Evaluating the implementation of a ward-based training programme within a psychiatric intensive care unit using Normalisation Process Theory

Background: Strong staff–patient relationships are essential for the provision of high quality care within psychiatric intensive care units. These relationships can be strengthened through staff training interventions, for example, the Safe & Secure programme. However, interventions delivered in psychiatric intensive care units are difficult to implement and sustain. Normalisation Process Theory offers a framework through which to measure how effectively new interventions are implemented in this setting. Method: The aim of the study was to assess the implementation of a ward-based team training programme within a psychiatric intensive care unit. Following the delivery of the Safe & Secure ward-based team training programme, staff were interviewed about their experience and completed a quantitative measure of normalisation: the NoMAD. Interviews were analysed using reflexive thematic analysis with codes being grouped under the four constructs of Normalisation Process Theory. Results: Staff reported being able to recognise the utility of the intervention and, qualitatively, reported seeing it as beneficial for their clinical practice. NoMAD scores were high, indicating the normalisation of the intervention. However, staff found it difficult to quantify how the intervention had improved their practice. They also reported difficulties with applying the intervention in certain circumstances. Staff expressed concerns about intervention sustainability. Conclusions: The Safe & Secure ward-based team training programme was implemented and normalised into routine practice. The study identified areas for improvement in future deliveries of the programme. The study also provided useful information to help inform the future implementation of ward-based team trainings in psychiatric intensive care units.