Binary construct analysis of forensic psychiatric nursing in the UK: High, medium, and low security services

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.

Respect in forensic psychiatric nurse-patient relationships: A practical compromise

“…Participants in the current study reported witnessing contrary cases of other colleagues used and misused power through “power over” others with insinuations of patient and nurse victimization. These data resonate with Mason, King, and Dulson's (2009) UK survey of forensic psychiatric nurses who found that the need to feel in control of, exerting power over forensic psychiatric patients was more common in medium and high security settings. In this study, intimidation was the most morally distressing contrary case, particularly nurse–patient intimidation.…”

“…“ … I did find them [psychiatrists] very challenging because sometimes they didn't respect your opinion and sometimes I’d get frustrated and say, we are here 24 hours a day! How can you discredit the information I am providing to you ?” forensic psychiatric nurses in a large UK survey endorsed a similar perspective of lack of appreciation and a sense of abuse (Mason et al, 2009). Other participants discussed the challenge of balancing the security demands with nursing care needs of the patients.…”

Detached Concern of Forensic Mental Health Nurses in Therapeutic Relationships With Patients

“…These patients in particular have difficulty regulating their frustrations and aggression, also in contact with nurses (Koekkoek, Van Meijel, & Hutschemaekers, 2006;Mason et al, 2009). They often have difficulty to discuss these kind of behaviors, and this may particularly be the case with female nurses.…”

“…In particular in risk management, nurses' detachment from and concern for patients are more often discussed in relation to a balance between security and treatment. In this respect, Mason et al (2009) described "…the tension between professional knowledge and public outcry in the event of an untoward incident" (p. 217) could cause nurses to perceive fear, abuse, failure, loss, and countertransference. Nurses' interactive skills should contribute to the de-escalation of tense situations and encourage patients to participate in relapse-prevention strategies (Fluttert et al, 2008;Jonker et al, 2008;Mason et al, 2009;Meehan et al, 2006).…”

“…T HE OCCURRENCE OF severe aggressive incidents on acute psychiatric wards is a serious problem and can have a great impact on staff; they can trigger feelings of shock, fear, or anger and are often followed by rumination, guilt, or anxiety (Bowers, Brennan, Flood, Lipang, and Olapado, 2006;Camerino, Estryn-Behar, Conway, Heijden van der, & Hasselhorn, 2007;Jonker, Goosens, Steenhuis, & Oud, 2008;Martin & Daffern, 2006;Mason, King, & Dulson, 2009;Needham, Alberhalden, Halfens, Fischer, & Dassen, 2005). Patients also suffer from the consequences of their aggressive behavior; it is likely that these kinds of behaviors cause conflicts with staff, possibly resulting in coercive measures (Meehan et al, 2006;Paterson & Duxbury, 2007).…”