Building from the ground up: exploring forensic mental health staff’s relationships with patients

Marshall, Lisa A.; Adams, Emma A

doi:10.1080/14789949.2018.1508486

Cited by 47 publications

(51 citation statements)

References 33 publications

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“…Furthermore, as identified in the documentation reviewed in our study, there is a tendency for nurses to take a paternalistic role with forensic patients which is expressed as “control, rule enforcement, and parenting behaviours” (Marshall & Adams, 2018). The NCRMD finding suggests that as a society, we have taken an individual's responsibility for their actions and committed to supporting their return to full citizenship.…”

Section: Discussionmentioning

confidence: 92%

How forensic mental health nurses’ perspectives of their patients can bias healthcare: A qualitative review of nursing documentation

Martin

Ricciardelli

Dror

2020

Journal of Clinical Nursing

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Aims and Objectives Our aim was to examine the notes produced by nurses, paying specific attention to the style in which these notes are written and observing whether there are concerns of distortions and biases. Background Clinicians are responsible to document and record accurately. However, nurses’ attitudes towards their patients can influence the quality of care they provide their patients and this inevitably impacts their perceptions and judgments, with implications to patients’ care, treatment, and recovery. Negative attitudes or bias can cascade to other care providers and professionals. Design This study used a retrospective chart review design and qualitative exploration of documentation using an emergent theme analysis. Methods We examined the notes taken by 55 mental health nurses working with inpatients in the forensic services department at a psychiatric hospital. The study complies with the SRQR Checklist (Appendix S1) published in 2014. Results The results highlight some evidence of nurses’ empathic responses to patients, but suggest that most nurses have a style of writing that much of the time includes themes that are negative in nature to discount, pathologise, or paternalise their patients. Conclusions When reviewing the documentation of nurses in this study, it is easy to see how they can influence and bias the perspective of other staff. Such bias cascade and bias snowball have been shown in many domains, and in the context of nursing it can bias the type of care provided, the assessments made and the decisions formed by other professionals. Relevance to Clinical Practice Given the critical role documentation plays in healthcare, our results indicate that efforts to improve documentation made by mental health nurses are needed and specifically, attention needs to be given to the writing styles of the notation.

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Section: Discussionmentioning

confidence: 92%

How forensic mental health nurses’ perspectives of their patients can bias healthcare: A qualitative review of nursing documentation

Martin

Ricciardelli

Dror

2020

Journal of Clinical Nursing

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“…However, it is the 'social skin' that can be powerful in transforming identities (Winship, 2000, p.176). For example, positive interpersonal interactions contribute towards social connectedness (Baumeister and Leary, 1995) and positive therapeutic relationships can promote wellbeing (McKeown et al, 2016a;Marshall and Adams, 2018). Positive and supportive social environments are particularly important when diminished social networks are found to negatively influence wellbeing (Kawachi and Berkman, 2001;Hare-Duke et al, 2018).…”

Section: Forensic Mental Health: Secure Carementioning

confidence: 99%

Inpatient Institutional Care: The Forced Social Environment

et al. 2021

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The landscape of mental health recovery is changing; there have been calls for a shift from the clinical expertise being the dominant voice within mental healthcare towards a more personalised and collaborative service that supports those in need of mental healthcare to define what recovery is for the individual. Within this new recovery movement, there has been a recognition of the importance of the social environment in which individuals are situated and the relationship of this to mental health and wellbeing. Included in this is the importance of an individual’s role within society and the ways in which knowledge, such as experts by experience, can hold an important value. The argument then, is that social connectedness forms part of the recovery journey and that relationships can help us develop or re-connect with who we are in powerful ways. Such a view has only been strengthened by the recent and ongoing global COVID-19 pandemic. Within the UK, discussions of the importance of our wellbeing have become commonplace within the context of restricted social contact. With this heightened awareness of how the social contributes to wellbeing, it is important to consider the environments in which those in receipt of mental healthcare are situated. One of which is institutionalised care, where it is commonplace to restrict social contact. For example, by virtue of being within a locked environment, individuals’ freedom of movement is often non-existent and thus contacts with those not residing or working within the institution is restricted. While such restrictions may be deemed necessary to protect the individual’s mental health, such environments can be unintentionally toxic. Data are presented from an ethnography that was conducted within an inpatient forensic mental health hospital in the UK to highlight the problematic social environment which some individuals experience. Key interpersonal issues are presented, such as, trust, racism, the threat of physical violence and bullying that was experienced by staff and residents at the hospital. Consideration is given to the coping strategies enacted by residents and the pathologising of such behaviour. The consequences on interpersonal wellbeing are explored.

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“…In the shorter term, participants reported that staff could play an important role in providing reassurance to users. The suggestion that staff could lead by example by trialing the devices themselves reflects the role of staff as positive role models in inpatient services [38] and is a practical approach to alleviating user concerns.…”

Section: Discussionmentioning

confidence: 99%

Predicting Inpatient Aggression in Forensic Services Using Remote Monitoring Technology: Qualitative Study of Staff Perspectives

Greer¹,

Newbery²,

Cella³

et al. 2019

J Med Internet Res

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BackgroundMonitoring risk of imminent aggression in inpatient forensic mental health services could be supported by passive remote monitoring technology, but staff attitudes toward the relevance and likelihood of engagement with this technology are unknown.ObjectiveThis study aimed to explore staff views, specifically potential benefits and implementation barriers, on using this technology for monitoring risk of inpatient aggression.MethodsWe conducted semistructured focus groups with nurses in an inpatient forensic mental health service. We used thematic analysis with two independent raters to identify themes and subthemes related to staff attitudes toward passive remote monitoring. We subsequently checked with members to ensure the validity of the themes identified by the raters.ResultsFrom January to March 2019, a total of 25 nurses took part in five focus groups. We identified five main themes, one of which concerned the potential benefits that passive remote monitoring could provide for monitoring risk of aggression. Staff suggested it could provide an early warning of impending aggression and enable support to be provided earlier. The remaining themes concerned implementation barriers, including risks to the users’ physical and mental well-being; data security concerns and potential access by third parties; the negative impact of a constant stream of real-time data on staff workload; and design characteristics and user awareness of the benefits of passive remote monitoring.ConclusionsPassive remote monitoring technology could support existing methods of monitoring inpatient aggression risk, but multiple barriers to implementation exist. Empirical research is required to investigate whether these potential benefits can be realized, and to identify ways of addressing these barriers to ensure acceptability and user engagement.

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Building from the ground up: exploring forensic mental health staff’s relationships with patients

Cited by 47 publications

References 33 publications

How forensic mental health nurses’ perspectives of their patients can bias healthcare: A qualitative review of nursing documentation

How forensic mental health nurses’ perspectives of their patients can bias healthcare: A qualitative review of nursing documentation

Inpatient Institutional Care: The Forced Social Environment

Predicting Inpatient Aggression in Forensic Services Using Remote Monitoring Technology: Qualitative Study of Staff Perspectives

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