• behavioural interventions;
  • mental health;
  • nursing;
  • risk management;
  • self-harm

Accessible summary

The term ‘formal observation’ includes routine or general observation, 30- to 15-min checks, and constant or continuous observation. Although nurses have used formal observation in the psychiatric setting for more than 25 years to monitor patient behaviour, the benefits of such approaches are questionable. While formal observation is utilized in a defensive mode to prevent patient harm, the actual efficacy of formal observation is unclear. Additionally, formal observation consumes nursing resources; thus, evidence is necessary to validate and support this intervention.

The purpose of this paper is to:

  • determine whether or not research supports the use of formal observation as an effective strategy in preventing potential harm to patients or others;
  • • 
    identify any therapeutic benefit;
  • • 
    identify any gaps in the research.

Findings suggest that large gaps continue to exist in the research, but specifically:

  • • 
    a lack of consensus exists in the literature about formal observation definitions and how it should be carried out regardless of effectiveness;
  • • 
    formal observation is rooted in tradition, as little evaluative research exists as to its actual efficacy in reducing harm to patients;
  • • 
    historically it is considered negligent to not utilize the practice as a protective measure.


Formal observation in psychiatric settings is a widely accepted intervention employed by psychiatric nurses to reduce the incidence of adverse patient outcomes such as suicides, self-harm, violence and elopements in the psychiatric population. Formal observation includes general or routine observation, observation every 15 or 30 min, continuous or constant observation, and one-to-one observation. While formal observation consumes nursing resources, the efficacy of formal observation in reducing patient risk and providing therapeutic benefit remains unclear. To date, no randomized controlled studies exist. The existing qualitative research fails to demonstrate a direct correlation between the act of formal observation and the prevention of adverse patient outcomes. Common in the literature is a debate as to whether formal observation or therapeutic engagement is more beneficial. This paper, therefore, identifies gaps in the research and synthesizes relevant research regarding the effectiveness of formal observation in preventing adverse outcomes like suicides, self-harm, violence and elopements.