Forensic Mental Health Nursing

The number of forensic mental health inpatients is increasing and the field is growing fast. In Denmark forensic mental health nursing is part of the current psychiatric treatment offered to inpatients and from a historical point of view it would seem that nursing is built upon personal characteristics, traits or ways of conduct that to a greater extent seem to be based on existing experience rather than on scientific evidence. The aim of these projects was to examine everyday care as it is carried out on the forensic mental health ward. The primary 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 would hold for them. The knowledge generated about existing practice in the area of forensic mental health nursing constituted essential grounds for further research in and development of clinical forensic mental health practice.

Collaboration contacts:
Frederik A. Gildberg: fgildberg[a]
Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark & Psychiatric dept. Middelfart, Mental Health Services in the Region of Southern Denmark. 

Gildberg, F.A., Bradley, S.K., & Hounsgaard, L. 2013. Comparing the Obvious: Interactional characteristics of staff in acute mental health nursing and forensic psychiatric nursing Vol 2013, no 12, pp. 205-214. International Journal of Forensic Mental Health. Forskning: Artikel, peer reviewed. Status: Published.

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.

Gildberg, F.A., Bradley, S.K., Fristed, P., & Hounsgaard, L. 2012. Reconstructing normality: Characteristics of staff interactions with forensic mental health inpatients. vol. 2012, no.21, pp. 103-113., Int J.Ment.Health Nurs. available from: PM:22321258 Acces

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 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 by correcting their behaviour, and at the same time, maintaining control and security by staying abreast of potential conflicts.

Gildberg, F. A., Elverdam, B., & Hounsgaard, L. 2010, “Forensic psychiatric nursing: a literature review and thematic analysis of staff-patient interaction”, Journal of Psychiatric and Mental Health Nursing, vol. 2010, no. 17, pp. 359-368. Forskning: Artikel, peer reviewed.

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 & behaviourchanging 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.