Patients can react with fear or anger after ward events or episodes. Events such as violence, absconding, the admission of disturbed patients, arguments and containment measures like manual restraint or coerced IM medication can all have an impact on everyone on the ward. Night time may be particularly frightening for patients particularly if they are unused to the environment where they may be sharing a sleeping area with other people that they do not know, and illness may make them particularly vulnerable to additional stress. Patients may wake to the sound of shouting in the middle of the night, and lie awake fearfully imagining what might be going on.
These reactions partly explain why one event triggers another, why if there is one significant incident on the ward a second is more likely to occur. This intervention seeks to reduce the risk of 'contagion' between patients by allaying the anxieties that occur in these circumstances.
Following the occurrence of a potentially anxiety provoking incident on the ward every patient should be spoken to, either alone or in small groups, to ask them their understanding of what has happened, what effect it has had on them and to give them an explanation as to what has happened. If not all patients have witnessed the incident or heard of it in some way, then only those who have could be spoken to. Staff should make increased efforts in the short term to be more visible and out on the ward with patients, moving about a lot, covering the whole of the ward, being noticeably watchful, not an anxious way (which would make things worse) but in a warm, caring, non-negative emotional way. The goal of staff presence, explanation and support is to leave everyone feeling safe and secure.
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