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Rask M, Lundqvist LO, Schröder A, Brunt D. Psychometric Properties of the Verbal and Social Interaction Questionnaire for Psychiatric Outpatient Care (VSI-OP), Staff and Patient Versions. Issues Ment Health Nurs 2022; 43:936-943. [PMID: 35580349 DOI: 10.1080/01612840.2022.2072549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this paper is to investigate the psychometric properties of the Verbal and Social Interaction questionnaire for psychiatric outpatient care (VSI-OP) by using a confirmatory factor analysis. A further aim is to present the patient and staff perceptions of the frequency of these interactions in this context. The factor structure of the VSI-OP could be explained by three factors for both the staff and the patient versions. The three factors are: 'Inviting the patient to establish a relationship', 'Showing interest in the patients' feelings, experiences and behaviour' and 'Helping the patients to establish structure and routines in their everyday life'. The two first factors were the most frequently occurring actions according to the staff and the patients.
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Affiliation(s)
- Mikael Rask
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Agneta Schröder
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Nursing, Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU), Gjövik, Norway
| | - David Brunt
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Moyo N, Jones M, Kushemererwa D, Arefadib N, Jones A, Pantha S, Gray R. Service User and Carer Views and Expectations of Mental Health Nurses: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11001. [PMID: 36078717 PMCID: PMC9517907 DOI: 10.3390/ijerph191711001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Service users' views and expectations of mental health nurses in a UK context were previously reviewed in 2008. The aim of this systematic review is to extend previous research by reviewing international research and work published after the original review. Five databases were searched for studies of any design, published since 2008, that addressed service user and carer views and expectations of mental health nurses. Two reviewers independently completed title and abstract, full-text screening and data extraction. A narrative synthesis was undertaken. We included 49 studies. Most included studies (n = 39, 80%) were qualitative. The importance of the therapeutic relationship and service users being supported in their personal recovery by mental health nurses were core themes identified across included studies. Service users frequently expressed concern about the quality of the therapeutic relationship and indicated that nurses lacked time to spend with them. Carers reported that their concerns were not taken seriously and were often excluded from the care of their relatives. Our critical appraisal identified important sources of bias in included studies. The findings of our review are broadly consistent with previous reviews however the importance of adopting a recovery approach has emerged as a new focus.
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Affiliation(s)
- Nompilo Moyo
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC 3000, Australia
| | - Martin Jones
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Department of Rural Health, University of South Australia, Whyalla Campus, Whyalla Norrie, SA 5608, Australia
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia
| | - Diana Kushemererwa
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Noushin Arefadib
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Adrian Jones
- Faculty of Life Sciences, Wrexham Glyndwr University, Wrexham LL11 2AW, UK
| | - Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
- Department of Rural Health, University of South Australia, Whyalla Campus, Whyalla Norrie, SA 5608, Australia
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Waxell A, Wiklund Gustin L. "Walking Together Towards Freedom." Patients' Lived Experiences of Participation in Outpatient Forensic Care. Issues Ment Health Nurs 2022; 43:455-462. [PMID: 34762558 DOI: 10.1080/01612840.2021.1998262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a general agreement regarding the significance of patient participation in care. In forensic psychiatric care, however, this appears to be troublesome because of the paradoxical nature of having responsibility; to give person-centered, recovery-oriented psychiatric care and to protect society from potentially dangerous individuals. The aim of this study was to describe patients' lived experiences of participation in outpatient forensic psychiatric care. Data were collected by means of individual interviews with five patients. The phenomenological hermeneutical analysis shed light on patient participation as having two dimensions. The outer dimension focuses on participation as "doing" and as a means of developing the understanding and skills necessary for being discharged from forensic care, while the inner dimension is related to "being" and experiences of acceptance and inclusion in communion with other people. This emphasises the importance of supporting patients' experiences of being involved in everyday life together with others, even in periods when patients' possibilities to affect decisions regarding their care are limited.
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Affiliation(s)
- Anni Waxell
- Division of Psychiatry, Region Vastmanland, Västerås, Sweden
| | - Lena Wiklund Gustin
- School of Health, Care and Social Welfare, Mälardalen University Sweden, Västerås, Sweden.,Department of Health and Care Sciences, UiT/The Arctic University of Norway, Tromsø, Norway
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Bennett A, Hanna P. Exploring the Experiences of Male Forensic Inpatients' Relationships with Staff within Low, Medium and High Security Mental Health Settings. Issues Ment Health Nurs 2021; 42:929-941. [PMID: 33914668 DOI: 10.1080/01612840.2021.1913683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Therapeutic relationships within psychiatric settings are highlighted as important throughout the literature. However, research from the forensic inpatient perspective is limited. We address this gap by exploring the patient-staff relationships within forensic mental health inpatient services, from the patient's perspective. Thirty adult male forensic inpatients were interviewed about their experiences on the ward and their interactions with staff. Our analysis examines inpatients experiences of respectful and reciprocal relationships, relationships that empower, a disinterest in their patients' and authoritarian relationships. This study concludes by highlighting the need to prioritise the development of reciprocal relationships within forensic services.
