Risk assessment tools available to inform a nurse practitioner's determination of tolerable risk

Risk in health care, often discussed in terms of its tolerability, is an abstract term that is patient- and context-specific. An older adult living at risk can be someone falling frequently at home risking a fractured hip, to someone self-neglecting. Family Nurse Practitioners working in Primary Care are well-situated to support patients over time and to mitigate risk. A better understanding of the risk assessment tools available to inform a level of risk tolerability for Nurse Practitioners working in Primary Care may enhance clinical reasoning and enhance their comfort with the concept of risk, resulting in consistent care delivery for patients. Evidencebased literature highlights the complexity of both defining and assessing risk, which is further reflected within the assessment tools. For these reasons, the purpose of this integrative literature review is to provide recommendations, founded in current literature findings, regarding the comprehensive risk assessment tools used to inform a Nurse Practitioner’s determination of tolerable risk for community-dwelling older adults. A search of three databases, as well as hand searches, resulted in nine tools for analysis. The interpretation of the findings suggested that risk assessment tools varied in their approach to risk, with some focused preventatively on risk mitigation while others could be applied in real-time to assess the severity of a perceived risk. Each tool included elements of risk which together, comprise a comprehensive, holistic risk assessment to be considered in the ongoing assessment of tolerable risk. A positive risk-based approach is also a shift in risk perception that Nurse Practitioners are encouraged to consider. The implications for practice include how the described approaches guide decision-making and the definitions of tolerable and intolerable risk can steer the Nurse Practitioner’s care, as well as to inform future research and the development of new risk assessment tools.