T.O.E.S - Therapeutic Observation and Engagement Support (Patient Watch)
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Exclusive Secure Care is committed to providing a safe and supportive environment to all service users wherever their care is provided. Those admitted into acute care settings are often deemed at their most vulnerable. The effective and appropriate implementation of supportive observations and engagement is fundamental to discharging the duty of care in these circumstances.
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Harm Minimisation and recovery
Observation of service users is by its very nature intrusive, particularly where it is for prolonged for many hours or even days, and if managed inappropriately can damage that recovery process. Moreover, service users have said that they find observations provocative and that it can lead to feelings of isolation and dehumanisation. Therefore it should be undertaken sympathetically and only when necessary. It should be recognised however that if carried out well, that Supportive Observation is important as a supportive mechanism, for the purpose of engaging positively with the service user. Supportive observation and engagement, over and above the lowest level of observations and engagement, is a therapeutic intervention aimed at reducing factors which contribute to increased risk and promoting recovery. It should focus on engaging the person therapeutically and enabling them to address their difficulties constructively. It is important that staff balance the distressing effect and potential long term harm of being on high level of observations and engagement (e.g. loss of skills, loss of autonomy) against the risk of immediate harm (e.g. serious self-harm or violence). As this will change over time, this balance will need to be continually and dynamically assessed
Human Rights
The use of supportive observation and engagement must not breach The European Convention on Human Rights, and in particular the right to have private life respected (Article 8). No service user should be subject to unnecessarily observations in a way that would breach this right. In order for this policy to comply with the law observations must be justifiable and proportionate. Clinicians therefore need to make sure that the use of supportive observation is no more intrusive – nor continues longer – than is required by the circumstances. Therefore they need to ensure that the right to life (Article 2) is sufficiently threatened to make the use of observations justifiable. Levels should never be regarded as routine practice, but must be based on assessed and current need. Supportive observations and engagement should be recognised as a restrictive practice and may be perceived by service users as a coercive intervention. It should therefore only be implemented after positive engagement with the service user has failed to reduce the risk to self or others and only used for the least amount of time clinically required.
Principles of Supportive Observation and Engagement
Supportive Observation and Engagement is more than just watching a person. It is the active and sensitive support of an individual when at their most vulnerable or when harm is most likely to arise. What keeps people safe is not the act of being under surveillance (observation); rather it is the quality of engagement between that individual and staff.
Supportive engagement is therefore underpinned by continuous attempts for compassionate and therapeutic interaction to meet the holistic needs of a service user. Staff should be approachable and listen to the service user and be able to convey to the service user that they are valued. It is essential that during supportive observation and engagement the service user should be given the opportunity to talk and take part in activities meaningful to them and appropriate to their needs and recovery. Such activities need to be collaboratively identified and regularly reviewed with the service user and documented in the care plan, which should be reiterated at each handover. If for any reason involving the service user in dialogue and activities during supportive observation and engagement is not possible or desirable, then the reasons for this needs to be clearly recorded.
Supportive engagement is therefore underpinned by continuous attempts for compassionate and therapeutic interaction to meet the holistic needs of a service user. Staff should be approachable and listen to the service user and be able to convey to the service user that they are valued. It is essential that during supportive observation and engagement the service user should be given the opportunity to talk and take part in activities meaningful to them and appropriate to their needs and recovery. Such activities need to be collaboratively identified and regularly reviewed with the service user and documented in the care plan, which should be reiterated at each handover. If for any reason involving the service user in dialogue and activities during supportive observation and engagement is not possible or desirable, then the reasons for this needs to be clearly recorded.
Carrying out supportive observations and engagement
The actual practice of delivering supportive observation and engagement is largely, though not exclusively, a nursing responsibility. This authority is exercised through appropriate delegation of responsibilities within the multidisciplinary team. Attention should be paid to meeting the service user’s need for support and therapeutic engagement by providing a member of Exclusive Secure Care staff with whom they can develop rapport and feel comfortable, taking into account wherever possible gender, background and other attributes. The individual's perceptions and views should be considered and responded to. If this is not possible an explanation should be offered. The implementation of supportive observation and engagement levels may have an effect on the workload for the ward team. Every effort should be made so that the Exclusive Secure Care staff is implementing supportive engagement, with additional support from other members of the team as necessary. The use of skilled staff that are familiar to the area, the type of clinical work, and the service users is preferable to unskilled and unfamiliar staff.
