Observation is a fundamental skilled nursing intervention. Special observation is an intensified and often prolonged form of this intervention. Depending upon their nature, and the circumstances under which they are carried out, special observations may invoke varying degrees of stress in both the observer and the observed. They may also raise important ethical and significant financial questions. In psychiatry, special observations are usually imposed where a patient is assessed as representing some degree of risk to themselves or others because of their behaviours or potential behaviours. Special observations vary in their degree of intrusiveness and restrictiveness, and may arouse strong emotions in the patient and staff. Patients may be denied privacy for their most intimate needs, and staff may become a focus for patients' acting-out behaviours. Special observations may be medically imposed with minimal consultation with nursing staff, and where there is no nursing and medical staff agreement on their need, nursing staff may at times feel frustrated and powerless to reduce the patients' discomfort with their situation. This paper presents a study into the use of special observations on psychiatric inpatients across a range of clinical settings. The literature on special observations is reviewed, and the findings of an audit into the documentation of special observations is presented and discussed. The study sites comprised two open acute wards, one elderly functionally mentally ill assessment unit which also treats patients with eating disorders, and a secure high dependency unit, which provides rehabilitation within a secure environment for patients with severe and enduring mental illness.

Lone working is increasing in the UK, as care delivery aims to keep people at home. This means that the relative safety of a hospital or clinic with colleagues present is increasingly being replaced by isolated workers in unfamiliar and potentially dangerous situations. Lone workers should be as safe and protected as colleagues who work in a shared base and employers have a legal responsibility to protect lone workers and minimize the risks which may have traditionally been viewed as occupational hazards. This article sets out a rapid risk assessment tool that employees can use to assess the risk of a lone visit on a case-by-case basis, and take precautions accordingly.

Nurses' uniforms have been the subject of ongoing debate in many areas. Following the Ashworth Hospital inquiry, two wards at the hospital piloted the wearing of casual clothes by nurses. Patients and nurses in these wards completed questionnaires to evaluate the effects of the change. The results showed that the patients felt casual clothes helped remove a 'them and us' distinction and enhanced nurse/patient relationships. Nurses found casual clothes to be more comfortable and practical. Although concern was expressed that, without uniform, nurses might not be readily identifiable in an emergency situation, the change to casual clothing was generally viewed positively by both patients and nurses.

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