Meanings of carers’ lived experience of “regulating oneself” in forensic psychiatry

Abstract

Purpose This study aimed to illuminate the essential meanings of carers’ lived experience of regulating themselves when caring for patients with mental illnesses in forensic inpatient care. Methods Qualitative analysis was used to analyse data from narrative interviews with open-ended questions conducted with nine carers, which were analysed using a phenomenological-hermeneutic approach. Results Findings revealed three themes, “preserving oneself as a carer,” “building an alliance with the patient” and “maintaining stability in the community.” Carers not only regulated emotions related to patients but also the ward to facilitate a caring climate. For carers, encounters with patients meant facing expressions of suffering that evoked unwanted emotions. Regulating one’s emotions also meant being emotionally touched and facing one’s vulnerability. Conclusion Regulating oneself was a strategy used by carers to get closer to the patient and establishing a trusting relationship. Regulating oneself meant becoming aware of one’s shortcomings, not projecting them onto others, which may impair establishing relationships with patients and fulfilling the aim and caring task of forensic psychiatry. This study stresses the importance of carers being guided to manage their conflicting emotions and vulnerabilities and finding courage and an approach that allows a permissive climate of self-reflection.

Facilitating a safe and caring atmosphere in everyday life in forensic mental health wards - a qualitative study

“…Fosse et al ( 2021 ) found that patients’ serious mental illnesses and lived lives entail the potential for violence in everyday life situations. Dangerous behaviour caused by severe childhood experiences and losses may occur in healthcare professional—patient encounters in forensic care, and the presence of qualities such as fellowship, togetherness, dignity, and self-respect may reduce violent behaviour, promote recovery, humanize patient behaviour in light of lived lives, and make care less stigmatized and rigid (Hammarström et al, 2022 ; Rytterström et al, 2021 ; Söderberg et al, 2022 ). Patients in forensic psychiatric settings express the need to feel a sense of belonging that allows them to be themselves and feel accepted (Aga et al, 2019 ; Hörberg, 2018 ).…”

Everyday ordinariness, neglected but important for mental health nurses' therapeutic relationships: An initial exploration for applying Daniel Kahneman's two systems of thinking

“…(Hartley et al, 2020, p. 1) Thirdly, MHNs working in A&S care practice in emotionally and professionally demanding contexts. They are expected to 'regulate' their emotional expression to match variable service user contexts and needs (Hammarström et al, 2022;Jackson & Stevenson, 2000) whilst negotiating issues of differential power over people receiving A&S care (Cutcliffe & Happell, 2009). Consequently, the experience of personal anxiety, stress and sometimes burnout is associated for MHN with 'emotional labour' involving the suppression of their own emotions whilst caring for people (Edward et al, 2017;Mann & Cowburn, 2005).…”

‘Fleeing’ as a Strategy for Navigating Resistance in Patient Encounters within Forensic Care

“…Regulating oneself entails more than just introspection; it also involves recognizing and addressing conflicting emotions without displaying the ongoing internal conflict. In other words, this means challenging one's understanding of oneself and one's preconceived notions to be open to the patient's world of life [21].…”

“…In psychiatric care, a need for regulating one's own emotions usually occurs in connection with staff experiencing emotional reactions, such as fear and anger, in connection with conflicts with patients [19]. Hammarström et al [21] have described nurses' handling of emotions in such situations as coping strategies. Among the strategies identified was 'preserving oneself as a carer', which included 'fleeing from situations' as a way of coping with emotions when faced with resistance or feeling threatened.…”

“…Björkdahl et al [7] succinctly categorize carers' coping strategies into confrontational or avoidant approaches, while Hammarström et al [21] reveal that carers, when overwhelmed by their own emotions, sometimes opt to distance themselves from patient encounters, a tactic that not only separates them from the patient but also creates a divide from their own fears or frustrations. This inability to consistently manage their emotions during patient interactions can be assumed to have implications for staff well-being, staffing stability, as well as the quality of patient care [26].…”