Evidence map›Paper›PMID 41546468›Full record

ArticleJournal of psychiatric and mental health nursing2026

Perspectives and Experiences of Nurses Implementing the Safe Steps for De-Escalation in Acute Mental Health Units.

Esario Iv Daguman, Jacqui Yoxall, Richard Lakeman, Marie Hutchinson

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Article in Journal of psychiatric and mental health nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

4 authors.

Esario Iv DagumanFaculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia.ORCID 0009-0009-3319-7077
Jacqui YoxallFaculty of Health, Southern Cross University, Lismore, New South Wales, Australia.ORCID 0000-0001-5335-8282
Richard LakemanFaculty of Health, Southern Cross University, Lismore, New South Wales, Australia.ORCID 0000-0002-4304-5431
Marie HutchinsonFaculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia.ORCID 0000-0003-0025-2681

Funding

Southern Cross Universitythe Translational Research Grant Scheme of the NSW Office for Health and Medical Research
6 · The paper itself

Abstract

introductionEfforts to reduce restrictive practices in acute mental health units require more than operational reform; they also need to give voice to clinicians who implement these changes.

aimThis paper forms part of a broader evaluation of the Safe Steps for De-escalation, which was aimed at investigating the impact of the Safe Steps implementation on the perceived professional quality of life of the nurse participants. This paper also presents a qualitative assessment of the process, aimed at identifying the factors that influence the successful implementation of the Safe Steps from the perspective of the nurse participants.

methodsSafe Steps is a structured approach for de-escalation, intended to reduce restrictive practices and promote the development and maintenance of therapeutic relationships, as well as individuals' self-management. It was implemented in three adult inpatient units in New South Wales, Australia, from March 2024 to April 2025. This paper was nested within a mixed concurrent control study and was informed by a pragmatic and complex intervention research framework. Nurse focus group discussions were analysed using reflexive thematic analysis. Paired measures of compassion satisfaction, burnout, and compassion fatigue before and after one-year implementation were compared.

resultsScores after implementation indicated a decline in compassion satisfaction and an increase in burnout, compared to the baseline. Two superordinate themes were identified from seven focus groups, with twenty-six nurse participants: (i) de-escalation is a relational, adaptive, and collective nursing practice, and (ii) ecological pressures shape the practice of de-escalation. These superordinate themes were developed from seven subordinate themes. DISCUSSION: A cautious interpretation of the quantitative measures is warranted, given the challenges of obtaining follow-up responses in busy, under-resourced inpatient units. The thematic findings suggest that successful implementation depends on the organisational and relational contexts in which interventions are deployed. RECOMMENDATIONS: Future evaluations of the Safe Steps need to consider extending beyond nurses' relational capabilities to encompass the relational responsiveness of multidisciplinary teams.

Indexed as

Attitude of Health PersonnelBurnout, ProfessionalCompassion FatigueNursing Staff, HospitalPsychiatric Department, HospitalPsychiatric NursingRestraint, PhysicalAdultFemaleHumansMaleMiddle AgedNew South WalesQualitative Research

Identifiers

PMID41546468
PMCPMC12974916

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.