Tom Mason

Forensic psychiatric nursing: skills and competencies: II clinical aspects

This study reports on research undertaken to identify the skills and competencies of forensic psychiatric nurses working in secure psychiatric services in the UK. The rationale for this research is the lack of clarity in the role definition of nurses working in these environments and the specific content that may underscore the curriculum for training forensic nurses. Over 3300 questionnaires were distributed to forensic psychiatric nurses, non-forensic psychiatric nurses and other disciplines and information obtained on (1) the perceived clinical problems that give forensic nurses the most difficulty; (2) the skills best suited to overcome those problems; and (3) the priority aspects of clinical nursing care that needs to be developed. A 35% response rate was obtained with 1019 forensic psychiatric nurses, 110 non-forensic psychiatric nurses and 43 other disciplines. The results highlighted a ‘top ten’ list of main problems with possible solutions and main areas for development. The conclusions drawn include a focus on skills and competencies regarding the management of personality disorders and the management of violence and aggression.

The social construction of evil in a forensic setting

Abstract This paper is a product of serendipity. It explores how wardbased psychiatric nurses in one Special Hospital attribute the notion of ‘evil’ to deviant activities. Staff were asked to read and make comments about a series of vignettes, abbreviated offence scenarios, from which emerged the construction of a taxonomic order of evil. These explanations of evil were then juxtaposed alongside their counterparts from theodicy. Deviancy attributed to extreme psychoticism is not credited with being an evil act, such individuals having a primordial contract of innocence. In contrast, extreme crimes committed by those with a psychopathic disorder are considered evil. An evil act is seen to be one which transgresses a ‘natural boundary’; the product of purposeful action after the accumulation of stages of ‘reality testing’; and, finally, a consequence of the extinction of moral bonding leading to residual instinctive behaviour.

Gender differences in the use of seclusion.

This paper offers a contribution to the research on the use of seclusion by focusing specifically on gender. The study was carried out in a special hospital which provides care in conditions of high security. Data were collected on all seclusions over a one-year period which resulted in a database of 823 episodes of seclusion. The results indicate that female patients account for more seclusions than their male counterparts and that they are secluded more often but for shorter durations. Whereas the mentally ill category are subject to more seclusions it is the psychopathically disordered classification that is responsible for more female episodes. Further research is under way to examine the reasons for the disparities.

A new look at seclusion: stress, coping and the perception of threat

Abstract In this paper we wish to develop a new perspective on the issue of seclusion. Much of the debate on seclusion has become polarized between its supporters and antagonists with a variety of rationales put forward for the employment of the technique. We seek to move this debate forward by emphasizing the social psychology of the seclusion episode and focusing in particular on the experience of threat and anxiety by staff prior to the initiation of seclusion. Anticipation of possible violence and harm generates high levels of anxiety in staff, especially as the predictability of violence is often low. We propose a new model of the seclusion decision-making process based on Lazarus and Folkmans (1984) cognitive theory of stress. This model enables us to examine the role of the nurses appraisal of threat and of his (or her) coping resources as key factors in the decision to seclude a patient.

Forensic Learning Disability Nursing Skills and Competencies: A Study of Forensic and Non-Forensic Nurses

This paper reports on an investigation into the skills and competencies of forensic learning disability nurses in the United Kingdom. The two sample populations were forensic learning disability nurses from the high, medium, and low secure psychiatric services and non-forensic learning disability nurses from generic services. An information gathering schedule was used to collect the data; of 1200 schedules, 643 were returned for a response rate of 53.5%. The data identified the “top ten” problems that forensic learning disability nurses may encounter, the skills and competencies necessary to overcome them, and the areas that need to be developed in the future. The results indicated that the forensic learning disability nurses tended to focus on the physical aspects to the role whilst the non-forensic learning disability nurses tended to perceive the forensic role in relational terms. This has implications for practice, policy, and procedures.

Binary construct analysis of forensic psychiatric nursing in the UK: High, medium, and low security services

The aim of this study was to identify if differences in perceptions of the role of forensic psychiatric nurses exist across the three levels of secure psychiatric provision: high, medium, and low. Any differences may reflect the type of clinical conditions found in different levels of security provision. An information-gathering schedule containing a validated 7-point Likert scale was distributed to 1200 forensic psychiatric nurses across the UK in 2005. A response rate of 34.6 was achieved, with 122 from high-security, 159 from medium-security, and 135 from low-security services. Differences in perceptions regarding role constructs were found across all three levels, with numerous differences being statistically significant using analysis of variance. The main implications are in relation to the development of skills and competencies, which should target specific clinical conditions in relation to effective interventions, the development of a specialist education and training curriculum focused on treatment outcomes, and the need for further research to draw together theory and practice. Finally, creative policy initiatives should be developed to cross-fertilize the levels of security provision in order that staff may acquire and deliver experiences in high-, medium-, and low-security psychiatric services.

