Evaluation of the Implementation of the Safewards Model in an Open-Door Acute Inpatient Unit. A quasi-experimental study

BackgroundSafewards is a multi-intervention mental health nursing model evidence-based practice, aimed at preventing and reducing conflict and containment. ObjectiveTo evaluate the effectiveness of the implementation of Safewards model in an open-door acute mental health unit. This analysis examines the impact of the Safewards model on conflict levels and restrictive therapeutic measures. DesignA prospective quasi-experimental study was conducted between August 2019 and January 2022, with patients admitted to an acute mental health unit from Spain. MethodsDescriptive and inferential analysis will be conducted. Multivariate regression models will be used to investigate the relationship between coercive measures, conflict levels, and clinical and demographic variables, adjusting for covariates if necessary. ResultsThe results indicated statistically significant differences in several variables such as rule violations (F=6.11, df= 1, p < .014), verbal aggression (F=14.9, df = 1, p < .001), and physical aggression towards objects (F = 7.2, df= 1, p < .008). The results indicated a statistically significant differences in restrictive therapeutic measures: intramuscular forced medication (F=8.5, df= 1, p < .004), environmental seclusion (F=14.6, df = 1, p < .001), and verbal/behavioural containment (F=75.0, df = 1, p < .001). ConclusionThis is the first study to evaluate the implementation of the Safewards model in an open-door acute inpatient unit in Spain with respect to restrictive therapeutic measures. Social media abstractSafewards Model in an Open-Door Acute Inpatient Unit in Barcelona @annabcn_24, @SafewardsBCN, @jcuevasesteban What is already known?O_LISafewards reduces conflict and restrictive interventions in mental health inpatient units. C_LIO_LISafewards uses 10 interventions based on mental health nursing theory. C_LIO_LISafewards is a mental health model for practice improvement implemented internationally. C_LI What this paper addsO_LIThis study is the first evaluation of Safewards implementation in Spain. C_LIO_LIThe research team translated Safewards into Spanish for staff training. C_LIO_LITranslating Safewards aids its use in Spanish-speaking mental health units. C_LIO_LIRestrictive measures reduced significantly, except for mechanical restraint. C_LI Reporting MethodThis study adheres to the relevant EQUATOR guidelines and follows the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting method. Patient or Public ContributionThe implementation of the Safewards model relies on the active participation of both healthcare professionals and patients to promote a safer and more therapeutic environment. Through structured interventions, staff facilitate communication strategies, de-escalation techniques, and conflict resolution, while patients actively contribute to fostering a climate of mutual respect and support. This bidirectional approach not only reduces coercion and incidents but also strengthens the therapeutic relationship and enhances the sense of community within the unit