Search

This thesis explored how positive risk management (PRM) was conceptualised and operationalised within national policies and by practitioners in acute mental health settings. The thesis consists of three papers 1) a systematic literature review, 2) an empirical study and 3) a critical reflection of the research process. Paper one is a systematic review aiming to understand how national policies and guidelines conceptualised, defined and operationalised PRM. The authors identified and included 26 documents. A thematic synthesis generated three main themes and ten subthemes: 1) aims of PRM ('to empower and aid recovery', 'to prescribe risk management and remove risk', 'to aid or demonstrate recovery', 'to be safety focused'), 2) conditional PRM ('the right to take risks', 'PRM suitability', 'insight as a requirement') and 3) practicing PRM ('PRM culture that is everyone's responsibility', 'relational risk management', 'learning from experience'). Analysis highlighted the discrepancies across documents. Recommendations for clinical practice and policies were made considering the review's findings. Paper two employed thematic analysis to examine how practitioners in acute mental health settings understood and experienced PRM. The lead author completed 16 semistructured interviews with Registered Mental Health Nurses, Occupational Therapists, Social Workers and Support Workers. Analysis generated three main themes and nine subthemes: 1) within staff barriers ('beliefs based practice', 'emotional decision making', 'the impact of experience'), 2) within service user barriers ('determining PRM suitability', 'trusting the untrusted'), and 3) delivery in practice ('the need for support and verification', 'collaborative process', 'the multiple perspective taking predicament', 'competing demands'). Findings revealed how practitioners were keen to provide the best care possible for service users; however, they often struggled with competing demands. Recommendations for clinical practice were discussed in light of the findings. Paper 3 provides a critical appraisal of the research process and reflective account of papers 1 and 2. Paper 3 discusses the strengths and limitations, the considerations of the decision-making process, clinical implications and personal reflections of the research process.