Safewards: An integrative review of the literature within inpatient and forensic mental health units.
Antony Mullen, Graeme Browne, Bridget Hamilton and 2 others
PMID 35365947WHAT IT FOUND
Safewards can lower conflict and containment in adult inpatient and forensic mental health units, but only where staff are broadly trained and the ten interventions are actually delivered.
Fidelity varied from 27% to 95%, and four studies found no change in coercive practices.
Key findings
01Effectiveness for reducing restrictive practices is inconsistent across studies, with four reporting no or little change in coercive practice and others reporting reductions.
02Fidelity of implementation varied widely, from 27% in one service evaluation to between 73.7% and 95% in five other studies, and low fidelity was linked to null results.
03Consumer perspectives were underrepresented, with only one study exploring them, and some consumers found the interventions patronizing or condescending.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 19 papers were included, and they were heterogeneous in design, so effect sizes are not pooled and cannot be compared directly. English-language papers only were included, and studies outside adult inpatient or forensic mental health settings were excluded, so findings may not generalise. Consumer perspectives are severely underrepresented, with only one study exploring them, and no meta-analysis of effectiveness was possible. Fidelity measurement varied in timing and method across studies, from weekly checks to four measures over 12 months, making it hard to compare implementation quality. The review included discussion and theoretical papers alongside empirical studies, which can blur the strength of evidence.
Declared interests
No funding source or conflicts of interest declaration is stated in the supplied text.
The easy way to misread this
Do not read Safewards as a proven method for reducing restraint or seclusion. The evidence is mixed: four studies found no change in coercive practice, and the reductions that were reported, such as 15% for conflict and 26.4% for containment, came from a single trial where independently rated fidelity was only 36%. The benefit appears to depend on high fidelity and broad staff training, which many services do not achieve.