Mental Health Nursing

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