Postnatal disclosure of domestic violence: comparison with disclosure in the first trimester of pregnancy.

AIMS AND OBJECTIVES This study explored the prevalence rates of domestic violence reported during the first trimester of pregnancy and in the postnatal period. BACKGROUND Domestic violence is known to have a deleterious effect on the physical and psychological well-being of a woman, with an adverse effect on the unborn child. DESIGN A validated anonymous and self-administered questionnaire (Abuse Assessment Screen) using five closed questions was used for data collection in all samples. All women were approached alone, and the questionnaire was completed in private. METHOD Drawn from the same geographical area, this survey collected data from women accessing hospital clinics, in a large university teaching hospital in the UK. RESULTS Comparing self-reporting rates of domestic violence in the first trimester of pregnancy to the postnatal period yielded statistically significant results (p < 0·01). Only 7·3% booking-in clinic and 8% postnatal women reported violence at some stage in their life, whilst higher rates in pregnancy counselling clinic (35·1%) and early pregnancy unit (26%) were reported. However, the reported rates of domestic violence in the year before the women were pregnant revealed a different trajectory. Lower rates of domestic violence were evident in three samples. CONCLUSIONS The disparity in disclosure rates of domestic violence suggests that an emotional inhibitory response to disclosure may occur at specific periods of pregnancy and that the timing of asking about domestic violence may be critical to this disclosure. The pandemic nature of domestic violence reflects the need for practice in maternity care to reflect the changing needs of a woman during her gestational experience. RELEVANCE TO CLINICAL PRACTICE The primary objective of health care providers should be to engage a pregnant woman in a meaningful relationship, gaining her trust to facilitate the disclosure of domestic violence. Hence, whatever the policies for the provision of maternity care, the changing needs of a pregnant woman must be met.

Forensic nurses' perceptions of labels of mental illness and personality disorder: clinical versus management issues

Anecdotally, forensic psychiatric nurses generally have a more negative perception of people diagnosed with a personality disorder and this negativity is focused more towards managing the behaviours rather than on treatment efficacy and clinical outcomes. This study reports on research carried out across the High, Medium and Low secure psychiatric services in the UK. One thousand two hundred questionnaires were distributed with a response rate of 34.6%. The results indicated a statistically significant difference across High (z = 9.69; P < or = 0.01), Medium (z = 11.06; P < or = 0.01) and Low (z= 9.57; P= 0.01) security with a focus on the management of people with a personality disorder using the Wilcoxon paired samples test. There was also a statistically significant difference in relation to a more clinical/treatment focus for those with a diagnosis of mental illness in Medium (z = 9.69; P < or = 0.01) and Low (z = 9.57; P < or = 0.01) security but not in the High security services. Finally, the results showed significant differences between High, Medium and Low security on each of the four scales of Personality Disorder Clinical-Personality Disorder Management and Mental Illness Clinical-Mental Illness Management. This raises issues of stigma, prejudice and discrimination and suggests a refocus on skills development, acquisition and application for those with a label of personality disorder.

Some Specific Problems of Secluding Female Patients

This paper reports on a study of secluded female patients in a special hospital. A random selection of seclusions occurring within one week of initiation were chosen and data were collected by a structured interview, involving nurses who had made the decision to initiate the seclusion. The interview schedule contained 18 items and the analysis utilized chi square test for categorical data and Speramans rank coefficient for correlation on the scores on two variables. The results indicated that there was an erratic use of alternative approaches attempted prior to the use of seclusion and that the stripping of patients as they are secluded is rationalized as ‘in the interest of their safety’. It is argued that further research is urgently required to interview the female patients concerned and to explore the specific issues pertaining to the seclusion of female patients. We question whether a high security psychiatric hospital is the most appropriate placement for females.

Binary constructs of forensic psychiatric nursing: a pilot study

The aim was to develop an Information Gathering Schedule (IGS) relevant to forensic psychiatric nursing in order to establish the perceived differences in the three levels of security, high, medium and low. Perceived differences in the role constructs of forensic psychiatric nursing is said to exist but the evidence is qualitative or anecdotal. This paper sets out a pilot study beginning in 2004 relating to the development of two rating scales for inclusion into an IGS to acquire data on the role constructs of nurses working in these environments. Following a thematic analysis from the literature two sets of binary frameworks were constructed and a number of questions/statements relating to them were tested. The Thurstone Scaling test was applied to compute medians resulting in a reduction to 48 and 20 items for each respective framework. Two 7-point Likert scales were constructed and test-retest procedures were applied on a sample population of forensic psychiatric nurses. Students t-test was conducted on the data and the results suggest that the IGS is now suitable for application on a larger study. The IGS was piloted on a small sample of forensic psychiatric nurses. The two scales were validated to coefficient values ranging from 0.7 to 0.9. Amendments were made and the IGS was considered acceptable.