title: Serious untoward incidents and their aftermath in acute inpatient psychiatry: the Tompkins Acute Ward study.
abstract: Serious untoward incidents, or sentinel events (suicide, homicide, suicide attempt, serious assault, and absconding of high-risk patients) occur from time to time in association with acute psychiatric inpatient wards. The aim of this study was to discover the impact of serious untoward incidents on inpatient wards. Doctors, nurses, and occupational therapists at three hospitals were interviewed about these events and their impact on their wards. Staff reported feelings of shock, depression, demoralization, upset, loss, and grief, followed by ruminations, guilt, and anxiety. Levels of containment increased, as did the focus on risk assessment. Processing of the emotional impact was hindered by the pace of ward life, a lack of external support, and management investigations. Patient responses were largely ignored. A few staff responded negatively, hindering service improvements. Much more attention needs to be given to the needs of the patient group following incidents. Substantial planning, organization, and investment are required to properly prepare for such events and manage their outcome. Without this planning and action, acute inpatient work has the capacity to be damaging to staff.
authors.affiliation: St Bartholomew School of Nursing and Midwifery, City University, London, UK. l.bowers@city.ac.uk
authors.forename: Len
authors.initials: L
authors.lastname: Bowers
authors.forename: Alan
authors.initials: A
authors.lastname: Simpson
authors.forename: Sophie
authors.initials: S
authors.lastname: Eyres
authors.forename: Henk
authors.initials: H
authors.lastname: Nijman
authors.forename: Cerdic
authors.initials: C
authors.lastname: Hall
authors.forename: Angela
authors.initials: A
authors.lastname: Grange
authors.forename: Louise
authors.initials: L
authors.lastname: Phillips
mesh_terms: D000208:Acute Disease; D000223:Adaptation, Psychological; D000328:Adult; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000517:prevention & control / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006117:Grief; D006167:Guilt; D006708:Homicide / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D015404:Nursing Methodology Research; D016272:Occupational Health; D009788:Occupational Therapy; D010564:Personnel, Hospital / Q000523:psychology*; D011568:Psychiatric Nursing; D011570:Psychiatry; D036301:Qualitative Research; D012944:Social Support; D013405:Suicide / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014754:Violence / Q000706:statistics & numerical data