Constant or special observations of inpatients presenting a risk of aggression or violence: Nurses' perceptions of the rules of engagement

Abstract

In acute psychiatric settings the practice of 'observation' is commonly employed. Increased levels of observation, 'constant' or 'special' are used for those perceived as presenting a 'higher' risk. As an intervention it is used most frequently for those at risk of self-harm or suicide, the practice is also however, used for those thought to present a risk of violent behaviour. In this descriptive study the perceptions of 1st level registered mental nurses (RMNs) gave an account of observation for those perceived to be at risk of violence or aggression and insight into what was considered important and desirable in practice. Unstructured qualitative interviews were conducted with a purposive sample of six RMNs from a psychiatric intensive care unit. Three major categories, Procedure, Role, and Skills emerged which revealed a complex practice far removed from its literal description as merely 'watching'. Six subcategories emerged from the Role. (1) intervening; (2) maintaining the safety of the patient and others; (3) prevention de-escalation and the management of aggression and violence; (4) assessing; (5) communication; and (6) therapy. Skills in these and, experience were thought to IMPACT on the success of the practice. The description of this and the skills involved offer a definition of the 'rules of engagement' which give insight to the practice and the training needs of staff advocated for 'observation'. The acronym IMPACT may be useful in this.