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Int J Ment Health Nurs. 2014 Aug;23(4):336-43. doi: 10.1111/inm.12063. Epub 2014 Feb 18.

Clinical responsibility, accountability, and risk aversion in mental health nursing: a descriptive, qualitative study.

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Canterbury District Health Board, Christchurch, New Zealand.


A number of recent, highly-publicized, perceived health-care service failures have raised concerns about health professionals' accountabilities. Relevant to these concerns, the present study sought to examine how mental health nurses understood clinical responsibility and its impact on their practice. A descriptive, qualitative design was used, and a convenience sample of 10 mental health nurses was recruited from specialist inpatient and outpatient mental health settings in Canterbury, New Zealand. Data were collected using semistructured interviews, and the transcriptions were analysed using an inductive, descriptive approach. Three major themes were identified: being accountable, fostering patient responsibility, and shifting responsibility. Being accountable involved weighing up patients' therapeutic needs against the potential for blame in an organizational culture of risk management. Fostering patient responsibility described the process of deciding in what situations patients could take responsibility for their behaviour. Shifting responsibility described the culture of defensive practice fostered by the organizational culture of risk aversion. The present study highlighted the challenges mental health nurses experience in relation to clinical responsibility in practice, including the balancing required between the needs of patients, the needs of the organization, and the perceived need for self-protection.


accountability; clinical responsibility; defensive practice; mental health nursing; qualitative study; risk aversion

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