Exploring the Impact of Safewards on Aggression and Coercion in Psychiatric Inpatient Care: Findings From a Swedish Longitudinal Quasi-Experimental Trial.
Jenny Karlsson, Anna Björkdahl, Nina Gårevik and 3 others
PMID 41630556WHAT IT FOUND
Safewards did not show reduced coercive measures or aggressive incidents in Swedish psychiatric wards.
Staff reported Safewards becoming more routine over time.
Key findings
01Safewards implementation did not significantly reduce coercive measures compared with comparison wards.
02Aggressive incident counts and severity did not differ significantly between the pre-implementation period and later periods.
03Staff reported Safewards becoming more normalised into daily practice over time.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Wards were not randomised, and comparison wards were chosen after implementation. The analysis was at ward level, with only 18 wards, so statistical power was limited. Survey response rates dropped over time, and some administrative data were missing. Wards implemented only two to five of the ten Safewards interventions, so this was not full model delivery. Patient views and broader conflict outcomes such as self-harm or absconding were not measured. Coercive measure documentation may be incomplete, and staff aggression reporting may have declined over time. It is unknown whether comparison wards used other ways to reduce conflict or coercion. Implementation began during the COVID-19 pandemic, which affected routines and data collection.
Declared interests
This study was funded by AFA Insurance and FORTE. The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude Safewards reduces coercion because staff reported it becoming more routine. The primary outcome was not significant, and only 18 wards were analysed.