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Affiliation(s)
- Alice Bennett
- Department of Psychological Interventions, University of Surrey, Guildford, UK
| | - Paul Hanna
- Department of Psychological Interventions, University of Surrey, Guildford, UK
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Jones E, Wright KM, McKeown M. An integrative review exploring the experiences of service users carrying a diagnosis of personality disorder and student mental health nurses and the time they share together. NURSE EDUCATION TODAY 2021; 98:104659. [PMID: 33199063 DOI: 10.1016/j.nedt.2020.104659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/10/2020] [Accepted: 11/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This integrative review provides a collective understanding of the experiences of student mental health nurses and service users carrying a diagnosis of personality disorder and the time they share together. DESIGN Published studies about the time service users and students share together were systematically selected in order to integrate their findings in a thematic analysis. DATA SOURCES Various databases were searched from 1984 until 2020. Specific search terms were used. REVIEW METHODS 37 studies were included in the integrative review. The studies were from peer reviewed nursing, student, psychology and health related journals. A quality appraisal was completed using Walsh and Downe (2006) framework. FINDINGS Four themes emerged from a thematic analysis of the integrative review. These were; With 'Impact of time' as an overarching theme. CONCLUSION A positive environment which considers time and focuses on seeing the person, as an individual can lead to the development of therapeutic relationships; a core element of the Nursing and Midwifery Council standards for nursing registration in the UK (Nursing and Midwifery Council, 2018). Students attempting to build such relationships need to be mindful of service users' and their own attachment experiences and the impact these can have on experiences of transference and countertransference, particularly for service users carrying a personality disorder diagnosis. It is important for students to be aware of the supportive impact of positive environments and how doing 'everyday stuff' can make a person feel human despite residing in potentially dehumanizing places.
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Affiliation(s)
- Emma Jones
- School of Nursing, University of Central Lancashire, United Kingdom.
| | - Karen M Wright
- School of Nursing, University of Central Lancashire, United Kingdom.
| | - Mick McKeown
- School of Nursing, University of Central Lancashire, United Kingdom.
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Hammarström L, Häggström M, Devik SA, Hellzen O. Controlling emotions-nurses' lived experiences caring for patients in forensic psychiatry. Int J Qual Stud Health Well-being 2019; 14:1682911. [PMID: 31645227 PMCID: PMC6818121 DOI: 10.1080/17482631.2019.1682911] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose: Nurses working in forensic psychiatry often encounter offenders who have a severe mental illness, which may cause ethical challenges and influence nurses' daily work. This study was conducted to illuminate the meaning of nurses' lived experiences of encounters with patients with mental illnesses in forensic inpatient care. Methods: This qualitative study employed narrative interviews with 13 nurses. Interviews were audiotaped and transcribed verbatim and analysed following a phenomenological-hermeneutic approach. Results: Four key themes were revealed: "Being frustrated" (subthemes included "Fighting resignation" and "Being disappointed"), "Protecting oneself" (subthemes included "To shy away," "Being on your guard," and "Being disclosed"), "Being open-minded" (subthemes included "Being confirmed," "Developing trust," and "Developing compassion"), and "Striving for control" (subthemes included "Sensing mutual vulnerability" and "Regulating oneself"). Further, working in forensic psychiatry challenged nurses' identity as healthcare professionals because of being in a stressful context. Conclusions: Dealing with aggressive patients with severe mental illnesses threatens nurses' professional identity. Nurses must attempt to empathize with patients' experiences and respond accordingly. Utilizing strategies rooted in compassion such as self-reflection, emotional regulation, and distancing themselves when necessary may enable nurses to more effectively respond to patients' needs.
