In the know: cognitive and social factors in mental health nursing assessment.

Aims And Objectives: To develop an integrated cognitive and social understanding of assessment in mental health nursing.

Background: Assessment is a vital component of nursing care for mental health service users, largely driven by a tacit, experiential model of assessment; this approach is at variance with an evidence-based approach to assessment.

Design: A qualitative design was employed in the study, with a thematic analysis carried out on transcripts of focus groups with mental health nurses.

Method: Ten focus groups were carried out, guided by questions on nurses' contribution to care and the problems patients present with. Fifty-nine registered mental health nurses were sampled from eight acute and community mental health services across urban and rural regions in Ireland.

Results: References to assessment were identified (how nurses acquired information, how it was made sense of and used in the system of care). Assessment talk was characterised by reliance on a experientially based clinical schema and recognition of the task environment's shaping influence. Nurses' clinical knowledge was a pragmatic tool that permitted nurses to assess risk, promote patient engagement and work with doctors.

Conclusions: Nurses strived to 'know the patient', while having to 'work the system', with implications for patient care and decision-making quality. Reliance on experiential knowledge is a professional trait, but one that renders nursing assessment 'invisible' in significant ways.

Relevance To Clinical Practice: Cognitive and social aspects of nursing decision-making have been considered apart from one another, whereas cognitions about mental health conditions are, in fact, applied in a pragmatic, task-oriented organisational system. Nurses believed that spending time with the service user led to a privileged position of knowledge in comparison with doctors ('knowing the person'), but this knowledge is frequently applied to the task of 'knowing the patient', assessing the person as a source of risk and danger.