Mental Health Nurses’ Experiences of Risk Assessments for Care Planning in Forensic Psychiatry

Abstract

The risk of patients committing violence implies major challenges throughout the care process in forensic psychiatry and brings risk assessments to the fore. The aim was to explore nurses' experiences of risk assessments for their care planning and risk management in forensic psychiatry. Data were collected through focus groups with 15 nurses. The qualitative content analysis followed a deductive approach guided by the person-centered philosophy. When exploring nurses' reasoning on risk assessment, units related to person-centered principles were identified. The findings showed that nurses made great efforts to confirm the unique person behind the patient, even when challenged by patients' life histories of violence. They also regarded therapeutic alliance as crucial, although this needed to be balanced between caring and restricting actions. A fruitful strategy to preserve therapeutic alliance may be to increase the use of a structured focus on protective factors in treatment plans towards promoting recovery-oriented policies and practices.

Violence rate dropped during a shift to individualized patient-oriented care in a high security forensic psychiatric ward

“…Studies based upon patient and staff views also emphasise relations and individualized aspects of risk management in forensic settings. Relationships are highlighted as a fundamental part of recovery trajectories [41], therapeutic alliances are seen as crucial in risk assessment, providing personal information about the patient and contributing to inclusion and participation [50] and encouraging patient participation is considered important in avoiding and preventing violence [51].…”

“You Should Just Keep Your Mouth Shut and Do As We Say”: Forensic Psychiatric Inpatients’ Experiences of Risk Assessments

“…This also connects to findings from mental health nurses that stress the importance of establishing a trusting relationship with patients as a crucial factor of the risk assessment process (Nyman et al, 2019). The trusting relationship was formulated in terms of keeping the patient informed and prepared before meetings which in turn, was assessed as crucial for ensuring involvement and awareness of the arguments related to the patients' risk assessments (Nyman et al, 2019).…”

“…The importance of a trusting relationship with staff was also stressed among inpatients in a medium secure forensic setting when offering their perspectives on rehabilitation (Barnao et al, 2015) and their satisfaction with care in forensic mental health settings (MacInnes et al, 2014). This also connects to findings from mental health nurses that stress the importance of establishing a trusting relationship with patients as a crucial factor of the risk assessment process (Nyman et al, 2019). The trusting relationship was formulated in terms of keeping the patient informed and prepared before meetings which in turn, was assessed as crucial for ensuring involvement and awareness of the arguments related to the patients' risk assessments (Nyman et al, 2019).…”

“…Despite the fact that the importance of a patient's perspective is stressed in modern psychiatric care, findings still indicate a lack of awareness from the patients regarding the actual contents of the risk assessment (Dixon, 2012); there seems to be, "a difficult balancing act" (Shingler et al, 2018, p. 3208). This idea resembles the findings of another study exploring forensic mental health nurses' experiences of risk assessments and their use of them in care planning (Nyman et al, 2019). The risk assessments' focus on the patients' histories of violence challenged the nurses strive to establish a mutual relationship with the patient, in order to confirm the unique person behind the patient.…”

“…The risk assessments' focus on the patients' histories of violence challenged the nurses strive to establish a mutual relationship with the patient, in order to confirm the unique person behind the patient. The nurses also viewed the therapeutic alliance as crucial, though there was also a need to balance both caring and restricting actions (Nyman et al, 2019).…”