The Lived Experiences of Clients Under Close Observation During In-Patient Care Essay

Background

Placing patients under close observation is a critical clinical practice, especially in the context of mental health. The essence of this exercise is to ensure the safety of patients who are likely to cause harm to themselves, especially those deemed to have suicidal tendencies. Despite this practice being common across the world, the current literature illustrates that the lived experiences of clients under close observation are hardly explored. There may have been attempts to explore the perspectives of the nurses but even this stream of research appears to be in dire need of updates. This literature will explore some of the literature available on the subject. Ideally, it would be prudent to examine the most recent literature, mostly not older than five years. However, this would not help to offer a full picture of the practice partly due to the scarcity of recent studies and partly because many studies on the subject span the past two decades. Therefore, older materials may be critical in examining how close observation has evolved or failed to do so, which will become a key indicator of the need for fresh studies.

Patients Targeted in Close Observation

Exploring the available literature reveals that a diversified population of patients is targeted for this practice, which means that the potential for harm is not the sole concern for the nurses. For example, a study by Wilkes et al. (2010) explores close observation of older persons with behavioral disturbances. In this case, the focus is not to prevent the patients from inflicting self-harm as would be the case with mental health patients. In essence, older patients are deemed to be inherently vulnerable and have acute health needs that need constant attention. Additionally, acute hospital environments are perceived to be unsuitable for optimum care for the elderly, especially those with behavioral disturbances. The argument is that extended hospitalization tends to cause acute confusion and disorientation of such patients as those suffering from dementia. Therefore, even though mental health is not the target for the nurses in these settings, it still applies that there are possibilities that there may be harm caused to the patients, including self-inflicted.

Even though it has been acknowledged that mental health patients are not the sole recipients of close observation, available literature proves that this group is often the primary target. Only very few studies adopt the same focus as Wilkes et al. (2010) in the elderly, and even those that do pay greater attention to the broader context of psychiatry. For instance, Reen et al. (2020) explore close observations of elder patients in psychiatric wards. The main objective was to explore the interventions implemented in these settings, especially considering that most patients are admitted involuntarily. Therefore, self-harm emanated from violent behaviors and aggression, which could also pose risks to other people. It emerges that in these settings, close observation serves as a critical restrictive tool by the nursing staff used in the monitoring and managing of the behavior of patients.

It is also important to notice that self-harm does not necessarily result from acute mental health issues. The argument is that multiple other reasons may affect the behavior of people and increase their tendencies towards self-harm. Examples include diagnosis of such chronic illnesses as cancer, where the patients develop suicidal inclinations within a specified period. According to Saad et al. (2019), close observation of these patients is also necessary because they meet the criteria for self-harm. Crucially, these authors express that the patients are often handed over to mental health services for close observation and the implementation of related interventions. Despite the patients not having mental illnesses, the shocking news from the diagnosis may cause emotional and psychological trauma. The stressful events often tend to leave patients with upsetting emotions, anxiety, and memories that tend to persist for prolonged periods. This explains why some scholars believe that suicidal tendencies tend to develop within a year after the patient is unable to withstand the trauma. The transfer to mental health services may be explained that these departments can handle all cases of mental problems.

In summary, the patients who are targeted by close observation display certain characteristics, most of which hint at the possibility of self-harm. Some studies have expressed that those patients placed under close or special observation are more likely to have a history of self-harm, be subjected to compulsory detention by the hospital, or have been known to be violent and a potential threat to other people or even the hospital property (Bowers & Park, 2001). Therefore, it follows that the decision to place patients under close observation is based on the risk assessment conducted by the hospital. Many patients in the acute wards are often perceived to be at high risks due to the historical outcomes of assessments. In other words, assessments conducted over time have revealed that the probability of patients in acute care requiring close observation is high. As a science, risk management practice may incorporate current examinations of be based on the historical records kept by the hospital.

Lived Experiences

The lived experiences of nurses in the context of close observation of patients are hardly explored. However, the available literature can be explored for the slightest of insights onto this subject, especially from those that study the meaning of close observation and the perspectives of both the patients and staff on this practice. Such attempts have been made by Insua-Summerhays et al. (2018) who define close or one-to-one observation as an intervention used to ensure patient safety in psychiatric wards. This is achieved by allocating a staff member to keep a continuous watch or to be at an arm’s length of a patient deemed to be at risk of causing self-harm. Some of the experiences of the staff are illustrated in the findings of their study, including the fact that nurses and patients are physically together but emotionally apart. Close observation is often a risk-management procedure where the staff is emotionally detached. In certain cases, mutual resentment has been experienced, which is possibly the result of involuntary admission to the psychiatric wards.

