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Inpatient and clinician perspectives on constant observation

Centre for Psychiatry

Funding Body: East London NHS Foundation Trust
Project Investigator: Stefan Priebe

{tab Overview}

The Department of Health enquiry on suicide in people with mental illness [1,2] recommended the increased use of 'constant observation' for inpatients judged to be at risk of suicide, i.e. placement of a patient within sight or reach of a mental health professional at all times.

The aim of such observation is to prevent psychiatric patients from committing suicide. This practise entails severe restrictions on patient privacy and autonomy. The East London Foundation Trust guidelines on observation state that staff must ensure that individual patient safety is balanced with the maintenance of privacy and dignity and so that therapeutic relationships are maintained [2].

There has been no research to date on how patients and clinicians perceive this balance and act to maintain it. Such research is important in order to determine the lived experiences of the patients undergoing these restrictions and the staff enforcing them, so that each can be better supported through the process, and so that reflective practise can be encouraged.

This project therefore aims to establish patient, nurse and psychiatrist perspectives on the benefits and difficulties of constant observation, and to determine how they negotiate the balance between harm prevention and preserving patient autonomy.

Activities & Outputs

In-depth interviews are being conducted with inpatients who have experienced constant observation for self-harm or suicide risk, and with staff who have implemented the observation as well as the ward doctors making the decisions to implement or stop observation. The interviews explore patients' and staff's opinions about the benefits and difficulties of constant observation and how patients and staff work to negotiate the balance between keeping patients safe and respecting their privacy, dignity and autonomy. Thematic analysis will be used to develop a series of themes encapsulating these experiences.

{tab References}

  • Department of Health. SAFER SERVICES. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. DOH 1999.
  • National Institute for Mental Health in England. Fourth annual report on progress in implementing the national suicide prevention strategy for England. NIMHE 2006.
  • East London NHS Foundation Trust. Observation Policy. Version 3.0. ELFT 2011.

{tab Staff}

 

{tab Main Contact}

Kirsten Barnicot
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Phone: +44 (0) 20 7540 6755

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