“You Know Where the Boundary Is When You Cross It” - A Phenomenological Understanding of Vulnerability as Experienced by Carers in Forensic Inpatient Care

Hammarström, Lars; Devik, Siri Andreassen; Häggström, Marie

doi:10.1080/01612840.2022.2053011

Cited by 3 publications

(3 citation statements)

References 36 publications

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“…A CCN can end up damaging the nurse-patient relationship in situations where they come too close to the patient, and the boundary defining what is considered private is blurred. Hammarström et al (2022) highlighted that nurses know where the boundary is when they cross it and that by getting close to the patient nurses can become aware of the boundary determining how private and personal they can be. Furthermore, nurses also need to be aware that their view that WLST should be initiated may not align with patients' and family's view as patients and families may want to continue with invasive interventions.…”

Section: Discussionmentioning

confidence: 99%

Critical care nurses' role in the decision‐making process of withdrawal of life‐sustaining treatment: A qualitative systematic review

Heradstveit

Larsen

Solberg

et al. 2023

Journal of Clinical Nursing

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AimTo synthesise the qualitative evidence regarding the role of critical care nurses in the decision‐making process of withdrawing life‐sustaining treatment in critically ill adults.DesignQualitative systematic review.Review MethodsThis qualitative systematic review employed the guidelines of Bettany‐Saltikov and McSherry. The review was reported according to the ENTREQ checklist. Pairs of authors independently assessed eligibility, appraised methodological quality and extracted data. Data were synthesised using thematic synthesis.Data SourcesCINAHL, MEDLINE and EMBASE were searched for studies published between January 2001 and November 2021.ResultsTwenty‐three studies were included. Three analytical themes were synthesised: performing ethical decision‐making to safeguard patients' needs rights, and wishes; tailoring a supporting role to guide the family's decision‐making process; and taking on the role of the middleman by performing coordination.ConclusionThe role of the critical care nurses in the decision‐making process in withdrawal of life‐sustaining treatment requires experience and the development of the clinical perspective of critical care nurses.Implications for the profession and/or patient careEnhanced knowledge of the decision‐making process of withdrawing life‐sustaining treatment can prepare critical care nurses to be more equipped to master this role and enhance their ability to handle the emotional and moral stress associated with this part of the critical care unit.ImpactThe literature reveals the complex and challenging role of critical care nurses during the decision‐making process of withdrawing life‐sustaining treatment. Critical care nurses perform ethical decision‐making to safeguard patients' concerns, guide the family's decision‐making process and take on the role of the middleman. The findings have implications for critical nurses working in critical care units in hospitals and for educators and students in training in critical care nursing.Patient or Public ContributionNo patient or public contribution was included.

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Section: Discussionmentioning

confidence: 99%

Critical care nurses' role in the decision‐making process of withdrawal of life‐sustaining treatment: A qualitative systematic review

Heradstveit

Larsen

Solberg

et al. 2023

Journal of Clinical Nursing

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“…Controlling one's own emotions can be understood as a strategy for managing and minimizing problematic behavior [8]. According to Hammarström et al [20], nurses regulate their emotions in a forensic psychiatric environment as a way of dealing with emotions, not only in relation to themselves and the patient's expression of suffering, but also in relation to other nurses and patients (i.e., to preserve the institution's stability as a way of creating conditions for a caring climate). Regulating oneself as a way of striving for control means recognizing one's shortcomings and vulnerability as a prerequisite of getting to know the patient, getting closer to them, and establishing an alliance and a trusting relationship.…”

Section: Introductionmentioning

confidence: 99%

“…However, interventions that promote the establishment of therapeutic relationships and individualized patient-directed care appear to yield more promising results [24]. Nevertheless, the strategies used by carers when confronted with challenging patient behavior in forensic treatment remain largely unexplored [20]. The same applies to knowledge about how carers navigate their own emotions in general during interactions with patients in this context [25].…”

Section: Introductionmentioning

confidence: 99%

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

Hammarström,

Hellzén,

Devik

2023

Healthcare

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The aim of this study was to describe the phenomenon of “fleeing the encounter when facing resistance” as experienced by carers working in forensic inpatient care. Qualitative analysis, namely reflective lifeworld research, was used to analyze data from open-ended questions with nine carers from a Swedish regional forensic clinic. The data revealed three meaning constituents that describe the phenomenon: shielding oneself from coming to harm or harming the other, finding one’s emotional balance or being exposed, and offering the patient emotional space and finding patience. The carers described their approaches in the encounters with the patients as alternating between primitive instincts and expectant empathy in order to gain control and deal with the interaction for their own part, for that of the patient, and for that of their colleagues. The phenomenon of fleeing the encounter when facing resistance was intertwined with carers’ self-perception as professional carers. Negative encounters with patients evoked feelings of shame and self-blame. A carer is a key person tasked with shaping the care relationship, which requires an attitude on the part of the carer that recognizes not only the patient’s lifeworld but also their own.

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A Meta-Ethnographic Review of Forensic Psychiatry Inpatient Care. Nursing Staff Experiences of the Nurse-Patient Encounter

Hellzén,

Hammarström,

Ekman

et al. 2023

Issues in Mental Health Nursing

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“You Know Where the Boundary Is When You Cross It” - A Phenomenological Understanding of Vulnerability as Experienced by Carers in Forensic Inpatient Care

Cited by 3 publications

References 36 publications

Critical care nurses' role in the decision‐making process of withdrawal of life‐sustaining treatment: A qualitative systematic review

Critical care nurses' role in the decision‐making process of withdrawal of life‐sustaining treatment: A qualitative systematic review

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

A Meta-Ethnographic Review of Forensic Psychiatry Inpatient Care. Nursing Staff Experiences of the Nurse-Patient Encounter

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