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Flexible observation: guidelines versus reality.

A M Kettles1, K Paterson

  • 1NHS Grampian, Bennachie, Royal Cornhill Hospital, Aberdeen, UK. alyson.kettles@nhs.net

Journal of Psychiatric and Mental Health Nursing
|May 23, 2007
PubMed
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This pilot study introduced flexible patient observation in acute psychiatry, shifting decisions to nurses and reducing high observation levels. Staff found the new system more practical, though recording completeness remains a challenge.

Area of Science:

  • Psychiatric Nursing
  • Patient Observation Protocols
  • Clinical Decision-Making

Background:

  • Current guidelines recommend specific observation levels for acute psychiatric patients.
  • Traditional observation practices often involve intermittent or time-based checks, considered unsafe.
  • Existing protocols clearly define responsibilities for observation procedures.

Purpose of the Study:

  • To pilot a flexible patient observation system in an acute psychiatric setting.
  • To increase nurse autonomy in making observation level decisions.
  • To evaluate the impact of flexible observation on patient care and staff practices.

Main Methods:

  • A 6-month action research pilot study involving 57 patient incidents.
  • Analysis of changes in observation levels and decision-making processes.

Related Experiment Videos

  • Statistical analysis using SPSS v.14.0 with non-parametric statistics and chi-square tests.

    • Main Results:

    • A shift from physician-led to multidisciplinary/nursing decisions regarding observation levels.
    • A decrease in the duration and frequency of high-level observations.
    • Staff reported the new recording system as more practical, despite incomplete data in 56% of records.

    Conclusions:

    • Flexible observation models can empower nurses and reduce prolonged high-level observations.
    • Further improvements in documentation completeness are necessary.
    • Continued engagement and training are needed to ensure full staff participation in decision-making.