Mental Health Nursing

174 Acute Mental Health Nursing
• specific level of observation to be implemented;
• clear directions regarding therapeutic approach; i.e., occupational therapy
sessions;
• timing of next review.
It is also specified that the records should include the name of the person
conducting the observation, the time they commenced and concluded their
period of observation. It is also recommended that a detailed record of the
patient’s behaviour, mental state and attitude to observation be recorded
every 15 minutes.
Such guidance, if implemented, should ensure accurate and clinically
useful recording of an individual’s care. However, on the evidence of
audits, such rigorous record keeping is not always observed. Porter et al.
(1998) and Neilson and Brennan (2001) demonstrated substantial inconsistencies
in record keeping, with missing or inaccurate information in
patients’ records regarding their care whilst being observed. Examples
included: missing staff names and signatures; lack of information for long
periods of time; the times when observations were changed or reduced not
clearly documented; alterations to written information, the use of correction
fluid; poor information regarding patients’ mental state that bore no relevance
to the stated risks (such as ‘watching TV’, ‘settled’, or ‘resting in bed’). Not
only does such poor record keeping limit the ability to maintain a continual
assessment of patients at risk, it also has legal implications as mental
health professionals have a duty of care and are accountable for their
actions, decisions and omissions. Thus if a nurse omits to record certain
information in a patient’s records, or fails to communicate important information,
concerns and/or observations to the appropriate team members,
then a nurse could be seen to be acting negligently.
Who should observe?
There is considerable debate whether patients at-risk should always be
observed by a permanent qualified member of staff, or whether it is acceptable
for support workers, students or non-permanent (e.g., agency) staff to
conduct this role. In practice, a variety of people perform the ‘observer’
role, including qualified nurses, agency nurses, nursing and medical
students, support workers, family members, friends and volunteers (Bowers
and Park, 2001). Observation is often regarded as an unpleasant lowstatus
and low-skill task and frequently delegated to either junior staff, or
agency and bank staff who may be unknown to the patient (Barker and
Cutcliffe, 1999; Dodds and Bowles, 2001). The reasons for this are complex
and debatable, but include: problems of recruitment and retention
of qualified and experienced nursing staff in acute in-patient units