Who is Navigating this Ship? A Qualitative Interview Study of Nursing Staff’s Experiences of Implementing Safewards in a Forensic Mental Health Clinic

The need to reduce restrictive practices in forensic mental health settings reflects a broader shift from traditional authoritarian and custodial approaches toward a more recovery-oriented ward environment. Safewards is an evidence-based model of care with ten interventions to reduce conflict and containment, focusing on social inclusion, communication skills, and patient support in stressful situations. This study aimed to describe the experiences of nursing staff with the implementation of Safewards in a Swedish forensic mental health clinic. Nine nurses participated in two focus group interviews. Using qualitative content analysis, three main themes were identified: Calling for leadership and resources, Striving for engagement, and Fostering awareness of nursing practice. Each main theme included two sub-themes. Participants described a general lack of leadership that left them feeling lost and uncertain during the implementation process. Descriptions related to preparation and training, hesitance to include patients in the implementation, and concerns about the fit of Safewards with existing clinical practices. Despite these challenges, the nurses were overall positive about Safewards, viewing the model as a step towards a recovery-oriented approach. The results support the implementation of Safewards Secure, a complement developed to the original Safewards model, tailored to the context of forensic mental health settings.