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Evaluating the Introduction of the Safewards Model to a Medium- to Long-Term Forensic Mental Health Ward

Maguire, Tessa, RN, BN, GD FBS, MMentHlthSc1,2; Ryan, Jo, RN, Bed, GC VRAM1,2; Fullam, Rachael, BSc, PhD1,2; McKenna, Brian, RN, PhD2,3

doi: 10.1097/JFN.0000000000000215
Original Articles

ABSTRACT Care and treatment in forensic mental health wards can present with challenges when loss of hope and freedom, and aggression are present, which can then influence ward atmosphere and feelings of safety. Safewards is a model designed to address a range of conflict (e.g., aggression and self-harm) and containment (e.g., use of restrictive interventions) events and may provide a suitable approach to delivery of care in a forensic setting, while also addressing aggression, restrictive interventions, and ward atmosphere. The aim of this study was to evaluate the introduction of Safewards to a forensic mental health ward to determine suitability, and to explore if changes to conflict, containment, and ward atmosphere occurred. A mixed methods approach was used involving the collection of incident data related to conflict and containment, an assessment of the degree to which interventions were implemented, and an assessment of the social climate before and after implementation. Results suggested that there were fewer conflict events after Safewards was introduced; however, there did not appear to be any changes in the already low use of restrictive interventions. The Safewards interventions were implemented to a high degree of fidelity, and there was indication of an increase in a positive perception of ward atmosphere, supported by themes of positive change, enhanced safety, and respectful relationships. Safewards may assist in contributing to an improvement in the perception of ward atmosphere. To enhance implementation in a forensic mental health setting, there may be a need to consider additional elements to Safewards, pertinent to this setting.

Author Affiliations:1Forensicare,

2Centre for Forensic Behavioural Science, and

3Auckland University of Technology.

The authors declare no conflict of interest.

Correspondence: Tessa Maguire, RN, BN, GD FBS, MMentHlthSc, C/O Thomas Embling Hospital, Yarra Bend Road, Fairfield 3078, Melbourne, Victoria, Australia. E-mail:

Received May 1, 2018; Accepted July 12, 2018.

© 2018 by the International Association of Forensic Nurses. All rights reserved.
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