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Conlon Bn Bcl Hons Llm Grad Cert University Teaching Grad Dip Legal Practice PhD Candidate U Syd D, Raeburn Np Rn Ma PhD Facmhn T, Wand Np Rn Mn Hons PhD T. Mental Health Risk Assessments of Patients, by Nurses Working in Mental Health Settings: A Qualitative Study Using Cognitive Continuum Theory. Issues Ment Health Nurs 2024; 45:488-497. [PMID: 38502217 DOI: 10.1080/01612840.2024.2320731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Mental health risk-assessments are an important part of nursing in mental health settings, to protect patients or others from harm. Even so, nurses often have difficulty identifying patients posing a credible risk (either to self or others), so guidance is recommended. However, despite an extensive and growing body of risk-oriented literature, comparatively little expands upon contemporary knowledge of nurses and patient risk assessment. Therefore, it remains unclear how nurses understand risk and undertake their risk assessments. To address this knowledge gap in nurses' decision-making processes, this study used the established Cognitive Continuum Theory as a novel means to explore the risk-assessment of patients by nurses working in mental health settings.
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Cantrell A, Sworn K, Chambers D, Booth A, Taylor Buck E, Weich S. Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-107. [PMID: 38314750 DOI: 10.3310/vkty5822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway. Aims To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment. Objectives To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: i. to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context ii. to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK. Data sources Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites. Review methods A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines. Results From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan. Limitations Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment. Conclusions No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement. Study registration This study is registered as PROSPERO CRD42021276671. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Cantrell
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Katie Sworn
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | - Andrew Booth
- Health Economics & Decision Science (HEDS) School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
| | | | - Scott Weich
- School of Health and Related Research (ScHARR), Regent Court, Sheffield, UK
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Dickens GL, Al Maqbali M, Hallett N, Ion R, Kemp C, Schoultz M, Watson F. Mental health nurses' attitudes towards risk assessment: An integrative systematic review. J Psychiatr Ment Health Nurs 2023; 30:1137-1151. [PMID: 37350430 DOI: 10.1111/jpm.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/24/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Risk assessment and risk management are considered to be important practices carried out by mental health nurses. Risk assessment can help keep mental health service users' safe, but some nurses see it as a 'tick the box' exercise. Some studies have looked at nurses' attitudes to risk assessment but no one has systematically described all the studies. WHAT THE ARTICLE ADDS TO EXISTING KNOWLEDGE?: Mental health nurses' attitudes towards risk assessment are diverse with regard to its legitimacy, conduct and value. This study provides an organised framework to help understand the areas in which these different attitudes occur. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Since attitudes can influence clinical practice, nurses need to reflect on how they view risk assessment. Further research is required to investigate whether particular attitudes are positive or negative and whether attitudes can be changed. ABSTRACT INTRODUCTION: Understanding nurses' attitudes towards risk assessment could inform education and practice improvements. AIM/QUESTION To explore mental health nurses' attitudes towards risk assessment. METHOD An integrative systematic review (PROSPERO: CRD42023398287). Multiple databases (PubMed, CINAHL, MEDLINE, EMBASE and PsycINFO) were searched for primary studies of mental health nurses' attitudes towards risk assessment. Qualitative studies were subject to inductive coding and thematic analysis; quantitative data were integrated with emerging themes. RESULTS Eighteen articles were included. Qualitative studies commonly lacked rigorous analyses. Four themes emerged: underlying purpose and legitimacy of risk assessment (philosophical orientation); use of structured approaches (technical orientation); value of intuition (intuitive orientation); and service user involvement (relationships orientation). There were contradictory study findings in each thematic category indicating different attitudes among mental health nurses. DISCUSSION Mental health nurses' attitudes towards risk assessment vary in four key domains. Survey studies suggest they are more approving of structured approaches to risk assessment than many qualitative studies suggest. There is a need to develop a valid measure of attitudes to risk assessment. IMPLICATIONS FOR PRACTICE This review could help health organisations to develop strategies to improve their risk assessment policies and practice. There is a need to develop structured training and education programmes.
