Clinical responsibility, accountability, and risk aversion in mental health nursing: A descriptive, qualitative study

Abstract

A number of recent, highly-publicized, perceived health-care service failures have raised concerns about health professionals' accountabilities. Relevant to these concerns, the present study sought to examine how mental health nurses understood clinical responsibility and its impact on their practice. A descriptive, qualitative design was used, and a convenience sample of 10 mental health nurses was recruited from specialist inpatient and outpatient mental health settings in Canterbury, New Zealand. Data were collected using semistructured interviews, and the transcriptions were analysed using an inductive, descriptive approach. Three major themes were identified: being accountable, fostering patient responsibility, and shifting responsibility. Being accountable involved weighing up patients' therapeutic needs against the potential for blame in an organizational culture of risk management. Fostering patient responsibility described the process of deciding in what situations patients could take responsibility for their behaviour. Shifting responsibility described the culture of defensive practice fostered by the organizational culture of risk aversion. The present study highlighted the challenges mental health nurses experience in relation to clinical responsibility in practice, including the balancing required between the needs of patients, the needs of the organization, and the perceived need for self-protection.

Nurses experiences of delivering care in acute inpatient mental health settings: A narrative synthesis of the literature

“…In order to maintain a safe environment nursing staff are often expected to apply force and restrain people against their will. In doing so, they are required to balance consumer's therapeutic needs with organisational requirements of risk management (Manuel & Crowe ). This means that nursing staff need to undertake a complex array of work such as: managing the environment to ensure safety for all; accurately communicating relevant information in a timely manner; monitoring, managing and delivering care; and being able to tolerate and manage challenging behaviour (Bowers et al .…”

‘To be treated as a human’: Using co‐production to explore experts by experience involvement in mental health nursing education – The COMMUNE project

“…These factors may influence nurses to become personally detached from those who use the service (Hendry et al . ; Manuel & Crowe ). In addition, substantial administrative processes limit the time that nurses spend interacting on a personal level (Kessler et al .…”

Suicide prevention in mental health services: A qualitative analysis of coroners’ reports

“…), or being unwilling to work with families because of privacy issues (Wynaden & Orb ). Clinical cultures are often influenced by the organization's approach to risk management (Manuel & Crowe ), and it is curious that of all the coroners’ recommendations, MHS are more likely to implement those related to risk containment, perhaps because these align more with the organizational culture rather than necessarily meeting the needs of service users (Crowe & Carlyle ).…”