Standard Of Risk Assessment For Patient Harm

Standard Of Risk Assessment For Patient Harm

Abstract

This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand District Health Board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.

Table of Contents

Abstract2

Introduction5

Nursing sensitive indicators6

Surveys to measure nursing practice7

The assessment of mental health nursing practice8

Risk Assessment9

Understanding and Managing Risk11

Patient Safety Risk Assessment12

Study 113

Method14

Results16

Discussion18

Study 219

Method20

Results21

Discussion22

Study 322

Method23

Results26

Discussion49

Conclusion51

References55

Standard Of Risk Assessment For Patient Harm

Introduction

The Australian and New Zealand College of Mental Health Nurses has developed six all-encompassing Standards of Practice for mental health nursing in New Zealand (ANZCMHN 1995). These standards, however, are too broad to be measured in their stated form because they do not have measurable performance criteria. The development of clinical indicators that are indicative of these standards being met would facilitate a more thorough and systematic assessment of nursing practice. Therefore, O'Brien et al. (2003) conducted a study to develop clinical indicators for the ANZCMHN (1995) Standards of Practice. One set of clinical indicators was developed to evaluate nursing practice by examining consumer case notes for occurrences of the practices described by the indicators (O'Brien et al. 2002). Nevertheless, not all nursing practices that are indicative of best practice can be discovered from the nursing documentation in consumer case notes, and another set of clinical indicator statements were required to enable measurement of such nursing practices. This paper focuses on the three-stage development of the latter set of clinical indicator statements, which were incorporated into an audit questionnaire to assess the frequency with which nurses perceive they engage in practices that are indicative of the ANZCMHN (1995) Standards of Practice.

 

Nursing sensitive indicators

Nurses make up the largest single professional group in health care (Duffy 2002). Nurses provide both round the clock care, and are the professionals most likely to be called after hours in home care situations. Despite this obvious contribution of the discipline of nursing, many of the important decisions that nurses make are invisible within the ...