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

L. Bowers*, J. Alexander, H. Bilgin, M. Botha, C. Dack, K. James, M. Jarrett, D. Jeffery, H. Nijman, J. A. Owiti, C. Papadopoulos, J. Ross, S Wright, D. Stewart

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

111 Citations (Scopus)

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.

Original languageEnglish
Article numberN/A
Pages (from-to)354-364
Number of pages11
JournalJournal of Psychiatric and Mental Health Nursing
Volume21
Issue number4
DOIs
Publication statusPublished - May 2014

Keywords

  • acute hospital
  • aggression
  • coercion
  • control and restraint
  • inpatient issues
  • ACUTE PSYCHIATRIC-WARDS
  • ACUTE INPATIENT CARE
  • SELF-HARM
  • STAFF
  • VIOLENCE
  • BEHAVIOR
  • INCIDENTS
  • RESTRAINT
  • SUICIDE
  • IMPLEMENTATION

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