High, medium, and low security care: Does the type of care make any difference to the role of the forensic mental health nurse?

Abstract

This paper describes a survey of the educational preparation of nurses working in high, medium and low security mental health settings. Data from focus groups and interviews were also content-analysed to yield a theory of nursing in secure environments comprising of statements of competency. The competences were translated into a questionnaire and distributed to nurses working in high, medium and low security mental health settings. Respondents stated whether individual competences were part of their current practice or supervisory involvement, and the degree of importance they accorded to each competency. The competence framework received widespread support from nurses at all levels of security in relation to their role description and level of importance. Results identified issues in relation to security and how procedures in parts of the system (notably in high security) militate against therapeutic care. Noticeable differences emerged between respondents working in high and medium secure environments in relation to involvement of the patient's family and preparation for discharge. Issues of concern common to all levels of security included teamwork, balancing security and therapy, boundaries of professional practice, and clinical supervision.

Forensic psychiatric nursing: a description of the role of the psychiatric nurse in a high secure psychiatric facility in Ireland

“…Respondents recognized the importance of such interventions but they were not using them in the course of their work. Dale & Storey (2004) had similar findings in the UK and considered that high secure services have become isolated from local communities with subsequent difficulties in discharging patients to local psychiatric services (O'Neill et al . 2002).…”

“…The United Kingdom Central Council (1999) study highlighted similar findings for these community orientated interventions, which may have some resonance in an Irish setting. Nurses in both studies were restricted in their autonomy as they worked shifts and consequently missed important team briefings, were moved between units to cover staff shortfalls and felt disenfranchised from the decision making process (Dale & Storey 2004).…”

“…The use of a ‘competency framework’ has also been put forward as one method that may assist in describing the role of FPNs and one that received widespread support in Canada, the UK and Scotland (Niskala 1986, Royal College of Nursing 1997, National Board for Scotland 1999; United Kingdom Central Council 1999, Dale & Storey 2004, Mason et al . 2008a).…”

“…2008a). Dale & Storey (2004) were the authors of the United Kingdom Central Council (1999) study and surmised that the development of skills and knowledge linked to appropriate attitudes and values would construe a competency framework. This study examined nursing practice in secure environments in the UK via initial interviews and focus groups with key personnel (United Kingdom Central Council 1999).…”

Working with people with learning disabilities in varying degrees of security: nurses' perceptions of competencies

“…Furthermore, there is also evidence that skills evident in other forensic nursing roles may be transferable to the forensic learning disability role. Dale and Storey () list 45 competency statements produced from research with forensic mental health nurses working in low, medium and high secure settings. Some factors were common to all three settings, such as team working, balancing care and control; others were setting‐specific, for example, those working in a high secure setting did not see discharge planning and community support as part of their role.…”