to by ward acuity, staff shortages and limited professional experience (Baumgardt et al, 2019, 2020; Davies et al, 2020; Dawson, 2020; Fletcher et al, 2017, 2021; Lee et al, 2021; Palviainen et al, 2020; Yates & Lathlean, 2022). Time was also a barrier to the ability of staff to attend Safewards training (Fletcher et al, 2021; Higgins et al, 2018; Lee et al, 2021).…”

“…Palviainen was not able to determine whether service user non‐engagement was related to mental health or refusal. High acuity and turnover of service users were identified as a barrier to implementation (Baumgardt et al, 2020; Higgins et al, 2018; Lee et al, 2021). Price et al (2016) felt that service users should have been more involved in the implementation process.…”

“…Kipping summarized that engaging staff through co‐creation enhanced staff acceptance and adherence to Safewards. Good adherence to Safewards seems crucial and the fidelity checklist is a reliable tool for evaluating the quality and fidelity of eight interventions (Baumgardt et al, 2019, 2020). Extended fidelity monitoring in one study was attributed to their implementation success (Fletcher et al, 2017).…”