Safewards is an evidence-based practice improvement model to minimise conflict in inpatient mental health units. There is limited published research on implementing Safewards in acute medical/surgical care wards. To identify, from nurses' perspectives, barriers, and facilitators to implement four Safewards interventions in acute medical/surgical care wards. This article reports qualitative findings from a funded mixed-method evaluation of the Safewards Acute Care Pilot Project. Six focus group interviews comprising 35 nursing staff from four hospitals in Victoria, Australia were completed between April and October 2022. The semi-structured interview guide included questions developed using the Capability, Opportunity, Motivation and Behaviour (COM-B) model. Data was thematically analysed and mapped to a matrix combining COM-B and the Theoretical Domains Framework (TDF) to elucidate barriers and facilitators to implementing four Safewards interventions in acute medical/surgical care wards. Three components in the COM-B model and three TDF domains were identified as barriers to the adoption of Safewards in acute medical/surgical care wards. Specific barriers included physical opportunity challenges related to the environmental context and resources domains. The key themes included time constraints and competing priorities; lack of physical space and infrastructure; and poor patient uptake due to lack of understanding. Gaps emerged as a psychological capability barrier within the TDF knowledge domain. Additionally, resistance to practice changes were associated with the motivation component of the COM-B model. Conversely, six TDF domains were relevant to facilitating the implementation of the Safewards interventions: memory, attention, and decision processes; physical skills; social influences; social/professional role and identity; goals; and beliefs about consequences. Key facilitators included the Safewards interventions serving as reminders to focus on compassionate nursing care; nursing staff possessing the skillset for interventions; peer pressure and mandated change; supportive and passionate leadership; presence of champions to drive momentum; belief in nursing staff ownership and expertise for leading implementation; personal commitment to improve work environments and care quality; and the belief that Safewards would improve ward culture. Addressing barriers and leveraging facilitators can inform strategies for enhancing staff capability to implement Safewards in acute care wards. Specifically, a tailored, multilayered approach focusing on leadership support, training, resources, patient input, and feedback can promote effective adoption of the Safewards model and adaptation of discrete interventions. Safewards adaptation: Addressing barriers like resources, space, and patient awareness; leveraging peer modelling and leadership strategies for success.

中文翻译：

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急性内科/外科护理病房的安全：能力、机会、动机和行为模型以及理论领域框架分析


Safewards 是一种基于证据的实践改进模型，旨在最大限度地减少住院精神卫生部门的冲突。关于在急症内科/外科护理病房实施安全措施的已发表研究有限。从护士的角度确定在急症内科/外科护理病房实施四项安全干预措施的障碍和促进因素。本文报告了 Safewards 急性护理试点项目资助的混合方法评估的定性结果。 2022 年 4 月至 10 月期间，完成了六次焦点小组访谈，包括来自澳大利亚维多利亚州四家医院的 35 名护理人员。半结构化访谈指南包括使用能力、机会、动机和行为 (COM-B) 模型提出的问题。对数据进行主题分析并映射到结合 COM-B 和理论领域框架 (TDF) 的矩阵，以阐明在急症内科/外科护理病房实施四项 Safewards 干预措施的障碍和促进因素。 COM-B 模型中的三个组成部分和三个 TDF 领域被认为是在急症内科/外科护理病房采用 Safewards 的障碍。具体障碍包括与环境背景和资源领域相关的物理机会挑战。关键主题包括时间限制和相互竞争的优先事项；缺乏物理空间和基础设施；由于缺乏理解，患者接受度较差。差距成为 TDF 知识领域内的心理能力障碍。此外，对实践变革的抵制与 COM-B 模型的动机成分相关。 相反，TDF 的六个领域与促进安全干预措施的实施相关：记忆、注意力和决策过程；身体技能；社会影响；社会/职业角色和身份；目标；以及关于后果的信念。主要促进因素包括提醒人们关注富有同情心的护理的安全干预措施；护理人员具备干预技能；同侪压力和强制变革；支持和热情的领导；冠军的存在可以推动动力；对护理人员主人翁精神和领导实施的专业知识的信念；个人致力于改善工作环境和护理质量；以及 Safewards 将改善病房文化的信念。解决障碍并利用促进因素可以为增强员工在急症护理病房实施安全措施的能力提供策略。具体而言，专注于领导支持、培训、资源、患者意见和反馈的量身定制的多层方法可以促进 Safewards 模型的有效采用和离散干预措施的适应。安全适应：解决资源、空间和患者意识等障碍；利用同行建模和领导策略取得成功。