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Affiliation(s)
| | - Marie Häggström
- Department of Nursing, Mid-Sweden University, Sundsvall, Sweden
| | | | - Ove Hellzen
- Department of Nursing, Mid-Sweden University, Sundsvall, Sweden
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Magnusson E, Axelsson AK, Lindroth M. 'We try' - how nurses work with patient participation in forensic psychiatric care. Scand J Caring Sci 2019; 34:690-697. [PMID: 31749183 DOI: 10.1111/scs.12773] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/15/2019] [Indexed: 11/26/2022]
Abstract
RATIONALE Patients in secure forensic psychiatric care have reduced autonomy because of the constraints imposed on them by compulsion laws. Thus, it is vital that nurses enable patient participation whenever possible. Patient participation, and it's clinical use in forensic psychiatric care, is an understudied field. AIM To describe nurses' experiences of their work with patient participation in forensic psychiatric care. METHODS Managers at different secure forensic psychiatric institutions in the south of Sweden approved the study, and oral consent was retrieved from informants. Interviews guided by a semi-structured interview guide were conducted with nine nurses from five different forensic psychiatric institutions and analysed with content analysis. FINDINGS Nurses describe diverse understandings and abilities in an inflexible setting. This indicates that what participation is, and how to achieve it, is not the same for nurses as for patients. Moreover, patients have different abilities to participate, and the secure setting in itself is perceived as hindering participatory work. Still, participation is described as a crucial part of work that requires a caring relationship. Furthermore, nurses pronounce potentially excluding attitudes and strategies that may obstruct patient participation for all, and at the same time, they have a belief that improvement is possible. CONCLUSION Compulsory forensic psychiatric care is a complex care context that requires constant efforts from nurses to balance patients' rights and needs with mandatory care. The very nature of this caring context appears to be a major obstacle when promoting patient participation. Nevertheless, nurses express that they do aim for patient participation, 'they try'. From a patient's perspective, trying is not sufficient and a need for improvement is evident. The results can be of clinical interest in similar secure forensic psychiatric nursing settings, and a point of departure in future development of care striving for increased patient participation for all.
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Affiliation(s)
- Emilie Magnusson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Anna Karin Axelsson
- CHILD research group, School of Education and Communication, Jönköping University, Jönköping, Sweden
| | - Malin Lindroth
- Department of Nursing Sciences, Department of Social Work, Center for Sexology and Sexuality Studies, School of Health and Welfare, Sweden & Faculty for Health and Society, Jönköping University, Malmö University, Malmö, Sweden
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Brunt D, Rask M. Resident and staff perceptions of the content of their relationship in supported housing facilities for people with psychiatric disabilities. J Multidiscip Healthc 2018; 11:673-681. [PMID: 30532551 PMCID: PMC6247964 DOI: 10.2147/jmdh.s179322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The work of staff in supported housing facilities for people with psychiatric disabilities has most often been studied from the perspective of one of the two groups but not from both. The staff in these facilities generally come from differing professions, reflecting either the beliefs of the medical or social models of psychiatric care. Aim The aim of the present study was thus to investigate the perceptions of residents and staff of the frequency and the importance of verbal and social interactions in supported housing facilities for people with psychiatric disabilities and to compare these perceptions. A further aim was to investigate whether differences in education background and other sociodemographic factors are reflected in the staff perceptions of these interactions. Methods One hundred and eleven residents living in supported housing facilities in Sweden and 223 staff completed the Verbal and Social Interaction Supported Housing questionnaire. Results The results revealed significant differences between the perceptions of the residents and staff on all six categories of interactions, where the staff rated the frequency and importance higher than the residents, but also some similarities in terms of the relative order of the frequency of the categories of interactions. Both the residents and staff perceived that “To build a relationship with a supportive quality” as the most frequently occurring and most important category. The mean levels of importance for all the categories were higher than for the frequency according to both groups. No differences were found between the staff with a medical or social educational background. Similarly, no differences were found in staff perceptions between those with short experience and those with long experience. Conclusion This study is the first survey of its kind and the results indicate the need for reducing the gap between the staff intentions and the residents’ preferences, which could form the basis for in-house training activities.
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Affiliation(s)
- David Brunt
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden,
| | - Mikael Rask
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden,
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Pollak C, Palmstierna T, Kald M, Ekstrand P. "It Had Only Been a Matter of Time Before I Had Relapsed Into Crime": Aspects of Care and Personal Recovery in Forensic Mental Health. JOURNAL OF FORENSIC NURSING 2018; 14:230-237. [PMID: 30080709 DOI: 10.1097/jfn.0000000000000210] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Forensic psychiatry has the dual task of focusing on the prevention of reoffending as well as maintaining psychiatric rehabilitation. No previous studies addressing the patients' own views on reducing their risk of serious reoffending were found. AIM This study describes forensic psychiatric inpatients' own views on what aspects of care and personal recovery are important in reducing their risk of serious reoffending. METHODS A structured qualitative approach was used. Data were collected from semistructured interviews and analyzed with a systematic qualitative content analysis. RESULTS The results highlight aspects of care and personal recovery. Four themes emerged: "time: opportunity for change," "trust: creating a context with meaningful relations," "hope: to reach a future goal," and "toolbox: tools needed for recovery." DISCUSSION The themes present with a continuum. At one end, there are patients who appreciated possibilities to participate actively in care and treatment. At the other end, patients felt they had no use for their care. Interestingly, although patients in our study were asked for their opinion on how they could reduce their dangerousness, all themes fit into established personal recovery processes found in general psychiatric populations. The theme "time: opportunity for change" seems to have an overarching importance. IMPLICATIONS FOR PRACTICE By understanding the specific content along these themes, relevant to the individual patient, carers may be able to better support their personal recovery journey. Because time spent as inpatients in forensic psychiatry is an overarching issue, carers need to be persistent over time.
