Table 5 Staff, patient and carer pre-implementation perceptions of body-worn cameras (BWCs)
Body-worn cameras (BWCs) | Pre-implementation perceptions of technology | MMAT qualityrating | Conflicts of interest | |
|---|---|---|---|---|
Quantitative survey results | Staff 2 papers Hakimzada et al. [54]: n = 60 nursing staff Ellis et al. [44]: n = 15 | Quantitative findings from a survey of nursing staff (n = 60) [54] • 30% were neutral when asked if they would support BWC use in mental health settings (most common response) • 45% would feel comfortable wearing a BWC • 61.7% felt wearing a BWC would not deter them from working • 35% felt BWCs would de-escalate violent situations on the ward • 75% were confident in the ability of BWCs to reduce false patient accusations. This item had the lowest negative response (8.3%). • 51.7% agreed BWCs could “resolve violent incidents” • 50% agreed BWCs would put their mind at ease • 55% felt BWCs would cause staff to modify their behaviour • 56.7% agreed there may be ethical issues regarding patients being recorded in compromising situations • 65% agreed there may be ethical issues regarding patient confidentiality | 1 × low 1 × medium | 1/2 papers reported a conflict of interest |
Quantitative findings from a questionnaire to mental health ward staff (n = 15) [44] • 80% thought BWCs would have a positive impact • 86% thought BWCs help reassure both staff and patients • 100% encountered verbal or physical aggression at least once a week • 87% spent a “considerable portion of their time dealing with aggressive behaviour” • 80% said dealing with aggressive behaviour “often gets in the way of doing the job they ought/want to be doing” • 80% said if BWCs could help reduce aggressive behaviour or the time spent dealing with it, “it would have a positive impact on their day-to-day job” • 60% could recall a work incident “where they wished they’d had a body camera” | ||||
Potential uses or benefits | Staff Hakimzada et al. [54]: n = 60 nursing staff Ellis et al. [44]: n = not reported Foye et al. [52]: n = 16 | • Reduce and deal with false patient accusations. • Enable accurate, unbiased evidence documentation of incidents. • Increase staff and patient safety. • Reduce violent and aggressive incidents. • Potential use as a training, learning or reflective tool for staff to reinforce good practice and identify faults in staff behaviour. • Cause patients to “think before acting”. • Monitor the interaction between patients and staff. • Similar protocols to other security measures made staff view BWCs as easier to implement. • A minority of staff felt BWCs could improve relationships by providing transparency around staff behaviour and encouraging positive staff behaviour and high-quality care. | 2 × low 1 × medium | 1/3 papers reported a conflict of interest |
Patients 1 paper Foye et al. [52]: n = 5 | • May hold staff to account for their own behaviours and so improve care, though concern expressed that this effect may wear off after the first few months as people may forget about the cameras being there. | Low | None | |
Concerns and potential harms | Staff Hakimzada et al. [54]: n = 60 nursing staff Foye et al. [52]: n = 16 staff Foye et al. [51] n = 31 staff | • Violates patient confidentiality, which could lead to legal action against Trusts. • BWCs are intrusive/violate patient privacy. • Increase patient paranoia, aggression, annoyance, make them feel intimidated. • Particular concerns around potential negative impact on patients with paranoia, psychosis, and previous negative experiences of being filmed. • Ambivalence amongst some staff that introducing BWCs would reduce violence and aggression, due to acceptance of violence and aggression being “part of the job”. • BWCs could aggravate violent situations or instigate incidents. • Could negatively impact therapeutic relationships, increase power differentials between patients and staff, and make it difficult for patients to trust staff. • Could be unethical. • Could increase assault against staff/make staff a target. • Issues obtaining patient consent, and some patients may not understand the rationale for them. • Continued information surrounding BWC use needs to be provided to patients, as their health and capacity may fluctuate during their stay on the ward. • Staff would be uncomfortable wearing BWCs. • Staff may forget to wear BWCs, forget to switch them on, and forget to charge them. • Staff may be unable to use BWCs correctly. • Staff may be less willing to get involved in incidents. • Staff/patients could “act” for the camera. • Patients could break the BWCs/use them as a weapon. • Doubts over transparency of using cameras to collect evidence around incidents as cameras remain in staff control, resulting in issues of bias and power. • When multiple initiatives and directives were introduced simultaneously, staff felt negative towards interventions more generally, viewing BWCs as “just another thing to do” which increased their workload and reduced staff enthusiasm for BWCs. • Staffing issues, contributing to higher workloads, higher rates of bank and agency staff, and staff burnout are barriers to implementing BWCs. • Need for a continued training approach as opposed to a one-off session during induction to ensure changes in personnel, practice and shift patterns are part of the implementation process. | 1 × high 1 × medium 1 × low | None |
Patients 1 paper Foye et al. [52]: n = 5 patients | • Concerns about BWCs being used to collate evidence relating to incidents as cameras remain in staff control, creating issues of bias and power—more so than CCTV, which was viewed as more neutral. • Some felt BWCs do not reduce incidents as some patients are too acutely unwell to have insight into their own actions or those of staff activating the cameras. • Perception of BWCs as an intervention for staff intervention and safety, thereby increasing the culture of “them and us” and creating patient resistance towards BWC use. • Potential for resistance from patients with previous negative experiences of police use of BWCs or mistrust in staff. • Staffing issues, contributing to higher workloads, higher rates of bank and agency staff, and staff burnout are barriers to implementing BWCs. • BWCs do not address wider systemic issues contributing to violence and aggression. | Low | None | |