Risky behaviour and patient safety: a critical culturist perspective

Patient Safety Strategies in Psychiatry and How They Construct the Notion of Preventable Harm: A Scoping Review

OBJECTIVES

The literature on patient safety in psychiatry has not been explored systematically in terms of what interventions are used, how they are used, and what type of (preventable) harm is targeted. The aims of this scoping review are to explore patient safety strategies used in psychiatry and determine how they construct the notion of preventable harm.

METHOD

A scoping review of literature on patient safety in psychiatry published in English between 2000 and 2019 was conducted using Scopus, MEDLINE, PsycInfo, and CINAHL. Keywords of patient safety strategies and possible outcomes were coded from the results, discussion, or conclusion. Patient safety strategies were inductively categorized into themes according to the focus of the strategy.

RESULTS

The review introduces 7 focus areas of patient safety strategies identified within the psychiatric literature: "risk management," "healthcare practitioners," "patient observation," "patient involvement," "computerized methods," "admission and discharge," and "security." The result shows that patient safety strategies mainly aim to reduce suicide, self-harm, violence, and falls and present a large diversity of measures, often aimed at reducing variability while increasing standardization.

CONCLUSIONS

The strategies that are supported in the literature to achieve safer psychiatry mainly arise from linear cause-effect models and rely on staff performance, competence, and compliance. Contemporary safety science acknowledges the performance variability of everyday normal work and sees risk as the dynamic migration of these daily activities. The field of psychiatry has not yet included this view of safety in the strategic actions to reduce preventable harm.

Cultural Theory's Contributions to Risk Analysis: A Thematic Review with Directions and Resources for Further Research

Cultural theory (CT) developed from grid/group analysis, which posits that different patterns of social relations-hierarchist, individualist, egalitarian, and fatalist-produce compatible cultural biases influencing assessment of which hazards pose high or low risk and how to manage them. Introduced to risk analysis (RA) in 1982 by Douglas and Wildavsky's Risk and Culture, this institutional approach to social construction of risk surprised a field hitherto focused on psychological influences on risk perceptions and behavior. We explain what CT is and how it developed; describe and evaluate its contributions to the study of risk perception and management, and its prescriptions for risk assessment and management; and identify opportunities and resources to develop its contributions to RA. We suggest how the diverse, fruitful, but scattered efforts to develop CT both inside and outside the formal discipline of RA (as exemplified by the Society for Risk Analysis) might be leveraged for greater theoretical, methodological, and applied progress in the field.

How Individuals Who Self-Harm Manage Their Own Risk-'I Cope Because I Self-Harm, and I Can Cope with my Self-Harm'

Self-harm is a complex and idiosyncratic behaviour. This article focuses on how those who self-harm manage their own risk. Utilising opportunity sampling, ten members of a self-harm support group were interviewed about how they risk manage their self-harm and the data analysed using interpretative phenomenological analysis. The analysis showed that all participants were actively involved in risk management of their self-harm. Through a process of managing consequences, exercising control in the process, and an awareness of the social context. It is posited that people who self-harm should be viewed as actively engaging with the risks of self-harm whilst it is a coping mechanism, as opposed to passive or ignoring. This understanding can be integrated into current risk management plans within services and invites a more dynamic conversation of self-harm between services users and services. Effective risk management involves good relationships between individuals who self-harm and clinicians, services which promote positive risk taking as opposed to defensive practice, and true collaboration between services and service users.

Nosocomial suicide

OBJECTIVE AND METHOD

To consider the possibility that adverse aspects of psychiatric hospitalisation may precipitate suicide contributing significantly to the increased rate of suicide among inpatients, given little has been published about this.

RESULTS AND CONCLUSIONS

It is likely that psychiatric hospitalisation itself contributes to some inpatient suicides. This has significant implications for the delivery of inpatient psychiatric care.