A rapid ethnographic study of observations
Research type
Research Study
Full title
De-implementing low value practices in mental health care: A rapid ethnographic study of observation
IRAS ID
327293
Contact name
Qandeel Shah
Contact email
Sponsor organisation
University of Leeds
Clinicaltrials.gov Identifier
n/a, n/a
Duration of Study in the UK
0 years, 3 months, 30 days
Research summary
This study is part of a wider research project which aims to explore low value practices in mental health care from the perspective of service users. Service users have previously identified several practices as potential targets for de-implementation including enhanced observations.
In order to monitor risks associated with mental health issues and provide therapeutic engagement, all people admitted to an inpatient mental health unit must be on one of three levels of observation. These include constant observations, intermittent observations, and general observations. However, evidence for the efficacy of observations is limited. While proportionally fewer suicides occur when service users are on constant observations (Flynn et al., 2017) there appears to be no relationship between constant observation and frequency of self-harm (Stewart et al., 2009). Additionally, service users often report feeling distressed, anxious and have little privacy during observations (Waldemar et al., 2018). Observations appear to have a negative impact on service users yet there has been little effort to explore their perspectives or to de-implement this practice.
Using rapid ethnographic methods, we will closely observe how observations are conducted in inpatient mental health wards. This will help us understand how staff and service users experience this practice. This will also offer an insight into how the context and culture of the ward influences decisions surrounding enhanced observations. Observations will be followed by interviews with staff and service users to explore their attitudes towards the de-implementation of observations.
Data from this study will be used to inform a wider project where workshops with key stakeholders will be used to co-design a de-implementation intervention. This may include developing strategies to reduce, remove, replace, or restrict the use of observations.In addition, the data will be explored via the lens of safety culture, to understand the beliefs, values, assumptions and patterns of attention that surround perceptions of de-implementing enhanced observations. This will be brought together with other practically-grounded understandings of the cultural processes that shape different safety interventions, safety infrastructures and safety interfaces in complex healthcare settings, to produce a more sophisticated understanding of organisational safety culture. The purpose is to develop a framework that can support organisations and regulators to design and implement the systems, structures and processes that enable strong and sustainable cultures of
safety.REC name
Yorkshire & The Humber - Bradford Leeds Research Ethics Committee
REC reference
23/YH/0179
Date of REC Opinion
7 Sep 2023
REC opinion
Further Information Favourable Opinion