Risk Management in Nursing Practice

Bowers (2014) identifies the need for the preservation of safety as the most crucial objective for mental health nursing. However, this is a very isolative environment with seclusion being a part of this treatment and intervention. Clifton et al (2017) argues that this could lead to possible deterioration of social inclusion, independence and communication. Shared decision-making (SDM) is a frequently utilized model for the purpose of approaching sensitive decisions (Stiggelbout et al, 2015). This process is where clinicians and patients make decisions together, using the best available evidence, with consideration for the patient’s values and beliefs (Chi, 2018).

The collaborative approach amongst professionals, patients and family can enhance the delivery of care through improved outcomes for service users. However according to the Department of Health (1999) mental health professionals faced with the task of providing care to service users with severe mental illnesses such as psychosis will need to act as care coordinators under the care program approach (DOH, 2008).

This is mandatory in the case of service users with serious and enduring mental illness (Lovell et al, 2018).

Professional standards set out by the NMC code, states that mental health professionals have a duty of care to preserve the safety of individuals (NMC, 2015) under the mental health act (amended 2007), through providing treatment, care, rehabilitation and protection to service users who are mentally dysfunctional or mentally ill, both voluntarily and involuntarily in some circumstances, where deemed to be at risk of harm to self or others (Scott, 2013). Therefore decisions are made in the best interest of the individual at the time of crisis (MCA, 2005).

However principal two of the mental capacity act is that the mental health act is implemented when the patient cannot be treated under the mental capacity act and is non-compliant with treatment. Therefore, the shared decision-making process is reduced to shared information and perspectives of professionals and carers only in the first instance.

Coordinating an assessment under the mental health act is the responsibility of an approved mental health professional (AMHP). This involves organising two consultants to assess the individual, identifying the person’s nearest relative in order to adhere to guidelines and legislation and consult with other professionals and carers involved in the individual’s life (DOH, 2008). The AMHP’s acts on behalf of the local authority, however they must provide an independent decision based on their own judgement and the evidence base presented to determine if an individual is being detained under the mental health act, or if there are less restrictive alternatives (Morris’s, 2016).

Additionally they must act with integrity to ensure that all legislation, such as mental health act (2007), the mental capacity act (2005) and the human rights act (1998) of the individual being assessed or upheld and protected (Gaag, 2016).

On reflection, I wondered if this could have been addressed earlier, due to the information of a previous attempt of suicide, to avoid the second incident entirely. However, on the knowledge and understanding of the roles and responsibilities of the crisis team on the liaison service, under the guidance of the mental health cluster care pathways, I have discovered and understand the need to maintain service user empowerment. With the option to offer support in the community to accommodate the least restrictive strategies in the assessment and treatment process as part of the holistic Approach to care delivery. The environmental and social factors need to be considered in an individual’s recovery journey. The sensitive nature of the incident leading to the need for a multi professional share decision, also facilitates the perspectives of individuals involved from professionals, carers and the service user themselves. In addition to evidence based through appropriate information sharing, across multi agencies involved with the individuals care delivery.

Positive risk-taking, in addition to assessment and management, is a fundamental part of practice to facilitate their recovery approach. Maintaining individual’s independence and identity through safely avoiding an isolative or institutionalised environment, which could have a detrimental negative impact on an individual’s mental well-being. Managing risks effectively is a complex task, with risk and recovery intertwined and therefore requiring the involvement of multiple expertise and experience to collaboratively agree the best interest decision. In practice this could optimise success and satisfactory care delivery and enhance the service user’s outcome and experience of mental health care delivery. Elimination of risk is not a possibility, however assessing and managing the risk with sound clinical judgement, utilising evidence base and facilitating the multi perspective approach can be achieved and make for safer care delivery in mental health services.

This incident has informed my future practice, through the demonstration of optimal care delivery through evidence based practice. I observed and participated in effective communication across professional agencies, service users and carers with consideration for all information and perspectives shared, to achieve a shared decision in nursing practice. The crucial need for accurate record keeping was identified when formulating a holistic perspective of Peter’s current and recent experiences as well as social factors. I have gained increased knowledge and understanding of other professional roles and identified areas for continuous professional development through reflective practice. The severity of Peter’s suicide attempt was elevated due to the perspective of his landlady and her knowledge of his social and environmental circumstances surrounding this incident.

My initial instinct prior to this would be to detain an individual following a serious attempted suicide, without consideration for the environmental factors and the impact this could have in hindering an individual’s recovery. In future I would attempt to offer the same support through positive risk taking, by facilitating assessment and treatment in a more therapeutic environment if evidenced to be so and optimise a successful recovery in the community and offer suicide prevention strategies, through empowering individuals in a solution focused approach.

This assignment has critically analysed a decision made in nursing practice through a systematic search of current literature, to reflect on the actions taken to retain a man under section 2 of the mental health act and admitted onto an acute inpatient ward as an approach to managing risk.

This assignment has explored the attitudes and attributes of professionals involved in this process and demonstrated the essential skills required, to make evidence based decisions in a person centred approach to aiding recovery from suicide. Protocol and policies guided this practice and the rights of the service user considered for best interest decision making and the use of multi perspectives, leading to a more subjective evidence and holistic view of current circumstances, to enable a better understanding of the individual’s current situation and affect.

All the teams involved and professionals demonstrated good knowledge and understanding of the roles and responsibilities, alongside additional knowledge of their colleagues and other agencies. There was evidence to demonstrate effective communication across services and a shared or common goal was successfully identified and formed. A shared decision was made and all in agreement for the safety and welfare of this gentleman being identified as paramount before any further assessment could be conducted and possible treatment options formulated.

Evidence of least restrictive practice and positive risk taking had been exhausted and identified some always needed to safeguard the gentleman to undergo a full assessment his human rights were upheld and an example of optimal service delivery was performed.

Good practice, effective communication, evidence-based decision-making led to a best interest decision to be met and carried out. An integral part of the nursing practice, is for continuous reflective practice and continuous learning to enable confidence in the nurse’s responsibilities and accountability in decision-making and perform the role with integrity. Furthermore, within a collaborative working environment and following protocol to deliver recovery focused care through effective risk assessing, managing and evidence-based approach to support any nursing decision making rational.

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