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

Abstract

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.

“Attenuating Anxieties”: A grounded theory study of mental health nurses’ responses to clients with suicidal behaviour

“…As in other research findings, nurses in this study defined risk as "a negative and harmful phenomenon located within the individual" (Higgins et al, 2016, p. 161) and one that needs to be managed and prevented (Clancy & Happell, 2014;Higgins et al, 2016). Suicide prediction is an inexact science and very few, if any, valid tools exist within mental health that can predict suicide.…”

“…The Tool for Assessment of Suicide Risk (TASR) (Kutcher & Chehil, 2005), the research suggests that intuition or the unstructured approach continues to form a key part of how nurses determine decisions about suicide risk (Aflague & Ferszt, 2010;Higgins et al, 2016). Assessment in many situations involves nurses observing for overt and covert suicidal cues in an effort to identify warning signs (Cutcliffe & Stevenson, 2008).…”

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

“…The views expressed by the nurses in the present study are in line with those in Higgins et al . () findings, where although risk assessment and safety practices were a central component of mental health nursing, nurses maintained narrow definitions of risk, and did not necessarily demonstrate recovery‐oriented practice in relation to risk.…”

Preparing master‐level mental health nurses to work within a wellness paradigm: Findings from the eMenthe project

“…Historically within mental health assessment, there has been a focus on assessing deficiencies the person is perceived to have or problems they experience (Higgins et al . ; Slade ; Wand , ). From a wellness perspective, however, an alternative assessment strategy is required, which takes a strengths‐based approach, emphasizing well‐being over deficits with a more person‐centred, rather than professional‐centred, focus (Slade ; Wand ).…”