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

Journal article


Niall Higgins, Thomas Meehan, Nathan Dart, Michael Kilshaw and Lisa Fawcett. (2018). Implementation of the Safewards model in public mental health facilities: A qualitative evaluation of staff perceptions. International Journal of Nursing Studies. 88, pp. 114-120. https://doi.org/10.1016/j.ijnurstu.2018.08.008
AuthorsNiall Higgins, Thomas Meehan, Nathan Dart, Michael Kilshaw and Lisa Fawcett
Abstract

Background
The Safewards model is gaining increasing acceptance in the mental health field in Australia and overseas. One of the most important goals of inpatient psychiatric services is to provide a safe and therapeutic environment for both patients and staff. However, this goal can be difficult to achieve if staff-patient interaction is not conducive to preventing violence and aggression.

Objective
The purpose of this study was to explore nursing staff perceptions of the factors impacting on their capacity to establish Safewards in acute adult inpatient wards.

Design
This study was guided by a phenomenological approach to develop a rich understanding of staff perceptions using semi-structured interviews.

Setting and sample
The setting was three acute mental health wards attached to general hospitals; one in a large provincial hospital and two in metropolitan hospitals in south-east Queensland. Interview participants were a purposive sample of fifteen registered nurses across each of the three wards.

Method
Semi-structured interviews were conducted at 12 months post-implementation of Safewards. The study was underpinned by Michie’s integrative framework of behaviour change that helped identify target areas in order to enhance successful implementation of this model.

Results
Content analysis of interview transcripts highlighted a range of factors including failure to address the difficulties encountered by some staff in engaging with Safewards interventions, lack of support from management, poor use of nurse educator time, the ‘language’ of Safewards, high acuity on the study wards, and staff and patient turnover.

Conclusion
This study highlights some difficulties with implementing Safewards and maintaining fidelity of the Safewards interventions in busy acute inpatient wards. Although these findings are from a qualitative study consisting of only 15 staff, our results indicate that efforts to implement Safewards need to address challenges faced by staff in engaging with the interventions, ensure buy-in from management, ensure adequate training and support during implementation and review training materials to ensure they fit with the local (i.e. Australian) context. Safewards provides an opportunity for a change in attitudes and development of a more therapeutic ward environment.

KeywordsSafewards; implementation; staff perceptions; mental health nursing
Year2018
JournalInternational Journal of Nursing Studies
Journal citation88, pp. 114-120
PublisherElsevier Ltd
ISSN0020-7489
Digital Object Identifier (DOI)https://doi.org/10.1016/j.ijnurstu.2018.08.008
Scopus EID2-s2.0-85053483050
Publisher's version
File Access Level
Controlled
Publication process dates
Deposited11 May 2021
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