Alternative approaches to ‘enhanced observations’ in acute inpatient mental health care: a review of the literature

Abstract

Accessible summary • Enhanced observation can be an intrusive and impersonal approach to monitoring individuals requiring intensive nursing care. However, the evidence for what could replace it effectively is not well known. • This study looks at research studies that study alternatives to enhanced observation and argues that there are other ways, perhaps involving less intrusive monitoring or organizing care differently, that could be used as a more acceptable replacement. • The paper also argues that more research is needed into this area of mental health nursing. Formal ‘enhanced observations’ involving allocating one or two nurses to place an patient under continuous observation when acutely ill and at risk of self-harm are ineffective, contribute to impersonal care, are stressful to practitioners and reinforce the perception of a custodial environment. The aim of this literature review was to systematically bring together published studies and research that identified alternative approaches to ‘enhanced observations’ from those proposed in the Standing Nursing and Midwifery Advisory Committee guidelines on individuals receiving care on open acute inpatient settings. The literature search strategy resulted in the retrieval of five empirical studies, with further analysis revealing six potential interventions relating to the development of an alternative approach to observations. These are: (1) assessment; (2) nurse autonomy; (3) ward management initiatives (4) engagement and collaboration; (5) a team approach; and (6) intermittent observations. The review emphasized how enhanced observations and the development of alternative approaches are a complex activity requiring planning and consideration to facilitate appropriate implementation. The review also highlights a dearth in empirical evidence for alternatives, and a need to revise current practices because of the dissatisfaction from clients and practitioners involved in this intervention.

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