Expert Witness Journal Issue 66 April 2026 - Flipbook - Page 27
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The nurse’s seniority, professional experience,
and clinical role.
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Whether it is an initial risk assessment or a
review.
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The availability of senior medical input.
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The extent and availability of collateral
information.
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Organisational pressures, such as high patient
caseloads, sta昀케ng shortages, time constraints,
competing ward demands or limited access to
supervision.
discharge from hospital and patient described
ongoing ambivalence but stated he will seek
support if urges increase. Patient’s mum reports
increased withdrawal over past week and remains
concerned.”. This entry demonstrates that, rather
than simply accepting the patient’s denial of suicidal
thoughts, the nurse explored further by eliciting
ambivalence, considering historical risk factors, and
incorporating collateral information from a family
member. By doing so, the nurse demonstrated a
thorough approach to assessing risk. This helps
show that their actions aligned with the expected
standard of care, addressing uncertainty rather
than overlooking potential concerns.
Because there is no nationally prescribed method
for carrying out a risk assessment, courts and
experts must consider whether, in the speci昀椀c
context, a reasonable and responsible mental health
nurse would have recognised the need for deeper
exploration.
Conversely, certain documentation patterns may
raise questions as to the depth of risk assessment.
In the context of a mental health ward for example,
the contemporaneous records may include
repetitive and vague descriptions of the nursing
observations of the patient’s mood or behaviour,
such as “no concerns”, “settled” or “presented as
calm and maintained low pro昀椀le in bedroom”.
In circumstances where recent events of harm
occurred, or an acute deterioration in mental state
was known, the absence of any reference to a nurse’s
direct inquiry into current risk factors could raise
concerns. Such documentation might suggest that
the assessment was more passive rather than active.
Still, it would be important to understand the entire
context before drawing a conclusion.
The contextual factors outlined above are meant
to highlight both the complexity of clinical
practice and to provide a balanced approach to
evaluating professional curiosity. While each case is
unique, considering these factors o昀昀ers a practical
framework, helping to bring clarity when assessing
whether a reasonable standard of care was met in a
speci昀椀c context.
How Evidence Helps Determine Whether
Professional Curiosity Was Exercised
Conclusion:
In clinical negligence claims related to mental
health care, allegations of omission frequently
require careful reconstruction of a risk assessment
process. This reconstruction typically relies upon
contemporaneous records, such as clinical notes,
observation charts, risk assessment documentation,
multidisciplinary team discussions and witness
statements. Capturing professional curiosity is
arguably challenging because it often occurs in
the moment through verbal exchanges or clinical
reasoning that is not necessarily re昀氀ected in
documentation. However, whilst challenging, it is
not impossible to re昀氀ect professional curiosity in
documentation, even when notes are brief, they can
still demonstrate that the clinician such as a mental
health nurse actively engaged with the patient’s
presentation, explored uncertainties or deliberately
took time to understand risk before concluding
upon an intervention.
In conclusion, professional curiosity is not an
abstract ideal, but rather a practical aspect of
delivering sound, reasonable care in mental health
risk assessment. When professional curiosity is
exercised, it may uncover risks that can be addressed
early, potentially preventing harm. Conversely, a
lack of curiosity could mean missed opportunities
to intervene. For solicitors, understanding this
causal link helps them evaluate whether a failure
to explore uncertainty might have contributed to
the outcome, and whether that outcome could have
reasonably been avoided. Ultimately, for solicitors,
determining whether professional curiosity was
proportionately exercised is central to assessing
whether the standard of care was met.
Alexandra Penfold,
Registered Mental Health Nurse
Documentation might note that the nurse
directly asked about suicidal thoughts, explored
a patient’s ambivalence, documented changes in
presentation or referenced collateral information
from family. For example, a note might say “Patient
reported feeling low but denies current intent
to harm self. We discussed recent overdose and
explored whether thoughts have returned since
EXPERT WITNESS JOURNAL
References:
Bolam v Friern Hospital Management Committee [1957] 1 WLR
582
Bolitho v City and Hackney Health Authority [1998] AC 232
25
APRIL 2026