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Affiliation(s)
| | | | - Magnus Kald
- Economic Information Systems, Linköping University
| | - Per Ekstrand
- Department of Health Sciences, The Swedish Red Cross University College
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10
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Rask M, Schröder A, Lundqvist LO, Ivarsson AB, Brunt D. Residents' View of Quality in Ordinary Housing with Housing Support for People with Psychiatric Disabilities. Issues Ment Health Nurs 2017; 38:132-138. [PMID: 27936987 DOI: 10.1080/01612840.2016.1253806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the present study was to investigate the quality of housing support provided in housing services for people with psychiatric disabilities living in ordinary housing with housing support from the residents' perspective, by using the QPC-H instrument. A sample of 174 residents in ordinary housing, receiving housing support from 22 housing support services in nine Swedish municipalities, participated in this study. The results show that the quality of psychiatric care in housing services was mainly rated highly as measured with the QPC-H instrument. The dimensions Encounter and Secluded Environment were the aspects that were rated as the two with the highest quality of housing service. The dimensions Participation and Secure Environment were rated as those with the lowest quality. There were more residents who totally disagreed with the statements in the dimensions Participation and Housing Specific than in the other dimensions. The perceived lower quality in Encounter, Participation, Support and the Housing Specific dimensions was associated with a low frequency of psychiatric outpatient clinic contacts. A conclusion is that the support staff could be more observant regarding the residents' need for support and also talk more with them about what could be done to assist them. It also seems important that the support staff discuss with the residents regarding how they can help them to feel more secure in their accommodation.
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Affiliation(s)
- Mikael Rask
- a Linnaeus University, School of Health and Caring Sciences , Växjö , Sweden
| | - Agneta Schröder
- c Örebro University, University Health Care Research Center, Faculty of Medicine and Health, Örebro, Sweden Norwegian University of Science and Technology (NTNU), Department of Nursing, Faculty of Health, Care and Nursing , Gjövik , Norway
| | - Lars-Olov Lundqvist
- b Örebro University, University Health Care Research Center, Faculty of Medicine and Health , Örebro , Sweden
| | - Ann-Britt Ivarsson
- d Örebro University, School of Health and Medical Sciences , Örebro , Sweden
| | - David Brunt
- a Linnaeus University, School of Health and Caring Sciences , Växjö , Sweden
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Vincze M, Fredriksson L, Wiklund Gustin L. To do good might hurt bad: exploring nurses' understanding and approach to suffering in forensic psychiatric settings. Int J Ment Health Nurs 2015; 24:149-57. [PMID: 25639292 DOI: 10.1111/inm.12116] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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.
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Lundqvist LO, Schröder A. Patient and staff views of quality in forensic psychiatric inpatient care. JOURNAL OF FORENSIC NURSING 2015; 11:51-58. [PMID: 25695210 DOI: 10.1097/jfn.0000000000000060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The study describes and compares perceived quality of care among patients and staff using the Quality in Psychiatric Care-Forensic In-Patient and the Quality in Psychiatric Care-Forensic In-Patient Staff questionnaires. The questionnaires are both based on the perception of the quality of the forensic psychiatric care given to the patients, but the wording is adjusted to fit patients or staff. The study sample consisted of 66 patients and 202 staff members from 12 forensic units in Sweden. Using multiple regression analyses to adjust for demographic variables, it was found that patients perceived the quality of support and secluded environment lower than did staff, whereas staff had lower perceptions than patients of the quality of secure environment. The combination of these questionnaires provides new possibilities for assessing the quality of forensic psychiatric care and evaluating interventions, important factors in the management and planning of forensic care.
