Mental Health Nursing

178 Acute Mental Health Nursing
… a hidden contributory factor to the rotten state of acute admission wards that can be
changed by clinicians. (Bowles and Dodds, 2001: 18)
In response they conducted a structured programme of change to observation
and nursing practice as a whole, in a ‘refocusing’ practice development
project in which they reported how the project significantly reduced the
use of observation. This occurred alongside a process of more structured
and individualised activity for patients, involving greater patient/staff contact
and engagement, leading them to be better informed and more involved in
their care. A key principle that underpinned this work was ‘the gift of
time’ which was valued highly by the patients (Jackson and Stevenson,
1998). In addition, following the implementation of this project there have
been significant reductions in: incidents of deliberate self-harm; incidents
of violence and aggression; absconding; and staff sickness. There have
also been financial savings by employing fewer agency and bank staff.
The work of Bowles, Dodds and their colleagues is considered by many
to be innovative and to demonstrate good practice. It is important to remember
that one must be cautious of making generalisations from such a small
case-study; however, the achievements in Bradford demonstrate that the
practice of observation cannot be changed in isolation. In order to reduce
the use of observation, the nursing team, with support of the rest of the multidisciplinary
team, totally reorganised the ‘culture’ of patient care and nursing
practice on the ward. This highlights the fact that if practice is to be
challenged and improved, it has to involve a cultural shift within the clinical
team. This type of change is the greatest challenge of all, but it is clearly
needed to turn around the poor state of acute in-patient care in the UK.
Nurses’ and patients’ experiences of observation
The fact that there is a dearth of research on observation per se has already
been highlighted. There are even fewer studies that consider the nurses’ and
patients’ perspectives of observation. This section will provide an overview
of these studies, and highlight the main findings relevant to practice.
Nurses’ experiences
Most studies that consider nurses’ experiences about observation are smallscale
and qualitative, offering a depth of understanding of some of the difficulties
faced by nurses when conducting observation. Duffy (1995)
conducted semi-structured interviews with 10 nurses in one in-patient unit
in England. All of the nurses had experience of observing suicidal patients
and the interviews disclosed a number of problematic issues for nurses