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Dn today's changing health care environment, both psychiatric and general hospitals are facing an increasingly acute need to monitor patient behavior. This includes patients who are confused, who are harmful to themselves or others, and those whose behavior is unpredictable. The increased burden of caring for these patients has required nursing departments to create guidelines for constant observation of patients and, in some facilities, to develop the category of employee known as a "sitter." Constant observation is utilized across acute care, long-term care, and psychiatric and nonpsychiatric settings. It has become a means to manage and decrease patient care related risks.
Both policy and fiscal issues involved in providing this level of observation should be of concern in hospitals today. While constant observation may be an effective patient management tool, the overall implications of its implementation have not been adequately identified or addressed.
Constant Observation
Constant observation is an increased level of observation and supervision in which continuous one-to-one monitoring techniques are utilized to assure the safety and well-being of an individual patient or others in the patient care environment. Therefore, constant observation often is utilized for patients who are confused, who may be harmful to themselves or others, or whose behavior is unpredictable and difficult. The individual who sits with the patient and provides constant observation often is referred to as the "special," "sitter," or "one-to-one."
The role of the "sitter" varies among institutions. This often is related to professional preparation and skill level of the individual assigned to monitor the patient. On one end of the spectrum, if qualified to do so, the "sitter" may provide all levels of nursing care, or on the other end, simply may "sit" with the patient and call the assigned nurse whenever the patient may require care. The individual "sitter" generally is supervised by the professional nurse who is ultimately responsible for the care of the patient. Constant observation, therefore, is carried out by any category of professional, paraprofessional and nonprofessional staff.
Review of the Literature
The need for maximum or constant observation for patients whose safety is unable to be maintained, or who pose a threat to the safety of others, is well known to nursing staffs, but has not received an abundance of attention in...