This essay will discus a decision that was made on a local male acute ward. Using this example, an analysis of the decision making process has been made and a reflective model has been used in order to generate personal knowledge that will inform further practice (Rolfe, 2011a). A pseudonym of Tim has been used for the discussed patient to maintain confidentiality in accordance with the NMC code of conduct (2010a).
Observation is one way in which mental health nurses can protect acutely mentally ill inpatients from harm and is commonly implemented for patients who impose a risk of harming themselves, others and for those who are vulnerable (Bowers et al, 2006). Tim, who was on a local male acute ward, posed a risk of harming himself and became very vulnerable during his stay. On admission he was perceived to be at low risk of harming himself and vulnerability, therefore was observed on the minimum level of observation, general observation, which includes all patients and involves an hourly eyesight check on the patient (DH, 1999; NICE, 2005).
The decision to increase his observation level was jointly taken by the mentor and the author by gathering information from bank support workers about Tim's current presentation.
After a noted deterioration in Tim's mental health, it was decided to increase observations to within eyesight of staff. Justification for this was that he was becoming a serious risk of harming himself as he threatened to jump from the ward roof, as he was determined to leave. Tim was detained under section 2 or the mental health act (DH, 2007). He felt that he needed to leave in order to find his son who he had recently lost contact with. He had been stopped attempting to climb a drain pipe to leave via the ward roof and had been in a very distressed state. Eyesight level of observation is seen as the second highest of four levels and demands intense nursing, only within arms length is higher (DH, 1999; Jones & Eales, 2009; NICE, 2005).
Close observation is an example of decision making which is exclusive to mental health nursing. The Chief Nursing Officer described observation as a key area where good practice is essential and that nurses should ‘demonstrate an understanding of the benefits and limitations of the use of levels of observation to maximise the therapeutic effect on inpatient units’ (DH, 2006). Additionally NICE (2005) recommends the use of observation in the short-term management of disturbed/violent patients. The Nursing and Midwifery Council (NMC, 2010a) require nurses to be able to apply knowledge and an appropriate repertoire of skills that is indicative of safe and effective practice and based on the best available evidence.
At the time of making the decision it seemed the right course of action. The mentor's final decision was taken for granted as he was an experienced nurse and a lack of personal experience meant that the author had limited personal experience to work with. Before undertaking this assignment it could not decided what could be done differently if faced with a similar situation on qualification.
On qualification, such a decision will have to be well informed and made with confidence and one that has to be made in accordance with the NMC code of professional conduct (2010) which requires nurses to be accountable for their own actions and omissions in practice. By using the decision making tool below the advantage of hindsight can be used when analysing this decision to better inform future practice. Pritchard (2006) sees decision making as one of the most difficult processes that a nurse can undertake and one of the most important parts of nursing practice. Aitkin (2003) concludes that formal decision analysis can improve future decision making. The utilised decision making model, as described by Jasper (2003), asks the questions Who/What/When/Where/Why and...