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Affiliation(s)
- Geoffrey L Dickens
- Department of Nursing Midwifery & Health, Northumbria University, Newcastle-Upon-Tyne, UK
| | - Mohammed Al Maqbali
- Northumbria University, Newcastle-Upon-Tyne, UK
- Fatima College of Health Sciences, Mafraq, UAE
| | | | - Robin Ion
- University of the West of Scotland, Glasgow, UK
| | | | - Mariyana Schoultz
- Department of Nursing Midwifery & Health, Northumbria University, Newcastle-Upon-Tyne, UK
| | - Fiona Watson
- Department of Nursing Midwifery & Health, Northumbria University, Newcastle-Upon-Tyne, UK
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Cabilan CJ, Eley R, Snoswell C, Jones AT, Johnston ANB. Inter-rater reliability of the occupational violence risk assessment tool for emergency departments. Australas Emerg Care 2023; 26:54-58. [PMID: 35906121 DOI: 10.1016/j.auec.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND The three-item occupational violence (OV) risk assessment tool was developed and validated for use in emergency departments (EDs). It prompts review of each patient's aggression history, behaviours, and clinical presentation. However, confidence around representativeness and generalisability are needed before widescale adoption; hence we measured the inter-rater reliability of the tool among a large group of emergency nurses. METHODS A cross-sectional study was conducted between Sep 2021 and Jan 2022. Nurses were directed to a website that hosted an e-learning module about the tool. They were asked to apply the tool to two video scenarios of typical patient presentations. Demographic data, including years of emergency experience, were collected to contextualise their responses. Gwet's Agreement Coefficients (AC1) were calculated to determine inter-rater reliability. RESULTS There were 135 participants: typically female, under the age of 40 years, with more than 3 years of emergency nursing experience. Overall, there was excellent inter-rater agreement (AC1 =0.752, p = 0.001). This was consistent when years of ED experience was stratified: 0-2 years, AC1 = 0.764, p = 0.002; 3-5 years, AC1 = 0.826, p = 0.001; 6-10 years, AC1 = 0.751, p < 0.001; 11-15 years, AC1 = 0.659, p = 0.004; ≥ 16 years, AC1 = 0.799, p < 0.001. CONCLUSION The three-item OV risk assessment tool has excellent inter-rater reliability across a large sample of emergency nurses.
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Affiliation(s)
- C J Cabilan
- Emergency Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland 4102, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland 4072, Australia.
| | - Robert Eley
- Emergency Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland 4102, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Centaine Snoswell
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, Queensland 4102, Australia
| | - Andrew T Jones
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Australia
| | - Amy N B Johnston
- Emergency Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland 4102, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland 4072, Australia
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Muacevic A, Adler JR, Crawford OA, Zimbron J. The Impact of Stopping Risk Assessment Checklists at a Specialist Personality Disorder Unit. Cureus 2023; 15:e33935. [PMID: 36819427 PMCID: PMC9937679 DOI: 10.7759/cureus.33935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
Aim This study was conducted in Springbank Ward, a specialist ward for patients with emotionally unstable personality disorder, based in Cambridge, United Kingdom. We aimed to assess any change in incident frequency following the introduction of a new protocol for leaving the ward, in which patients are offered an optional conversation with staff in place of a formal risk assessment checklist. We also aimed to assess patient and staff perceptions of the change. Methods We used data routinely collected by Springbank Ward to compare incident frequency in the year before and after the change in protocol. We conducted structured interviews with patients and staff to obtain qualitative data on the new protocol and used thematic analysis to interpret the interview data. Results There were 466 incidents during the period before the change in protocol and 408 incidents in the period after. Adjusted for occupancy rate, there was no statistically significant difference in the frequency of incidents. Patients and staff were generally satisfied with the new protocol, with an average satisfaction rating of 4.1 out of 5. Thematic analysis generated five main themes: 'taking ownership', 'autonomy versus restriction', 'staff-patient interaction', 'staff expertise' and 'protocol efficiency'. Conclusions Our study reveals high satisfaction with the new way risk is assessed and managed for patients leaving Springbank Ward, with an appreciation for its holistic and minimally restrictive approach. This was achieved without significantly increasing incident frequency.
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Hristodoulidis D, Munro I, Brooks C. Exploration of personal recovery-oriented care on an acute mental health unit. Collegian 2022. [DOI: 10.1016/j.colegn.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Terzioğlu C, Doğan S. The Effects of a Psychodrama-Based Risk Management Training Program on the Knowledge and Practices of Turkish Nurses in Psychiatric Clinics. Issues Ment Health Nurs 2022; 43:76-82. [PMID: 34232839 DOI: 10.1080/01612840.2021.1933279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to assess the effects of a psychodrama-based risk management training program on nurses' knowledge and practices. This study used a mixed methods design; quantitative and qualitative methods were used together with a single group pretest, post-test, and follow-up. The training program, in which the nurses took part, comprised six lessons that were designed using psychodrama methods. The result showed that risk management scores increased significantly after the training. Thus, this training is effective for improving the knowledge and practices of mental health nurses for risk management.
