Safewards: Changes in conflict, containment, and violence prevention climate during implementation.
Geoffrey L Dickens, Tracy Tabvuma, Steven A Frost
PMID 32691495WHAT IT FOUND
Conflict and containment reports fell across eight mental health wards after the Safewards package, including physical aggression and restrictive practices.
Violence-prevention climate scores did not change. Without a control group, this cannot prove the package caused the fall.
Key findings
01Conflict and containment incidents fell significantly from baseline to implementation and outcome phases.
02After adjustment, conflict incidents were reported 23% lower and containment incidents 12% lower relative to baseline.
03The adjusted analysis showed lower outcome-phase risk than baseline for physical aggression and highly coercive containment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
No control ward, randomisation, or blinding was used, so reductions cannot be attributed to Safewards rather than chance, observer effects, or other ward changes. Only eight wards were studied, which was too few to analyse whether implementation fidelity affected the results. Safewards was a package of 10 interventions, and wards used 8, 9, or 10 of them, so the contribution of any single component cannot be separated. Shift-report response was uneven and lower than complete, with more missing data at outcome than at baseline. Fidelity was assessed mainly by visible signs, not by whether staff had adopted the interventions in daily practice. The violence-prevention climate responses could not be linked between baseline and outcome because identifying details were not collected. The study lasted 20 weeks, so it did not test whether the changes were sustained.
Declared interests
The paper states the funder had no role in design, conduct of the intervention, data collection, data analysis, or writing of the study report. No other conflict-of-interest declaration is given.
The easy way to misread this
Do not conclude Safewards caused the reductions. This was a before-after implementation with no control ward or randomisation, and Safewards was delivered as a package of 8 to 10 interventions, so the changes could be due to other ward developments, chance, observer effects, or components not measured.