Adaptation of the safewards model to the New Zealand context: A mixed-methods evaluative study
type: CreativeWork
description: Background: Mental health inpatient units can provide a sanctuary for people to recover from mental illness. However, research has shown these units to be sites of conflict, in an environment that service users do not experience as therapeutic. To support a therapeutic environment, the safety and wellbeing of service users and staff need protection through reduced conflict and containment rates. Conflict can be physical or verbal aggression, self-harm, suicide attempt, absconding, substance misuse and medication refusal. Containment involves methods used to control conflict, including administration of sedative medication, coerced intramuscular medication, increased level of observation, restraint and seclusion. The Safewards model, originating in the United Kingdom in 2015, proposes 10 interventions to address conflict and containment. These interventions are centred on: therapeutic relationships; person-centeredness; teamwork; and least restrictive care. This research pursued active transformation through codesign of an adapted Safewards model to fit the socio-cultural context of New Zealand. Objective: This thesis with publication describes the adaptation of the Safewards model to the New Zealand context. Cultural adaptation was critical due to significant health outcome disparities between Māori and non-Māori populations and the disproportionate representation of Māori within mental health services. The research sought to discover what a New Zealand model required, what the perspectives of inpatient tangata whai ora and staff were of the developed model and what changes it made to rates of conflict, containment and the ward atmosphere. Participants: Tangata whai ora and staff from the study setting were recruited to participate in focus groups before and after the implementation of the New Zealand Safewards model. Phase one focus groups included 15 staff and three tangata whai ora. Phase three focus groups included 13 staff and four tangata whai ora. Methods: Th…
abstract: Background: Mental health inpatient units can provide a sanctuary for people to recover from mental illness. However, research has shown these units to be sites of conflict, in an environment that service users do not experience as therapeutic. To support a therapeutic environment, the safety and wellbeing of service users and staff need protection through reduced conflict and containment rates. Conflict can be physical or verbal aggression, self-harm, suicide attempt, absconding, substance misuse and medication refusal. Containment involves methods used to control conflict, including administration of sedative medication, coerced intramuscular medication, increased level of observation, restraint and seclusion. The Safewards model, originating in the United Kingdom in 2015, proposes 10 interventions to address conflict and containment. These interventions are centred on: therapeutic relationships; person-centeredness; teamwork; and least restrictive care. This research pursued active transformation through codesign of an adapted Safewards model to fit the socio-cultural context of New Zealand. Objective: This thesis with publication describes the adaptation of the Safewards model to the New Zealand context. Cultural adaptation was critical due to significant health outcome disparities between Māori and non-Māori populations and the disproportionate representation of Māori within mental health services. The research sought to discover what a New Zealand model required, what the perspectives of inpatient tangata whai ora and staff were of the developed model and what changes it made to rates of conflict, containment and the ward atmosphere. Participants: Tangata whai ora and staff from the study setting were recruited to participate in focus groups before and after the implementation of the New Zealand Safewards model. Phase one focus groups included 15 staff and three tangata whai ora. Phase three focus groups included 13 staff and four tangata whai ora. Methods: Th…
author: Knauf, Sarah
keywords: inpatient, nursing care, psychiatric nursing, risk management, safety
license: https://researchcommons.waikato.ac.nz/bitstreams/836f78a4-7a02-47e1-9ba3-7fa3523b5a8b/download
date published: 2024
date modified: 2026-07-24T05:57:30Z
provider: University Waikato
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: The University of Waikato