Mental Health Nursing

no evaluative work conducted to assess the extent of implementation or
effectiveness of the guidance (Kettles, 2000). There is no national guidance
for the practice of nursing observation available in Northern Ireland.
As in the rest of the UK, in Northern Ireland observation policies and procedures
remain the domain of individual trusts and hospitals.
The local picture
Observation 167
It is clear that from the work conducted by Bowers et al. (2000) in England
and Wales that there is enormous variation in the way that observation is
being conducted in different trusts and hospitals. There is also evidence that
within individual trusts, the practice of observation may vary. An audit of
observation procedures in a Scottish NHS trust showed that not only were
there variations in the use of observation between different wards but also
between consultant psychiatrists (Porter et al., 1998). Similar variations
have been uncovered by other studies; for example, an audit conducted in a
single trust in England by Neilson and Brennan (2001) found a variation in
the use of different levels of observation across four different wards and in
the documentation of the risk factors. Variations of this type have also been
found during a study of patients’ experience of observation (Jones et al.,
2000a, 2000b). During a three-month period, data were obtained from the
numbers of patients being observed across five acute in-patient wards in a
single NHS trust in England. The use of different levels of observation, and
the amount of time that particular patients remained on higher levels of
observation, varied considerably across the five wards.
Similar findings are also reported by Bowers and Park (2001). So why
is there so much variation in the way that observation is carried out and
documented within a single trust or hospital? There is no conclusive evidence
to answer this question, although the findings of different research
studies do offer possible suggestions. The work of Porter et al. (1998)
highlighted that different consultant psychiatrists in a single trust displayed
different patterns of usage, with some consultants placing patients
on observation for longer time periods than others. This could be put
down to ‘defensive’ practice, although Porter et al. (1998) stated that a
consultant with the highest number of hours consulted nursing staff more
than many other consultants and was held in esteem by his colleagues.
Another possible reason highlighted by Porter et al. (1998) and Neilson
and Brennan (2001) is that even when most nurses display good knowledge
of the local observation policy and procedure, errors and inconsistencies
in documentation are widespread. However, it cannot always be
taken for granted that all staff have a good knowledge of the local Trust
observation policy, as demonstrated by Midence et al. (1996), who found
that nursing staff were often not familiar with their trust’s observation