Managing Risk: Clinical Decision-Making in Mental Health Services

Muir‐Cochrane, Eimear; Gerace, Adam; Mosel, Krista A; O’Kane, Deb; Barkway, Patricia; Curren, David; Oster, Candice

doi:10.3109/01612840.2011.603880

Cited by 34 publications

(69 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These findings need to be considered, however, within the wider mental health service context of risk‐management requirements in risk‐averse practice cultures (Muir‐Cochrane et al . ), and a continued adherence to individualistic models of care. The views expressed by the nurses in the present study are in line with those in Higgins et al .…”

Section: Discussionmentioning

confidence: 99%

Towards relational recovery: Nurses’ practices with consumers and families with dependent children in mental health inpatient units

Foster

Isobel

2017

Int J Mental Health Nurs

View full text Add to dashboard Cite

Facilitating parent-child and family connections during parental hospitalization provides important opportunities for mental health services to support individual and family recovery. Nurses are often the primary point of contact for families in the inpatient context. They play an integral role in the care provision of consumers and families and in supporting consumers' recovery. The aim of the present qualitative study was to explore nurses' practice with families in inpatient mental health settings in the context of designated family rooms. Three themes were derived from the thematic analysis of semistructured interviews with 20 nurses from four mental health inpatient units. Nurses experienced tensions within their roles in balancing safety and risk, a lack of confidence in family-focused practices in relation to role expectations, and challenges in juggling nursing care ideals with the contemporary realities of inpatient practice. A family-centred relational recovery approach is recommended for mental health services, which is underpinned by family-focused policies and processes, and supported at an organizational, managerial, and local-unit level. At an individual level, nurses need professional development on the models of care they practice in, explicit role clarity on their practice with families, and education on evidence-based brief family interventions.

show abstract

Section: Discussionmentioning

confidence: 99%

Towards relational recovery: Nurses’ practices with consumers and families with dependent children in mental health inpatient units

Foster

Isobel

2017

Int J Mental Health Nurs

View full text Add to dashboard Cite

show abstract

“…A recovery-oriented approach to care has implications for risk-assessment and safety-management practices (Muir-Cochrane et al 2011). A recovery-oriented approach to care has implications for risk-assessment and safety-management practices (Muir-Cochrane et al 2011).…”

Section: Discussionmentioning

confidence: 99%

“…One study was located that reported nurses using validated tools or derivatives to guide their practice (Godin 2004). In particular, little evidence of proactive safety planning and therapeutic risk taking was located, with a focus instead on crisis intervention (Delaney et al 2001;Muir-Cochrane et al 2011;Murphy 2004;Raven & Rix 1999;Trenoweth 2003;Woods 2013). In addition, ineffective safety-planning practices were also found, with studies highlighting the dissociation between riskassessment and safety-management plans (Gilbert et al 2011;Langan & Lindow 2004;Woods 2013).…”

Section: Risk and Mental Health Nursingmentioning

confidence: 99%

“…Historically, risk assessment and management within mental health have been viewed primarily from the perspective of assuring public safety (Rose 1996). Consequently, emphasis was on 'dangerousness' and 'dramatic risks', which in recent years has been fuelled by high-profile cases of homicide involving people with a history of mental health problems (Muir-Cochrane et al 2011), the growth in literature that perpetuated the idea that all risks can and should be identified and prevented (Higgins et al 2015), and the development of the availability of actuarially-based risk-assessment tools, which attempt to identify individuals' potential for violence or the risk of suicide (Doyle & Dolan 2002;Godin 2004). However, it is acknowledged that screening and prediction are very much an inexact science beset with false positives and negatives (Woods 2013).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

There is more to risk and safety planning than dramatic risks: Mental health nurses’ risk assessment and safety‐management practice

Higgins

Doyle

Downes

et al. 2015

Int J Mental Health Nurs

111

View full text Add to dashboard Cite

Risk assessment and safety planning are considered a cornerstone of mental health practice, yet limited research exists into how mental health nurses conceptualize 'risk' and how they engage with risk assessment and safety planning. The aim of the present study was to explore mental health nurses' practices and confidence in risk assessment and safety planning. A self-completed survey was administered to 381 mental health nurses in Ireland. The findings indicate that nurses focus on risk to self and risk to others, with the risk of suicide, self-harm, substance abuse, and violence being most frequently assessed. Risk from others and 'iatrogenic' risk were less frequently considered. Overall, there was limited evidence of recovery-oriented practice in relation to risk. The results demonstrate a lack of meaningful engagement with respect to collaborative safety planning, the identification and inclusion of protective factors, and the inclusion of positive risk-taking opportunities. In addition, respondents report a lack of confidence working with positive risk taking and involving family/carers in the risk-assessment and safety-planning process. Gaps in knowledge about risk-assessment and safety-planning practice, which could be addressed through education, are identified, as are the implications of the findings for practice and research.

show abstract

“…Community mental health nurses reported that formalized risk assessment and management procedures prioritized safety and 'avoiding blame' over an individual's personal development (Godin 2004), while in another qualitative study, multidisciplinary staff identified with a propensity for risk aversion (with associated negative consequences for patients) and a 'blame culture' (Muir-Cochrane et al 2011). Community mental health nurses reported that formalized risk assessment and management procedures prioritized safety and 'avoiding blame' over an individual's personal development (Godin 2004), while in another qualitative study, multidisciplinary staff identified with a propensity for risk aversion (with associated negative consequences for patients) and a 'blame culture' (Muir-Cochrane et al 2011).…”

mentioning

confidence: 99%

Considering the culture of blame in mental health care and service delivery

Wand

2017

Int J Mental Health Nurs

View full text Add to dashboard Cite

Managing Risk: Clinical Decision-Making in Mental Health Services

Cited by 34 publications

References 43 publications

Towards relational recovery: Nurses’ practices with consumers and families with dependent children in mental health inpatient units

Towards relational recovery: Nurses’ practices with consumers and families with dependent children in mental health inpatient units

There is more to risk and safety planning than dramatic risks: Mental health nurses’ risk assessment and safety‐management practice

Considering the culture of blame in mental health care and service delivery

Contact Info

Product

Resources

About