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Risk assessment following self-harm: comparison of mental health nurses and psychiatrists.
- Source :
-
Journal of advanced nursing [J Adv Nurs] 2011 Jan; Vol. 67 (1), pp. 127-39. Date of Electronic Publication: 2010 Oct 25. - Publication Year :
- 2011
-
Abstract
- Aim: This paper is a report of a study conducted to compare risk assessments by psychiatrists and mental health nurses following an episode of self-harm.<br />Background: Self-harm assessments by nurses and psychiatrists are similar in terms of overall content, but risk assessment may vary by professional discipline. To our knowledge previous researchers have not compared the positive predictive value of risk assessments by nurses and psychiatrists, the factors that inform those assessments in clinical practice or the management of people assessed as being at high risk.<br />Methods: We conducted a prospective cohort study (2002-2006) of 3491 individuals presenting with self-harm to three hospitals in the North West of England. A standard assessment form including detailed demographic and clinical data was completed by the assessing psychiatrist or nurse.<br />Results: The positive predictive value of risk assessments for self-harm repetition was 25% (95% CI: 20-31) among nurses and 23% (95% CI: 13-37) among psychiatrists. There was strong agreement on factors associated with high risk assessment by both professions. Following assessment of high risk, psychiatrists were much more likely than nurses to admit people for inpatient treatment (RR=5.6, 95% CI: 3.2-9.7). This difference remained highly statistically significant after controlling for case-mix differences (RR=4.3, 95% CI: 2.4-7.7).<br />Conclusion: Our finding that risk assessments were comparable by profession supports the provision of nurse-led assessment services. However, inpatient admission was influenced largely by assessor type rather than patient characteristics. This has important implications for equity of care and may reflect professional differences in referral practices.<br /> (© 2010 Blackwell Publishing Ltd.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Emergency Service, Hospital statistics & numerical data
England epidemiology
Epidemiologic Methods
Female
Hospitalization statistics & numerical data
Humans
Male
Middle Aged
Nursing Assessment statistics & numerical data
Outcome Assessment, Health Care statistics & numerical data
Practice Guidelines as Topic
Referral and Consultation statistics & numerical data
Secondary Prevention
Self-Injurious Behavior epidemiology
Self-Injurious Behavior prevention & control
Socioeconomic Factors
Young Adult
Practice Patterns, Nurses' statistics & numerical data
Practice Patterns, Physicians' statistics & numerical data
Psychiatric Nursing
Psychiatry
Self-Injurious Behavior diagnosis
Suicide Prevention
Subjects
Details
- Language :
- English
- ISSN :
- 1365-2648
- Volume :
- 67
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of advanced nursing
- Publication Type :
- Academic Journal
- Accession number :
- 20969616
- Full Text :
- https://doi.org/10.1111/j.1365-2648.2010.05484.x