Eastern Health, Melbourne, Australia.
Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
Int J Ment Health Nurs. 2022 Feb;31(1):199-221. doi: 10.1111/inm.12950. Epub 2021 Nov 12.
Safewards is an internationally adopted framework that provides interventions to reduce conflict and containment in healthcare settings. This systematic review evaluated the effect of Safewards on conflict and containment events in inpatient units and the perceptions of staff and consumers. Quantitative, qualitative, and mixed-methods studies were considered for inclusion. Following the Joanna Briggs Institute methodology, two reviewers independently screened, appraised, and extracted data. Qualitative data were synthesized using inductive-thematic analysis. Quantitative and qualitative data were integrated with a convergent-segregated approach and presented in tabular and narrative format. A search of 13 databases and grey literature yielded 14 studies of variable methodological quality. Four studies reported reduced rates of conflict and one study reported reductions that were not statistically significant. Six studies reported reductions in rates of containment, three studies found no statistical significance and one study reported statistically significant reductions at follow-up. Staff and consumers in four studies reported an improved experience of safety. Three themes were developed as follows: (i) therapeutic hold, cohesion, support and the environment, (ii) conflict, containment and the experience of safety, and (iii) the complexities of adapting and embedding change. This review found most staff and consumers reported Safewards improved therapeutic relationships, cohesion, and ward atmosphere. Staff and consumers reported improved ward atmosphere, leading to consumer-centred, recovery-oriented care. Safewards improved the experience of safety from the perspective of staff and consumers when combined with ongoing training, leadership and time for consolidation. While results are promising they should be used cautiously until more robust evidence is established.
安全保障是一种国际上采用的框架，提供干预措施以减少医疗环境中的冲突和限制。本系统评价评估了 Safewards 对住院病房中冲突和限制事件的影响，以及工作人员和消费者的看法。纳入了定量、定性和混合方法研究。根据 Joanna Briggs 研究所的方法，两名审查员独立筛选、评估和提取数据。使用归纳主题分析对定性数据进行综合。采用收敛-分离方法整合定量和定性数据，并以表格和叙述形式呈现。对 13 个数据库和灰色文献进行了检索，共检索到 14 项方法学质量不同的研究。四项研究报告冲突发生率降低，一项研究报告降低率无统计学意义。六项研究报告限制率降低，三项研究无统计学意义，一项研究在随访时报告降低率有统计学意义。四项研究中的工作人员和消费者报告安全体验得到改善。得出以下三个主题：（i）治疗性约束、凝聚力、支持和环境，（ii）冲突、限制和安全体验，（iii）适应和实施变革的复杂性。本综述发现，大多数工作人员和消费者报告 Safewards 改善了治疗关系、凝聚力和病房氛围。工作人员和消费者报告说，病房氛围得到改善，从而实现了以患者为中心、以康复为导向的护理。当结合持续培训、领导力和巩固时间时，Safewards 从工作人员和消费者的角度提高了安全体验。虽然结果很有希望，但在建立更可靠的证据之前，应谨慎使用。
