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Br J Psychiatry. 2008 Nov;193(5):395-401. doi: 10.1192/bjp.bp.107.037721.

Relationship between service ecology, special observation and self-harm during acute in-patient care: City-128 study.

Author information

1
Psychiatric Nursing, City University, Philpot Street, London E1 2EA, UK. L.Bowers@city.ac.uk

Abstract

BACKGROUND:

Special observation (the allocation of nurses to watch over nominated patients) is one means by which psychiatric services endeavour to keep in-patients safe from harm. The practice is both contentious and of unknown efficacy.

AIMS:

To assess the relationship between special observation and self-harm rates, by ward, while controlling for potential confounding variables.

METHOD:

A multivariate cross-sectional study collecting data on self-harm, special observation, other conflict and containment, physical environment, patient and staff factors for a 6-month period on 136 acute-admission psychiatric wards.

RESULTS:

Constant special observation was not associated with self-harm rates, but intermittent observation was associated with reduced self-harm, as were levels of qualified nursing staff and more intense programmes of patient activities.

CONCLUSIONS:

Certain features of nursing deployment and activity may serve to protect patients. The efficacy of constant special observation remains open to question.

PMID:
18978321
DOI:
10.1192/bjp.bp.107.037721
[Indexed for MEDLINE]
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