Exploring the nature of close observation can help establish some of the experiences. Further observations made Insua-Summerhays et al. (2018) include that the staff and patients experience uncomfortable silence, judging and misunderstanding of feelings, questioning of the efficacy of one-to-one observation, and balancing expectations of the therapeutic engagement. While this study does not target the nurses exclusively, their experiences are understandable, which can serve to show that they do not feel comfortable with the practice. Another study that explores the experiences has been presented by Solomon et al. (2021) who pays specific attention to the nurses’ understanding and application of recovery-oriented practices and principles. Close observation can be perceived as an adaptation of more ancient procedures that involved the use of involuntary treatment and coercive practice. Solomon et al. (2021) notice that within New Zealand, several alternatives have developed with time, including Māori support services, talking therapies, trauma-informed care, peer support, advocacy, and building therapeutic relations with the patients. However, it is important to notice that these interventions do not prevent the patients from feeling like objects of clinical observation.

Different studies reveal different experiences among the nurses but this majorly depends on how close observation is implemented. Solomon et al. (2021) find that nurses in recovery-oriented care feel that they have created a shared relationship with the patients, which contradicts the findings by Insua-Summerhays et al. (2018) involving emotional distance. However, it can be understood that close observation is a sensitive practice that requires a careful approach from the nurses. The lack of emotional connection has also been illustrated by those studies exploring the patient experience. For example, Talseth et al. (1999) find that the nurses were not being open with the patients while others listened to patients with prejudice. While these observations do not highlight the staff experiences, it can be inferred that the nurses in psychiatric wards do not have good relations with their patients. The fact that some tend to question the efficacy of these practices illustrates that most would wish to work in different environments, while the persistence of close observation may be an indicator of the practice being indispensable.

The key idea in close observation is that the patients are kept safe by preventing them from inflicting self-harm. This is the main benefit of the practice since the whole essence of healthcare is to sustain the health of patients. Further evidence on patient’s experiences provided by Page (2006) also highlights the fact that patients often feel that the staff are unempathetic and remote. Therefore, the experiences of the nurses are also shaped by the attitudes of the patients towards them. The argument is that when the patients feel well-tended, their relationship with the nurses may develop and they may give the nurses an easier time in the psychiatric wards. However, this article by Page (2006) serves little purpose to explain the experiences of nurses but it helps paint a vivid picture of the environment in which they operate.

A few of those explored above show little focus on nurses’ experiences, which can be as a result of the focus being on a different aspect of close observation in psychiatric wards. However, the common theme is that the relationship between the patients and the nurses is not always positive, especially where the traditional practices are followed. However, the practices may differ across care providers due to their varied understanding of one-to-one observations. The study by Rooney (2009) reveals that many nurses hardly have an advanced understanding of what close observation should entail. Some of their experiences include the fact that they never feel prepared for the role because there is usually no training about observations. There are no trial runs, which means that the nurses and the patients do not know what to expect from the practice. Different clients have varied needs, which many nurses lack the experience or the capacity to handle. Therefore, many staff in psychiatric wards think close observation is all about being with the patients or watching them. This may exclude those practitioners administering other forms of medication required by patients.

Even without training or trial runs, it is important to acknowledge that close observation in psychiatric wards is implemented in the form of policies, procedures, and checklists that guide the practitioners. In many cases, close observation means that the nurses have to perform some checks on the clients. A more sinister side of this story, as explained by Holyoake (2013), is that close observation is implemented with a greater concern on protecting the hospitals from litigation. If patients are to be harmed whilst in the wards, the hospitals may suffer from such risks as scandals, professional shame, and lawsuits in the line of neglect and abuse of psychiatry. whether or not this is true, the practices and policies of the institutions may help define the experiences of both the patients and the nurses. Those that focus on the property or avoid the aforementioned risks may offer less specialized services with untrained personnel. However, the main aspect of interest to this literature review is the actual experiences. For example, the respondents in this study revealed that prolonged watching times made them prone to letting their minds wander.

