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Active Ingredients Across the 10 Safewards Interventions: Expert Consensus Towards Fidelity Measurement
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.
Psychiatric Research Unit, Region Zealand Psychiatry, Department of Regional Health Research, University of Southern Denmark, University College Absalon, Roskilde, Denmark.
Centre for Mental Health Nursing Research, Care in Long Term Conditions Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Örebro University, School of Medical Sciences. Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.ORCID iD: 0000-0002-2655-3573
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2026 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 35, no 3, article id e70276Article in journal (Refereed) Published
Abstract [en]

Safewards is implemented internationally to prevent conflict and containment in psychiatric settings. Although evaluations generally show a reduction in such incidents, effects vary across studies. A key limitation is the absence of a valid and robust measure of implementation fidelity to indicate how closely Safewards is implemented as originally intended. Without this knowledge, replication, refinement, and effective implementation is difficult, jeopardizing both clinical quality assurance and scientific evaluation rigour. This study reports the first steps in developing a new implementation fidelity tool for Safewards. The objective was to identify important active ingredients and corresponding measurement levels for the 10 Safewards interventions. A Delphi survey design with an international expert panel was used to reach consensus on active ingredients and measurement levels. The preliminary survey list was derived from the Safewards.net website and informed by implementation fidelity theory, incorporating both direct and indirect measurement levels. The resulting set of ingredients and measurements was pilot tested for comprehensibility by likely end-users in an acute psychiatric clinic. Their experiences were explored in a group interview, analyzed with thematic content analysis, and informed adjustments. The final output comprises 48 active ingredients and 122 measurements across the 10 interventions, each represented by three to seven statements and up to four measurement levels. The findings provide a conceptual and content-valid foundation for the development of a new Safewards fidelity tool. In addition, the active ingredients have intrinsic value, offering guidance for the clinical implementation of Safewards.

Place, publisher, year, edition, pages
John Wiley & Sons, 2026. Vol. 35, no 3, article id e70276
Keywords [en]
Delphi method, Safewards, fidelity measurement, psychiatric nursing, violence prevention
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
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URN: urn:nbn:se:oru:diva-129125DOI: 10.1111/inm.70276ISI: 001801457200005PubMedID: 42226452OAI: oai:DiVA.org:oru-129125DiVA, id: diva2:2065526
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Karolinska InstituteAvailable from: 2026-06-03 Created: 2026-06-03 Last updated: 2026-07-22Bibliographically approved

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