Cindy Peternelj-Taylor

A Re-Visioning of Boundaries in Professional Helping Relationships: Exploring Other Metaphors

There are many ethical issues arising for practitioners in what are termed the boundaries of professional helping relationships. In this article, the authors argue that the boundary metaphor is not sufficient for conceptualizing these ethical issues and propose that alternative metaphors be considered. The use of a different metaphor might allow practitioners to re-vision the relationship issues in a more realistic, richer, and holistic way. Those explored here include highway, bridge, and territory. For the authors, it is territory that seems to hold the greatest promise.

Professional boundaries. A matter of therapeutic integrity.

1. Establishing and maintaining boundaries creates a relational space in which the patient and nurse are able to explore treatment issues within the safety of the therapeutic relationship. 2. The therapeutic relationship in founded on the basis of trust, respect, and appropriate use of power. Understanding the power differential within the nurse patient relationship is critical to the establishment and maintenance of professional boundaries. 3. Therapeutic integrity is rooted in knowledge, experience, and clinical judgment. As such, there are not always clearly demarcated answers to the tough questions posed by the dilemmas in practice. 4. Questions arising from practice challenge nurses to reflect on the meaning of boundaries in their personal and professional lives.

Forbidden Love: Sexual Exploitation in the Forensic Milieu

Strategies must be developed within forensic psychiatric nursing practice that deal with issues surrounding forbidden love before, during, and after they arise. Unfortunately, nurses are generally ill prepared to deal with the sexual dilemmas that can occur in clinical practice. Sexual dilemmas must be recognized as an occupational hazard and not a professional taboo. Open acknowledgement that the potential for abuse exists in all nurse-client relationships is the key to avoiding the pitfalls that lead to sexual impropriety.

A ‘good death’ for all?: examining issues for palliative care in correctional settings

Abstract The notion of dying a ‘good death’ is widespread among many cultures, despite variation in what this actually means. Efforts to facilitate dying well are reflected in palliative care and related movements. However, greater attention is needed with regard to the accessibility of a ‘good death’ in diverse social settings. In particular, we examine the attributes of a ‘good death’ relative to correctional settings to illustrate the tension between the objectives of palliative care and incarceration. Through this critical narrative review of the literature, we identify personal, social and political concerns that influence prisoners’ ability to access a ‘good death’ and health care providers’ potential to contribute to such an outcome. In doing so, we highlight divergence between palliative care theory and practice, and the complex issues faced by dying prisoners and their families, prison officials, health care providers and other members of palliative care teams. We conclude that, while dying well is potentially achievable within the contentious realm of corrections, further efforts are needed to improve access to palliative care and ensure the incarcerated are not denied their right to a ‘good death’.

Culturally Competent Care for Psychiatric Clients Who Have a History of Sexual Abuse

Canadian psychiatric nurses (N = 1,701) participated in a survey in which theyassessed their ability to nurse clients with a history of sexual abuse when cultural differences are present. Thirty-nine percent worked at a facility having a significant number of clients from a different culture. Only 4.6% rated themselves as “very competent.” Four themes emerged from nurses’ assessment of their ability: culture is not the problem, culture is not an issue, culture influences perspective and responses, and culturally specific competence. Only one cultural group, First Nations, was identified by sufficient numbers of nurses to generate themes concerning the challenge of working with clients from a particular culture. These themes (abuse as a cultural norm, concurrent and related health and social problems, reluctance to talk about problems, a need to learn about First Nations culture, and developing culturally competent caregivers), critical areas of concern, and possible solutions suggested by the nurses are discussed.

Mental health promotion in forensic & correctional environments.

I hope this brief glimpse into the concept of mental health promotion within forensic and correctional environments will challenge nurses to explore creative ways in which a mental health agenda can be formulated and actualized in practice.

Forensic nursing: a global perspective

Over the last decade there has been considerable growth in the role that psychiatric nurses play in providing care for the mentally disordered offender (MDO). Yet there has been little written about this specialty from a global perspective. Examination of the literature illustrates a large body of research and development programmes reporting the development of services to the MDO, for example, self‐harm and clinical risk assessment. Such service development is growing at a rapid pace, yet training and education to meet the needs of this patient group is something that is added onto post registration courses. Furthermore, the lack of vision and career pathways into forensic care is stifling a growing profession, which is subject to continual permanent change and investigation. Leaders and professional associations have contributed little to this unique nursing group which plays a major role in the multidisciplinary care of a very demanding set of patient needs.

