Mental health nursing practice in acute psychiatric close-observation areas

The provision of evidence-based therapeutic nursing care in close-observation units or psychiatric intensive care units, has been identified as a problem internationally. These areas of nursing practice have been the subject of considerable discussion particularly in relation to the management of aggression, violence, involuntary treatment, and seclusion. This study used a participatory action research framework to identify qualitative and quantitative measures of activity in the area. Quantitative data collected included rates of critical incidents, the use of prn medication, and the use of seclusion. These data were used as base-line data and were predicted as a measure of change. Qualitative data, collected by interview and focus groups, were used to reveal the experience of patients, relatives, and nurses in a close-observation area. Analysis of this data revealed three main themes: design and environment, lack of activity and structured time, and nursing care. The importance of this study is in demonstrating the multiple problems that exist in the provision of care in close-observation areas and the corresponding need for fundamental changes.