Background: Special observation is a practice in common use in acute care settings for older people, in particular when dementia and/or delirium are/is experienced, but there is little evidence of best practice approaches.
Aim and objectives: The overall aim of this project was to develop a working definition of special observation in acute aged care settings. The objectives were to identify barriers and enablers for undertaking special observation and compare descriptions of special observation practice by staff with those in policy and related documents.
Methods: The setting was an acute care ward in a large regional hospital in New South Wales, Australia and the participants worked on this ward. Data consisted of policy and related documents and focus groups (Round 1 and Round 2). The data analysis technique adopted was content analysis.
Findings: A total of four policy and related documents were reviewed and a total of six focus groups were undertaken (3 in Round 1 and 3 in Round 2). Participants consisted of Registered Nurses, Enrolled Nurses and Assistants in Nursing (n=11). All participants completed Round 1 and Round 2 focus groups. The outcome was a working definition of special observation in acute aged care.
Conclusions: The working definition reflects current and aspirational practice. Special observation is delivered following an individual assessment undertaken by nurses with advanced assessment and care planning skills using a nurse-patient ratio of 1:1 to: (i) enable person-centred therapeutic practice interventions and (ii) promote safety. Best practice special observation is promoted through the delivery of evidence based education and monitoring of adherence to a single policy. Future initiatives include writing a new policy and influencing other services in the hospital with reviewing their special observation practice.
Implications for practice: Special observation with older persons is an area of practice where the potential for therapeutic activities remains unrecognised.
Definitions need to have meaning for staff at a local level
Staff need help to know how to make better use of locally available evidence
Evidence based policies can be more easily developed from clearly generated definitions of special observation in acute aged care