A survey of psychiatric nurses regarding working with clients who have a history of sexual abuse

Abstract Background : There is strong evidence that a history of sexual abuse can have serious psychologic sequelae. Objective : The purpose of the study was to assess the comfort, attitudes, identified competencies, and educational needs of psychiatric nurses who work with these clients. Study Design : Surveys were mailed to a random sample of 3542 nursing personnel in four Canadian provinces. Measures were used to assess comfort, sexual attitudes, competencies, and educational needs. Results : A response rate of 48% (1701 responses) was achieved. Comfort and competency regarding working with clients varied according to educational preparation, gender of the nurse, and a personal history of abuse ( p Conclusion : The surveys showed that significant numbers of nurses are working with clients who report a history of sexual abuse. However, most participants do not believe they have adequate knowledge or therapeutic skills to work with these clients. Information from this study should provide direction for content of sexual abuse education programs.

Is impostor syndrome getting in the way of writing for the Journal of Forensic Nursing

Over the years, I have had the pleasure of working with many nurses interested in promoting nursing science through writing for publication. Whether in my academic role, or in my editorial role, I have had the opportunity to facilitate a number of seminars and writing workshops dedicated to writing for publication. I typically begin each seminar by asking those in attendance, some version of the following questions: (1) Why should nurses write for publication; (2) What do you hope to accomplish through writing for publication; and (3) What gets in the way of writing for publication? The first question typically generates a lively yet learned discussion on the merits of knowledge transfer and dissemination, the importance of professional discourse and debate, and improvements in client care that are realized through the sharing of clinical innovations. Nurses are equally forthcoming regarding their hopes and aspirations, and the inherent rewards related to seeing their names in print: professional recognition, fame and notoriety, career advancement, promotion and tenure, and last, a more altruistic response—personal satisfaction for a job well done. However, it is not until I pose the third question, regarding what gets in the way of writing, that I begin to see their vulnerabilities. Lack of time, resources, and support are consistently identified; after all this is the “easy” response, one that most of us can readily relate to. Who among us couldn’t use more hours in the day? More resources to do our jobs? Additional supports to cheer us on? And after a few light hearted comments on the virtues of cloning ourselves, the group generally becomes quite subdued. The real culprit isn’t time, resources, or even support. When I propose that perhaps a lack of confidence, or fear of failure, or “imposter syndrome” may be holding them back, I know that my suggestions resonate with them; not only can I see it in their faces, I can hear it in their nervous laughter.

Have you read your Forensic Nursing: Scope and Standards of Practice?

It has been a year since the revised edition of Forensic Nursing: Scope and Standards of Practice was published. Originally copublished by the American Nurses Association (ANA) and the International Association of Forensic Nurses (IAFN) in 1997, the revised edition published in 2009 not only builds upon the more than 20 years of an evolving knowledge base in forensic nursing, but moreover represents—the who, what, where, when, why, and how of forensic nursing practice (ANA & IAFN, 2009). Professional standards are authoritative statements, which reflect the current state of knowledge and understanding of a discipline and articulate the profession’s values and priorities. These statements describe the responsibilities for which its practitioners are accountable, in order to promote safe, competent, and ethical care. As such, the standards are written in a way that not only informs and guides practice, but also facilitates evaluation and measurement of outcomes, and speaks to professional accountability within the specialty, the profession, and to the public at large (ANA, 2004; Canadian Nurses Association (CNA), 2002). Forensic Nursing: Scope and Standards of Practice, represents the unique body of knowledge inherent to forensic nursing, including both the standards of practice and the standards of professional performance, written in a manner that differentiates between practice at the basic or generalist level, and the advanced practice level (something that is new to this edition). The six standards of practice (assessment, diagnosis, outcomes, identification, planning, implementation, and evaluation) and the nine standards of professional performance (quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership) are based on the ANA’s (2004) foundational document Nursing: Scope and Standards of Practice. Corresponding measurement criteria are identified, as a way of further actualizing each standard, by describing the inherent roles and responsibilities enacted by forensic nurses, while recognizing that “the depth and breadth in which individual registered nurses engage in the total scope of nursing practice is dependent upon education, experience, role, and the population served” (ANA & IAFN, 2009, p. ix). Forensic nursing has been recognized as a specialty area of nursing practice by the American Nurses Association since 1995, yet in many ways remains poorly understood. Clearly, some forensic nursing roles are more visible and prominent than others, and forensic nursing notoriety is often dependent upon where one is situated in the world. Kent-Wilkinson notes “without a doubt, the contemporary media has promoted the development of many ‘forensic’ specialties, as evident in the popularity of forensic-related television programmes (sic), inspiring a whole new generation of ‘CSI want-a-be’s’” (p. 381). Is it not our responsibility then, as forensic nurses, to educate other nurses, other healthcare professionals, other