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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, while 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 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.

Original publication




Journal article


Br J Psychiatry

Publication Date





395 - 401


Attitude of Health Personnel, Confounding Factors, Epidemiologic, Cross-Sectional Studies, Delivery of Health Care, Female, Humans, Inpatients, Male, Mental Disorders, Mentally Ill Persons, Nursing Staff, Hospital, Patient Care, Psychiatric Department, Hospital, Psychiatric Nursing, Self-Injurious Behavior, United Kingdom