The frustrations of many nurses are not only with the policies but also with some clients. Holyoake (2013) finds that some patients have found ways to manipulate the systems whenever they want to be left alone or go for a walk. Most of the time, they inform the doctors that they do not intend to harm themselves, and these incidences are perceived by nurses as making a mockery of the entire system. Additionally, some nurses have experienced resistance from patients, especially when the patients have their preferred staff members. While some nurses may feel unwanted and unappreciated, others may feel overburdened when their services are demanded by multiple patients. This may illustrate why psychiatry requires skilled personnel to handle the patients. This sentiment is shared by Mackay et al. (2005), who illustrates that besides observation the nurses need to have skills that enable them to handle such roles ad interventions and de-escalations. These roles require a deeper understanding of the patient and the likely trigger factors which can be acted upon once they manifest themselves.

However, the work environment itself is a key determinant of nurses’ lived experiences. Every organization has different priorities and resource capabilities to pursue them. In some studies, the nurses have expressed frustrations that they required organizational support to promote their therapeutic abilities (McAllister et al., 2019). This request was never met because the entities lacked the resources, including shortages of beds and staff. A key problem is bureaucracy where it takes too long before critical decisions can be made. With staff shortages, the nurses have expressed that the workload has prevented them from building meaningful relations with their patients. The argument is that they have to quickly move between patients, meaning that spend little time with each client. Additionally, the nurses’ frustrations have emanated from the layout of the wards themselves, especially enclosures, locked doors, and Plexiglas walls. In other words, some personnel has had to contend with physical barriers from their patients. Those studies that have found emotional distance to be a problem may have explored such settings where the staff is forced to observe their patients from a distance.

In addition to the physical barriers, other literature explains the conditions in the wards are extreme, both for the patients and staff. In many cases, nurses feel that the hospitals have not given them all the necessary tools they need to fulfill their jobs. For example, the lack of direct access to the medical room means nurses cannot adequately handle emergency cases. It can be argued that it is the patients who suffer more from these limitations. While this is entirely true, the failure is often reflected on the nurses themselves, which means they carry the greater burden. Some nurses may express their experiences as horror due to the poor conditions. For example, some staff reveals that the feeling of tension between the patient and the nurses is non-therapeutic. The patients may feel secluded and imprisoned because even the basic amenities may be lacking. For instance, no mean reheating, insufficient bathrooms, lack of recreational spaces or activities, and no doors in some bedrooms (O’Brien & Cole, 2004). The experiences created by these scenarios are traumatizing for both the patients and staff, especially when there is visitation.

Due to the nature of the psychiatric wards and the observation practices, both the watched and the watchers may experience tense moments. The nurses tend to incur a high degree of responsibility due to the consequences for all stakeholders. Examples of repercussions include human rights infringement and high stress levels for the nurses (Mason et al., 2009). The stress levels may be as a result of the knowledge of how great the responsibility is for a staff member. Additionally, the nurses may feel embarrassed, especially when they have to watch everything the client does even in private areas. The feeling gets worse when the staff understands that the patients do not like them, which may explain why most staff find the job demoralizing (Chu et al., 2018). Embarrassment goes both ways with the patients themselves expressing similar sentiment when they have to be watched doing private activities, including going to the loo and having to change clothes. These are first-hand experiences of nurses who may go on to develop mental issues of their own, either due to the stress levels or the things they witness around the patients.

Close observation is a contentious issue due to the many problems it poses, especially concerning the privacy of the patients. However, it can also be described as a situation requiring a fine balance between therapy and control. These arguments are held by Cox et al. (2010), who finds that nurses tend to experience a conflict of interest between humanism and paternalism. This is because close observation tends to be contradictory to the values of therapeutic nursing and is perceived as counterproductive. The nurses feel that the practices are degrading and disempowering and that they tend to create a culture of mental illnesses and heightens the perception of incarceration. In other words, one-to-one observation has a negative influence on the nurses who may start to feel that the best way to deal with patients is by controlling their space and behavior.

