Mental health nurses’ attitudes towards risk assessment: An integrative systematic review

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.