Careful observer, clear reporter or autonomous decision-maker? Mental Health Nurses and decision-making theory in the use of enhanced observation: A literature Review

Reading Florence Nightingale’s Notes on Nursing (1860), it is obvious that observation had a vital role to play in the life of the nurse. She considered it essential for a nurse to be a “careful observer” and a “clear... [ view full abstract ]

Reading Florence Nightingale’s Notes on Nursing (1860), it is obvious that observation had a vital role to play in the life of the nurse. She considered it essential for a nurse to be a “careful observer” and a “clear reporter.” However how does that subservient language fit in with modern nurses who are meant to be autonomous decision-makers? The practice of observation has a different meaning in the context of acute mental health nursing. The practice of enhanced (otherwise known as ‘special’ or ‘constant’) observation is still considered a controversial and divisive intervention. Bowers and Parks (2001) argue that it is a practise based on rationality, tradition, common sense and not on evidence-based findings. More believe the practice is ineffective, untherapeutic and is contradictory to the humanistic and values-based practice of modern mental health care (Dodds and Bowles 2001). In contrast to Nightingale, Buchannan-Barker and Barker (2005) consider it to be the “original sin” of mental health nursing- an intervention from the bygone days of psychiatric nursing and the epitome of the docile nurse/doctor relationship. However literature and policy documents state that nurses are the profession that perform most enhanced observation and are often the ones to initiate it (CRAG 2002, Vråle and Steen 2005, MacKay et al 2005, Addo et al 2010). Therefore nurses have a pivotal role to play in the decision-making surrounding its practice. Nevertheless there is a paucity of literature available on mental health nurses’ decision-making processes. The aim of this paper is to explore various decision-making models which nurses use in practice. The paper will present an alternative; Standing’s (2008) Matrix of conceptions and perceptions of decision-making, which may be more applicable to a mental health setting. The literature regarding enhanced observation will be reviewed and presented in the context of Standing’s (2008) model.