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Affiliation(s)
- Candan Terzioğlu
- Nursing Department, Faculty of Health Science, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Selma Doğan
- Nursing Department, Faculty of Health Science, Üsküdar University, Istanbul, Turkey
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Tölli S, Kontio R, Partanen P, Häggman-Laitila A. Conceptual framework for a comprehensive competence in managing challenging behaviour: The views of trained instructors. J Psychiatr Ment Health Nurs 2021; 28:692-705. [PMID: 33295055 DOI: 10.1111/jpm.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 10/10/2020] [Accepted: 11/30/2020] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: There is body of knowledge available about the harms associated with restrictive interventions used in behaviour management, service users' perceptions of the use of restraints, and staff competence in behaviour management. The staff perspective has been studied in terms of staff exposure, responses to and prevention of aggression, staff-related factors associated with service user aggression, and staff attitudes and perceptions towards violence. The definitions of competence in behaviour management provided in training interventions are fragmented and based on unilateral measurements. Training interventions with the purpose of enhancing staff competence in behaviour management are organized regularly, yet there is a lack of clarity on how effective these interventions are. Inadequate conceptual understanding of behaviour management can weaken the effectiveness of these interventions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study produced new knowledge by providing a preliminary conceptual framework that can be used to comprehensively describe and assess competence in managing challenging behaviour and to cover safely the whole care process. Humane care and ethical sensitivity should be the premises of interaction with people in distress. We also pointed out the needs for conceptual clarification of the concepts of confidence, support and restraint. We provide important new insight into the leadership and cultural issues of behaviour management that is relevant for patients, staff members and healthcare organizations. We found that staff members do not consider service user safety and workplace safety as opposing issues. Further, we provide new perspectives for prevention, the risk assessment process and effective communication in the context of behaviour management. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A comprehensive understanding of the competences related to behaviour management will foster universal definitions for "support" and "restraint," which can then be used to ensure that the best practices are used for behaviour management. Organizational culture and participative leadership on behaviour management should be developed with a special focus on safety issues, common understanding of comprehensive competence, risk assessment and prevention, views regarding the use of restraints, and teamwork. ABSTRACT: Introduction Previous research concerning staff views of behaviour management has not considered instructors' views. The definitions of competence in behaviour management are fragmented, which can undermine the effectiveness of training interventions. Aim/Question This study aimed to describe Finnish and British Management of Actual or Potential Aggression instructors' perceptions of safety and behaviour management-related competences and create a conceptual framework for comprehensive competence. Method An explorative-descriptive qualitative approach with purposive sampling (N = 22), semi-structured interviews and abductive content analysis. Results Conceptual framework of comprehensive competence in managing challenging behaviour includes five categories-knowledge, skills, attitude, confidence and ethical sensitivity-and 21 subcategories. Competent staff and supportive leadership ensured safety, while inconsistent risk management culture, the health and behaviour of service users, and inadequate staff orientation endangered safety. Discussion The study produced new knowledge of safety issues and competences from the perspective of the instructors who deliver behaviour management training. Implications for practice Competence to manage challenging behaviour should be developed based on our conceptual framework to provide an effective and safe training. Prevention, the risk assessment process, alternative communication, and the definitions of "confidence," "support" and "restraint" should all be sufficiently addressed in future training.
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Affiliation(s)
- Sirpa Tölli
- University of Eastern Finland, Kuopio, Finland.,Oulu University of Applied Sciences, Oulu, Finland
| | - Raija Kontio
- Director Hyvinkää Hospital, Adjunct Professor Helsinki University, Helsinki, Finland
| | | | - Arja Häggman-Laitila
- University of Eastern Finland, Kuopio, Finland.,Social and Health Care, City of Helsinki, Helsinki, Finland
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Redmond T. Exploring Therapeutic Risk in the Recovery Process of Adolescents at Risk of Self-harm: A Thematic Analysis of Support Staff Perceptions. ADOLESCENT PSYCHIATRY 2021. [DOI: 10.2174/2210676610999200623114504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background and Objective:
The high prevalence of adolescent self-harm
within mental health services presents considerable management concerns, exacerbated
by a lack of clear evidence regarding therapeutically effective approaches. This shortfall
perpetuates traditional risk-averse practice, despite likely inadequacies in mitigating
self-harm through failing to address underlying psychological mechanisms. Therapeutic
risk, defined as an approach whereby clinicians support individual risk-taking,
may be an alternative that yields improved recovery outcomes. However, related research
is adult-focused and provides limited detail on its features, practical delivery
and impact on recovery. Consequently, the current study explored the experiences of
professionals delivering a therapeutic risk ethos, including their conceptualisation of it
and its impact on young people.
