j0411674PhD Thesis 2012

Gildberg, F.A. 2012. Reconstructing Normality. Interactional Characteristics of Forensic Mental Health Nursing Odense, Det Sundhedsvidenskabelige Fakultet, Klinisk Institut, Enheden for Sygeplejeforskning, Syddansk Universitet. ISSN: 2244-9302 Status Published

The number of forensic mental health patients in Denmark is increasing at a rate of 11% per year and forensic psychiatric patients occupy 20% of all psychiatric beds. For this group of inpatients everyday care is a part of the current psychiatric treatment offered on the forensic mental health wards. From a historical point of view mental health nursing in Denmark seems to rest on experience and the use of personal characteristics rather than research. The aim of the study therefore was to examine everyday care as it is carried out on the forensic mental health ward. The objective was to describe and analyse the care provided by mental health staff as they interact with forensic mental health inpatients. A further objective was to examine the staff’s experiences of everyday care, and what meaning the interactions held for them. The research questions behind the project were:

What characterises forensic mental health staff’s way of conduct in interaction with the ethnic Danish forensic mental health inpatient over the age of 18? What meaning does forensic mental health staff give their use of the above-mentioned interactional characteristics in their interaction with the ethnic Danish forensic mental health inpatient over the age of 18?

As a theoretical framework, symbolic interactionism was taken as an epistemological, methodological standpoint. To answer the aim and research questions of the study the project included 32 forensic mental health staff members over 307 hours of participant observations and focused observations, 48 informal interviews and seven semi-structured interviews. Using domain, taxonomic & empirical testing thematic analysis, the study concludes that: Staff interaction with the forensic patient is characterised by two overall themes. The first is ‘Trust & Relationship Enabling Care’, which is characterised by the establishment and maintenance of an informal, trusting relationship through a repeated reconstruction of normality that is generated in ordinary and commonly shared activity without verbal reference to illness. The intention is to establish a trusting relationship that allows for an insight into the patient’s experience and problems and the trust and insight are used to form a care relationship that revolves around the second theme, ‘Behaviour & Perception Corrective Care’. This type of care is characterised by staff’s endeavours to change, halt or support the patient’s behaviour or perception in relation to staff’s perception of normality. The intention is to support and teach the patient normal behaviour, to protect the patient from becoming embarrassed by correcting their behaviour and at the same time maintaining control and security by staying abreast of potential conflicts.

(c 2012 – ) Frederik Alkier Gildberg


Master of Science 2007

Gildberg F.A. 2007, Psykiatrisk Sygepleje. – Om tillidsskabende og terapeutisk anvendelse af personlige egenskaber. Institut for Folkesundhed. Afdeling for Sygeplejevidenskab, Aarhus Universitet, Aarhus, s. 6-100. Danish version available under publications.

The purpose of this thesis is to conduct a study of what characterizes the essential behaviour of psychiatric ward nurses towards psychiatric patients hospitalized in acute/intensive care, as well as establish the ulterior motives of such behaviour. The use of personal attributes has been advocated in a draft from the government as part of the grounds of psychiatric nursing, yet in existing textbook literature it is stated, that said attributes have an apparent therapeutic application in the relationship between nurse and patient. As nursing is a part of the current psychiatric treatment offered by the public health, it is therefore a necessity to examine the apparent therapeutic utilization of personal attributes in the relation between nurse and patient, as a such basic knowledge is necessary to, if possible, evaluate, improve and develop practice. However, only sparse research exists in this area, which is why the problem of this thesis examines the characterization of essential behaviour of psychiatric nurses towards psychiatric patients hospitalized in acute/intensive care, and also which intention the nurses ascribe thereto, including which meaning this intention has in proportion to the term therapeutic.
To do so, an ethnographic data construction and analytical method, as it is presented by Spradley; triangulated with the application of semi-structured interviews, as presented by Kvale and Spradley; as well as content analysis, as presented by Dey, Zoglowek and Bjerrum, is applied.
The results of the examination indicate that the application of personal attributes by nurses, take place under two forms of utilization: The pre-therapeutical, relationally access obtaining, maintaining and trust-establishing utilization of personal attributes, distinguished by lack of verbal reference to the patient’s illness and laying priority to the informal, humane, mutually recognizable and ‘normal’ aspects of interaction, with the intention of winning and maintaining the patient’s trust, and thus; put trust to effect in the relational therapeutic utilization of personal attributes, which reversely is distinguished by the nurses verbal reference to the patient’s illness and assumption of the complementary role as ‘assistant’, with the therapeutic intention of supporting, guiding, teaching and helping the patient in coping with his own health situation.

(c) Frederik Alkier Gildberg 2007-