Discourse analysis of an 'observation levels' nursing policy

Area of Science:

• Psychiatric Nursing
• Health Policy Analysis
• Discourse Analysis

Background:

• Special observation (constant observation) is a prevalent practice in inpatient psychiatric settings for suicidal patients.
• Existing policies guide this practice but may not fully address therapeutic or ethical dimensions.
• Understanding the discourse within these policies is crucial for improving patient care and safety.

Purpose of the Study:

• To critically examine the discourse within a special observation nursing policy.
• To identify prevailing themes, assumptions, and omissions in the policy.
• To evaluate the policy's alignment with therapeutic relationships and patient rights.

Main Methods:

• Discourse analysis was employed to scrutinize the special observation nursing policy document.
• Key terms and phrases were identified and categorized.
• Analysis focused on professional roles, suicidality, patient context, behavior, and checklists.

Main Results:

• The policy emphasizes professional responsibilities and observable behaviors, reinforcing a medical hierarchy.
• Key elements such as the therapeutic nurse-patient relationship, patient rights, and ethical dilemmas were found to be absent.
• Assumptions underpinning risk assessment and the evidence for special observation practices were questioned.

Conclusions:

• The analyzed policy, while aiming for clarity, overlooks crucial aspects of patient-centered care and ethical considerations.
• There is a need to re-evaluate special observation policies to incorporate therapeutic processes and patient rights.
• Further research is needed to explore the evidence base for special observation and its impact on the therapeutic alliance.