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Affiliation(s)
- Lars-Olov Lundqvist
- Author Affiliations: 1Centre for Rehabilitation Research, Örebro County Council; 2School of Law, Psychology and Social work, Örebro University; 3School of Health and Medical Sciences, Örebro University; and 4Psychiatric Research Centre, Örebro County Council
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Esteves RB, Lasiuk GC, Cardoso L, Kent-Wilkinson A. Toward the establishment of a forensic nursing specialty in Brazil: an integrative literature review. JOURNAL OF FORENSIC NURSING 2014; 10:189-198. [PMID: 25411810 DOI: 10.1097/jfn.0000000000000048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Over the past two decades, Brazil has made progress in bringing political and community attention to issues related to violence. The recognition of links between violence and health has intensified calls to accelerate the development of a forensic nursing specialty in Brazil. AIM The aim of this study was to systematically examine and synthesize the literature on the development of the forensic nursing specialty around the globe and to extract important lessons for the establishment of a forensic nursing specialty in Brazil. METHOD An integrative review was conducted according to the method described by Whittmore and Knafl (2005). Electronic searches of the following databases were conducted between December 2012 and March 2013: CINAHL Plus with Full Text, Criminal Justice, Index to Legal periodicals, MEDLINE, Soc Index with Full Text, Social Work Abstracts, SCOPUS, and PsycINFO. The search terms used were: [(TI nurs* or SU nurs*) and [TI (forensic* or penal or prison*) or SU (forensic* or penal or prison*)] and (sexual assault nurse examiner*). Preestablished inclusion/exclusion criteria were used to select published articles for review. RESULTS Twenty-three articles met inclusion criteria and were included in the full review. Important lessons for Brazil are discussed in terms of education and curricular issues and forensic psychiatric nursing. CONCLUSIONS In Brazil, there is a window of opportunity to contribute the theoretical foundations of forensic nursing science and to advance nursing specialty practice in the areas of Sexual Assault Nurse Examiners and forensic psychiatric nurses.
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Affiliation(s)
- Rafael Braga Esteves
- Author Affiliations: 1Department of Psychiatric Nursing and Human Sciences, Ribeirão Preto College of Nursing, University of Sao Paulo; 2Faculty of Nursing, University of Alberta; and 3College of Nursing, University of Saskatchewan
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Graneheim UH, Slotte A, Säfsten HM, Lindgren BM. Contradictions between ideals and reality: Swedish registered nurses' experiences of dialogues with inpatients in psychiatric care. Issues Ment Health Nurs 2014; 35:395-402. [PMID: 24766174 DOI: 10.3109/01612840.2013.876133] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study explored ten registered nurses' experiences of dialogues with inpatients in psychiatric care. Data were collected through four focus group discussions, and two individual interviews. The nurses described contradictions between their nursing ideals about dialogues and the reality faced in psychiatric inpatient care, resulting in an unsatisfactory work situation and feelings of insufficiency. We conclude that in order to improve quality of care and increase well-being for both patients and health care workers, nursing interventions, such as dialogues and meaningful activities, need to be offered to patients. A management that is visible and present on-site should encourage and facilitate health care workers' participation in clinical supervision.
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Eidhammer G, Fluttert FAJ, Bjørkly S. User involvement in structured violence risk management within forensic mental health facilities -- a systematic literature review. J Clin Nurs 2014; 23:2716-24. [PMID: 25280135 DOI: 10.1111/jocn.12571] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine empirical literature on user involvement in collaboration between patients and nurses. The scope of the review was limited to structured violence risk management interventions in forensic mental health settings. BACKGROUND Violence in forensic mental health settings represents a significant problem for patients and staff. Structured violence risk management interventions in forensic mental health have been reported to ignore patient participation, despite the growing attention on user involvement in clinical practice. DESIGN A systematic review. METHOD Searches were conducted in six databases: the Cochrane Systematic Reviews, MEDLINE, CINAHL, ProQuest, ScienceDirect and PsycINFO. Papers were assessed according to a predetermined set of inclusion and exclusion criteria. RESULTS After searches of the reference lists of retrieved articles were conducted, only three papers met the inclusion criteria. CONCLUSIONS This review has shown that empirical research on the topic of risk management interventions in which patients are involved is scarce. RELEVANCE TO CLINICAL PRACTICE There is barely any research evidence of the clinical effect of user involvement approaches on violence risk management in forensic mental health practice. Therefore, we suggest that clinicians may learn from positive experiences concerning user involvement in general psychiatry and carefully adapt and test them out in the forensic treatment context.
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Affiliation(s)
- Gunnar Eidhammer
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway; Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Vestre Viken HF, Drammen, Norway
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Brunt D, Rask M. Validation of the Verbal and Social Interaction questionnaire: carers' focus in the carer-resident relationship in supported housing facilities for persons with psychiatric disabilities (VSI-SH). J Psychiatr Ment Health Nurs 2013; 20:279-85. [PMID: 22607221 DOI: 10.1111/j.1365-2850.2012.01925.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A questionnaire to measure the verbal and social interactions between carers and residents in supported housing facilities for persons with psychiatric disabilities has been developed. It is an adaptation of a questionnaire originally used in a forensic psychiatric setting. The aim of the present study was thus to investigate the construct validity and the reliability of this new version of the Verbal and Social Interactions questionnaire for use in supported housing facilities (VSI-SH). Two hundred and twenty-three carers from municipal and privately run housing facilities completed the questionnaire. A factor analysis was performed, which resulted in six factors. The number of items was reduced from the original 47 to 30 in order to minimize factorial complexity and multiple loadings. The reliability was tested with Cronbach's alpha and good internal consistency for the questionnaire and five of the six factors was found. The resulting six factors and the items were compared to the conceptual model and four of the six factors corresponded well with the categories in this original theoretical model. The questionnaire can be a useful contribution to the study of interactions between carers and residents in supported housing facilities for persons with psychiatric disabilities.
