What Decision-Making Processes Are Used by Nurses in Initiating, Monitoring, and Ending One-to-One Observations? A Systematic Review.

Abstract

Background: There is a lack of evidence-based processes to support nurses in appropriately utilizing one-to-one observations for patients at risk of avoidable harm in acute hospitals.

Purpose: The purpose of this systematic review was to identify the decision-making processes surrounding one-to-one observations.

Methods: Five databases were searched in July 2020 and July 2024. Papers were included if they discussed decision-making processes for one-to-one observations for acute adult inpatients. Data were extracted to a review database and analyzed thematically.

Results: Sixteen publications were included. The decision-making tools described were assessment tools, local processes, and clinical judgement. The most common tool was an institutional decision-making process, which often was a combination of clinical assessment and clinical action guidance.

Conclusion: Various tools and processes are used to facilitate decision-making on the use of one-to-one observations but few of the tools are evidence-based.