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Special observation and older persons with dementia/delirium: a disappointing literature review


  • Jan Dewing BSc, PhD, MN, RN, RNT

Jan Dewing
Nursing and Applied Clinical Studies
Canterbury Christchurch University
North Holmes Road
Kent CT1 1QU
Telephone: +44 (0)1227767700


Background.  In gerontological practice, special observation is a known nursing activity across different settings. The group that possibly are most effected by this intervention are older persons with dementia and/or delirium. The research literature about special observations in the mental health field is small, more disappointingly there appears to be little published literature about special observations in regard to older persons with dementia and/or delirium.

Aims.  The aims of this study are to (i) establish the state of current published research on special observations in regard to older persons with dementia and/or delirium and (ii) make recommendations for research and practice.

Design and method.  A literature review.

Results.  Most literature pertains to adult mental health practice and services. Themes were generated and discussed in relation to gerontological practice.

Conclusion.  This review has established there is variance in the usage of the terms ‘special observation’ and ‘constant observation’. It concludes that there is no published research on special or constant observations in relation to older people with dementia/delirium or the purpose of this activity. There is therefore a clear need to establish a research base in the topic.

Implications for practice.  Given the limited evidence, practitioners and managers need to be cautious when writing and implementing policies about special observation. However, until gerontological research is improved, research from mental health nursing will need to be drawn on with caution and the purpose of special observation determined locally. To be of therapeutic value and to be cost effective, special observation should be seen as a skilled nursing intervention and not a passive ‘watching’ or ‘sitter’ activity.