As argued earlier, many hospitals tend to adopt an approach of self-preservation rather than focusing on patient safety. Unqualified and inexperienced staff may be allocated these duties, which means that they will have little knowledge of what to do in certain circumstances. Some scholars may feel that the use of higher levels of expertise and experience may have positive influences because the staff can learn about the patients and make critical decisions regarding medication and interventions (Cox et al., 2010; Chu et al., 2018). The need for the development of new approaches and alternatives to close observation is evident in literature due to the frustrations with the current practices. If the lack of expertise makes nurses experience emotional disharmony with their jobs, then the use of experienced and skilled personnel should help resolve the problem. Some of the alternatives proposed by Cox et al. (2010) have proven effective, especially the use of records and assessments to develop therapeutic tools. This may require a policy change at the corporate level, but the bureaucracy has already been described as one of the elements that cause the frustrating experiences of the nurses.

High levels of stress have been described as one of the most common experiences for nurses in psychiatric wards. One of the pieces of literature to directly tackle the issue of lived experiences of nurses has been presented by Currid (2008). This researcher confirms most of the literature presented above regarding frustrations with the organizations and working conditions. This is because Currid (2008) states that heavy workload, difficulties with patients, under-resourcing, organizational structure, and professional self-doubt are the key stress factors among nurses in psychiatric wards. These notions have already been expressed by such scholars as Mason et al. (2009) and O’Brien and Cole (2004). However, some of these experiences may be generic among the nurses, who have often complained about being treated differently than the doctors. One of the respondents in the study by Currid (2008) was quoted saying that doctors are not ordered to conduct physicals only when they have found a bed, which means that the same should apply to nurses. While this illustrates frustration with the system, it indicates that psychiatric nurses are prone to those experiences most nurses encounter in the workplace.

Other experiences of the nurses can be classified as emotional responses to the conditions of the patients. For example, Sun et al. (2006) state that nurses may experience the feeling of guilt regarding suicide attempts of the patients. In certain cases, they may destruct the patients and experience a feeling of rejection from them. Compassion without emotional identification may be a common phenomenon among the nurses as a result of being emotionally distant from the clients. Even the concept of stress can be deemed to be an emotional response to the nature of the workplace. Many workers in hospitals dealing with sick people all the time may have similar experiences. Close observation may be more distressing because the staff is constantly with the patients. They take the client through the incarceration journal witnessing the agony and frustration of patients involuntarily admitted. Worse still, the fact that some of the patients may dislike the staff despite all the efforts may cause great emotional impacts on the nurses. Guilt may be experienced when patients are forced into close observation, which is a great emotional setback.

While the emotional implications have been described in a negative light, it is important to acknowledge that nurses need to protect their own emotions. An argument posed by Hagen et al. (2017) expresses that caring for suicidal clients tends to be highly emotionally demanding for the nurses because suicide or attempted suicide evokes painful feelings for the staff. Therefore, the only that the nurses can protect themselves from these feelings is by keeping an emotional distance. Assuming that the organizations adopt the self-preservation approach to mental healthcare in psychiatric wards, the nurses allocated to these patients are unskilled and untrained to deal with these situations. This explains why sufficient training, education, support, and supervision are critical elements to aid the nurses in close observation. Therefore, emotional distance is perceived to be a necessity if the nurses are to perform their tasks well. However, this may reflect negatively on the patients who may require emotional support from the staff. It is hard to establish if the nurses can offer emotional support without getting emotional themselves.

While the provision of care is usually highly uncertain in acute cases, nurses in close observation wards can experience high levels of uncertainty with the outcomes of their job. Firstly, it is important to acknowledge that close observation is intended to protect patients from self-harm. However, this will mean invading their privacy and being viewed with contempt by the patients. Secondly, it is not always guaranteed that the safety of the patients will be achieved because it may depend on their stubbornness, especially those involuntarily admitted. Lastly, sometimes close observation can cause more harm to the patients than good as explained by Barnicot et al. (2017). One of the respondents in their study stated that when patients feel restricted and controlled, it is impossible to build trust, which could be detrimental to the recovery process. While the theme of frustration has appeared constantly across the literature, it is apparent that the causes are extremely diverse. Uncertainty may leave the nurses frustrated and unsure of what to do, which tends to make their job tougher

Continuous observation simply implies that a nurse is allocated to a patient throughout, which means even during night times. To their knowledge, Veale et al. (2019), insist that there are no studies of lived experiences of nurses in the psychiatric wards at night. So far, the studies examined have not paid any attention to the time of the day. Nighttime is usually intended for sleep but chances are that the nurses will remain awake. Sleep deprivation can be among the lived experiences of the psychiatric staff. However, it is important to notice that this affects even the patients because they have to be observed several times per hour, which disrupts their sleep. Sleep interruptions are causes by shining torchlight on their faces, door noises opening and closing, and even staff members talking to each other. This environment is created by the nurses themselves, which means that the patients suffer more. However, nurses may be used to taking night shifts without necessarily interrupting their sleeping patterns or depriving themselves of sleep. The fact remains that night times are not conducive for close observations.

