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Development of a Functional Analytical Nurse Observation Chart (FANOC)

  • David Veale (a1), Selina Warlow (a2), Tara O'Donoghue (a2) and Chris Callow (a3)

Background: There has been little evaluation or development of nurse observation charts on psychiatric in-patient units since they were first introduced. Aim: We aimed to develop a new nursing chart that adds a functional and contextual assessment of the observed behaviour. We describe its initial evaluation in an in-patient setting. Method: A member of the staff coded a participant's behaviour as either an instance of an individual's daily life problem; or an improvement; or a non-clinically relevant behaviour. We evaluated the charts in 14 in-patients and compared the coding of the behaviour against that of one of the investigators. Results: After brief training the inter-rater agreement resulted in Kappa = 0.496 with p < .001. Removal of a rating of neutral behaviours resulted in a higher Kappa = 0.546 with p < .001. Conclusions: The inter-rater reliability was only moderate for the Functional Analytical Nurse Observation Charts. Frequent training and support from management and therapy staff is required to maintain a psychologically informed environment and observation in an in-patient setting. An area for further research is to explore the impact that a FANOC has on staff satisfaction and an individual's experience of care, and whether it can assist in determining mediators of change before an improvement in symptoms.

Corresponding author
Reprint requests to David Veale, Centre for Anxiety Disorders and Trauma, Maudsley Hospital, 99 Denmark Hill, London SE5 8AZ, UK. E-mail:
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Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
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