Reconstructing normality: Characteristics of staff interactions with forensic mental health inpatients

Abstract

Forensic psychiatry is an area of priority for the Danish Government. As the field expands, this calls for increased knowledge about mental health nursing practice, as this is part of the forensic psychiatry treatment offered. However, only sparse research exists in this area. The aim of this study was to investigate the characteristics of forensic mental health nursing staff interaction with forensic mental health inpatients and to explore how staff give meaning to these interactions. The project included 32 forensic mental health staff members, with over 307 hours of participant observations, 48 informal interviews, and seven semistructured interviews. The findings show that staff interaction is typified by the use of trust and relationship-enabling care, which is characterized by the establishment and maintenance of an informal, trusting relationship through a repeated reconstruction of normality. The intention is to establish a trusting relationship to form behaviour and perceptual-corrective care, which is characterized by staff's endeavours to change, halt, or support the patient's behaviour or perception in relation to staff's perception of normality. The intention is to support and teach the patient normal behaviour by correcting their behaviour, and at the same time, maintaining control and security by staying abreast of potential conflicts.

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

“…However, in this study, “protest behaviour” was mainly characterized by patients showing aggressive/violent behaviour. This appeared to be mainly due to a perceived loss of autonomy, suggesting that patients were protesting against the custodial care provided by professionals, as described by Gildberg, Elverdam, and Hounsgaard () and Gildberg, Bradley, Fristed, and Hounsgaard (). Moreover, the current review found that patients requested more communication (b) or de‐escalation from professionals to help manage their “protest behaviour.” Existing literature confirms that aggressive/violent behaviour is a common reason for initiating coercive measures (Stewart et al., ; Hui et al., ; Laiho et al., ), while research by Duxbury (), Dickens, Piccirillo, and Alderman () and Pulsford et al.…”

Forensic mental health clinician's experiences with and assessment of alliance regarding the patient's readiness to be released from mechanical restraint

“…This concept is identified among FMH clinicians as the basis for talking and listening to the patient to gain insight into and knowledge of the patient, create a positive contact, establish a relationship, and lays the ground for behaviour and perception corrective care (Gildberg et al . ). In this study, FMH clinicians stated that a personal alliance facilitated their interactions with, and understanding and prediction of the patient's reactions during MR, and this strengthened their feelings of safety and confidence in their assessment of the patient.…”

To do good might hurt bad: Exploring nurses' understanding and approach to suffering in forensic psychiatric settings

“…Even though this could be understood as nurses striving to keep order in the unit (Bowen & Mason 2012) and obtain equilibrium within a turbulent environment (Salzmann-Eriksson et al 2011), it could also be a threat to patients' dignity. Thus, if normality is defined from the perspective of the staff (Gildberg et al 2012), nurses' intentions to do good might hurt the patient.…”