The use of Risk Re-evaluation in Safety Management

The use of Risk Re-evaluation in Safety Management

Essay 2: DNP Scholarly Practice Project Essay

Please identify a professional practice issue for which you may pursue as you complete your

doctoral studies. Please include how you envision accomplishing this project and how it will

change nursing practice.  The purpose of this essay is for demonstration of critical thinking

related to a practice or patient problem and strategies to resolve or address the problem.

Completing the essay is not a formal approval of the project or a request that you must

complete this specific project.


  • Identify a professional practice issue and its significance.
  • Identify the project proposal’s, address the following item:

○  Population/Problem:

○  Intervention:

○  Comparison (ie: standard care vs proposed intervention)

○  Expected Outcome:


  • Proposed site(s) to conduct the study:
  • Identify at least one of the AACN DNP Essentials that you may find challenging as you

implement your project and how you might overcome that challenge.


All applicants should review the following additional guidelines and resources prior to writing

the required essays and include them in the essay where appropriate. Your Admissions

Advisor will speak to you in greater detail regarding this. – AACN Essentials for

Doctoral Education. This resource provides a solid foundation of the DNP’s focus and

philosophy.  – The latest white paper on DNP. – National Organization of Nurse Practitioner Faculties

(NONPF NP) Role Competencies and specialty-specific competencies.



Professional Practice Issue and Its Significance

It is common knowledge that in psychiatric mental health nursing, risk aversion has a significant influence, especially in inpatient settings. Safety in mental nursing is not just a goal; it is the priority, especially in inpatient settings. Consequently, nursing care and interventions are overly structured to ensure safety for the individual, other patients, health provider and the environment at large. The overemphasis placed on safety, however well-intentioned and perhaps rightfully so, has resulted in the frequent use of nursing practices, which rather prevents a much-needed development of a therapeutic relationship between the nurse and the client.

The use of Risk Re-evaluation in Safety Management

Across healthcare settings, safety involves concepts that include patient safety, quality improvement and quality assurance. Nowhere is this notion more important than in the nursing practice and more specifically mental health care (Pelto-Piri et al. 2019). Safety in nursing involves protecting patients from harm originating from events in care including lack of staffs, medication errors, lack of effective communication strategies especially during handovers and poor adoption of new technologies (Sherwood, 2015). With limited discussions of patient safety in mental health care institutions, an evidence-based approach that guarantees safety for patients, staff and the public must be developed. To uphold safety, practices that identify risks and take preventive action should constitute the main aim of psychiatric nursing (Slemon, Jenkins & Bungay, 2017). Current psychiatric inpatient settings value safety and maintain it through risk management strategies. In line with this objective, practices are implemented despite availability of evidence refuting their efficacy and patients’ view highlighting harm. Some of these practices include; seclusion, close observations, locking of doors and implementing defensice nursing practices (Slemon, Jenkins & Bungay, 2017). The use of these disputed strategies further emphasizes the need to shift persceptions about safety and risk in care. To offer meaningful treatment to clients, nurses should provide flexible and individualized care that incorporates measures that observe safety. Additionally, nurses should re-evaluate the risk management strategies implemented  to reduce any and all harmful practices.


Safety management in mental health care centers around risk determination and intervention. Safety management also encompasses the assement and mitigation of risks to safety. The main objective of safety risk management is to assess all the risks associated with the identified hazards and to develop effective mitigation strategies (Kaya, Ward & Clarkson, 2018). However, several challenges affect risk management practices in hospitals. Some of these challenges include; lack of transparency, lack of consultation and insuffiecient risk assessment guidelines (Kaya, Ward & Clarkson, 2018). Evaluation of improvement interventions in healthcare is therefore essential to establish whether interventions are beneficial and to understand how they can be replicated (Brewster et al. 2014). But with the existing culture of risk aversion in psychiatric nursing, many restrictive interventions are likely to be utilized even if they may not be therapeutically advantageous for the patient’s recovery. Implementing frequent risks potential re-evaluation and adjusting interventions to create a balance between safety and the development of a therapeutic relationship should become the new priority.

Project Proposal

As a practice issue, poor therapeutic relationship development cannot be underestimated for its value. Building a therapeutic relationship between nurses and clients shouldn’t be sacrificed for safety and viseVersa. Therefore, this project proposes to investigate the usefulness of frequent re-evaluation of the risk potential of clients in inpatient settings. The combination of periodic re-evaluation of risk potential and change of interventions may help cultivate environmental conditions that foster the development of therapeutic relationships.  The PICO questions are as follows;

The use of Risk Re-evaluation in Safety Management

Population/Problem: Mental health clients in inpatient settings experiencing difficulty forming therapeutic relations.

