Constant Observation in an Inpatient Psychiatric Setting: A Scoping Review

Observation of patients is integral to nursing's role in inpatient psychiatric settings. Constant observation (CO) is a common strategy for managing high-risk behaviors. Although widely used, the field seemingly does not have a standard definition of CO, and policies for the use of CO vary across institutions. To date, literature has focused on experimental data regarding CO improvement or has been limited in scope. Resultantly, researchers and clinicians have been restricted in their ability to characterize the usage of CO and the effectiveness of CO as a risk reduction strategy.

The purpose of this scoping review was to characterize the extant data regarding CO use and to assess how CO is being discussed in the literature.

This review included published manuscripts, that is, clinical discussions, critiques, commentaries, and research studies pertaining to CO within inpatient psychiatric units.

Fifty-nine articles were identified and reviewed. Findings suggested a lack of consensus regarding CO policy. Overall, more patients with more severe symptoms were more likely to receive CO, and high-risk behaviors were predictive of CO use. However, there is limited research suggesting that CO is an effective intervention to prevent or reduce high-risk behaviors. Even so, CO is generally well-accepted across disciplines and by patients, despite it being costly and resource-intensive. Some studies identified interventions such as restructuring staffing, increasing therapeutic interventions, and including patients in problem-solving as effective means of reducing CO use without increasing high-risk behaviors.

The role of CO in psychiatric settings was examined, and recommendations were made.