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Affiliation(s)
- D Brunt
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
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Gildberg FA, Bradley SK, Fristed P, Hounsgaard L. Reconstructing normality: characteristics of staff interactions with forensic mental health inpatients. Int J Ment Health Nurs 2012; 21:103-13. [PMID: 22321258 DOI: 10.1111/j.1447-0349.2011.00786.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Forensic psychiatry is an area of priority for the Danish Government. As the field expands, this calls for increased knowledge about mental health nursing practice, as this is part of the forensic psychiatry treatment offered. However, only sparse research exists in this area. The aim of this study was to investigate the characteristics of forensic mental health nursing staff interaction with forensic mental health inpatients and to explore how staff give meaning to these interactions. The project included 32 forensic mental health staff members, with over 307 hours of participant observations, 48 informal interviews, and seven semistructured interviews. The findings show that staff interaction is typified by the use of trust and relationship-enabling care, which is characterized by the establishment and maintenance of an informal, trusting relationship through a repeated reconstruction of normality. The intention is to establish a trusting relationship to form behaviour and perceptual-corrective care, which is characterized by staff's endeavours to change, halt, or support the patient's behaviour or perception in relation to staff's perception of normality. The intention is to support and teach the patient normal behaviour by correcting their behaviour, and at the same time, maintaining control and security by staying abreast of potential conflicts.
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Affiliation(s)
- Frederik A Gildberg
- Research Unit of Nursing, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark.
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Fluttert FAJ, Van Meijel B, Van Leeuwen M, Bjørkly S, Nijman H, Grypdonck M. The development of the Forensic Early Warning Signs of Aggression Inventory: preliminary findings toward a better management of inpatient aggression. Arch Psychiatr Nurs 2011; 25:129-37. [PMID: 21421164 DOI: 10.1016/j.apnu.2010.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 06/29/2010] [Accepted: 07/01/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE "Early warning signs of aggression" refers to recurring changes in behaviors, thoughts, perceptions, and feelings of the patient that are considered to be precursors of aggressive behavior. The early recognition of these signs offers possibilities for early intervention and prevention of aggressive behaviors in forensic patients. The Forensic Early warning Signs of Aggression Inventory (FESAI) was developed to assist nurses and patients in identifying and monitoring these early warning signs of aggression. METHODS The FESAI was developed by means of qualitative and quantitative strategies. One hundred seventy six early detection plans were studied to construct a list of early warning signs of aggression. Inventory drafting was done by merging and categorizing early warning signs. Forensic nursing professionals assessed face validity, and interrater agreement was tested. RESULTS The investigation of early detection plans resulted in the FESAI, which contains 44 early warning signs of aggression subdivided into 15 main categories. The face validity of the form was very good, and the interrater agreement was satisfactory. CONCLUSIONS Preliminary findings indicate that the FESAI provides a useful listing of early warning signs of aggression in forensic patients. It may facilitate the construction of early detection plans for the prevention of aggressive behaviors in forensic psychiatry.
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Fluttert F, van Meijel B, Nijman H, Bjørkly S, Grypdonck M. Detached concern of forensic mental health nurses in therapeutic relationships with patients the application of the early recognition method related to detached concern. Arch Psychiatr Nurs 2010; 24:266-74. [PMID: 20650372 DOI: 10.1016/j.apnu.2009.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 09/18/2009] [Accepted: 09/30/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Improvement of the interaction between forensic mental health nurses and patients may lead to a reduction of inpatient violence. The concept under study is detached concern, which refers to nurses' skills to neutralize the emotional appeal of patients by a balanced attitude between objectivity and emotional involvement. The Patient Contact Questionnaire (PCQ) aims at measuring the degree of concern of nurses for their patients. METHODS The PCQ was applied in a pretest-posttest design, evaluating the effects of the Early Recognition Method (ERM). This method aims at the prevention of inpatient violence in forensic psychiatry. Subjects were 116 forensic mental heath nurses working on 16 wards of a large Dutch forensic hospital. First, the baseline scores were compared to scores reported in an earlier study conducted in general psychiatry. Second, pretest-posttest comparisons were carried out for all nurses, and for subgroups of nurses with regard to gender, educational level, years of working experience, and patient population. Third, pretest-posttest comparisons were made on the PCQ item level. RESULTS The baseline scores of male nurses indicated significantly higher levels of concern than those of female nurses. In addition, more experienced nurses scored significantly higher with regard to concern than less experienced nurses. When comparing the scores before and after applying ERM, no significant differences were found. However, the sores of female nurses showed a tendency toward more concern after implementation of ERM. CONCLUSIONS Detached concern may be a meaningful concept in forensic mental health nursing in measuring nurses' concern for their patients. Levels of detached concern did not change significantly after application of ERM. However, the application of the PCQ could contribute to a better understanding of the interaction between nurses and their patients.
