Risk assessment following self-harm: comparison of mental health nurses and psychiatrists
Risk assessment following self-harm: comparison of mental health nurses and psychiatrists
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DOI：
10.1111/j.1365-2648.2010.05484.x
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发表时间：
2011-01-01
影响因子：
3.8
通讯作者：
Cooper, Jayne
中科院分区：
文献类型：
--
作者：
Murphy, Elizabeth;Kapur, Navneet;Cooper, Jayne
瞄准！本文是一份研究报告，旨在比较精神科医生和精神卫生护士在自我伤害事件后的风险评估。护士和精神科医生的自我伤害评估在总体内容上是相似的，但风险评估可能因专业学科而异。据我们所知，以前的研究人员没有比较护士和精神科医生的风险评估的阳性预测值，在临床实践中告知这些评估的因素或被评估为高风险的人的管理。我们进行了一项前瞻性队列研究（2002年至2006年）的3491人与自我伤害的三家医院在英格兰西北部。由精神科医生或护士填写一份标准的评估表，包括详细的人口统计学和临床资料。自我伤害重复风险评估的阳性预测值在护士中为25%（95%CI：20-31），在精神科医生中为23%（95%CI：13-37）。这两个专业对与高风险评估有关的因素有很强的一致性。在评估高风险后，精神科医生比护士更有可能让患者住院治疗（RR = 5.6，95%CI：3.2-9.7）。在控制病例组合差异后，该差异仍具有高度统计学意义（RR = 4.3，95%CI：2.4-7.7）。我们发现，风险评估是可比的专业支持护士主导的评估服务的提供。然而，住院的影响很大程度上是由评估类型，而不是病人的特点。这对保健的公平性具有重要影响，并可能反映出转诊做法的专业差异。
Aim. This paper is a report of a study conducted to compare risk assessments by psychiatrists and mental health nurses following an episode of self-harm.Background. Self-harm assessments by nurses and psychiatrists are similar in terms of overall content, but risk assessment may vary by professional discipline. To our knowledge previous researchers have not compared the positive predictive value of risk assessments by nurses and psychiatrists, the factors that inform those assessments in clinical practice or the management of people assessed as being at high risk.Methods. We conducted a prospective cohort study (2002-2006) of 3491 individuals presenting with self-harm to three hospitals in the North West of England. A standard assessment form including detailed demographic and clinical data was completed by the assessing psychiatrist or nurse.Results. The positive predictive value of risk assessments for self-harm repetition was 25% (95% CI: 20-31) among nurses and 23% (95% CI: 13-37) among psychiatrists. There was strong agreement on factors associated with high risk assessment by both professions. Following assessment of high risk, psychiatrists were much more likely than nurses to admit people for inpatient treatment (RR = 5 6, 95% CI: 3.2-9.7). This difference remained highly statistically significant after controlling for case-mix differences (RR = 4.3, 95% CI: 2.4-7.7).Conclusion. Our finding that risk assessments were comparable by profession supports the provision of nurse-led assessment services. However, inpatient admission was influenced largely by assessor type rather than patient characteristics. This has important implications for equity of care and may reflect professional differences in referral practices.