Documentary analysis of risk‐assessment and safety‐planning policies and tools in a mental health context

Abstract

Despite the articulated need for policies and processes to guide risk assessment and safety planning, limited guidance exists on the processes or procedures to be used to develop such policies, and there is no body of research that examines the quality or content of the risk-management policies developed. The aim of the present study was to analyse the policies of risk and safety management used to guide mental health nursing practice in Ireland. A documentary analysis was performed on 123 documents received from 22 of the 23 directors of nursing contacted. Findings from the analysis revealed a wide variation in how risk, risk assessment, and risk management were defined. Emphasis within the risk documentation submitted was on risk related to self and others, with minimal attention paid to other types of risks. In addition, there was limited evidence of recovery-focused approaches to positive risk taking that involved service users and their families within the risk-related documentation. Many of the risk-assessment tools had not been validated, and lacked consistency or guidance in relation to how they were to be used or applied. The tick-box approach and absence of space for commentary within documentation have the potential to impact severely on the quality of information collected and documented, and subsequent clinical decision-making. Managers, and those tasked with ensuring safety and quality, need to ensure that policies and processes are, where possible, informed by best evidence and are in line with national mental health policy on recovery.

Survey of mental health nurses' attitudes towards risk assessment, risk assessment tools and positive risk

“…To address this gap, a study was conducted to explore policy, practice and attitudes in relation to risk assessment and safety planning among mental health nurses in Ireland. Findings in relation to risk assessment and safety planning practices and policy have been published elsewhere (Higgins et al 2016a(Higgins et al , 2016b. This paper specifically focuses on the finding that explored mental health nurses' attitudes in relation to risk assessment, risk assessment tools and positive risk.…”

A text on which the ink never dries: dialogical practices for care and treatment planning

“…An analysis of risk assessment and safety management planning in Ireland found minimal accommodation of service user or carer involvement within the care plans and little evidence of positive risk taking (Higgins et al . ).…”

The development of simulated learning environments involving coroner’s court attendance in mental health nursing education

“…While several risk assessment tools do exist, it remains difficult to predict who will die by suicide; risk assessment is not an exact science, yet it needs to be managed and exercised as part of clinical practice (Woods 2013). Risk assessments and subsequent safety plans are considered core skills of the mental health nurse (Higgins et al 2016, NMC 2018 and translating this to record-keeping should be a competency that nursing students acquire as part of their training. Interrelating quality nursing processes with clinical decision-making and factual record-keeping are vital elements of transformative learning for the SLE.…”