Mental Health Nursing
Mental Health Nursing
Mental Health Nursing
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Fletcher (1999) employed an ethnographic approach to compare the<br />
perceptions of 12 nursing staff who conducted constant observation with<br />
those of 6 patients who were placed on constant observation for suicidal<br />
risk. The study found a degree of commonality between the two groups;<br />
for example, with regard to the purpose of constant observation to prevent<br />
harm to patients. However, there were also interesting anomalies between<br />
the nurses and patients; for example, sitting outside a patient’s room was<br />
considered by nurses to be therapeutic whereas patients considered it to be<br />
a controlling action. The majority of both positive and negative feelings<br />
on the part of patients were attributed to staff actions. Similarly, Ashaye<br />
et al. (1997) interviewed 13 patients and their respective primary nurses,<br />
in two different hospitals in the south of England, about their experiences<br />
of constant observation. The main findings were that most of the patients<br />
considered they had benefited from being on constant observation, although<br />
they disliked the intrusion on their privacy.<br />
Observation can be stressful for both nurses and patients. By asking the<br />
people who are actually being observed as well as those doing the observing,<br />
these studies have provided a valuable insight into this activity. Generally,<br />
nurses’ and patients’ views on the therapeutic use of observation are similar.<br />
Patients want to be observed by nurses who treat them as people with<br />
problems, rather than simply as a diagnosis, and nurses want to engage in<br />
a therapeutic relationship, rather than act as a custodian.<br />
Conclusion<br />
Observation 181<br />
The issues identified in this chapter highlight some of the very real problems,<br />
dilemmas and challenges faced by nurses who care for patients at<br />
risk on acute in-patient wards. It is highly problematic that there is no real<br />
‘evidence base’ for the effective practice of observation, and that the written<br />
guidance that does exist has not been effectively evaluated. There are<br />
two main reasons for this. First, there is a paucity of research on observation<br />
to provide reliable research ‘evidence’ on how to effectively conduct observation.<br />
Second, the written guidance that has been produced, specifically<br />
the SNMAC practice guidance (DoH, 1999b) and the CRAG/SCOTMEG<br />
(1995) good-practice statement, has yet to be evaluated. Thus however<br />
sensible (or not) this guidance may seem, there is no real evidence that<br />
this guidance will improve the care of people who are observed by nurses<br />
when they are acutely ill at risk of harm.<br />
It has been identified that even when there are local policies for observation<br />
in place, the actual practice of observation by nurses may deviate from<br />
any ‘official’ policy. This may be due to staff being trained inadequately<br />
and unsupported when conducting observation. However, when nurses