University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Psychiatric outpatient clinic, Region Värmland, Kristinehamn, Sweden.
BMC Health Serv Res. 2024 Aug 12;24(1):922. doi: 10.1186/s12913-024-11326-z.
The Safewards model aims to reduce conflict and use of containment on psychiatric wards. To evaluate the implementation of Safewards and understand why it is effective in some settings but not in others, it is important to assess the level of implementation fidelity. To do this, the Safewards Fidelity Checklist (SFC) is often used, which focuses on objective visual observations of interventions but does not include patient responsiveness. The latter is a key indicator of implementation fidelity and includes engagement, relevance, acceptability and usefulness. The aim of the present study was to investigate the fidelity of Safewards implementation on an acute psychiatric ward from the perspective of patient responsiveness.
The study was conducted on a ward for patients with mainly affective disorders. To assess the general level of fidelity the SFC was used together with a detailed ward walkthrough. Ten patients were interviewed with a focus on patient responsiveness to each of the seven interventions implemented on the ward. Data were analysed using qualitative descriptive analysis.
The findings indicate high implementation fidelity, which was reflected in the SFC assessment, walkthrough and patient responsiveness. Patients gave examples of improvements that had happened over time or of the ward being better than other wards. They felt respected, less alone, hopeful and safe. They also described supporting fellow patients and taking responsibility for the ward climate. However, some patients were unfamiliar with a ward where so much communication was expected. Several suggestions were made about improving Safewards.
This study confirms previous research that patient responsiveness is an important factor for achieving fidelity in a prevention programme. The patients' descriptions of the acceptability, relevance and usefulness of the specific interventions reflected to a high degree the objective visual observations made by means of the SFC and ward walkthrough. Patient engagement was demonstrated by several suggestions about how to adapt the interventions. There is potential to obtain valuable input from patients when adapting Safewards in practice. This study also presents many examples of practical work with these interventions and the effects it can have on patients' experiences of care.
Safewards 模式旨在减少精神病病房的冲突和使用约束。为了评估 Safewards 的实施情况，并了解为什么它在某些环境中有效而在其他环境中无效，评估实施保真度非常重要。为此，通常使用 Safewards 保真度检查表（SFC），它侧重于干预措施的客观视觉观察，但不包括患者的反应。后者是实施保真度的关键指标，包括参与度、相关性、可接受性和有用性。本研究的目的是从患者反应的角度调查急性精神病病房 Safewards 实施的保真度。
该研究在一个主要患有情感障碍的患者病房进行。为了评估总体保真度水平，使用 SFC 结合详细的病房巡视。对 10 名患者进行了访谈，重点是每位患者对病房实施的 7 项干预措施的反应。使用定性描述性分析对数据进行分析。
研究结果表明实施保真度很高，这体现在 SFC 评估、巡视和患者反应中。患者举例说明了随着时间的推移发生的改进，或者病房比其他病房好。他们感到受到尊重、不那么孤独、充满希望和安全。他们还描述了支持其他患者并为病房氛围负责。然而，一些患者对如此多的沟通期望的病房感到不熟悉。对改进 Safewards 提出了一些建议。
本研究证实了先前的研究，即患者反应是预防计划实现保真度的重要因素。患者对特定干预措施的可接受性、相关性和有用性的描述在很大程度上反映了通过 SFC 和病房巡视进行的客观视觉观察。通过一些关于如何调整干预措施的建议，展示了患者的参与度。在实践中，从患者那里获得有价值的投入是有可能的。本研究还提供了许多关于这些干预措施的实际工作及其对患者护理体验的影响的例子。