Intervention: Does frequent re-evaluation of potential risk lead to the re-classification of risk level? Also, does the subsequent adjustment of nursing interventions enhance the nurse-client therapeutic relationship?

Comparison: Nurse client therapeutic relations after re-evaluations of risk potential and change in the nursing intervention.

Expected Outcome: Improvement in the nurse-client therapeutic relationship after clients’ risk potential are re-evaluated and nursing intervention changed to promote nurse-client therapeutic interaction

Proposed site(s) to Conduct the Study

Possible places to do this research include Hope House Treatment Center in Laurel, The Maryland Centers for Psychiatry and Oasis: The Center for Mental Health, in Annapolis, Maryland.

AACN DNP essentials that may be challenging in the implementation of the Project and how to Overcome them

The practice issue identified in this project touches on safety and quality. Information systems and technology are at the center of safe and quality patient-centered care (DeCapua, 2016). To prepare for a doctors of nursing practice, nurses should utilize patient care technologies to supplement their decision making process. Understanding new technologies is at the center of healthcare delivery. To ensure compliance with this essential, the project will evaluate existing technologies in safety management practices and investigate how they are implemented in psychiatric care.

The use of Risk Re-evaluation in Safety Management

To actively engage in policy development, DNP graduates must identify problems in healthcare and spearhead legislation to mitigate these problems. additionally, DNP graduates are expected to spearhead legislation by actively advocating for social justice and consensus building. Implementing this essential is challenging. However, the project will reach out to Mental Health America, an organization that advocates for legislation and policies to improve the lives of people struggling with mental health issues (Mental Health America, 2019). Additionally, the project will advocate for the adoption of levels of safety to reduce safety issues in psychiatric inpatient settings (Bayramzadeh, 2016).

To improve patient care and health outcomes, professional collaboration is of the utmost importance. As a DNP graduate, one is expected to lead inter-professional teams in the investigation of practices and issues affecting communication. Likewise, DNP graduates are expected to take up leadership roles in the development and implementation of models in addition to other scholarly projects (DeCapua, 2016)

Nursing Paper Help

To implement the proposed interventions, several members of the healthcare team will need to understand why, when and how the project should be implemented. Timely communication between various team members becomes very crucial since time is of the essence between re-evaluation of a patient’s risk potential and subsequent change in the intervention. Nurses would need to be communicated the changes in re-evaluation results in a timely fashion to allow for the adjustment of treatment interventions. To help facilitate that process considering that critical information may be entered in electronic systems but not necessarily communicated to healthcare providers who make changes to treatment modalities, SBAR, should be used by nurses each time re-evaluation is complete and results reported to healthcare providers.

Essential VI: Interprofessional Collaboration for Improving Patient and Population Health Outcomes




Bayramzadeh, S. (2016). An Assessment of Levels of Safety in Psychiatric Units. HERD: Health Environments Research & Design Journal, 10(2): 66-80. Doi: 10.1177/1937586716656002

Brewster, L., Aveling, E., Martin, G., Tarrant, C. & Dixon-Woods, M. (2014). What to Expect When you’re Evaluating Healthcare Improvement: A Concordat Approach to Managing Collaboration and Uncomfotablle Realities. BMJ Quality & Safety, 24(5). Doi: 10.1136/bmjqs-2014-003732

DeCapua, M. (2016). The Essentials of the DNP Program. DNP Nursing Curriculum Planning Solutions. Retrieved from

Kaya, G.K., Ward, J.R. & Clarkson, P.J. (2018). A Framework to Support Risk Assessment in Hospitals. International Journal for Quality in Health Care, 31(5), 393-401. Doi: 10.1093/intqhc/mzy194

Mental Health America. (2019). Mental Health Policy. Retrieved from

Pelto-Piri, V., Wallsten, T., Hylen, U., Nikban, I. & Kjellin, L. (2019). Feeling Safe or Unsafe in Psychiatric Inpatient Care, a Hospital-based Qualitative Interview Study with Inpatients in Sweden. International Journal of Mental Health Systems, 13(23). Doi: 10.1186/s13033-019-0282-y

Sherwood, G. (2015). Perspectives: Nurses’ Expanding Role in Developing Safety Culture: Quality and Safety Education for Nurses-Competencies in Action. Journal of Research in Nursing, 20(8), 734-740. Doi: 10.1177/1744987115621142

Slemon, A., Jenkins, E. & Bungay, V. (2017). Safety in Psychiatric Inpatient Care: The Impact of Risk Management Culture on Mental Health Nursing Practice. Nursing Inquiry, 24(4). Doi: 10.1111/nin.12199


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