Under the Gaze of Staff: Special Observation as Surveillance

Institute of Psychiatry, Kings College, London, UK.
Perspectives In Psychiatric Care (Impact Factor: 0.65). 01/2012; 48(1):2-9. DOI: 10.1111/j.1744-6163.2010.00299.x
Source: PubMed


This study explores the relationship of special observation (SO) to a range of patient, staff, and ward variables.
End-of-shift reports were completed by nurses on 136 acute mental health wards in England during 2004 and 2005.
Intermittent SO (patient checked at specified intervals) was used five times more frequently than constant SO (patient kept within sight or reach). Significant relationships were found between SO and measures of ward surveillance, door locking, and the ease of observing patients on the wards. Both types of SO were more common when higher numbers of staff without a nursing qualification were on duty.
Improved ward design, less reliance on unqualified staff, and greater use of surveillance measures may reduce the need for SO.

Download full-text


Available from: Len Bowers
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Inpatient suicide is a tragedy, and removal of the means is only a partially effective strategy. To identify the mechanisms by which attempted inpatient suicides are prevented, so that their use can become more widespread. Analysis of one year of nationally reported suicide attempts on inpatient psychiatric wards from the National Patient Safety Agency. Patients are discovered in the act by staff checks (medication rounds, meals, routine activities, and intermittent observation) and by staff being caringly vigilant and inquisitive (noticing the absence of patients, their psychological distress, physical state, responding to unusual noises, etc.). The use of intermittent observation and other patient checks should be increased, and particularly directed to private areas of the ward. All staff should act on any sense of unease or feeling that something about a patient, their behaviour, or noises on the ward, are not right.
    Full-text · Article · Jun 2011 · International journal of nursing studies
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To describe the types and frequency of conflict behaviours exhibited by patients during the first 2 weeks of admission to acute psychiatric units, the methods staff use to manage them and bring to the surface underlying common patterns. Many studies have investigated the prevalence and impact of psychiatric inpatient aggression. Much of the research to date has studied conflict and containment behaviours separately; however, some studies have reported relationships between certain behaviours suggesting that there are complex causal links between conflict and containment behaviours. A cross-sectional survey of conflict and containment events. Nursing notes were accessed for 522 patients during the first 2 weeks of admission, in 84 wards in 31 hospitals in the South East of England. Conflict and containment events occurring during this period were recorded retrospectively. Factor analysis revealed six patterns of conflict behaviour, which were related to containment methods and patient demographic factors. These factors confirm some previously reported patterns of conflict. This study brings to light underlying common patterns of disruptive behaviour by psychiatric inpatients. The reasons for these remain obscure, but may relate to (1) national variations in policy and practice shaping static structural differences of interest between patients and staff and (2) normal developmental age and gender-specific behaviours. Conflict behaviour patterns may be differently motivated and therefore require different management strategies by staff. There is a need for awareness by clinical staff to the fact that different types of conflict behaviours may be co-occurring or indicative of each other. Clinical staff should consider that implementation of and changes to hospital policies have the potential to change the nature and frequencies of certain conflict behaviours by patients.
    Full-text · Article · Aug 2012 · Journal of Clinical Nursing
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To report the state of research about special observation and to develop implications for the German-speaking countries. Methods: Systematic literature search. Results: The literature consists mainly of descriptive studies. There are no standardized approaches. Use of assistants can have a negative impact on quality of the intervention and may result in an accumulation and change of measures. Nurses play a responsible role in special observation. There are different experiences and perceptions of patients and nurses. Special observation includes both therapeutic and non-therapeutic components. Conclusions: The focus should be on therapeutic aspects of observation; particularly involvement and development of hope. Observation might restrict personal freedom and should be used as rarely as possible. Strengthening nurses in decision-making is associated with increased quality. More research is needed regarding the effectiveness, the frequency of utilization and opportunities for prevention. The importance of observation is in contrast to the lack of relevant data.
    Full-text · Article · Jan 2013 · Psychiatrische Praxis
Show more