It can be noticed that many of the studies explored indicate negative experiences of the nurses in the psychiatric wards. Explanations offered include the fact that most nurses are inexperienced and untrained to offer close observation, which also highlights the lack of organizational support. However, it has also been explained that positive outcomes can be achieved when experienced staff are hired for this task, which should hint at the potential for positive experiences. A study by McAllister et al. (2019) reveals that nurse-patient engagement can facilitate the outcomes of mental healthcare among the patients. Nurses often feel proud when their jobs yield the desired outcomes, which explains why many can experience higher levels of job satisfaction. From a theoretical perspective, a positive correlation between engagement and improved outcomes also leads to improved perceptions of care by both the nurses and patients. The ultimate result is a situation where those nurses spending more time engaging patients will experience a higher level of job satisfaction (Wykes et al., 2018). Therefore, improving the practice of care in psychiatric wards enhances the experiences of both the nurses and the patients.

Potential and Barriers to Improvement

Job satisfaction has been highlighted as the only positive experience among the nurses in close observation. However, the arguments presented by McAllister et al. (2019) are based on the assumption that experienced and skilled nurses are involved and their practices entail creating an engagement with the clients. This argument hints at the potential for improving the experiences of nurses and patients, but it is also critical to explore what would work against improvement efforts. Traditionally, close observation has been associated with watching the patients. However, there is a potential to build better practices around psychological interventions. This potential can be realized if the nurses are to develop emotional coping skills. As mentioned earlier, the nurses may be left with no choice but to emotionally distance themselves from the suicidal patients (Hagen et al., 2017). According to Sharp et al. (2018), psychiatric settings are inherently a challenging environment for nurses. Emotional coping skills can make the workplace better and provide nurses with better experiences. However, the fact that the psychiatric wards are associated with high stress levels means that implementing the workbook for emotional coping may be extremely challenging.

The theme of emotion has been extensively referenced in this literature review. It follows that emotions can also be targeted to improve the nursing experiences. The emotional coping skills discussed by Hagen et al. (2017) may require emotional intelligence on the part of the psychiatric staff. According to Betteridge (2015), the nurses need to be aware of how their own experiences affect their ability to engage objectively with the patients in the observation process. Emotional intelligence and confidence have been touted as a mechanism to improve the nurses’ state of mind but this can be achieved through training, supervisor, and support from the organization. The primary focus of emotional intelligence is to help the nurses effectively manage their own anxiety and that of the people they work with in the psychiatric settings. Even though emotional distancing is currently used to shield the nurses from emotional disturbances, there is a possibility that the nurses can engage with the clients’ emotions without experiencing emotional detriments on their part. Care organizations should facilitate the development of the necessary training programs and regimes for psychiatry nurses.

The theme of frustration among the nurses has been discussed extensively, including the sources of this frustration. Lack of organizational support and a poor work environment has been cited regularly. Therefore, it can be argued that improving these aspects can reduce frustration and help the nurses build better experiences in psychiatric wards. This evidence can be obtained from the study by Kanerva et al. (2013) who find that organizational leadership plays a critical role in creating organizational cultures, implementing safety practices, and providing good working conditions for the nurse. Therefore, it can be argued that the experiences of the nurses depend on what the management has offered them in their work. In other words, the lack of support positively correlated with the negative experience, which means that improved support should enhance nurse experiences in close observation of patients. The practices undertaken by the nurses are developed by the management. The practices can be improved alongside an enhanced corporate and safety cultures. The potential of these efforts is only hindered by the bureaucracy and the ignorance of top-level managers.

