A multi-site survey of forensic nursing assessment
| Pages | 124-138 |
| DOI | https://doi.org/10.1108/JFP-11-2018-0045 |
| Published date | 13 May 2019 |
| Date | 13 May 2019 |
| Author | Helen Walker,Lindsay Tulloch,Karen Boa,Gordon Ritchie,John Thompson |
| Subject Matter | Health & social care |
A multi-site survey of forensic
nursing assessment
Helen Walker, Lindsay Tulloch, Karen Boa, Gordon Ritchie and John Thompson
Abstract
Purpose –A major difficulty identified many years ago in psychiatric care is the shortage of appropriate
instruments with which to carry out valid and reliable therapeutic assessments which are behaviourallybased and
therefore appropriate for use in a variety of contexts. The aim of this project was to ascertain the utility of a forensic
nursing risk assessment tool - Behavioural Status Index (BEST-Index). The paper aims to discuss the se issues.
Design/methodology/approach –A multi-site cross-sectional survey was undertaken using mixed method
design. Quantitative data was generated using BEST-Index to allow comparisons across three different levels
of security (high, medium and low) in Scotland and Ireland. Qualitative data were gathered from patients and
multi-disciplinary team (MDT) members using semi-structured interviews and questionnaire.
Findings –Measured over an 18-month period, there was a statistically significant improvement in
behaviour, when comparing patients in high and medium secure hospitals. Two key themes emerged from
patient and staff perspectives: “acceptance of the process”and “production and delivery of information”,
respectively. The wider MDT acknowledge the value of nursing risk assessment, but require adequate
information to enable them to interpret findings. Collaborating with patients to undertake risk assessments
can enhance future care planning.
Research limitations/implications –Studies using cross-section can only provide information at fixed
points in time.
Practical implications –The BEST-Index assessment tool is well established in clinical practice and has
demonstrated good utility.
Originality/value –This project has served to highlight the unique contribution of BEST-Index to both staff
and patients alike and confirm its robustness and versatility across differing levels of security in Scottish and
Irish forensic mental health services.
Keywords Risk assessment, Forensic, Secure hospital, Behavioural Status Index, Care planning,
Nursing assessment
Paper type Research paper
Introduction
In clinical practice, the imbalance of safety and security vs therapeutic engagement and recovery
creates tension and often leads to risk-aversion. Nowhere is the tension more keenly felt than in
forensic services, where the patients are by definition more prone to engage in high risk
behaviours that pose severe challenges to maintaining the safety of all concerned (Drennan and
Alred, 2012). The consequences of managing serious violent or sexual risks may reduce the
possibility for collaboration and empowerment and the possibility of patients remaining in
hospital for long periods increases the likelihood of institutionalisation (Corlett and Miles, 2010).
For the reasons highlighted above, it is important to find an assessment process that is suitable
and acceptable for both patients and staff alike, supported by decision-making methods that
relate to risk assessment and management (Doyle and Dolan, 2002).
Assessment of beha viour is an ongoing process tha t nurses undertake on a daily bas is, often in
order to aid the develo pment of individu al care plans (Olsson a nd Schon, 2016). It is
recognised that be haviour change is a n indicator of the like lihood and severit y of risk
behaviours occur ring, and observing clinicians tend t o use this as a measure t o gauge the
Received 14 November 2018
Revised 13 February 2019
28 February 2019
Accepted 28 February 2019
Helen Walker is based at
Forensic Network, Lanarkshire,
UK and Department of Health
and Life Sciences, University of
the West of Scotland,
Lanarkshire, UK.
Lindsay Tulloch is based at
Forensic Network,
The State Hospital,
Lanarkshire, UK.
Karen Boa and Gordon Ritchie
are both based at Murray Royal
Hospital, Perth, UK.
John Thompson is based at
National Forensic Mental Health
Services, Dublin, Ireland.
PAGE124
j
JOURNAL OF FORENSIC PRACTICE
j
VOL. 21 NO. 2 2019, pp. 124-138, ©Emerald Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-11-2018-0045
To continue reading
Request your trial