| A convergent parallel mixed methods design study, guided by a conceptual framework focusing on factors influencing constant observation practices, was conducted to describe constant observational practices in two hospitals. Quantitative data, collected through questionnaires and chart review, focused on the characteristics of the nurse, observer, unit and patient as well as the nurses' perceptions of constant observation use and the quality of communication and coordination of care with observers. Qualitative data, collected through non-participant observation of nurse-observer dyads and interviews with these dyads and managers, focused on describing constant observation practices including benefits of this intervention.;Patients receiving constant observation had multiple risk factors, such as the presence of responsive behaviours and risk for falls. On both units, nurses had a positive perception of constant observation use, particularly to prevent falls and the removal of treatment equipment. Nurses also had a positive impression of the quality of communication and coordination of care with the observers; important for good constant observation outcomes to occur. Thematic analysis of the data collected through non-participant observation and interviews, led to the identification of three main themes related to constant observation practices: 1) the observer had a multi-faceted role that included providing direct care, ensuring patient safety and sharing information; 2) the nurse had a supervisory role that involved providing support to the observer, directing patient care and sharing information; 3) constant observation outcomes included the prevention and management of responsive behaviour, in addition to the prevention of adverse events, resulting in "a good shift".;Convergence of the different sources of data in this mixed methods study led to a better understanding of the diversity of constant observation practices in different settings, and how these practices are dependent on various contextual, patient and staff factors. This new knowledge will help clinicians and policy makers optimize constant observation practices in their organizations. Clinicians and policy makers are advised to include the delivery of recreational activities to patients as part of the observer role, as these activities may assist in the prevention and de-escalation of patients' responsive behaviours, further improving the quality of constant observation provided. |
