The Evolution of Practice Changes in the Use of Special Observations

Published:November 09, 2010DOI:https://doi.org/10.1016/j.apnu.2010.07.007
      In acute psychiatric settings, it is common practice to increase the intensity of observations of patients who present with self-injurious thoughts, who are at risk of injuring others, or who exhibit behaviors that adversely impact the overall milieu. These intense observations are intrusive and may result in untoward stimulation of the patient. Nurses at an urban academic medical center addressed the problem of intrusive and overstimulating levels of observation by developing two practice changes using intuitive knowledge combined with input from current nursing literature. The first change was designed to move from observation to engagement. The second change was designed to decrease patient agitation related to intense observation. This article discusses the potential adverse consequences associated with the use of intense levels of observation and describes two protocols that have contributed to a reduction in the use of seclusion and restraints, as well as staff members' reported perceptions of feeling safer and experiencing improved job satisfaction.
      To read this article in full you will need to make a payment

      References

        • Bailey R.H.
        Violence and aggression.
        Time-Life books, New York, NY1976
        • Bowers L.
        • Whittington R.
        • Nolan P.
        • Parkin D.
        • Curtis S.
        • Bhui K.
        • Flood C.
        The City 128 study of observation and outcomes on acute psychiatric wards.
        Report to the NHS Service Delivery and Organization Program. City University, London2006
        • Bowers L.
        • Park A.
        Special observation in the care of psychiatric inpatients: A literature review.
        Issues in Mental Health Nursing. 2001; 22: 769-786
        • Bowers L.
        • Simpson A.
        Observing and engaging new ways to reduce self harm and suicide.
        Mental Health Practice. 2007; 10: 12-14
        • Clinical Resource and Audit Group
        Engaging people: Observation of people with acute mental health problems.
        (Retrieved from)
        • Cleary M.
        • Jordan R.
        • Horsfall J.
        • Mazoudier P.
        • Delaney J.
        Suicidal patients and special observation.
        Journal of Psychiatric and Mental Health Nursing. 1999; 6: 461-467
        • Cox A.
        • Hayter M.
        • Ruane J.
        Alternative approaches to ‘enhanced observations’ in acute inpatient mental health care: A review of the literature.
        Journal of Psychiatric & Mental Health Nursing. 2009; 17: 162-171
        • Cutcliffe J.R.
        • Barker P.
        Considering the care of the suicidal client and the case for ‘engagement and inspiring hope' or ‘observations'.
        Journal of Psychiatric & Mental Health Nursing. 2002; 9: 611-621
        • Cutcliffe J.R.
        • Stevenson C.
        Feeling our way in the dark: The psychiatric nursing care of suicidal people: A literature review.
        International Journal of Nursing Studies. 2008; 45: 942-953
        • Dodds P.
        • Bowles N.
        Dismantling formal observation and refocusing nursing activity in acute inpatient psychiatry: A case study.
        Journal of Psychiatric & Mental Health Nursing. 2001; 8: 183-188
        • Joint Commission
        Inpatient suicides: Recommendations for prevention.
        (Retrieved from)
        • Langley G.
        • Klopper H.
        Trust as a foundation for the therapeutic intervention for patients with borderline personality disorder.
        Journal of Psychiatric & Mental Health Nursing. 2005; 12: 23-32
        • Mackay I.
        • Patterson B.
        • Cassells C.
        Constant or special observations of inpatients presenting a risk of aggression or violence: Nurses' perceptions of the rules of engagement.
        Journal of Psychiatric and Mental Health Nursing. 2005; 12: 464-471
        • Mason T.
        • Mason-Whitehead E.
        • Thomas M.
        Special observations in forensic psychiatric practice: Gender issues of the watchers and the watched.
        Journal of Psychiatric & Mental Health Nursing. 2009; 16: 910-918
        • McMyler C.
        • Pryjmachuk S.
        Do ‘no-suicide’ contracts work?.
        Journal of Psychiatric and Mental Health Nursing. 2008; 15: 512-522
        • Neilson P.
        • Brennan W.
        The use of special observations: An audit within a psychiatric unit.
        Journal of Psychiatric and Mental Health Nursing. 2001; 8: 147-155
        • Potter M.
        • Vitale-Nolen R.
        • Dawson A.
        Implementation of safety agreements in an acute psychiatric facility.
        Journal of the American Psychiatric Nurses Association. 2005; 11: 144-155
        • Whitehead E.
        • Mason T.
        Assessment of risk and special observations in mental health practice: A comparison of forensic and non-forensic settings.
        International Journal of Mental Health Nursing. 2006; 15: 235-241