Role of the forensic psychiatric nurse

A critical ethnographic perspective on risk and dangerousness in forensic psychiatry

In the Canadian forensic psychiatric context, the concepts of risk and dangerousness interact, intersect, and morph into the notion of significant threat to the safety of the public. Stemming from the results of a critical ethnography of the Ontario Review Board, this article unpacks the central role of forensic psychiatric nursing, as an example of a 'psych' discipline (e.g., psychiatry and psychology), in a system that is built to produce risky persons and to legitimize their detention and supervision. By using excerpt of interviews conducted with nurses, ethnographic observations of Review Board hearings, and other documentary artifacts, the findings illustrate how rationalizations of risk and dangerousness are contingent on space, time, and observer. Depending on the time of the assessment or on the health-care professional who performs it, different elements including, but not limited to, mental illness, interpersonal relationships, financial instability, and sexual vulnerability, are relied upon in very fluid, interchangeable, and discretionary ways to justify findings of dangerousness. Such a dynamic expands the reach of psychiatry's legitimacy at identifying risky conduct and controlling risky persons to domains very loosely associated with the notion of dangerousness. The work of Foucault and Castel provides the theoretical backdrop on which rests the discussion and the implications for nursing.

The Totalising Nature of Secure and Forensic Mental Health Services in England and Wales

This evidence-based opinion piece explores the totalising risk averse nature of secure and forensic mental health services and associated iatrogenic harms in England and Wales. Drawing on the research literature I consider the various influences, both external and internal which impact on the provision of such services and how both the therapeutic alliance and recovery potential for patients may be improved. Especial attention is paid to the deployment of restrictive practise, practitioner attitudes, the potential for non-thinking, and how these may impact on decision-making and the care and treatment of mentally disordered offenders.

Caring as Coercion: Exploring the Nurse's Role in Mandated Treatment

When nurses work in environments that have overlapping medical, legal, institutional, social, and therapeutic priorities, nursing care can become an effective tool in advancing the competing goals of these multiple systems. During the provision of patient care, nurses manage the tensions inherent in the competing priorities of these different systems, and skillful nursing can have the effect of rendering these tensions invisible. This puts nurses in an ethically complex position, where on one hand, their humanizing empathy has the potential to improve the delivery and effect of mandated care yet, on the other hand, their skillfulness can render invisible the weaknesses in medicolegal structures. In this article, we present a composite case study as a vehicle to illustrate the way this dilemma manifests in day-to-day nursing interactions and explore the potential of microethics to inform the everyday decisions of nurses delivering care-as-coercion.

The Mentally Ill in Jail: Contemporary Clinical and Practice Perspectives for Psychiatric-Mental Health Nursing

Individuals with serious mental illnesses (SMI) who are incarcerated pose major treatment challenges for both correctional personnel and healthcare providers, yet deserve the same high standards of care as those in traditional mental health facilities. The literature references these challenges as types of mental health treatment disparities, and calls for improvement measures from clinicians, researchers, policy-makers, and advocates. From the standpoint of psychiatric-mental health (PMH) nursing, this paper explores, examines, and offers some contemporary clinical and practice perspectives for providing best-practice psychiatric care for SMI individuals who are in jails. The diverse roles of PMH nursing can contribute meaningfully to tackling quality improvement initiatives on mental health treatment agendas for SMI inmates.

Standards of practice for forensic mental health nurses--identifying contemporary practice

Forensic mental health nursing is a recognized field of nursing in most countries. Despite a growing body of literature describing aspects of practice, no publication has been found that captures the core knowledge, skills, and attitudes of forensic mental health nurses. One group of nurses in Australia have pooled their knowledge of relevant literature and their own clinical experience and have written standards of practice for forensic mental health nursing. This paper identifies the need for standards, provides a summary of the standards of practice for forensic mental health nurses, and concludes with how these standards can be used and can articulate to others the desired and achievable level of performance in the specialty area.

Seclusion reduction in a forensic mental health setting

Seclusion has become a contentious practice and initiatives have commenced to reduce or eliminate its use. This paper presents the initiatives that were introduced during a seclusion reduction project that was undertaken at an Australian forensic hospital. These initiatives are based on the six core strategies that have been successfully used in North America to reduce seclusion. However, there are challenges (patient characteristics, prisoner culture and ensuring safety) and opportunities (longer admissions, higher staff-patient ratio, staff confidence, sound risk assessment and management) that can influence projects to reduce seclusion in a forensic hospital. During this project, the frequency (mainly multiple seclusions of patients) and duration of seclusion events were reduced but there was less reduction in the number of patients that were secluded. It is possible that the strategies were successfully supported by the identified opportunities to reduce the frequency and duration of seclusion but the challenges were significantly powerful in the early period of admission to prompt the need for seclusion. Reducing seclusion in a forensic hospital is a complex undertaking as nurses must provide a safe environment while dealing with volatile patients and may have little alternative at present but to use seclusion after exhausting other interventions.

Juvenile mental health courts for adjudicated youth: role implications for child and adolescent psychiatric mental health nurses

TOPIC

Juvenile mental health courts for adjudicated youth.

PURPOSE

To describe the role of psychiatric nurses in reducing mental health disparities for adjudicated youth via juvenile mental health courts.

SOURCES

ISI Web of Knowledge; Sage Journals Online; HighWire; PubMed; Google Scholar and Wiley Online Library and websites for psychiatric nursing organizations. Years included: 2000-2010.

CONCLUSIONS

Juvenile mental health courts may provide a positive and effective alternative to incarceration for youth with mental health problems with psychiatric nurses playing a key role in program implementation.

Forensic psychiatric/mental health nursing: responsive to social need

Forensic nursing is an emerging global nursing specialty, with subspecialties that focus on nursing practice at the clinical-legal interface of tending to victims and offenders, living and deceased. An integrated review of the literature provides an overview of the role development of forensic nursing subspecialties. The subspecialties of forensic nursing that deal with the mental health care of victims and offenders are the focus of this paper. Forensic nursing, like all forensic specialties, developed from a need in society for a medico-legal role. This paper discusses the global role of forensic nursing and argues that role development has been both proactive and responsive to vital needs of victims and offenders in society. Advanced practice forensic nurses have taken leadership roles in the role development of this nursing specialty. A future challenge for forensic psychiatric/mental health nurses with advanced education is to take leadership roles in all areas of psychiatric assessment, intervention, and evaluation of clients.