title: There is more to risk and safety planning than dramatic risks: Mental health nurses' risk assessment and safety-management practice.
abstract: Risk assessment and safety planning are considered a cornerstone of mental health practice, yet limited research exists into how mental health nurses conceptualize 'risk' and how they engage with risk assessment and safety planning. The aim of the present study was to explore mental health nurses' practices and confidence in risk assessment and safety planning. A self-completed survey was administered to 381 mental health nurses in Ireland. The findings indicate that nurses focus on risk to self and risk to others, with the risk of suicide, self-harm, substance abuse, and violence being most frequently assessed. Risk from others and 'iatrogenic' risk were less frequently considered. Overall, there was limited evidence of recovery-oriented practice in relation to risk. The results demonstrate a lack of meaningful engagement with respect to collaborative safety planning, the identification and inclusion of protective factors, and the inclusion of positive risk-taking opportunities. In addition, respondents report a lack of confidence working with positive risk taking and involving family/carers in the risk-assessment and safety-planning process. Gaps in knowledge about risk-assessment and safety-planning practice, which could be addressed through education, are identified, as are the implications of the findings for practice and research.
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Agnes
authors.initials: A
authors.lastname: Higgins
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Louise
authors.initials: L
authors.lastname: Doyle
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Carmel
authors.initials: C
authors.lastname: Downes
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Jean
authors.initials: J
authors.lastname: Morrissey
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Costello
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Brennan
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Nash
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007494:Ireland; D008297:Male; D001523:Mental Disorders / Q000451:nursing* / Q000523:psychology; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology; D061214:Patient Safety; D010934:Planning Techniques; D011568:Psychiatric Nursing; D018570:Risk Assessment; D017751:Safety Management
keywords: Ireland; nursing practice; risk assessment; risk management; safety planning mental health