The fact that the practices of psychiatric observations have hardly changed means that care centers have been rigid. This can be the result of the protocols, policies, and procedures implemented by the organizations. Rigidity means that the nurses will continue with the negative experiences for prolonged periods. This explains why some studies express that the practice of close observation should be flexible enough to suit the needs of both the patients and nurses. In other words, a flexible observation can act as a forum for engaging and assessing the mental states of the patients to help make good clinical decisions (Sandy, 2016). It means that observation should not merely mean being with the patients but it should incorporate engaging in meaningful activities. The argument by Sandy (2016) is that the patients do not always feel safe when being watched and, in some cases, observation can cause distress. This supports the literature that close observation can go against nursing values. Flexibility can allow the nurses to create improved experiences but this will depend on the organizational policies.

Significant changes have occurred n the broader field of mental health nursing. However, the practices involving patient observation have remained anachronistic as explained by Buchanan- Barker and Barker (2005). Bureaucracy has been blamed by these scholars for its role in the stagnation of observation practices. Without this barrier, it is argued that new approaches can be implemented with better outcomes in terms of engagement experiences for the nurses and the patients. The concept of partnership has been recommended in the context of integrated patient care. The focus of partnering with the patients is that the patients will be involved in making certain decisions as opposed to being denied choices in all matters. The current experiences are the result of a power imbalance between the two stakeholders, where practitioners seek to gain total control of the patients. Contempt and dissatisfaction by the patients may reflect in the nurses’ feelings towards their patients and the job as a whole. These sentiments are similar to those of flexibility as discussed by Sandy (2016) and other literature explaining that engagement is the ultimate solution to negative experiences.

Another key source of the bad experiences for the nurses is understaffing and inadequate resources allocated to the psychiatric wards. Therefore, it follows that improving this situation may help enhance the experiences of the nurses. This observation is made by Beech and Norman (1995), who expresses that many patients hope that the psychiatric wards would have adequate nurses. The argument is that there are many cases where the patients cannot gain the attention of the nurses. Even though these are the sentiments of the patients, it can be argued that the few nurses allocated to the wards will have hectic schedules and heavy workloads since they need to give attention to multiple patients at once. Nurses in these situations may experience burnout and high stress levels. However, allocating more personnel means that the workload reduces for each nurse and adequate care can be afforded to each patient. Additionally, engagement becomes possible when the nurses can spend adequate time with a single patient as opposed to alternating across multiple clients. Therefore, it is upon the organizations to ensure that close observation in psychiatric wards is allocated adequate staff and other resources.

The effectiveness of close observation depends on increased levels of staffing. This is a key finding in a study by Ashaye et al. (1997), which also supports the argument that increasing the number of nurses in psychiatric wards will improve psychiatric experiences. However, the main observation made by Ashaye et al. (1997) is that many hospitals tend to deploy temporary staff who are unfamiliar with specific levels and roles in observation. Inadequate skillsets in the practice of close observation mean that the environment created is unsuitable, especially for the patients. However, the temporary staff may not be used to the psychiatric observation environment, which means that most of the literature showing negative experiences involved studies on temporary staff. This is only an assumption because the studies examined have not indicated the employment arrangement for the nurses. Working temporarily means that a staff member will be unable to create meaningful and trusting relations with the patients. This is one of the reasons that observation practices remain unchanged because the practitioners do not have adequate time to learn and drive change.

The recommendation for flexible practice may also be useful in the customization of care practices. It has been argued by Barnicot et al. (2017) that close observation does not always guarantee the safety of the patient. It also applies that some patients appreciate close observation because they feel that it works for them. These sentiments have been expressed in a study by Crepeau (2016) who finds that some patients tend to demand more attention due to their ever-changing health conditions. Some of the patients surveyed explain that today they may feel very sick and may feel better tomorrow. However, they may feel critically sick again and demand to be attended by the nurses and other healthcare practitioners. The capacity of nurses to attend to the clients influences the recovery and satisfaction of patients in close observation. The key point is that those that demand more attention should be granted the same while those demanding privacy should have their concerns addressed. It means that there are chances of customizing close observation practices to match the needs of the patients. However, a high understanding of patients requires engagement and adequate risk assessment.

It can be established that there is little that the nurses themselves can do to improve the working environment and their experiences in the psychiatric wards. This is because all the responsibility rests with the organizations and their management. The argument is that the practices involving close observation are designed by the management, including the decisions regarding the allocation of staff and resources. This means that nurses only work within the confines of the organizational structure and management decisions. Therefore, the firms are regarded as the main barrier to all the proposed improvements in close observation in psychiatric wards.

