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Relationship between service ecology, special observation and self-harm during acute in-patient care: City-128 study

Bowers, L., Whittington, R., Nolan, P. , Parkin, D., Curtis, S., Bhui, K., Hackney, D., Allan, T. & Simpson, A. (2008). Relationship between service ecology, special observation and self-harm during acute in-patient care: City-128 study. British Journal of Psychiatry, 193(5), pp. 395-401. doi: 10.1192/bjp.bp.107.037721


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.

Aims: To assess the relationship between special observation and self-harm rates, by ward, whilst controlling for potential confounding variables.

Method: A multivariate cross sectional study collecting data on self-harm, special observation, other conflict and containment, physical environment, patient and staff factors for a six 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.

Publication Type: Article
Additional Information: This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at
Publisher Keywords: Attitude of Health Personnel, Confounding Factors (Epidemiology), Cross-Sectional Studies, Delivery of Health Care, Female, Great Britain, Humans, Inpatients, Male, Mental Disorders, Mentally Ill Persons, Nursing Staff, Hospital, Patient Care, Psychiatric Department, Hospital, Psychiatric Nursing, Self-Injurious Behavior
Subjects: R Medicine > RT Nursing
Departments: School of Health & Psychological Sciences > Nursing
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