Reflecting on Risk Assessment and Management in Mental Health Nursing

This reflective analysis discusses the importance of risk assessment and management in mental health nursing, highlighting the need for continuous assessment and the implications for future practice.

Running Head: RISK ASSESSMENT AND MANAGEMENT
REFLECTING ON RISK ASSESSMENT AND MANAGEMENT IN
MENTAL HEALTH NURSING

RISK ASSESSMENT AND MANAGEMENT
Abstract
The current discussion details a reflective analysis of an experience related to risk
assessment in mental health nursing. It details a learning experience which changed from a
patient care experience at the mental health center. The change or new learning is associated with
a continuous process of risk assessment. This learning has immense implication for future
practice in mental health nursing.
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RISK ASSESSMENT AND MANAGEMENT
Table of Contents
Abstract............................................................................................................................................2
Introduction......................................................................................................................................4
Description.......................................................................................................................................4
Analysis...........................................................................................................................................5
Conclusion.......................................................................................................................................6
References........................................................................................................................................7
Mind Map........................................................................................................................................9
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RISK ASSESSMENT AND MANAGEMENT
Introduction
A major driver of acute psychiatric admission and community care arises from the risk
that a person poses to himself or to others (Ryan, Nielssen, Paton & Large, 2010). Risk
encompasses the likelihood of an adverse event occurring and requires working with the client.
The scope of current reflection report encompasses the change in behavior that occurred as a
result of practical experience at a healthcare center in managing the risk of a patient. Assessment
and management of clinical risks involve the core competence needed of the MHN and has to be
accepted in the social aspect of the client (Iozzino, Ferrari, Large, Nielssen & De Girolamo,
2015). Evaluation of risk and its management includes working with the patient and with those
who are significant to the patient.
Description
It becomes pertinent to describe the incidence along with my own feelings and reactions.
The case context here deals with a 45-year-old male patient, with associated past history in self-
harm, attempting to end his own life. The patient was admitted with such harm inflicted on him,
he had several cut marks and seemed mentally unstable (Van de Sande et al, 2011). He could not
make eye contact with anyone and seemed to be lost. He was living alone in his apartment and
lost his job last year. His wife had left him and he has no one else in his family. With a childhood
history in abuse, the patient now faces extreme mental traumatic condition and stress disorder.
He had been earlier admitted to the hospital as well on the previous occasion of inflicting self-
harm. He had past history attempts on his own life and had been discharged three times in the
last 2 years. His medical reports depicted the use of alcohol after his wife left him that
deteriorated his condition significantly. From his appearance, it could be understood that he
suffered from poor nutrition, hygiene, and hydration problem. In the current instance, his
neighbor found him not answering the door since past 1 day, hence the neighbor called the
mental health center predicting some occurrence had taken place.
The patient needed emergency treatment in mental health assessment. I had a risk
assessment of static, dynamic and future risk factors for analysis of the patient's changing
circumstance (Zhang, Harvey & Andrew, 2011). I expected the organization’s support in
handling the patient’s condition. However, I received policy guidelines and adequate training in
handling the situation. As the client appeared extremely tensed, I tried to ease him by sharing his
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RISK ASSESSMENT AND MANAGEMENT
personal experience. All my interaction was focused on him, which made him gradually open up
regarding his depressive situation. He stated his frightening lonely experience and I remained
non-judgmental regarding his situation so that he could open up. I felt that the patient was
extremely helpless and needed counseling and assistance. He required someone to be with him,
but as he was inflicting harm upon himself, such issues needed appropriate diagnosing. The
patient had been previously treated by the community mental health team, however, his behavior
depicts that he did not follow the medication and lifestyle recommendations provided to him.
Currently, he is ambivalent regarding his situation or his assessment.
Analysis
Risk assessment and management is one of the most critical aspects of mental health
