title: Relationship between service ecology, special observation and self-harm during acute in-patient care: City-128 study.
abstract: BACKGROUND
  Special observation (the allocation of nurses to watch over nominated patients) is one means by which psychiatric services endeavour to keep in-patients safe from harm. The practice is both contentious and of unknown efficacy.
  
  
  OBJECTIVE
  To assess the relationship between special observation and self-harm rates, by ward, while controlling for potential confounding variables.
  
  
  METHODS
  A multivariate cross-sectional study collecting data on self-harm, special observation, other conflict and containment, physical environment, patient and staff factors for a 6-month period on 136 acute-admission psychiatric wards.
  
  
  RESULTS
  Constant special observation was not associated with self-harm rates, but intermittent observation was associated with reduced self-harm, as were levels of qualified nursing staff and more intense programmes of patient activities.
  
  
  CONCLUSIONS
  Certain features of nursing deployment and activity may serve to protect patients. The efficacy of constant special observation remains open to question.
authors.affiliation: Psychiatric Nursing, City University, Philpot Street, London E1 2EA, UK. L.Bowers@city.ac.uk
authors.forename: Len
authors.initials: L
authors.lastname: Bowers
authors.forename: Richard
authors.initials: R
authors.lastname: Whittington
authors.forename: Peter
authors.initials: P
authors.lastname: Nolan
authors.forename: David
authors.initials: D
authors.lastname: Parkin
authors.forename: Sarah
authors.initials: S
authors.lastname: Curtis
authors.forename: Kamaldeep
authors.initials: K
authors.lastname: Bhui
authors.forename: Diane
authors.initials: D
authors.lastname: Hackney
authors.forename: Teresa
authors.initials: T
authors.lastname: Allan
authors.forename: Alan
authors.initials: A
authors.lastname: Simpson
mesh_terms: D001291:Attitude of Health Personnel; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000451:nursing*; D028642:Persons with Psychiatric Disorders / Q000523:psychology; D009741:Nursing Staff, Hospital; D005791:Patient Care / Q000379:methods; D011567:Psychiatric Department, Hospital; D011568:Psychiatric Nursing / Q000379:methods*; D016728:Self-Injurious Behavior / Q000517:prevention & control; D006113:United Kingdom / Q000453:epidemiology