Abstract / Summary
Abstract Safety incidents on mental health wards can harm patients, staff and organisations. An extensive body of research to improve the understanding of this issue frequently focuses on patient characteristics and staffing numbers. Exploration of the impact of staff and team characteristics may generate valuable new insights. The review aimed to describe the international evidence around the relationships between safety incidents on mental health wards, and staff and team characteristics, to answer the question, “How do staff and team characteristics relate to safety incidents in adult inpatient mental health settings?”. Systematic integrative review of the published literature focused on adult inpatient mental health settings globally. CINAHL, Cochrane, Embase, Medline, PsycINFO and Web of Science were searched (1999 onwards). Data were analysed using inductive narrative synthesis, comprising data reduction, display and comparison. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. 135 papers (80 quantitative; 46 qualitative; nine mixed methods studies) across 33 countries met the eligibility criteria. Most reported staff perspectives of incidents (n = 54) or retrospective analysis of routine hospital data (n = 40). Four themes were developed: (1) Team profile: composition, working patterns and culture; (2) Personal and professional profiles of individual staff; (3) Impact of staff communication and behaviour; (4) Factors affecting staff communication and behaviour. Evidence was most consistent around the impact of staff’s verbal and paraverbal communication, availability to patients and empathy. There was more evidence around the impact of staffing numbers, demographics of staff and staff experience but this was largely inconsistent, making the direction of impact unclear. This review examined a large body of international evidence demonstrating inconsistent findings around staffing numbers and demographic characteristics. An emerging body of evidence focused on the impact of interpersonal characteristics and team culture offers potential explanations for the discrepancies surrounding fixed characteristics and team numbers. This suggests possible reasons why focusing on staffing ratios, for instance, may not yield the expected safety outcomes.