Critique of Literature

A critique of literature focuses on examining scholarly work in terms of what has been done and the strengths and weaknesses that can be found. In this case, the critique will explore how the literature supports the current study and examine the visible shortcomings. It is important to acknowledge that the current study focuses on the lived experiences of the nurses and adopts a literature review approach to meet this goal. It can be seen that the researcher will explore previous studies as the primary source of data. In this case, many shortcomings can be highlighted, especially about the timeframe and the scopes of the studies.

Firstly, it has been observed that many of the studies have described the experiences of nurses in psychiatric wards. The findings of these studies can help understand how nurses feel about their jobs and what factors cause these feelings. Therefore, the current literature can be hailed for its contribution towards understanding nursing experiences. However, only one study among those explored directly addresses the research objectives. The study by Currid (2008) is the only example of the efforts to explored lived experiences. However, the findings summarized in the study can be perceived as a summary of what most of the other studies have found. Therefore, it means that the failure to directly address the subject is not necessarily a shortcoming, especially if an adequate focus has been given to nurse’s experiences.

Studying experiences of individuals in particular settings may require primary studies involving the collection of first-hand data from the targeted population. The literature review has comprised studies of this nature where the experiences have been summarized from the responses of the nurses. Again, the study by Currid (2008) serves as a perfect example in this regard. However, the fact that most of the studies have explored the experiences from the perspectives of patients means that much of the primary data available is collected from patients. Crepeau (2015), for example, uses the narratives of the patients in psychiatric care to explain why customization of close observation is necessary. Regarding the nursing experiences, such scholars as Insua-Summerhays et al. (2018) combined both the perspectives of clients and nurses where the experiences of each party were explored. It is also important to acknowledge those studies whose focus has involved a great deal of lived experiences of the nurses, including Solomon et al. (2021) and Rooney (2009). These studies illustrate that despite the focus not being entirely on lived experiences, there is adequate data on which a researcher can rely.

The major shortcoming of the available literature is that very few of the studies are recent, preferably below five years. This has meant that most of the literature explored is over five years old with a few being more than 20 years old. The fact that the current research may decide to map the evolution of close observation practices over several decades may be the only reason why such studies should be included. In this case, the researcher cannot effectively determine the advances in close observation because the literature establishes that the system has been rigid with organizations reluctant to implement new best practices. Even those that have highlighted such aspects as engagement have only meant them to recommendations as opposed to standard practice. There may be cases of real-life scenarios where the new approaches are implemented but they are too few to have featured in any significant research work. Nevertheless, the older studies have also made significant contributions towards this literature review and the broader research and their acceptability is based on the fact that few current studies are available and that the practices have remained unchanged.

However, it is important to acknowledge that the use of older studies will help the purpose of this research, especially because it seeks to highlight how the practice has evolved. The fact that there are no studies on the evolution of close observation means that the only way to get this information is by exploring ancient research. In the literature review explored above, there has been no mention of the historical developments, majorly because this information is missing. Conducting literature reviews may require the analysis of a large body of literature spanning several years. Therefore, as long as there will be no methodological anomalies all the studies used in this review can be acceptable. The basic inclusion criteria would be their significance in addressing the research objectives, which means that even the possibility of making inferences may qualify most of them.

Research Gaps

The current literature cannot be described as conclusive about the exploration of lived experiences of nurses undertaking close observation in psychiatric wards. Even though several of the studies have outlined these experiences, the fact that they are not recent means that the current situation is unexplored. It can be assumed that there are significant developments in psychiatric care where close observation practices have evolved. This evolution has not been outlined by the available literature, which leaves a significant gap. Additionally, if there are new practices then the lived experiences of the nurses and patients have also changed. Therefore, there is a need to find out what the current psychiatric ward environment looks like and how nurses interact with the patients.

Secondly, very few of the studies explored have directly explored the subject of lived experiences. Therefore, it means that the current research is inadequate and it requires more studies to help offer a more comprehensive view of the research topic. Additionally, different organizations have different settings, which means that exploring only a few may provide an unrepresentative sample and knowledge of the entire industry. It can be recommended that future research pays attention to exploring as many hospitals as possible and their practices in the psychiatric wards. A larger sample helps to eliminate bias, something that can be found in many of the studies that used samples of less than 50 respondents.

References

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