Risk Assessment in Mental Health Nursing: A Detailed Overview

This presentation provides an overview of risk assessment in mental health nursing, emphasizing the importance of balancing patient wishes with safety concerns. It covers general principles such as prioritizing the patient's narrative, obtaining consent, and gathering comprehensive information f...Read More

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Mental
Health NursingFriday, January 3, 2025

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Introduction
Risk assessment in mental health is has been identified as a
challenging area of clinical practice because of the conflicting
interests of keeping up with the patient’s wishes (Woods & Kettles,
2009).

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Approaches to Risk Assessment
General Principles
The narrative of the patient concerning their condition is the first
priority (Galynker, 2017). This is followed by acquiring consent from
the patient explaining the risks and benefits. Gathering of information
should be systematic, in team works from reliable sources and
comprehensive history search. Warm relationship between the
clinician and the patient is important in making assessment accurate
and with reduced risks.

4Factors to Consider
The following need to be considered (Royal College of Psychiatrists, 2018);
Historical Assessment
 Violence experience in the past and its relationship to mental
 Absence of supportive relationships
 Poor compatibility with treatment
 Impulsivity
 Alcohol or Substance abuse
 Changes in mental behavior before the deformed mental state
 The stability of risk factors

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Environmental Assessment
 -the risk factors diversity by setting
 -assessment of the availability or loss of protective factors
 -the relational security as per the Think Act, Department of Health
2015
 - overcrowding in the wards
 -accessibility of weapons or chances for violence
 - Past experiences in radicalization

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Mental State Assessment
 -presence of symptoms that link to the control of threats, or interference of
the person by external factors
 -emotional reaction (anger, hostility, deviousness, enthusiasm, enjoyment,
distinguished lack of emotion, unkindness or absurdity).
 - Grievance thinking
 -any suicide or sexual violence thoughts or attempts
 - Psychopathy symptoms
 -imperceptible risk factors

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Appraisal of Evidence
Acquiring consent from the patient as a general assessment practice is important but does
not always apply in all situations (Elder, Evans & Nizette, 2011). One particular instance is
when a patient’s mental condition is so severe that he/or she cannot make sound decisions
regarding the same. It is not possible to explain to such patients about the risks or benefits of
the assessment. The gathering of evidence from reliable sources and as a team, however, is a
good assessment practice in that mental data can be misinterpreted and therefore requires
comprehensive scrutiny. The creation of cordial relationships between the patient and the
clinician is important in that it allows for an easy assessment with minimal resistance.
Considering the many risks that are associated with mental illness like violence and
aggression, errors in treatment and clinical and non-clinical risks to the patient and to the
staff, a systematic assessment as per the above guidelines (general, historical, environmental
and mental state are necessary) (Briner & Manser, 2013).

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References
 Briner, M., & Manser, T. (2013). Clinical risk management in mental health: a
qualitative study of main risks and related organizational management practices. BMC
Health Services Research, 13(1). doi: 10.1186/1472-6963-13-44
 Elder, R., Evans, K., & Nizette, D. (2011). Psychiatric & Mental Health Nursing (p. 58).
London: Elsevier Health Sciences APAC.
 Galynker, I. (2017). The suicidal crisis (pp. 75-221). Oxford: Oxford University Press.
 Royal College of Psychiatrists. (2018). Risk assessment; Improving the Lives of People
with Mental Illness. Retrieved from
https://www.rcpsych.ac.uk/usefulresources/managingandassessingrisk/
riskassessment.aspx
 Woods, P., & Kettles, A. (2009). Risk Assessment and Management in Mental Health
Nursing. Chichester: John Wiley & Sons.

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The EndFriday, January 3, 2025