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Affiliation(s)
- Frans Fluttert
- Department of Nursing Science, Utrecht University, The Netherlands.
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Gildberg FA, Elverdam B, Hounsgaard L. Forensic psychiatric nursing: a literature review and thematic analysis of staff-patient interaction. J Psychiatr Ment Health Nurs 2010; 17:359-68. [PMID: 20529188 DOI: 10.1111/j.1365-2850.2009.01533.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In Denmark the increasing number of forensic mental health patients has led to prioritized services, including the area of nursing; however, this field is subject to sparse research. The aim of this study was to review existing research literature and in doing so investigate what characterizes forensic mental health staff interaction with forensic mental health inpatients and furthermore to investigate what significance these staff characteristics have for the inpatients. The literature review spans the period September 1997 to January 2009 and was based on a systematic keyword combination search in the following databases: CINAHL, CSB, PsycINFO, Scopus, Pubmed, MEDLINE and Sociological Abstracts. The articles were categorized using a literature matrix and analysed using content analysis. Seventeen quantitative and qualitative research studies were analysed. The results show that the interaction between forensic staff and forensic inpatients is characterized by two overriding themes: parentalistic & behaviour-changing care and relational & personal quality-dependent care. Only a few of the findings represent a clear account of how the interactional characteristics impact on the forensic inpatient. The conclusion is that no clear account of the patient impact issue can be reached at this point and that further investigation needs to take place.
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Affiliation(s)
- F A Gildberg
- Research Unit of Nursing, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C,Denmark.
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Fluttert FAJ, van Meijel B, Nijman H, Bjørkly S, Grypdonck M. Preventing aggressive incidents and seclusions in forensic care by means of the 'Early Recognition Method'. J Clin Nurs 2010; 19:1529-37. [PMID: 20384661 DOI: 10.1111/j.1365-2702.2009.02986.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Early Recognition Method aims at improving collaboration between nurses and patients to prevent aggression in forensic psychiatric care. To achieve this goal, Early Recognition Method strongly focuses on early signs of aggression. In the current study, we investigated whether application of Early Recognition Method led to a significant decrease in inpatient incidents. BACKGROUND Nurses in forensic settings are often confronted with patients' aggression. Better collaboration between nursing staff and patients may improve patients' ability to self manage aggression and contribute to a decrease in inpatient aggression. DESIGN Naturalistic one-way case-crossover design. METHODS The Early Recognition Method was introduced on 16 wards of a maximum security forensic hospital. Using a one-way case-crossover design, where cases were their own controls, the effects of Early Recognition Method were assessed by comparing the number of incidents of 189 patients during 'Treatment As Usual' with the period after Early Recognition Method was implemented. The Early Recognition Method intervention involved weekly evaluations of signs of aggression between staff and patients. The outcome measures were the number of seclusions and the severity of inpatient incidents. RESULTS A significant decline in the number of seclusions was observed after Early Recognition Method was introduced. Apart from this decrease, the mean severity of inpatient incidents was also found to be lower during the post intervention period. The effect size was most pronounced for patients with substance abuse and personality disorders. Patients with schizophrenia, however, showed modest, yet significant, effect sizes. CONCLUSIONS The results suggest that Early Recognition Method may be an innovative and effective risk management method for forensic psychiatric patients, in particular for patients with personality disorders. RELEVANCE TO CLINICAL PRACTICE This article aims to contribute to evidence-based risk management for nurses in collaboration with their patients, resulting in a decrease in inpatient aggression.
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Affiliation(s)
- Frans A J Fluttert
- Department of Nursing Science, Utrecht University, Utrecht, The Netherlands.
