Universität zu Köln

Baumgardt, Johanna, Jaeckel, Dorothea, Helber-Boehlen, Heike, Stiehm, Nicole, Morgenstern, Karin, Voigt, Andre, Schoppe, Enrico, Mc Cutcheon, Ann-Kathrin, Lecca, Edwin Emilio Velasquez, Loehr, Michael, Schulz, Michael, Bechdolf, Andreas and Weinmann, Stefan (2019). Preventing and Reducing Coercive Measures-An Evaluation of the Implementation of the Safewards Model in Two Locked Wards in Germany. Front. Psychiatry, 10. LAUSANNE: FRONTIERS MEDIA SA. ISSN 1664-0640

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Abstract

Introduction: Aggression and violence are highly complex problems in acute psychiatry that often lead to the coercive interventions. The Safewards Model is an evidence-informed conflict-reduction strategy to prevent and reduce such incidents. The aim of this study was to evaluate the implementation of this model with regard to coercive interventions in inpatient care. Materials and Methods: We evaluated outcomes of the implementation of the Safewards Model in two locked psychiatric wards in Germany. Frequency and duration of coercive interventions applied during a period of 10 weeks before and 10 weeks after the implementation period were assessed through routine data. Fidelity to the Safewards Model was assessed by the Organization Fidelity Checklist. Results: Fidelity to the Safewards Model was high in both wards. The overall use of coercive measures differed significantly between wards [case-wise: chi(2) (1, n = 250) = 35.34, p <= 0.001; patient-wise: chi(2) (1, n = 103) = 21.45, p <= 0.001] and decreased post-implementation. In one ward, the number of patients exposed to coercive interventions in relation to the overall number of admissions decreased significantly [chi(2) (1, 182) = 9.30, p = 0.003]. Furthermore, the mean duration of coercive interventions overall declined significantly [U(55,21) = -2.142, p = 0.032] with an effect size of Cohen's d = -0.282 (95% CI: -0.787, 0.222) in that ward. Both aspects declined as well in the other ward, but not significantly. Discussion: Results indicate that the implementation of the Safewards interventions according to the model in acute psychiatric care can reduce coercive measures. They also show the role of enabling factors as well as of obstacles for the implementation process.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Baumgardt, Johanna UNSPECIFIED UNSPECIFIED UNSPECIFIED Jaeckel, Dorothea UNSPECIFIED UNSPECIFIED UNSPECIFIED Helber-Boehlen, Heike UNSPECIFIED UNSPECIFIED UNSPECIFIED Stiehm, Nicole UNSPECIFIED UNSPECIFIED UNSPECIFIED Morgenstern, Karin UNSPECIFIED UNSPECIFIED UNSPECIFIED Voigt, Andre UNSPECIFIED UNSPECIFIED UNSPECIFIED Schoppe, Enrico UNSPECIFIED UNSPECIFIED UNSPECIFIED Mc Cutcheon, Ann-Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Lecca, Edwin Emilio Velasquez UNSPECIFIED UNSPECIFIED UNSPECIFIED Loehr, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Schulz, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Bechdolf, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Weinmann, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-147871
DOI:	10.3389/fpsyt.2019.00340
Journal or Publication Title:	Front. Psychiatry
Volume:	10
Date:	2019
Publisher:	FRONTIERS MEDIA SA
Place of Publication:	LAUSANNE
ISSN:	1664-0640
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE PSYCHIATRIC-WARDS; MENTAL-HEALTH; CONTAINMENT RATES; SECLUSION; MANAGEMENT; RESTRAINT; AGGRESSION; HOSPITALS; CONFLICT; PATIENT Multiple languages Psychiatry Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14787