[The Terms of (Enhanced) Engagement in the Psychiatric Care of Women; Interpreting the Language - A Literature Review]

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ACKNOWLEDGEMENT

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible

DECLARATION

I, [type your full first names and surname here], declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for academic examination towards any qualification. Furthermore, it represents my own opinions and not necessarily those of the University

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ABSTRACT

In this study we try to explore the concept of enhanced engagement in the psychiatric care of women in a holistic context. The main focus of the research is on enhanced patient observation levels and its relation with potential gap in policy and practice. The research also analyzes many aspects of enhanced patient observation levels and tries to gauge its effect on UK nursing policy and practice. Finally the research describes various factors which are responsible for enhanced patient observation level and tries to describe the overall effect of enhanced patient observation level on a potential gap in policy and practice.

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TABLE OF CONTENTS

ACKNOWLEDGEMENTII

DECLARATIONIII

ABSTRACTIV

CHAPTER 1: INTRODUCTION1

Background of the study1

Problem Statement2

Purpose of the study3

Rationale of the study4

Research Questions5

Aims & Objectives of the study6

CHAPTER 2: LITERATURE REVIEW7

CHAPTER 3: METHODOLOGY19

Research Design19

Literature Search19

Keywords19

CHAPTER 4: DISCUSSION20

CHAPTER 5: CONCLUSION25

REFERENCES27

CHAPTER 1: INTRODUCTION

Background of the study

The Standing Nursing and Midwifery Advisory Committee published a practice guidance report in 1999 that NHS Trusts use as a template to guide observation policy making (Standing Nursing & Midwifery Advisory Committee, 1999, 3). Increased observation levels on a patient in a psychiatric hospital is a contentious practice, often viewed as a paternalistic intervention, stemming from a history that considers it potentially neglectful for not raising the levels on a person at risk of harm to self or others in a risk management orientated institutional practice, conflicting with an individual's rights to maintaining privacy and dignity. So many terms describe the practice of close nursing observations (special obs, specialling, continuous obs, close obs, enhanced obs, one to one, increased supportive obs) that even if policy follows guidelines fairly closely, the language of this intervention has many cultural variants; a patient in the forensic mental health services who has experienced prison may refer to being "specialled" whereas on a rehabilitation and recovery ward, the practice may be referred to as increased therapeutic engagement. Whatever the language used, the close observation intervention, in practice, remains controversial and debatable as to its effectiveness (Bowers et al., 2008, 78) and ethicality.

Acute psychiatric in-patient wards provide care and a place of safety for individuals suffering in an acute phase of mental illness. Psychiatric intensive care units (PICU) are locked; often single sex, in-patient wards with a higher ratio of staff to patients and lower turnover of admissions and discharges than an open, acute ward. The purpose of this locked environment is to provide a more secure milieu, not only in respect of the physical ...