Risk as the key criterion for intervention? : A study of four psychiatric settings.

Risk management has become one of the major issues facing nurses. Its role in healthcare organisations has gained increased recognition as the consequences of risky decisions have become more visible. The project was primarily concerned with exploring issues that confront one particularly group of professionals -psychiatric nurses - as they experience a particular approach to risk management. The study used the advancement of the risk management agenda as an opportunity to examine the nature of risk management and consider what nurses understood to be the nature of a proficient risk management. Case studies analyses were provided of four psychiatric units. Data were collected over four years through observation, interviews and documents. It used an integrated approach to examine the development of risk management processes in its social, environmental and clinical contexts. Drawing on sociological theories of risk, it introduced the theoretical framework of arena concept and explained how this concept affect the decision making process. It was suggested that the decision making process is a social process in which regulative, normative and institutional effects influence the perceptions and management of risk. The processes were shown to involve a dynamic interweaving of certain structured interests mixing with both clinical and societal considerations inside and outside the healthcare settings. Risk was considered to be the outcome of a complex process of social construction comprising of cultural and political elements in which both the influence of institutions and individual evaluation can be discerned. The findings showed that psychiatric nurses presented a creative and critical understanding to the issues involved in risk management by adopting and absorbing new approaches to riskmanagement in order to advance their professional work. This study formulates a new conceptual framework of understanding risk management in organisational context and contributes by drawing together previously unrelated research and shows how it provides the basis for a theoretical model risk management that is more complete.