Methods:
Semi-structured interviews were conducted with seven mental health support
workers employed by a residential healthcare provider, which promotes a therapeutic
risk approach. The provider supported service users aged 15 - 20 experiencing complex
psychopathology who, following inpatient discharge, presented a high risk of self-harm
and suicidality. Interview data was thematically analysed.
Discussion and Conclusion:
Staff participants provided their understanding of a therapeutic
risk approach, suggesting risk is viewed as positive and beneficial to recovery,
alongside the promotion of service user freedom and flexible therapeutic risk management.
The perceived therapeutic risk incorporates both permission and support, which facilitate
the exploration of underlying feelings and alternative actions. Additionally, therapeutic
risk promotes positive recovery outcomes due to empowered service users having
increased control over their lives. They argued this can reduce psychological distress, encouraging
the development of emotional regulation and adaptive coping strategies.
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Affiliation(s)
- Tomos Redmond
- Manchester Metropolitan University, Manchester, United Kingdom
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Just D, Palmier-Claus JE, Tai S. Positive risk management: Staff perspectives in acute mental health inpatient settings. J Adv Nurs 2021; 77:1899-1910. [PMID: 33491803 DOI: 10.1111/jan.14752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/28/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
AIMS To explore inpatient staff's understanding and implementation of positive risk management. BACKGROUND Risk management is an essential skill for staff working in acute mental health inpatient settings. National policies advocate the use of positive risk management as a form of collaborative, recovery-focused risk management. However, little is known about how staff understand, operationalize, and use positive risk management in practice. DESIGN Qualitative reflexive thematic analysis study. METHODS The authors recruited a purposive sample of healthcare professionals working in acute inpatient settings (N = 16) in 2019 across three National Health Service Trusts in the North-West of England. Participants completed semi-structured interviews which were analysed using reflexive thematic analysis. RESULTS The analysis generated three themes: (a) within staff barriers; (b) within service user barriers; and (c) delivery in practice. CONCLUSION Understanding and implementation of positive risk management was dependant on multiple factors, including staffs' beliefs about mental health, levels of worry and anxiety, and amount of experience and seniority. Staff were more likely to use positive risk management with service users that they perceived as being trustworthy and less risky. Use of positive risk management was reliant on the support practitioners received, how able they were to view situations from multiple perspectives, and the degree to which they felt able to prioritize positive risk management. IMPACT Although staff expressed the desire and intention to practice positive risk management, the current study highlights challenges around operationalization and implementation. The authors discuss the clinical implications of the findings.
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Affiliation(s)
- Daniela Just
- School of Health Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jasper E Palmier-Claus
- Spectrum Centre for Mental Health Research, University of Lancaster, Lancashire, UK.,Lancashire and South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Sara Tai
- School of Health Sciences, University of Manchester, Manchester, UK
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Cutler NA, Sim J, Halcomb E, Moxham L, Stephens M. Nurses' influence on consumers' experience of safety in acute mental health units: A qualitative study. J Clin Nurs 2020; 29:4379-4386. [DOI: 10.1111/jocn.15480] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Natalie Ann Cutler
- School of Nursing University of Wollongong Northfields Ave Wollongong NSW 2522 Australia
- Illawarra Health and Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Jenny Sim
- School of Nursing University of Wollongong Northfields Ave Wollongong NSW 2522 Australia
- Illawarra Health and Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Elizabeth Halcomb
- School of Nursing University of Wollongong Northfields Ave Wollongong NSW 2522 Australia
- Illawarra Health and Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Lorna Moxham
- School of Nursing University of Wollongong Northfields Ave Wollongong NSW 2522 Australia
- Illawarra Health and Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Moira Stephens
- School of Nursing University of Wollongong Northfields Ave Wollongong NSW 2522 Australia
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Kar Ray M, Wyder M, Crompton D, Kousoulis AA, Arensman E, Hafizi S, Van Bortel T, Lombardo C. PROTECT: Relational safety based suicide prevention training frameworks. Int J Ment Health Nurs 2020; 29:533-543. [PMID: 31880076 DOI: 10.1111/inm.12685] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 11/29/2022]
