Rethinking Observations in Mental Health

Periodic intermittent clinical observations are commonly used in mental health services at admission for risk assessment and then for the clinical management of patients.

Nurses follow these practices as routine care to ensure patient well-being. However, being observed may make patients feel uncomfortable and anxious.

The Department of Health (2006) stipulated for the practice of observation to be implemented in a manner that would enable patients to experience it as a healing and compassionate practice. This is apparently not always realised as there are reported differences on how patients are observed, and clinical data obtained.

Whilst this may be attributed in part to lack of or limited training on the use of observations, it can also in part be attributed to lack of a standardised approach to implementation and documentation of the outcomes of observations (Stewart & Bowers 2012).This contributes to variability among healthcare workers in their interpretation of the outcomes/data of observations. Given that patients' care pathways are influenced by the outcomes/data of observations, it is critical to reduce the variability in the use of this practice. Doing so would lead to obtaining consistent and dependable data that reflect patients' mental state to guide their individual care pathways.

The focus of this qualitative study is to document how clinicians perform routine patient observations, the essential aspects of observations through a clinician's point of view and how can application of modern technology aid this process. This systematic documentation will capture the strengths and limitations of current practice creating a service provide based dataset to inform focused improvements.

Inclusion criteria

• Healthcare workers such as nurse directors, matrons, ward managers, nurses, healthcare support workers, including; nurse associates, nurse assistants and assistant practioners who work in inpatient mental health settings
• Healthcare workers with at least two years' experience of working in inpatient mental settings
• Healthcare workers who conduct or have conducted patient observations, and have used it for at least two years

Exclusion criteria

Students and clinicians in training who do not carry out independent patient observations.