The dynamics between structure and flexibility in constant observation of psychiatric inpatients with suicidal ideation.

The aim of the study is to describe how expert nurses perform constant observation of patients with suicidal ideation. A qualitative content analysis is used to analyse individual and focus group interviews of five nurses. One main finding is identified: organizing phases and transitional phases formed during constant observation and the creation of a therapeutic relation. The findings are explained and discussed. In summary, the findings show that constant observation of inpatients with suicidal ideation seems to consist of two main aspects. One refers to its phases and consists primarily of assessing the need for control and controlling the patient from self-harm. The other aspect refers to the relationship between the nurse and the patient during a period of constant observation. There is a dynamic relation between structure and flexibility, and between control and the development of a therapeutic relationship between the patient and the nurse. The therapeutic relation is important when staff assess the need to continue round-the-clock observation.