The purpose of this article is to present the results of a study conducted in a Canadian medium-security forensic psychiatric facility. The primary objective of this qualitative research was to describe and comprehend how fear influences nurse-patient interactions in a forensic psychiatric setting. Eighteen semistructured interviews with nurses were used as the primary source of data for analysis. In brief, the results from this research indicate, as other researchers have demonstrated, that within this highly regimented context, nurses are socialized to incorporate representations of the patients as being potentially dangerous, and, as a result, distance themselves from idealistic conceptions of care. Moreover, the research results emphasize the implication of fear in nurse-patient interactions and particularly how fear reinforces nurses' need to create a safe environment in order to practice. A constant negotiation between space, "at risk" bodies and security takes place where nurses are forced to scrutinize their actions in order to avoid becoming victims of violence. In parallel, participants also described how being able to self-identify with patients enabled therapeutic interventions to take place. However, exposure to the patient's criminal history fostered negative reactions on the nurses' part, which impede nursing work.
"The researchers found that constant surveillance by cameras did not necessarily contribute to a therapeutic relationship, but rather secured the area. This made the care distant and reactive, nurturing new dynamics between space, bodies, and security (Jacob & Holmes, 2011). "
[Show abstract][Hide abstract] ABSTRACT: This study explored the self-rated competence of 52 Swedish psychiatric nurses in three clinical environments: forensic psychiatry, general psychiatric inpatient care, and clinical non-residential psychiatric care. A questionnaire wtih 56 statements from nine areas of expertise was completed. Forensic nurses were more skilled in safety and quality and in dealing with violence and conflicts. Non-specialist nurses appreciated their skills more so than specialist nurses in health promotion and illness prevention and conduct, information, and education. Women were inclined to invite patients' relatives for education and information. Men attended to a patients' spiritual needs; they also coped with violence and managed conflicts.
Issues in Mental Health Nursing 07/2012; 33(7):469-79. DOI:10.3109/01612840.2012.663460
[Show abstract][Hide abstract] ABSTRACT: To be referred to care in forensic psychiatric services can be seen as one of the most comprehensive encroachments society can impose upon a person's life, as it entails a limitation of the individual's freedom with no time limit. This study focuses upon patients' experiences of their life situation in forensic psychiatric wards. Using a Reflective Lifeworld Research approach founded in phenomenology, we analysed 11 qualitative interviews with patients cared for on a maximum security unit in a Swedish forensic psychiatric service. Results show how forensic psychiatric care can be non-caring with only moments of good care, from the patient's perspective. By using different strategies, the patients attempt to adapt to the demands of the caregivers in order to gain privileges. At the same time the patients are lacking meaningful and close relationships and long to get away from the system of forensic care. Being cared for entails struggling against an approaching overwhelming sense of resignation.
Issues in Mental Health Nursing 11/2012; 33(11):743-51. DOI:10.3109/01612840.2012.704623
[Show abstract][Hide abstract] ABSTRACT: The intervention of seclusion is meant to be a measure of last resort, and there is increasing pressure within the mental health system to reduce or eliminate the use of seclusion and restraint for a number of persuasive reasons. This article describes the successful experience of integrating an unpredictably violent patient with autism who had been in seclusion on a forensic ward twenty-three hours per day on average, seven days per week, for seven years into the ward milieu and into the community with no further use of seclusion. Two of the authors are the main behavioral therapists who described the steps taken and the struggles faced in this process. Systemic barriers are reviewed, including concerns about staff and patient safety, the fear and resistance of front-line staff, and the culture shift needed to allow this patient the opportunity to make independent decisions and improve his quality of life.
International Journal of Mental Health 07/2013; 42(2):99-114. DOI:10.2753/IMH0020-7411420206
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