risk assessment Flashcards
What is a risk assessment
Risk assessment is a process where information has been gathered, the level of risk identified and a plan made to manage the identified risk.
The aim is not to eliminate or predict risk, rather to understand the factors contributing towards risk then work with the patient to manage risk.
Some factors are static such as gender, history of risk behaviours, previous incidents relating to risk etc
Other factors are dynamic including age, substance use, available supports etc
What are the categories of risk?
Suicide
Violence
Self harm
Neglect
Vulnerability
Absconding
Substance misuse
Other risks
Who are at risk of suicide
People who live with a mental illness are at significantly higher risk of suicide.
Risk of suicide is when a deliberate action it taken with the intent of ending ones life.
People who live with psychosis may hear voices compelling or commanding them to make a suicide attempt
Recent loss, lack of social supports (isolation), sense of helplessness/hopelessness, family history of suicide, level of distress, mood, previous attempts and the access to the means of a plan should be part of a suicide assessment.
Suicide risk completion is higher in men than women, higher for younger people and older people, higher for Māori compared to non-Māori and higher in socially disadvantaged areas.
Risk of violence
Risk of violence is when someone has previously caused harm to someone else.
A history of violence towards others is a strong indicator for future risk. Very common in forensic settings.
The nurse can assess the individuals engagement with care, available support systems, adherence to prescribed medication, substance misuse, level of arousal and the ability to use coping strategies provides valuable information when assessing violence.
People who live with psychosis may hear voices compelling or commanding them to act violently towards others.
Risk of self-harm
Self-harm is the action of causing physical harm to ones self without the motivation to end ones life.
Often it is a means of regulating emotional distress.
Situational stressors can influence the severity and frequency.
People who live with psychosis may hear voices compelling or commanding them to self-harm
The use of alcohol greatly increases the risk of self harm while the availability of supports reduces the risk.
Risk of neglect
Risk of neglect refers to a diminished capacity for someone to care for ones self.
People who are depressed, paranoid or have fewer support networks are at greater risk of neglect.
Commonly found in older people but increasingly in younger people.
Mood, energy levels and engagement with available supports help nurses assess the level of neglect.
Previous neglect incidents suggest a higher level of risk but also potentially provides information about appropriate supports/interventions.
Risk of vulnerability (victimisation)
People who live with a mental illness are more likely to fall victim to others rather than victimise others.
Being homeless, substance use or addiction, female, cognitive impairment, being arrested in the last 12 months, previous incidents, residing in a custodial setting or level of mood are assessable factors for a nurse to formulate a persons level of vulnerability.
Risk of absconding
Risk of absconding is when a patient leaves a ward setting after an assessment has been made they need to remain for safety reasons.
Absconding is a risk indicator as this is often done in a heightened but the driving factor to the absconding is related to another risk ie self-harm, suicide, use substances or alcohol or harm others.
Absconding can however also be related to feelings of disempowerment or attempting to maintain a sense of security.
Understanding the motivation behind absconding is important to assessing risk.
Risk of substance misuse
Substance misuse is common within mental health settings
People can be genetically vulnerable to substance use and addiction
It can be a result of contextually socially acceptable behaviour
The level of health literacy is a factor to consider
What the substance is, how much is used, how frequently they use it, how they access it and the cost is important to know
Can have legal ramifications for the misuse of substances
Assessing and documenting risk
Assessing risk is pointless unless it can be documented in a logical and coherent manner.
For the purpose of documenting risk, reference will be made to the portfolio risk assessment table.
At the end of an assessment, a formulation needs to be made to conclude the level of risk and the influencing factors for each category of risk.
