• Acute;
  • conflict;
  • containment;
  • observation;
  • surveillance

PURPOSE:  This study explores the relationship of special observation (SO) to a range of patient, staff, and ward variables.

DESIGN AND METHODS:  End-of-shift reports were completed by nurses on 136 acute mental health wards in England during 2004 and 2005.

FINDINGS:  Intermittent SO (patient checked at specified intervals) was used five times more frequently than constant SO (patient kept within sight or reach). Significant relationships were found between SO and measures of ward surveillance, door locking, and the ease of observing patients on the wards. Both types of SO were more common when higher numbers of staff without a nursing qualification were on duty.

PRACTICE IMPLICATIONS:  Improved ward design, less reliance on unqualified staff, and greater use of surveillance measures may reduce the need for SO.