Frederik Alkier Gildberg

Forensic psychiatric nursing: a literature review and thematic analysis of staff–patient interaction

In Denmark the increasing number of forensic mental health patients has led to prioritized services, including the area of nursing; however, this field is subject to sparse research. The aim of this study was to review existing research literature and in doing so investigate what characterizes forensic mental health staff interaction with forensic mental health inpatients and furthermore to investigate what significance these staff characteristics have for the inpatients. The literature review spans the period September 1997 to January 2009 and was based on a systematic keyword combination search in the following databases: CINAHL, CSB, PsycINFO, Scopus, Pubmed, MEDLINE and Sociological Abstracts. The articles were categorized using a literature matrix and analysed using content analysis. Seventeen quantitative and qualitative research studies were analysed. The results show that the interaction between forensic staff and forensic inpatients is characterized by two overriding themes: parentalistic & behaviour-changing care and relational & personal quality-dependent care. Only a few of the findings represent a clear account of how the interactional characteristics impact on the forensic inpatient. The conclusion is that no clear account of the patient impact issue can be reached at this point and that further investigation needs to take place.

Reconstructing Normality: Characteristics of Staff Interactions with Forensic Mental Health Inpatients

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 staffs endeavours to change, halt, or support the patients behaviour or perception in relation to staffs 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.

As time goes by: reasons and characteristics of prolonged episodes of mechanical restraint in forensic psychiatry

Abstract Evidence suggests the prevalence and duration of mechanical restraint are particularly high among forensic psychiatric inpatients. However, only sparse knowledge exists regarding the reasons for, and characteristics of, prolonged use of mechanical restraint in forensic psychiatry. This study therefore aimed to investigate prolonged episodes of mechanical restraint on forensic psychiatric inpatients. Documentary data from medical records were thematically analyzed. Results show that the reasons for prolonged episodes of mechanical restraint on forensic psychiatric inpatients can be characterized by multiple factors: “confounding” (behaviors associated with psychiatric conditions, substance abuse, medical noncompliance, etc.), “risk” (behaviors posing a risk for violence), and “alliance parameters” (qualities of the staff–patient alliance and the patients’ openness to alliance with staff), altogether woven into a mechanical restraint spiral that in itself becomes a reason for prolonged mechanical restraint. The study also shows lack of consistent clinical assessment during periods of restraint. Further investigation is indicated to develop an assessment tool with the capability to reduce time spent in mechanical restraint.

Mental Health Nursing, Mechanical Restraint Measures and Patients’ Legal Rights

Coercive mechanical restraint (MR) in psychiatry constitutes the perhaps most extensive exception from the common health law requirement for involving patients in health care decisions and achieving their informed consent prior to treatment. Coercive measures and particularly MR seriously collide with patient autonomy principles, pose a particular challenge to psychiatric patients’ legal rights, and put intensified demands on health professional performance. Legal rights principles require rationale for coercive measure use be thoroughly considered and rigorously documented. This article presents an in-principle Danish Psychiatric Complaint Board decision concerning MR use initiated by untrained staff. The case illustrates that, judicially, weight must be put on the patient perspective on course of happenings and especially when health professional documentation is scant, patients’ rights call for taking notice of patient evaluations. Consequently, if it comes out that psychiatric staff failed to pay appropriate consideration for the patient’s mental state, perspective, and expressions, patient response deviations are to be judicially interpreted in this light potentially rendering MR use illegitimated. While specification of law criteria might possibly improve law use and promote patients’ rights, education of psychiatry professionals must address the need for, as far as possible, paying due regard to meeting patient perspectives and participation principles as well as formal law and documentation requirements.

Comparing the Obvious: Interactional Characteristics of Staff in Acute Mental Health Nursing and Forensic Psychiatric Nursing

This article reports on and compares two separate studies of the interactional characteristics of forensic mental health staff and acute mental health staff as they interact with inpatients, respectively. Both studies were conducted using participant observation, along with informal and formal interviews. Findings show that both acute and forensic mental health nursing practice is characterized by two overriding themes; ‘trust and relationship-enabling care’ and ‘behavior and perception-corrective care.’ The comparison of the two studies shows no major differences in the characteristics of staff interactions with patients or in the overall meanings ascribed by staff in the different practice settings.

The use of humor in forensic mental health staff-patient interactions

ABSTRACT Humor utilized in the practice of forensic mental health nursing might seem somehow inappropriate, given the serious circumstances surrounding most forensic mental health patients. However, some recent research has pointed to the use of humor as an important component in staff interactions with forensic mental health patients. This study reviews the existing international forensic mental health research literature on humor to investigate (a) what characterizes forensic mental health staff–patient use of humor and (b) what significance humor holds within the forensic mental health setting. The search was conducted in June 2013. Scopus, CINAHL, PubMed, and PsychINFO were searched using keywords relevant to the study. Articles were categorized using a literature matrix and analyzed using thematic analysis. Twelve research articles were reviewed and included in the analysis. Three themes were identified: (a) “humor as staff skill,” showing that staff found humor to be important as an interpersonal ability; (b) “humor as a relational tool” with the purpose of establishing and maintaining staff–patient interactions; and (c) “the impact of humor on patients,” describing impacts on conflicts, dimensions of health, and motivation. The results of the analysis are however limited because of the dearth of published articles on the subject.

Humor: Power Conveying Social Structures Inside Forensic Mental Health Nursing

ABSTRACT According to research literature, humor inside the staff–patient interaction seems to be significant in the area of forensic mental healthcare. However, existing literature on the subject is limited. Therefore, the aim of this study was to explore the characteristics of the use humor by forensic mental health staff members in interactions with forensic mental health inpatients. The study included 32 forensic mental health staff members, used 307 hours of participant observations, 48 informal interviews, and seven formal semistructured interviews. Outcomes identify four themes concerning the conveyance of power to, from, and between forensic mental health staff and patients as they interact: (a) “the informal use: the human-to-human approach,” characterized by an informal use of humor and without any reference to mental health issues; (b) the “formal use of humor: the staff–patient approach,” characterized as formal with a view on the patient as mentally ill, unable to understand humor, and with the aim of using humor to prevent conflicts or negative behavior; (c) “protest against requested care: the human–patient approach,” characterized by the use of humor as a protest against requested care; and the use of (d) “inadequacy humor: the staff–human approach,” characterized by the use of inadequacy—humor referring to, for example, patients’ physical features. Recommendations and clinical implications are discussed.