Abstract
Preventing suicide is a global priority, and staff training is a core prevention strategy. However, frontline pressures make translating training into better care and better outcomes difficult. The aim of the paper was to highlight challenges in suicide risk assessment and management and introduce training frameworks to assist with mindful practice so professionals can strike a balance between risk and recovery. We combined the scientific literature with contemporary practice from two successful initiatives from Cambridgeshire, UK: 333 - a recovery-oriented model of inpatient/community crisis care and PROMISE - a programme to reduce coercion in care by enhancing patient experience. The resulting PROTECT (PROactive deTECTion) frameworks operationalize ongoing practice of relational safety in these programmes. PROTECT is a combination of novel concepts and adaptations of well-established therapeutic approaches. It has four training frameworks: AWARE for reflection on clinical decisions; DESPAIR for assessment; ASPIRE for management; and NOTES for documentation. PROTECT aims to improve self-awareness of mental shortcuts and risk-taking thresholds and increase rigour through time-efficient cross-checks. The training frameworks should support a relational approach to self-harm/suicide risk detection, mitigation, and documentation, making care safer and person-centred. The goal is to enthuse practitioners with recovery-oriented practice that draws on the strengths of the person in distress and their natural circle of support. It will provide the confidence to engage in participatory approaches to seek out unique individualized solutions to the overwhelming psychological pain of suicidal distress. Future collaborative research with people with lived and carer experience is needed for fine-tuning.
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Affiliation(s)
- Manaan Kar Ray
- Addictions and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia.,Southside Clinical Unit, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia.,Adult Mental Health Services, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Marianne Wyder
- Addictions and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - David Crompton
- Addictions and Mental Health Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia.,Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, Queensland, Australia.,Neuro-imaging Facility, Translational Research Institute (TRI), Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | - Ella Arensman
- School of Public Health, National Suicide Research Foundation, University College Cork, National University of Ireland, Cork, Ireland
| | - Sepehr Hafizi
- Adult Mental Health Services, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Tine Van Bortel
- Institute for Health and Human Development, University of East London, London, UK.,Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Chiara Lombardo
- Adult Mental Health Services, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK.,Research and Development, Mental Health Foundation, London, UK.,Institute for Health and Human Development, University of East London, London, UK
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Murphy C, Keogh B, Doyle L. 'There is no progression in prevention' - The experiences of mental health nurses working with repeated self-harm. Int J Ment Health Nurs 2019; 28:1142-1151. [PMID: 31240823 DOI: 10.1111/inm.12626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2019] [Indexed: 11/26/2022]
Abstract
Caring for people who self-harm is an everyday experience for mental health nurses and an important part of their role. How mental health nurses respond to and support those who self-harm can have a significant impact on the outcomes for service users and their intentions to seek help in the future. Repeated self-harm can be a particularly challenging phenomenon as it is often misunderstood and can have a negative impact on the therapeutic relationship. This qualitative descriptive study aims to explore how mental health nurses understand and work with repeated self-harm. Nine nurses working in a range of mental health settings within one service participated in semi-structured interviews which were analysed thematically. Findings are presented in two themes exploring participants' perceptions and understanding of repeated self-harm, and the process of learning to work with repeated self-harm, and are reported in accordance with the consolidated criteria for reporting qualitative research guidelines (COREQ). Participants reported that nursing practice relating to repeated self-harm remains largely focused on maintenance of safety and prevention of self-harm despite the identification that this often does not work. It was accepted that there is sometimes a lack of understanding about the function of self-harm; however, participants reported understanding increased following specific education about self-harm. Participants also identified the potential for more empowering and recovery-orientated responses, including the utilization of harm reduction approaches, to the care of those who repeatedly self-harm.
