When should I use one-to-one nursing for a patient with dementia or delirium?

A hospital admission can be bewildering for people with dementia or delirium. Staff can have difficulty managing what they perceive to be unsafe behaviour and so adopt one-to-one nursing to minimise risk. However, one-to-one nursing is often applied haphazardly or is not managed robustly enough to ensure efficacy and cost effectiveness. Some organisations have policies to guide staff about when and how to apply observation, but these are often in place to minimise organisational risk rather than to consider the needs of the person experiencing distress.