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Lilja L, Hellzén O. Disconfirmed in one's otherness: A comparison between the nurse's view of the patient's past, present and future and the patient's own view of the past, present and future. Int J Qual Stud Health Well-being 2009. [DOI: 10.1080/17482620601164862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Mason T, King L, Dulson J. Binary construct analysis of forensic psychiatric nursing in the UK: high, medium, and low security services. Int J Ment Health Nurs 2009; 18:216-24. [PMID: 19490233 DOI: 10.1111/j.1447-0349.2009.00601.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of this study was to identify if differences in perceptions of the role of forensic psychiatric nurses exist across the three levels of secure psychiatric provision: high, medium, and low. Any differences may reflect the type of clinical conditions found in different levels of security provision. An information-gathering schedule containing a validated 7-point Likert scale was distributed to 1200 forensic psychiatric nurses across the UK in 2005. A response rate of 34.6 was achieved, with 122 from high-security, 159 from medium-security, and 135 from low-security services. Differences in perceptions regarding role constructs were found across all three levels, with numerous differences being statistically significant using analysis of variance. The main implications are in relation to the development of skills and competencies, which should target specific clinical conditions in relation to effective interventions, the development of a specialist education and training curriculum focused on treatment outcomes, and the need for further research to draw together theory and practice. Finally, creative policy initiatives should be developed to cross-fertilize the levels of security provision in order that staff may acquire and deliver experiences in high-, medium-, and low-security psychiatric services.
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Affiliation(s)
- Tom Mason
- Mental Health & Learning Disabilities, University of Chester, Parkgate Road, Chester CH1 4BJ, UK.
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Rask M, Brunt D, Fridlund B. Validation of the verbal and social interaction questionnaire: nurses' focus in the nurse-patient relationship in forensic nursing care. J Psychiatr Ment Health Nurs 2008; 15:710-6. [PMID: 18844795 DOI: 10.1111/j.1365-2850.2008.01292.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is a need to develop a questionnaire that measures nurses' verbal and social interactions (VSI) with their patients from the nurses' perspective as well as from the patients' perspective in the psychiatric and especially in the forensic psychiatric field. The major aim of the present study was to determine the construct validity and the internal consistency reliability of the VSI questionnaire. The study had a methodological and developmental design and was carried out in four steps: construction of the items, face validity, data collection and data analysis. The number of items was reduced from 50 to 21. The factor analysis of the final 21 items resulted in three quite distinct factors, namely, 'inviting the patient to establish a relationship', 'showing interest in the patients' feelings, experiences and behaviour' and 'helping the patients to establish structure and routines in their everyday life'. The results showed satisfactory psychometric properties in terms of content validity, construct validity and the internal consistency reliability of the questionnaire.
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Affiliation(s)
- M Rask
- School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
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Fluttert F, Van Meijel B, Webster C, Nijman H, Bartels A, Grypdonck M. Risk management by early recognition of warning signs in patients in forensic psychiatric care. Arch Psychiatr Nurs 2008; 22:208-16. [PMID: 18640540 DOI: 10.1016/j.apnu.2007.06.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 06/23/2007] [Accepted: 06/24/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE To clarify the concept of early recognition for the field of forensic nursing. The concept is based on the proposition that patient behavior deteriorating toward aggression is idiosyncratic but nevertheless reconstructable like a "signature." Once reconstructed, this signature can be used to detect "early signs" of deterioration and thus prevent violent behavior. CONCEPT Early recognition is approached from the perspective of deteriorating behavior. Special attention is paid to the social and interpersonal factors related to the individual behaving violently. From this perspective, the thoughts, feelings, and behavior of the patient can indicate the onset of aggression, and early recognition of these warning signs can help thwart such deterioration. The aviation metaphor of a "black box" is used to emphasize the importance of attention to early warning signs. Patients in forensic care must draw upon their previous experiences (i.e., their own black boxes) to gain insight into their violent behavior and the warning signals for this. The emphasis is on the cooperation between the patient and the nurse in the application of risk management strategies. The Early Recognition Method provides an approach in which patients and nurses also gradually attune their perspectives on aggressive behavior. CONCLUSION The concept of early recognition is important because it extends the idea of early intervention to include enabling patients to control their own behavior. Early recognition has strong practical implications for forensic nurses as it allows them to attenuate aggression by assisting patients with the detection of early warning signs.
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Affiliation(s)
- Frans Fluttert
- Research Department, FPC Dr. S. Van Mesdag, The Netherlands.
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Rask M, Brunt D. Verbal and social interactions in the nurse?patient relationship in forensic psychiatric nursing care: a model and its philosophical and theoretical foundation. Nurs Inq 2007; 14:169-76. [PMID: 17518829 DOI: 10.1111/j.1440-1800.2007.00364.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The present paper focuses on the nurse-patient relationship in forensic psychiatric care. From research in the field six categories of nurse-patient interactions are identified: 'building and sustaining relationships', 'supportive/encouraging interactions', 'social skills training', 'reality orientation', 'reflective interactions' and 'practical skills training'. The content of each category of interaction in the context of forensic psychiatric care is described. A conceptual model is presented together with an empirical, philosophical and theoretical foundation for the use of verbal and social interactions in nurse-patient interactions in forensic psychiatric nursing care. The implications and possible uses of the model in the practical field of forensic psychiatric care are discussed.
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