User involvement in structured violence risk management within forensic mental health facilities – a systematic literature review

Eidhammer, Gunnar; Fluttert, Frans; Bjørkly, Stål

doi:10.1111/jocn.12571

Cited by 26 publications

(26 citation statements)

References 35 publications

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“…Forensic psychiatric care aims to mitigate psychiatric symptoms and prevent the occurrence of further offences. Eidhammer, Fluttert, and Bjørkly (2014) argued that a common problem within forensic psychiatric care settings is that health care staff make decisions and act without involving or informing patients. Fluttert, Meijel, Nijman, Bj€ orkly, and Grypdonck (2010) demonstrated a significant decrease in seclusions and violent behaviour among patients who participated in the establishment of their own risk management plans compared to those who did not, supporting the benefits of active patient participation in the care.…”

Section: Introductionmentioning

confidence: 99%

An Interview Study of Professional Carers’ Experiences of Supporting Patient Participation in a Maximum Security Forensic Psychiatric Setting

Söderberg

Wallinius

Hörberg

2019

Issues in Mental Health Nursing

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Patient participation in forensic psychiatric settings seems to be complex by nature, and previous studies show that patients rate their participation as lower in this context compared to general psychiatric contexts. Studies on caregivers' perspective could provide a clearer picture of the components and possibilities of patient participation in forensic psychiatry. The aim of the study is to describe carers' experiences in supporting patient participation in a maximum security forensic psychiatric care setting. Twelve psychiatric caregivers were interviewed about how they support patients' participation. The result shows that a complexity of patient participation emerges as a difficult act of balancing the paradoxical role of caring for the patient's interests and development, while simultaneously representing and adhering to the rules and regulations of the system in which one is employed. In conclusion, it is suggested that participation is comprehended as an umbrella term and that focus is directed to conceptualising what caregivers can do in order to create positive patient-carer relationships, as well as what constitutes such a relationship.

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Section: Introductionmentioning

confidence: 99%

An Interview Study of Professional Carers’ Experiences of Supporting Patient Participation in a Maximum Security Forensic Psychiatric Setting

Söderberg

Wallinius

Hörberg

2019

Issues in Mental Health Nursing

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“…This finding is in line with those of Bressington, Stewart, Beer, and MacInnes (2011), who concluded that the users of forensic mental health services perceived that their satisfaction with care was strongly associated with the quality of the therapeutic alliance. In addition, Eidhammer, Fluttert, and Bjørkly (2014) highlight the importance of developing a good alliance between nurses and patients to achieve successful risk management.…”

Section: Discussionmentioning

confidence: 99%

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

Nyman

Hofvander

Nilsson

et al. 2019

International Journal of Forensic Mental Health

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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.

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“…Given the limited presence of patient perspectives in the risk management literature (Eidhammer et al, ), the SR employed a mixed studies design to maximize the capture of relevant studies. Moreover, it was thought to be particularly important to include qualitative and mixed‐methods research that may capture patient lived experiences of practices that might be helpful.…”

Section: Methodsmentioning

confidence: 99%

“…Given the limited presence of patient perspectives in the risk management literature (Eidhammer et al, 2014), the SR employed a mixed studies design to maximize the capture of relevant studies.…”

Section: Justification For a Mixed Studies Reviewmentioning

confidence: 99%

Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research

Deering

Pawson

Summers

et al. 2019

Psychiatric Ment Health Nurs

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Accessible Summary What is known about the subject? Risk in psychiatry involves harm to self or others owing to mental health difficulties, for example iatrogenic effects of treatment, self‐harm, suicide and violence. Risk management is a framework to minimize risks, comprising of risk assessment, generation of risk management plans and evaluation of interventions. Literature has extensively explored risk management and presented a critique that its practices can lead to patient harm. However, there is a paucity of literature about what patients identify as helpful risk management practices, despite the potential for such patient views to ameliorate harm and improve mental health care. What this paper adds to existing knowledge Interpersonal relationships with clinicians, and communication that keeps patients involved and informed of management processes, were found to be central to beneficial risk management practices, while patients having agency and autonomy to influence their participation was also important. Beneficial interpersonal relationships and connectivity in the form of patients’ wider community of support were found to be influential in aiding risk management. Meaningful relationships, and particularly peer support, that maintained personal and collective identities were prevalent in the literature. What are the implications for practice? Rendering risk management more visible and accessible in practice might cultivate an openness that promotes patient participation. This includes drawing on a wider network of support, for example the patient’s friends and family, as well as having advocacy utilizing peer support. AbstractIntroductionMinimizing the harm that patients pose to themselves and others, due to mental health difficulties, is a central component of risk management in psychiatry. However, risk management itself can cause patient harm, but despite this and the potentially informative value of lived experience, little is known about what patients want or expect from risk management.AimTo review research and explore what patients consider beneficial in risk management practice.MethodA mixed studies systematic review utilizing PRISMA guidelines, alongside a convergent qualitative design to categorize findings.ResultsTwelve papers were identified, generating two categories of beneficial practices: interpersonal relationships and communication with clinicians; coupled with patient agency in their own risk management.DiscussionConnectivity appears important. Particularly patients feeling involved, and their voices being heard in both the identification of risks and then shaping risk management practice. Moreover, this included involvement of friends, family and peers to widen input and supportive networks beyond clinical relationships.Implications for PracticeRisk management needs to be an accessible part of care, which is more inclusive of patient views and needs. The latter might also be aided by drawing on the patient's wider community in order to provide more effective support and r...

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User involvement in structured violence risk management within forensic mental health facilities – a systematic literature review

Cited by 26 publications

References 35 publications

An Interview Study of Professional Carers’ Experiences of Supporting Patient Participation in a Maximum Security Forensic Psychiatric Setting

An Interview Study of Professional Carers’ Experiences of Supporting Patient Participation in a Maximum Security Forensic Psychiatric Setting

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

Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research

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