Exploring practices, policies and processes around risk and safety management within mental health nursing services. (SMARTER Nursing study)

Risk assessment and management is a cornerstone of mental health practice yet limited research exists into how mental health nurses conceptualise ‘risk’ and how they engage with risk assessment and safety planning within... [ view full abstract ]

Risk assessment and management is a cornerstone of mental health practice yet limited research exists into how mental health nurses conceptualise ‘risk’ and how they engage with risk assessment and safety planning within an organisational context.

The overall aim of the study was to explore practices, policies and processes around risk assessment and safety management within mental health nursing and within a number of mental health services in Ireland.

Data for the study were collected using a mixed methods design involving an anonymous, self-completed survey and documentary analysis. A total of 381 adult mental health nurses completed a survey about their practices, confidence and attitudes in relation to risk assessment and management. Risk assessment and management related documentation was received from Directors or Acting Directors of Nursing. Ethical approval was received from University ethics committee.
Organisations’ risk-related documentation and nurse’s practice was found to be closely aligned in terms of its orientation towards risk to self and others, in particular the risk of suicide, self-harm, substance misuse and violence. An absence of support for and guidance on positive risk taking at an organisational level was reflected in nurse’s lack of confidence and knowledge in this area. Many screening tools being used were not validated and inconsistencies and a lack of guidance in how they were selected and applied was found. A lack of meaningful engagement with services users was evident with no routine communication of risk or consideration of a persons’ strengths and protective factors.

Organisations should review their policies on risk and safety to ensure that they have a recovery and positive risk focus and reflect a comprehensive definition of risk. Training should be delivered to mental health practitioners to enable them to acquire the knowledge and competencies to practice in a recovery-orientated manner.