Close observation by 'specials' to promote the safety of the older person with behavioural disturbances in the acute care setting

Lesley Wilkes
Family and Community Health Research Group (FaCH), Clinical Nursing Research Unit, Nepean Hospital; University of Western Sydney and Sydney West Area Health Service, Sydney NSW

Debra Jackson
Professor, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney (UTS), Broadway NSW

Shantala Mohan
Family and Community Health Research Group (FaCH), University of Western Sydney, Sydney NSW

Marianne Wallis
Clinical Nursing Research, Gold Coast Health Service District; Griffith University, Southport QLD

PP: 131 - 142


This paper reports a two-phased pilot study that explored the concept of 'specialling' older patients with challenging behaviours in acute ward situations. Previous research suggests that the nursing workforce is not equipped with the skills and resources required to provide quality care for these patients.

The hospital in which this study was conducted, instigated a model where these patients were closely observed by 'specials'. Phase 1 of the study involved a retrospective analysis of de-identified 'Specials' Observation Charts' and 'Request for Patient Special' forms of patients aged 65 years and above, over 12 months in 2006. Phase 2 involved in-depth interviews with the nurses caring for these patients.

Findings revealed inadequacy of the forms, gaps in service provision for this vulnerable group of patients and the need for education of specials and ward staff, with suggestions to improve care for this patient group. Findings suggest the necessity to design and structure the observation forms more efficiently. It is important to formulate clear assessment criteria for these patients and incorporate in-service education programmes for 'specials' and ward staff and adequately prepare and support them to meet the challenges of caring for older persons with behavioural disturbances in ward situations.


nursing; acute care; specials

View references


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