Working under threat: Fear and nurse–patient interactions in a forensic psychiatric setting

ArticleinJournal of Forensic Nursing 7(2):68-77 · June 2011with49 Reads
DOI: 10.1111/j.1939-3938.2011.01101.x · Source: PubMed
Abstract
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.
    • "However, there are major gaps in personality disorder training (Duggan, 2009; Hayward & Moran, 2007), including developing skills with relation to boundary setting. As the students in this study highlighted, it is important to establish agreed professional boundaries while also continuing to promote therapeutic work (Jacob & Holmes, 2011; Kozar & Andrew, 2007; Peternelj-Taylor & Yonge, 2003). The development of therapeutic relationships can be hindered by the roles given to the nurse, including that of an enforcer of security and safety (Schafer & Peternelj-Taylor, 2003). "
    [Show abstract] [Hide abstract] ABSTRACT: The therapeutic relationship is of particular importance when working with patients with antisocial personality disorder, but despite this, there is a paucity of literature exploring student nurses' perceptions of developing a therapeutic relationship with such patients. Hence, this qualitative study explored the perceptions of second-year mental health nursing students of developing a therapeutic relationship with this patient group. Student nurses from a University in the Northwest of England participated in two focus groups, to compare the perceptions of a group of student nurses who had experience in secure settings (forensic hospital) with those who had not. Four key themes emerged: diagnosis, safety, engagement, and finally environmental influences. Both groups commented on looking beyond the diagnosis and seeing the person. The student nurses cited other staff in their clinical placement areas as hugely influential in terms of the development of their perceptions of patients with antisocial personality disorder and how to relate to them. © The Author(s) 2015.
    Full-text · Article · Jul 2015
    • "Then the encounter can be transformed into a learning experience, through which patients are able to ascribe meaning and gain a new perspective on their suffering (Hörberg et al. 2012). However, when nurses are socialized into a context where patients are presented as potentially dangerous, they tend to distance themselves from patients (Jacob & Holmes 2011). A distant position can block nurses' understanding of patients' expressions of suffering, so that instead of facilitating patients' understanding of, and reconciliation with suffering, they might focus on restrictions and fostering interventions (Hörberg et al. 2004; Martin & Street 2003). "
    [Show abstract] [Hide abstract] ABSTRACT: Patients in forensic psychiatric settings not only have to deal with their mental illness, but also memories of criminal activities and being involuntarily hospitalized. The aim of the present study was to explore how nurses working in forensic psychiatric services understand and approach patients' experiences of suffering. Data were generated by semistructured interviews with psychiatric nurses from two different forensic psychiatric units in Sweden. Data were analysed by means of a hermeneutic approach inspired by Ricoeur's hermeneutics. The findings are reflected in four main themes: (i) ignoring suffering; (ii) explaining suffering as a natural and inevitable part of daily life in the forensic context; (iii) ascribing meaning to suffering; and, (iv) being present in suffering. To engage in alleviating suffering is a struggle that demands courage and the strength to reflect on its character and consequences. To encounter suffering means that nurses are not only confronted with patients' suffering, but also their own reactions to those patients. If suffering is not recognized or encountered, there is a risk that actions may have a negative impact on patients.
    Article · Feb 2015
    • "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). Nursing and Medical Science comprised, among other items, the nurses' self-rated capacity to attend to patients' spiritual needs. "
    [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.
    Full-text · Article · Jul 2012
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