Handley Melanie, Theodosopoulou Danai, Taylor Nicky, Hadley Rebecca, Goodman Claire, Harwood Rowan H, Phillips Rosemary, Young Alex, Surr Claire
Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK.
Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK.
Aging Ment Health. 2023 Nov-Dec;27(12):2305-2318. doi: 10.1080/13607863.2023.2219632. Epub 2023 Jun 9.
Constant observation is used in hospitals with people with dementia to manage their safety. However, opportunities for proactive care are not consistently recognised or utilised. A systematic review of constant observation was conducted to understand measures of effectiveness and facilitators for person-centred approaches.
Electronic databases were searched between 2010 and 2022. Four reviewers completed screening, quality assessments and data extraction with 20% checked for consistency. Findings were presented through narrative synthesis (PROSPERO registration CRD42020221078).
Twenty-four studies were included. Non-registered staff without specific training were the main providers of constant observation. Assessments and processes clarifying the level of observation encouraged reviews that linked initiation and discontinuation to a patient's changing needs. Examples of person-centred care, derived from studies of volunteers or staff employed to provide activities, demonstrated meaningful engagement could reassure a person and improve their mood. Proactive approaches that anticipated distress were thought to reduce behaviours that carried a risk of harm but supporting evidence was lacking.
Non-registered staff are limited by organisational efforts to reduce risk, leading to a focus on containment. Trained staff who are supported during constant observation can connect with patients, provide comfort and potentially reduce behaviours that carry a risk of harm.
在收治痴呆症患者的医院中，持续观察用于保障患者安全。然而，积极护理的机会并未得到一致认可或利用。为了解以患者为中心的方法的有效性衡量标准和促进因素，对持续观察进行了系统评价。
检索了2010年至2022年期间的电子数据库。四名评审员完成了筛选、质量评估和数据提取，并对20%的内容进行了一致性检查。研究结果通过叙述性综合呈现（PROSPERO注册号CRD42020221078）。
纳入了24项研究。未经专门培训的非注册工作人员是持续观察的主要提供者。明确观察水平的评估和流程鼓励进行将观察的启动和停止与患者不断变化的需求联系起来的审查。从志愿者或受雇提供活动的工作人员的研究中得出的以患者为中心的护理示例表明，有意义的互动可以让患者安心并改善他们的情绪。预计会出现痛苦的积极主动方法被认为可以减少有伤害风险的行为，但缺乏支持证据。
非注册工作人员受到组织降低风险努力的限制，导致重点放在控制上。在持续观察期间得到支持的经过培训的工作人员可以与患者建立联系、提供安慰，并有可能减少有伤害风险的行为。
