ABSTRACT
Special observations in psychiatric practice are, usually, implemented when there is a perceived increased risk of harm being enacted, either to the patients themselves or towards others. In mental health settings, this type of observation can be distinguished from more general observations by their level of intensity by which they are embarked upon, and the closeness to the individual who is being observed. Other terms and phrases used, some colloquially, include ‘close observations’, ‘maximum observations’, ‘continuous observations’, ‘constant observations’, ‘precautionary observations’, ‘one-to-one observations’, and so on (Jones and Jackson 2004, Bowers and Park 2001). There is usually a distinction drawn between the levels of observations in terms of the required closeness by which the person undertaking them should be to the person being observed. If the patient is perceived to be at-risk from, say, command hallucinations instructing them to pull out their eye, it is clear that the observing nurse(s) must be very close to the patient to prevent a sudden surge to enucleate. Alternatively, if the patient is considered to be a threat towards assaulting others, it may be more appropriate to observe them from several feet away rather than encroach upon their personal space and provoke an attack. These levels of close observations are known by various gradations. For example, the Standing Nursing and Midwifery Advisory Committee (1999) defined four levels of observations: level 1, general observations; level 2, intermittent observations; level 3, within eyesight; and level 4, within arm’s length. For the purposes of this paper we will employ the term special observations to include all such variations above and beyond the general observations undertaken on an everyday level in psychiatric practice. Special observations are predominantly undertaken as an alternative to seclusion and/or restraining techniques, either as a precursor to them or in supplanting them. However, their efficacy as a therapeutic intervention is largely a neglected area of investigation.
