Niall Higgins1, Thomas Meehan2, Nathan Dart3, Michael Kilshaw4, Lisa Fawcett3. 1. Queensland University of Technology, Kelvin Grove, Australia; Royal Brisbane and Women's Hospital, Metro North Mental Health, Herston, Australia. Electronic address: n.higgins@qut.edu.au. 2. West Moreton Hospital and Health Service, Ipswich, Australia; The University of Queensland, Herston, Australia. 3. Royal Brisbane and Women's Hospital, Metro North Mental Health, Herston, Australia. 4. The Prince Charles Hospital, Metro North Mental Health, Chermside, Australia.
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. Crown
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. Crown
Authors: Johanna Baumgardt; Dorothea Jäckel; Heike Helber-Böhlen; Nicole Stiehm; Karin Morgenstern; Andre Voigt; Enrico Schöppe; Ann-Kathrin Mc Cutcheon; Edwin Emilio Velasquez Lecca; Michael Löhr; Michael Schulz; Andreas Bechdolf; Stefan Weinmann Journal: Front Psychiatry Date: 2019-05-24 Impact factor: 4.157