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Relationship between service ecology, special observation and self-harm during acute in-patient care: City-128 study

  • Len Bowers (a1), Richard Whittington (a2), Peter Nolan (a3), David Parkin (a1), Sarah Curtis (a4), Kamaldeep Bhui (a4), Diane Hackney (a5), Teresa Allan (a1) and Alan Simpson (a6)...

Special observation (the allocation of nurses to watch over nominated patients) is one means by which psychiatric services endeavour to keep in-patients safe from harm. The practice is both contentious and of unknown efficacy.


To assess the relationship between special observation and self-harm rates, by ward, while controlling for potential confounding variables.


A multivariate cross-sectional study collecting data on self-harm, special observation, other conflict and containment, physical environment, patient and staff factors for a 6-month period on 136 acute-admission psychiatric wards.


Constant special observation was not associated with self-harm rates, but intermittent observation was associated with reduced self-harm, as were levels of qualified nursing staff and more intense programmes of patient activities.


Certain features of nursing deployment and activity may serve to protect patients. The efficacy of constant special observation remains open to question.

Corresponding author
Len Bowers, Professor of Psychiatric Nursing, City University, Philpot Street, London E1 2EA, UK. Email:
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Declaration of interest

None. Funding detailed in Acknowledgements.

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Relationship between service ecology, special observation and self-harm during acute in-patient care: City-128 study

  • Len Bowers (a1), Richard Whittington (a2), Peter Nolan (a3), David Parkin (a1), Sarah Curtis (a4), Kamaldeep Bhui (a4), Diane Hackney (a5), Teresa Allan (a1) and Alan Simpson (a6)...
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