Whose risk is it anyway?

Mental Health Nursing,  Jul/Aug 2000  by McMahon, Brian

• E-mail
• Print
• Link

Risk management is one of those issues, like motherhood and apple pie, that we all agree with, But Brian McMahon has been thinking a little deeper about the underlying reality

The government has recently emphasised the importance of risk management with the introduction of control assurances and clinical governance. However, these measures appear to be about reducing the risks to the organisation rather than exploring clinical therapeutic risks.

Therapeutic risk-taking is accepted as a normal part of community mental health nurses' work. But there is a danger that we often decide a risk is too great without fully consulting the client first. This limits their choice before they know it. We should be explicitly and impartially exploring the risks involved with their, or our, proposed plans. Also, we need to be honest and identify whom the risk is too great for, the clients or ourselves.

For example, when a client wants to stop their medication because they are experiencing side effects shouldn't we be exploring all the alternatives and potential problems with them?

All too often we see this as a warning sign and clients are encouraged to continue with their medication because the are coping so well with it. Rather than seeing it as a potential for involving clients in their own care, why not give them a copy of the BNF and discuss the side-effects as compared with the original symptoms they were experiencing?

Let them decide if the risks-are too high to take. Rather this, than having the client discontinue their medication without support.

As part of this risk-taking process we should explore with the client the `stakes' involved to themselves, the service and any others involved. Another aspect of this process is identifying what additional services may be required to help the client achieve their goal. This is an area that is often overlooked and thereby almost ensures that the client will fail.

By doing this we allow the client to become fully involved in their care, as outlined in The New NHS, Modern, Dependable. This also acknowledges the right of the client to get things wrong. This is important because it allows for the possibility of the client getting things right.

It is too easy for us as mental health nurses to hide behind the protective cover of the system's paternalistic power base. Part of this is about protecting ourselves, not just from potential punitive measures from our employers or bad publicity, but also from a possible increase in our already stretched workloads.

This can cause a dilemma for mental health nurses if we are expected to act as advocates. This can mean that we have to defend our clients' rights to make a decision even if we disagree with their risk assessment. It also provides us with the opportunity to explore how we can balance the needs of clients with any restrictions that we may feel are placed upon us.

While it is important to identify risks that we cannot take, I feel we should be more open and creative with our risk-taking process. Otherwise we run the risk of becoming stilted in the care we provide to clients. We need to be using clinical governance and risk management to expand our own practice rather than seeing it as a restriction on our risk taking.

What do you think?

Send your letters and views to Bermondsey Street or e-mail: 100614.1041@compuserve.com.

Brian McMahon is a day unit manager based in Skegness

Copyright Community Psychiatric Nurses Association Jul/Aug 2000
Provided by ProQuest Information and Learning Company. All rights Reserved