Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial

Bowers, Len; James, Karen; Quirk, Alan; Simpson, Alan; Stewart, Duncan; Hodsoll, John

doi:10.1016/j.ijnurstu.2015.05.001

Cited by 289 publications

(433 citation statements)

References 36 publications

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“…The components of de-escalation have only recently been brought together and described, 79 and have been coded into a model 80 that forms part of the Safewards interventions known to be effective in reducing rates of conflict and containment. 39 This account of de-escalation is further expanded by the de-escalatory interventions identified in this study. Around half of all incidents to which a rapid response team were called in one hospital were resolved without the use of restraint, although this may have been as much a product of show of force as de-escalation.…”

Section: Seclusion As An Alternative To Psychiatric Intensive Care Unmentioning

confidence: 72%

“…Rather than focus on the provision of specific interventions, services could address overall conflict and containment prevention via such evidence-based methods as Safewards. 39 …”

Section: Discussionmentioning

confidence: 99%

“…38 Acute psychiatric wards manage patients whose actions may threaten their own safety and that of hospital staff. 39 To aid in management, wards may be fitted with a seclusion room and/or have direct or indirect access to a PICU.…”

Section: Effects Of Treatment On Adverse Incidents Length Of Stay Anmentioning

confidence: 99%

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Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES): combined qualitative and quantitative approaches to the uses and outcomes of coercive practices in mental health services

Bowers

Cullen

Achilla

et al. 2017

Health Serv Deliv Res

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Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 11/1024/02. The contractual start date was in March 2013. The final report began editorial review in January 2016 and was accepted for publication in December 2016. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of He...

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Section: Seclusion As An Alternative To Psychiatric Intensive Care Unmentioning

confidence: 72%

“…Rather than focus on the provision of specific interventions, services could address overall conflict and containment prevention via such evidence-based methods as Safewards. 39 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES): combined qualitative and quantitative approaches to the uses and outcomes of coercive practices in mental health services

Bowers

Cullen

Achilla

et al. 2017

Health Serv Deliv Res

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“…While the authors stated that they were unaware of any other policy being simultaneously introduced, Safewards, a new model of care which aims to reduce conflict and containment within inpatient wards,4 was first delivered to staff in SLaM wards in February 2014.…”

Section: Limitationsmentioning

confidence: 99%

Implementation of a smoke-free policy appears to reduce physical violence in inpatient settings

Hedges

Facer-Irwin

2018

Evid Based Mental Health

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“…It may also be a reflection of some of the other initiatives that have been promoted in an attempt to improve inpatient services, such as the Royal College of Psychiatrists' AIMS, 92 Bright charity's Star Wards 94 and most recently, the mental health nurse-led evidence-based intervention, SafeWards. 155 However, as in the community study, staff also spoke of the socioeconomic context within which they were operating and some of the tensions and pressures that this created when they were unable to fully DISCUSSION NIHR Journals Library www.journalslibrary.nihr.ac.uk deliver the levels of personalised, quality care that they wanted to. Although, arguably, this was not articulated as strongly as among community staff who appeared to be under enormous pressures, nevertheless concerns about insufficient funding, and in particular insufficient staff numbers, were highlighted.…”

Section: Making Connections In Inpatient Mental Health Care Planning mentioning

confidence: 99%

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

Simpson

Coffey

Hannigan

et al. 2017

Health Serv Deliv Res

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BackgroundMental health service users in acute inpatient wards, whether informal or detained, should be involved in planning and reviewing their care. Care planning processes should be personalised and focused on recovery, with goals that are specific to the individual and designed to maximise their achievements and social integration.Objective(s)We aimed to ascertain the views and experiences of service users, carers and staff to enable us to identify factors that facilitated or acted as barriers to collaborative, recovery-focused care and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving 19 mental health wards in six NHS sites in England and Wales included a metanarrative synthesis of policies and literature; a survey of service users (n = 301) and staff (n = 290); embedded case studies involving interviews with staff, service users and carers (n = 76); and a review of care plans (n = 51) and meetings (n = 12).ResultsNo global differences were found across the sites in the scores of the four questionnaires completed by service users. For staff, there was significant difference between sites in mean scores on recovery-orientation and therapeutic relationships. For service users, when recovery-orientated focus was high, the quality of care was viewed highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Across all sites, staff’s scores were significantly higher than service users’ scores on the scale to assess therapeutic relationships. Staff across the sites spoke of the importance of collaborative care planning. However, the staff, service user and carer interviews revealed gaps between shared aspirations and realities. Staff accounts of routine collaboration contrasted with service user accounts and care plan reviews. Definitions and understandings of recovery varied, as did views of the role of hospital care in promoting recovery. ‘Personalisation’ was not a familiar term, although there was recognition that care was often provided in an individualised way. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.ConclusionsOur results suggest that there is positive practice taking place within acute inpatient wards, with evidence of widespread commitment to safe, respectful, compassionate care. Although ideas of recovery were evident, there was some uncertainty about and discrepancy in the relevance of recovery ideals to inpatient care and the ability of people in acute distress to engage in recovery-focused approaches. Despite the fact that staff spoke of efforts to involve them, the majority of service users and carers did not feel that they had been genuinely involved, although they were aware of efforts to keep them safe.Future workFuture research should investigate approaches that increase contact time with service users and promote personalised, recovery-focused working; introduce shared decision-making in risk assessment and management; and improve service user experiences of care planning and review and the use of recovery-focused tools during inpatient care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial

Cited by 289 publications

References 36 publications

Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES): combined qualitative and quantitative approaches to the uses and outcomes of coercive practices in mental health services

Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES): combined qualitative and quantitative approaches to the uses and outcomes of coercive practices in mental health services

Implementation of a smoke-free policy appears to reduce physical violence in inpatient settings

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

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