DOES THE NURSING-CARE PLAN HELP IN THE MANAGEMENT OF PSYCHIATRIC RISK

The Nursing Care Plan (NCP) is routinely used to direct the nursing ca re of psychiatric in-patients, but the impact of NCPs on patient care and clinical outcome is not firmly established. NCPs from 246 patients , chosen at random fi om admissions to acute psychiatric wards, were a nalysed. The NCPs were scored for quality and also specifically for th e presence of recorded risk assessment and appropriate level of nursin g supervision. NCPs were evaluated in relation to psychiatric risk fac tors present prior to admission, and in relation to risk behaviour dur ing hospitalization. Quality of NCP records was generally poor, with s cores in all areas assessed being approximately half of the possible m aximum. Patients with a perceived high risk of suicide prior to admiss ion had significantly better NCP quality than other patients, but abou t a third of these high risk patients had no recorded risk assessment or supervision level in the nursing notes. Patients who had actually s elf-banned within 4 weeks prior to admission were more likely to have a recorded risk assessment but did not score more highly than the rest of the patient population on any other measures of NCP quality. Patie nts who had made suicidal threats prior to admission but who were not deemed to be of high suicide risk before admission had significantly l ower quality NCPs and were less likely to have a record of supervision level than the rest of the patients. The highest rate of supervision records occurred in patients who had shown dangerous behaviour prior t o admission. Outcome in terms of two risk behaviours during admission (self-harm and violence) was not related to whether or not risk assess ment and supervision levels had been recorded. Patients admitted compu lsorily to hospital were more likely to have a supervision level recor ded but were also more likely to abscond. It is concluded that issues of psychiatric risk were not adequately addressed in this sample of NC Ps. Furthermore, the data raise serious questions about the usefulness of the NCP in helping to predict and prevent risky behaviour amongst psychiatric in-patients.