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Affiliation(s)
- Caroline Murphy
- Department of Psychiatry, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Väkiparta L, Suominen T, Paavilainen E, Kylmä J. Using interventions to reduce seclusion and mechanical restraint use in adult psychiatric units: an integrative review. Scand J Caring Sci 2019; 33:765-778. [PMID: 31058332 DOI: 10.1111/scs.12701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/24/2019] [Indexed: 11/28/2022]
Abstract
The aim of this integrative review was to describe interventions aimed at reducing seclusion and mechanical restraint use in adult psychiatric inpatient units and their possible outcomes. CINAHL, MEDLINE, PsycINFO and Medic databases were searched for studies published between 2008 and 2017. Based on electronic and manual searches, 28 studies were included, and quality appraisal was carried out. Data were analysed using inductive content analysis. Interventions to proactively address seclusion were environmental interventions, staff training, treatment planning, use of information and risk assessment. Interventions to respond to seclusion risk were patient involvement, family involvement, meaningful activities, sensory modulation and interventions to manage patient agitation. Interventions to proactively address mechanical restraint were mechanical restraint regulations, a therapeutic atmosphere, staff training, treatment planning and review of mechanical restraint risks. Interventions to respond to mechanical restraint risks included patient involvement, therapeutic activities, sensory modulation and interventions to manage agitation. Outcomes related to both seclusion and mechanical restraint reduction interventions were varied, with several interventions resulting in both reduced and unchanged or increased use. Outcomes were also reported for combinations of several interventions in the form of reduction programmes for both seclusion and mechanical restraint. Much of the research focused on implementing several interventions simultaneously, making it difficult to distinguish outcomes. Further research is suggested on the effectiveness of interventions and the contexts they are implemented in.
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Affiliation(s)
- Laura Väkiparta
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tarja Suominen
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Eija Paavilainen
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jari Kylmä
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
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15
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Felton A, Repper J, Avis M. The construction of people with mental health problems as risk objects: Findings of a case study inquiry. J Psychiatr Ment Health Nurs 2018; 25:558-568. [PMID: 30372573 DOI: 10.1111/jpm.12501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/09/2018] [Accepted: 10/23/2018] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Risk assessment and management in mental health services are contested and perceived as problematic by both professionals and service users. There is substantial emphasis on risk as a core component of professional practice. However, recovery for people with mental health problems emphasizes self-determination which seems to conflict with risk management. A critique is emerging of risk assessment and management. However, there is a lack of empirical evidence which seeks to explore how professionals manage the conflicts between recovery orientated practice and risk management. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper reports on qualitative research which highlights people with mental health problems are objectified and frequently associated with the potential for harm. Risk dominates the work of mental health professionals and undermines individualized care. Service users are subject to increased surveillance and medication as a result. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Service users' subjective experiences need to be prioritized in mental health care by renewed focus on the relationship between professionals and service users. Mental health professionals should question the centrality of risk to their practice. ABSTRACT: Introduction The emergence of recovery, alongside significant focus on risk management, creates potential for conflicting influences in mental health care. Although evidence has critiqued risk assessment, there is a lack of research that seeks to explore how professionals make decisions within these apparently incompatible agendas. Aim To explore how practitioners, experience potential tensions arising from delivering recovery-orientated care and enforcing containment. Method This paper reports on a case study inquiry, using interviews with mental health professionals and observations in an acute ward and an assertive outreach team. Results Risk governed the practice of mental health professionals to such an extent it defined how service users were understood and treated. Service users were constructed as objects of risk, first by being objectified and secondly by creating a link between that object and harm. Discussion Hilgartner's (1992, Organizations, uncertainties and risk (pp. 39-53). Boulder, CO: Westview Press) theory of risk explains how risk dominates the identity of people with mental health problems at the cost of recovery. This results in increased monitoring, surveillance and medication to enact control. Implications for practice To undermine the dominance of risk, professionals should reconnect with the subjective experiences of people with mental health problems and challenge the acceptance of risk as central to their role.
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Affiliation(s)
- Anne Felton
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Julie Repper
- ImRoC, Nottinghamshire Healthcare NHS Foundation Trust, UK
| | - Mark Avis
- School of Health Sciences, University of Nottingham, Nottingham, UK
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16
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Marsh P, Kelly L. Dignity of risk in the community: a review of and reflections on the literature. HEALTH RISK & SOCIETY 2018. [DOI: 10.1080/13698575.2018.1519115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Pauline Marsh
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Tasmania, Australia
| | - Lisa Kelly
- Centre for Rural Health, College of Health and Medicine, University of Tasmania, Tasmania, Australia
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17
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Barrett P, Linsley P. A text on which the ink never dries: dialogical practices for care and treatment planning. J Psychiatr Ment Health Nurs 2017; 24:461-468. [PMID: 28393482 DOI: 10.1111/jpm.12368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P Barrett
- Lincolnshire Partnership NHS Foundation Trust, Peter Hodgkinson Centre, Lincoln, UK
| | - P Linsley
- University of East Anglia, Colney, Norwich, UK
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