Mental Health Nursing

176 Acute Mental Health Nursing
Involving patients and carers in observation
A guiding value of the National Service Framework for Mental Health
(DoH, 1999c) is that patients and their carers are involved in the planning
and delivery of their care. However, in reality this is not always the case.
Much of the research that focuses upon the patient perspective of observation
suggests that a major complaint among patients is that they are
sometimes not even told that they are being observed. Even when they are
told, often it is not explained clearly to them and they rarely feel involved
in the decision-making about this component of their care.
Although giving information could be viewed as a procedural matter,
with little bearing on the nurse/patient interaction, it can equally be considered
an important opportunity to involve patients in their care. This
issue yet again highlights the importance of nurse/patient relationships
which are open and supportive, and which convey a sense of respect for
the patient and their autonomy. It is therefore imperative that every effort
is made to involve patients and their carers/friends in the decision-making
process, making certain that the procedure and the reasons for its implementation
are clearly explained, and ensuring that the observation is conducted
in a way that is both supportive and therapeutic.
Gender, ethnicity and culture
The issues of gender, ethnicity and culture remain relatively ‘invisible’ in
the literature on observation. Regarding gender, two quantitative studies
show that women are placed on more intensive levels of observation compared
to men (Shugar and Rehaluk, 1990; Kettles, 2001), although the
reasons for this are not clear. Further exploratory research is required,
within the context of the care and safety of women in acute inpatient psychiatric
settings, a topic highlighted in reports by the Sainsbury Centre for
Mental Health (1997; 1998) and in Addressing Acute Concerns (DoH,
1999a). Regarding the practice of observation, we believe that it is important
to ask women (and also men) if they prefer an observer of the same
or different gender, as far as staffing situations allow. This is particularly
important when a nurse needs to accompany a patient to the bathroom.
Gender issues regarding observation clearly require greater attention than
they currently receive.
In the National Visit 2 (SCMH, 2000) it was reported that patients from
black and minority ethnic communities were often not receiving care that
was sensitive to their cultural backgrounds. To our knowledge no research
has examined observation from the perspective of ethnicity and culture. It
has been demonstrated that within the mental health care system ethnic
minority patients are treated differently, and that in many cases this was