service (Cornaggia, Beghi, Pavone & Barale, 2011). The key to effective risk management is
maintaining a good relationship between the service user and with those who are rendering the
care. As assessment and management of clinical risks are regarded as one of the most critical
tasks of mental health services, risk needs to be reviewed regularly. The current issue of patient
handling was understood by means of my previous learning, understanding, and experience in
mental health. I felt that risk assessment for a patient is a single time practice and encompasses
an understanding of the patient once and for all. From my past learning, I had totally ignored that
risk assessment needs to encompass dynamic risk factors such as usage of drug or alcohol,
clinical intervention or current psychological stressors. Accommodating in dynamic risk factors
can aid in understanding the future risk factors and estimating the repetition of an incidence.
Moreover, a risk plan for the patient needed to be developed, communicated and implemented.
With the risk plan, the probability of an event occurring or minimization of associated harm or
contingencies can be effectively prevented.
The patient earlier had a risk assessment, which I referred to and found him to be
completely cured. Initially, I was assessing him on the basis of the last report, which I felt would
provide a comprehensive understanding. However, the development of the patient symptoms
again revealed that there needs to be a new risk assessment conducted for the patient. There were
several dynamic factors and other incidents which have changed in recent days, which needed
analysis. Re-appearance of risk symptoms and the patient not adhering to the recommendations
let me realize the importance of fresh risk assessment. As risks can appear in both non-clinical
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RISK ASSESSMENT AND MANAGEMENT
and clinical forms, mental illness can have vulnerabilities to the patient. Not only the patient
depicted self-harming attitude but also reduced functionality and incapability to undertake sound
decision. My training provided me with adequate knowledge to apply my skills to identify risks,
conduct intervention and then subsequently manage them. I utilized my therapeutic tools for
assessment of mental health and in establishing relationship enabling to develop communicative
skills with the patient. In the assessment process, I remained focused on the client that allowed
me to develop a responsive interview process with the patient.
Conclusion
The above reflective discussion highlights changes brought about in my behavior as a
result of experience. Earlier I felt one-time risk assessment to be sufficient to conduct risk
management, however, re-appearance of the patient symptom led me to consider risk assessment
again. The change in my understanding took place due to the re-occurrence of symptoms
inpatient. This change in my behavior has tremendous implications for my future professional
practice. I have learned that risk assessment is a continuous process and not discrete in nature.
Further continuous risk assessment can enable the undertaking to compete for a cure for a patient
in mental health.
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References
Cornaggia, C. M., Beghi, M., Pavone, F., & Barale, F. (2011). Aggression in psychiatry wards: a
systematic review. Psychiatry research, 189(1), 10-20.
doi:10.1016/j.psychres.2010.12.024. Retrieved from
https://www.sciencedirect.com/science/article/pii/S0165178110007924
Iozzino, L., Ferrari, C., Large, M., Nielssen, O., & De Girolamo, G. (2015). Prevalence and risk
factors of violence by psychiatric acute inpatients: a systematic review and meta-
analysis. PloS one, 10(6), e0128536. doi: 10.1371/journal.pone.0128536. Retrieved from
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0128536
Ryan, C., Nielssen, O., Paton, M., & Large, M. (2010). Clinical decisions in psychiatry should
not be based on risk assessment. Australasian Psychiatry, 18(5), 398-403. doi:
10.3109/10398562.2010.507816. Retrieved from
https://journals.sagepub.com/doi/abs/10.3109/10398562.2010.507816
Van de Sande, R., Nijman, H. L. I., Noorthoorn, E. O., Wierdsma, A. I., Hellendoorn, E., Van
Der Staak, C., & Mulder, C. L. (2011). Aggression and seclusion on acute psychiatric
wards: effect of short-term risk assessment. The British Journal of Psychiatry, 199(6),
473-478. doi:10.1192/bjp.bp.111.095141. Retrieved from
https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/
aggression-and-seclusion-on-acute-psychiatric-wards-effect-of-shortterm-risk-
assessment/CD679C44B996DC54C71F82CB0464346C
Zhang, J., Harvey, C., & Andrew, C. (2011). Factors associated with length of stay and the risk
of readmission in an acute psychiatric inpatient facility: a retrospective study. Australian
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and New Zealand Journal of Psychiatry, 45(7), 578-585.
doi:10.3109/00048674.2001.585452. Retrieved from
https://www.tandfonline.com/doi/abs/10.3109/00048674.2011.585452
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Risk Assessment in Mental Health Nursing
Follow procedure and regulation of the center
Patient risk evaluation
Organization’s support in risk management
Collect facts from interview
Past record assessment of patient
Provide medication & recommendation to patient
RISK ASSESSMENT AND MANAGEMENT
Mind Map
Figure 1: Mind-map
Source: Author
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