9
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Safewards: the empirical basis of the model and a critical appraisal

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Accessible summary
          • In the previous paper we described a model explaining differences in rates of conflict and containment between wards, grouping causal factors into six domains: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework.

          • This paper reviews and evaluates the evidence for the model from previously published research.

          • The model is supported, but the evidence is not very strong. More research using more rigorous methods is required in order to confirm or improve this model.

          Abstract

          In a previous paper, we described a proposed model explaining differences in rates of conflict (aggression, absconding, self-harm, etc.) and containment (seclusion, special observation, manual restraint, etc.). The Safewards Model identified six originating domains as sources of conflict and containment: the patient community, patient characteristics, the regulatory framework, the staff team, the physical environment, and outside hospital. In this paper, we assemble the evidence underpinning the inclusion of these six domains, drawing upon a wide ranging review of the literature across all conflict and containment items; our own programme of research; and reasoned thinking. There is good evidence that the six domains are important in conflict and containment generation. Specific claims about single items within those domains are more difficult to support with convincing evidence, although the weight of evidence does vary between items and between different types of conflict behaviour or containment method. The Safewards Model is supported by the evidence, but that evidence is not particularly strong. There is a dearth of rigorous outcome studies and trials in this area, and an excess of descriptive studies. The model allows the generation of a number of different interventions in order to reduce rates of conflict and containment, and properly conducted trials are now needed to test its validity.

          Related collections

          Most cited references75

          • Record: found
          • Abstract: found
          • Article: not found

          Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial.

          There is a lack of research on the possible contribution of a structured risk assessment to the reduction of aggression in psychiatric in-patient care. To assess whether such risk assessments decrease the incidence of violence and coercion. A cluster randomised controlled trial was conducted with 14 acute psychiatric admission wards as the units of randomisation, including a preference arm. The intervention comprised a standardised risk assessment following admission with mandatory evaluation of prevention in high-risk patients. Incidence rates decreased substantially in the intervention wards, whereas little change occurred in the control wards. The adjusted risk ratios suggest a 41% reduction in severe aggressive incidents and a 27% decline in the use of coercive measures. The severity of aggressive incidents did not decrease. Structured risk assessment during the first days of treatment may contribute to reduced violence and coercion in acute psychiatric wards.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Identifying key factors associated with aggression on acute inpatient psychiatric wards.

            Aggressive behaviour is a critical issue for modern acute psychiatric services, not just because of the adverse impact it has on patients and staff, but also because it puts a financial strain on service providers. The aim of this study was to assess the relationship of patient violence to other variables: patient characteristics, features of the service and physical environment, patient routines, staff factors, the use of containment methods, and other patient behaviours. A multivariate cross sectional design was utilised. Data were collected for a six month period on 136 acute psychiatric wards in 26 NHS Trusts in England. Multilevel modelling was conducted to ascertain those factors most strongly associated with verbal aggression, aggression toward objects, and physical aggression against others. High levels of aggression were associated with a high proportion of patients formally detained under mental health legislation, high patient turnover, alcohol use by patients, ward doors being locked, and higher staffing numbers (especially qualified nurses). The findings suggest that the imposition of restrictions on patients exacerbates the problem of violence, and that alcohol management strategies may be a productive intervention. Insufficient evidence is available to draw conclusions about the nature of the link between staffing numbers and violence.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Self-harm and attempted suicide within inpatient psychiatric services: a review of the literature.

              Self harm is a major public health concern, yet there are considerable challenges in providing support for those who self harm within psychiatric inpatient services. This paper presents the first review of research into self harm within inpatient settings. Searches of the main electronic databases were conducted using key words for self harm and inpatient care. There was substantial variation in the rates of self-harm and attempted suicide between studies, but rates were highest on forensic wards. There was no evidence of differences in prevalence of self-harm between men and women; women, however, were at increased risk of attempting suicide. People were more likely to self-harm in private areas of the ward and in the evening hours, and often self-harmed in response to psychological distress, or elements of nursing care that restricted their freedom. Wards used a variety of strategies to prevent self-harm; however, there is little research into their effectiveness.
                Bookmark

                Author and article information

                Journal
                J Psychiatr Ment Health Nurs
                J Psychiatr Ment Health Nurs
                jpm
                Journal of Psychiatric and Mental Health Nursing
                BlackWell Publishing Ltd (Oxford, UK )
                1351-0126
                1365-2850
                May 2014
                24 January 2014
                : 21
                : 4
                : 354-364
                Affiliations
                [1 ]Professor of Psychiatric Nursing
                [2 ]Research Assistant
                [3 ]Research Assistant
                [4 ]Research Fellow, Section of Mental Health Nursing
                [5 ]Research Assistant, HSPR, Institute of Psychiatry, Kings College London
                [6 ]Research Associate
                [7 ]Research Associate, Department of Primary Care and Population Health University College London
                [8 ]Trainee Occupational Therapist, Brunel University, London
                [9 ]Postdoctoral Research Fellow, Queen Mary Westfield College University of London, London
                [10 ]Senior Lecturer in Public Health University of Bedfordshire, Belford, UK
                [11 ]Director of Undergraduate Studies, Irish College of Humanities and Applied Sciences, Limerick, Republic of Ireland
                [12 ]Associate Professor, Florence Nightingale School of Nursing, Istanbul University, Turkey
                [13 ]Independent clinical psychologist Stellenbosch, South Africa
                [14 ]Professor, ACSW/faculteit der sociale wetenschappen, Radboud University Nijmegen, Netherlands
                Author notes
                Correspondence:, L. Bowers, Institute of Psychiatry, Section of Mental Health Nursing, De Crespigny Park, London SE5 8AF, UK, E-mail: len.bowers@ 123456kcl.ac.uk
                Article
                10.1111/jpm.12085
                4237197
                24460906
                2d25ee0a-3ff1-4f26-85f3-9060641d582e
                © 2014 John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 03 April 2013
                Categories
                Original Articles

                acute hospital,aggression,coercion,control and restraint,inpatient issues

                Comments

                Comment on this article