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

Fluttert, Frans; Meijel, Berno van; Nijman, Henk; Bjørkly, Stål; Grypdonck, Mieke

doi:10.1016/j.apnu.2009.09.002

Cited by 16 publications

(10 citation statements)

References 30 publications

(54 reference statements)

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“…The response rate for q3 was moderate, but somewhat lower than in previous implementation studies with a naturalistic and test-retest setting (12,53). The response rate prevented us from performing some intended longitudinal analyses, e.g.…”

mentioning

confidence: 77%

What is important for the sustained implementation of evidence-based brief psychotherapy interventions in psychiatric care? A quantitative evaluation of a real-world programme

Lindholm

Koivukangas

Lassila

et al. 2019

Nordic Journal of Psychiatry

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Behavioural activation and motivational interviewing, both evidence-based treatments (EBTs), were implemented in secondary psychiatric care. This longitudinal evaluation of a real-world programme focused on the penetration of EBT adoption and its associations with therapist-related and perceived intervention-related variables. The implementation plan was also compared to sub-processes of Normalization Process Theory. Material and Methods: Six participating units employed 72 therapists regularly and they comprise the target group. Due to staff turnover, a total of 84 therapists were trained stepwise. Three survey points (q1, q2, q3) were set for a four-year cycle beginning a year after the initial training and completed 4-5 months after closing patient recruitment. The implementation plan included two workshop days, one for each EBT, and subsequent case consultation groups and other more general strategies. Results: Fifty-seven (68%) of programme-trained therapists responded to one or more of three questionnaires. The self-reported penetration covers about a third of the target group a few months after the completion of the programme. Therapists' favourable perceptions of the EBTs regarding relative advantage, compatibility and complexity were associated with their sustained adoption. Therapists' background factors (e.g. work experience) and positive adoption intention at q1 did not predict the actual adoption of the EBTs at q3. No specific sustainment strategies were included in the implementation plan. Conclusion: Brief but multi-faceted training with subsequent case consultations promoted the adoption of EBTs in a real-world setting. Adding specific sustainment strategies to the 2 implementation plan is proposed to ensure the long-term survival of the implementation outcomes.

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mentioning

confidence: 77%

What is important for the sustained implementation of evidence-based brief psychotherapy interventions in psychiatric care? A quantitative evaluation of a real-world programme

Lindholm

Koivukangas

Lassila

et al. 2019

Nordic Journal of Psychiatry

View full text Add to dashboard Cite

show abstract

“…This might explain research findings describing the therapeutic relationship between nurses and patients as social chatting (Martin & Street ) or detachment (Fluttert et al . ). Holmqvist and Armelius () identified that treatment outcomes were largely dependent on the clinician's ability to demonstrate emotional flexibility and sensitivity towards patients.…”

Section: Literature Reviewmentioning

confidence: 97%

Working with people who have killed: The experience and attitudes of forensic mental health clinicians working with forensic patients

Harris

Happell

Manias

2014

Int J Mental Health Nurs

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Forensic mental health (FMH) clinicians sometimes feel unsupported and unprepared for their work. This article explores their experiences of working in a FMH setting in Australia. The research examined the clinical context of clinicians working with forensic patients (FP), particularly those individuals who have killed while experiencing a mental illness. A qualitative, exploratory design was selected. Data were collected through focus groups and individual interviews with hospital and community-based forensic clinicians from all professional groups: psychiatric medicine, social work, psychology, mental health nursing, occupational therapy, and psychiatric service officers. The main themes identified were orientation and adjustment to FMH, training in FMH, vicarious traumatization, clinical debriefing and clinical supervision, and therapeutic relationships. Participants described being frustrated and unsupported in making the transition to working with FP and felt conflicted by the emotional response that was generated when developing therapeutic relationships. Recommendations include the development of programmes that might assist clinicians and address gaps in service delivery, such as clinical governance, targeted orientation programmes, and clinical supervision.

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“…Forensic mental health nurses have reported using detached concern as a coping strategy when working with their patients (Fluttert et al, 2010). Detached concern may help with nursing staff burnout given that this strategy could potentially allow nurses to keep their emotional distance from their patients in an effort to reduce the psychological impact of instances of aggression (Fluttert et al, 2010). Similar issues apply to other professionals that work within forensic settings, which impact their performance (Jeanguenat & Dror, 2018).…”

Section: Literature Reviewmentioning

confidence: 99%

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

Cited by 16 publications

References 30 publications

What is important for the sustained implementation of evidence-based brief psychotherapy interventions in psychiatric care? A quantitative evaluation of a real-world programme

What is important for the sustained implementation of evidence-based brief psychotherapy interventions in psychiatric care? A quantitative evaluation of a real-world programme

Working with people who have killed: The experience and attitudes of forensic mental health clinicians working with forensic patients

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

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