Enhanced Observation: How Therapeutic Are They Within A Medium Secure Forensic Mental Health Setting?

ABSTRACT

Enhanced observations (EO) have been integral to mental health nursing care for decades. However, research examining patient’s experiences of EO within forensic mental health settings is limited. This study explored patients’ lived experiences of EO within a medium secure hospital as part of a service review. Four patients and one staff member completed semi-structured interviews. The data were analysed using Interpretive Phenomenological Analysis (IPA). The four themes that emerged were: 1) The importance of the therapeutic relationship;

2) Focus on staff’s interpersonal qualities; 3) EO experienced as loss; and 4) Factors to improve the therapeutic experience. Staff awareness training and development of guidelines (embedded within service policy) were suggested recommendations; with the aim of enhancing patient focused practice and altering a ritualistic task to become a recovery orientated therapeutic experience.

KEYWORDS:

• Enhanced observations
• forensic mental health
• medium secure hospital
• training
• policy

Acknowledgments

We would like to thank the patients and staff who volunteered to take part in this study. We are also grateful to the independent reviewer, Dr Andy Cook, for her thoughtful and detailed comments during the preparation for publication.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. ‘Preventing future deaths’ action plan, patients reporting intrusiveness and artificiality of EO, and a desire to reduce observations being counter-therapeutic.

2. Evidence for each super-ordinate theme is represented in the following way: Participant (patient) number, page number from transcript and then transcript line number (s).

3. Noted within this study; loss of freedom, social connectivity, impact on mental health.

4. Procter et al. (2017).

5. The importance of the therapeutic relationship, staff interpersonal qualities and factors to improve the therapeutic experience.

6. Multi-disciplinary team meeting which reviews care with a patient.

Additional information

Funding

No funding was required for this research and no grants awarded.