Patient Assessment and Monitoring

Identifying and preventing patient self-ham or harm to others is a core focus of psychiatric-mental health nursing. Ongoing assessment and monitoring are critical to ensuring safety. Nurses must be present and engaged in the milieu, using consistent interactions to assess risk over time. Effective risk assessments rely on therapeutic relationships, with attention to modifiable factors that can be addressed through treatment. Traditionally, psychiatric settings have used “observations” (either intermittent or constant) to monitor at-risk patients. However, concerns have emerged about whether these practices are truly therapeutic or simply procedural. When observations are carried out mechanically, they lose their effectiveness. To be meaningful, they must occur within authentic, engaged relationships.

These articles, organized chronologically from newest to oldest, examine key challenges and considerations in the assessment and monitoring of mental health patients.

References

Implementing and evaluating patient-focused safety technology on adult acute mental health wards
Kendal, S., Louch, G., Walker, L., Shafiq, S., Halligan, D., Brierley‐Jones, L., & Baker, J. (2024). Implementing and evaluating patient‐focused safety technology on Adult Acute Mental Health Wards. Journal of Psychiatric and Mental Health Nursing, 31(5), 742–754. https://doi.org/10.1111/jpm.13028

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study
Shetty, S. R., Burke, S., Timmons, D., Kennedy, H. G., Tuohy, M., & Terkildsen, M. D. (2023). Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study. Journal of Psychiatric and Mental Health Nursing, 31(3), 393–404. https://doi.org/10.1111/jpm.12979

A qualitative synthesis of patients’ experiences of re-traumatization in acute mental health inpatient settings
Hennessy, B., Hunter, A., & Grealish, A. (2023). A qualitative synthesis of patients’ experiences of re‐traumatization in acute mental health inpatient settings. Journal of Psychiatric and Mental Health Nursing, 30(3), 398–434. https://doi.org/10.1111/jpm.12889

The Impact of Milieu Nurse–Client Shift Assignments on Monthly Restraint Rates on an Inpatient Child/Adolescent Psychiatric Unit
Magnowski, S. R., & Cleveland, S. (2020). The Impact of Milieu Nurse–Client Shift Assignments on Monthly Restraint Rates on an Inpatient Child/Adolescent Psychiatric Unit. Journal of the American Psychiatric Nurses Association, 26(1), 86–91. https://doi.org/10.1177/1078390319834358

Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research
Deering, K., Pawson, C., Summers, N., & Williams, J. (2019). Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of Primary Research. Journal of Psychiatric and Mental Health Nursing, 26(5–6), 185–197. https://doi.org/10.1111/jpm.12521

Evaluation of an alternative model for the management of clinical risk in an adult acute psychiatric inpatient unit
Harrington, A., Darke, H., Ennis, G. and Sundram, S. (2019), Evaluation of an alternative model for the management of clinical risk in an adult acute psychiatric inpatient unit. Int J Mental Health Nurs, 28: 1102-1112. https://doi.org/10.1111/inm.12621

The Impact of Nursing Protocols on Continuous Special Observation
Ray, R., Perkins, E., Roberts, P., Fuller E. (2017) The Impact of Nursing Protocols on Continuous Special Observation Journal of the American Psychiatric Nurses Association 23 (1) 19-27. https://journals.sagepub.com/doi/full/10.1177/1078390316668993