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‘We try’ – how nurses work with patient participation in forensic psychiatric care
Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
Jönköping University, School of Education and Communication, HLK, CHILD. Jönköping University, School of Health and Welfare, HHJ. CHILD.
Faculty of Health and Society, Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden.ORCID iD: 0000-0002-5637-5106
2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed) Epub ahead of print
Abstract [en]

Rationale: Patients in secure forensic psychiatric care have reduced autonomy because of the constraints imposed on them by compulsion laws. Thus, it is vital that nurses enable patient participation whenever possible. Patient participation, and it′s clinical use in forensic psychiatric care, is an understudied field.

Aim: To describe nurses’ experiences of their work with patient participation in forensic psychiatric care. Methods: Managers at different secure forensic psychiatric institutions in the south of Sweden approved the study, and oral consent was retrieved from informants. Interviews guided by a semi-structured interview guide were conducted with nine nurses from five different forensic psychiatric institutions and analysed with content analysis.

Findings: Nurses describe diverse understandings and abilities in an inflexible setting. This indicates that what participation is, and how to achieve it, is not the same for nurses as for patients. Moreover, patients have different abilities to participate, and the secure setting in itself is perceived as hindering participatory work. Still, participation is described as a crucial part of work that requires a caring relationship. Furthermore, nurses pronounce potentially excluding attitudes and strategies that may obstruct patient participation for all, and at the same time, they have a belief that improvement is possible.

Conclusion: Compulsory forensic psychiatric care is a complex care context that requires constant efforts from nurses to balance patients’ rights and needs with mandatory care. The very nature of this caring context appears to be a major obstacle when promoting patient participation. Nevertheless, nurses express that they do aim for patient participation, ‘they try’. From a patient's perspective, trying is not sufficient and a need for improvement is evident. The results can be of clinical interest in similar secure forensic psychiatric nursing settings, and a point of departure in future development of care striving for increased patient participation for all.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019.
Keywords [en]
compulsory care, forensic psychiatric care, nurses, participation, people with mental illness
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-46974DOI: 10.1111/scs.12773ISI: 000497429600001PubMedID: 31749183Scopus ID: 2-s2.0-85075472504OAI: oai:DiVA.org:hj-46974DiVA, id: diva2:1375315
Available from: 2019-12-04 Created: 2019-12-04 Last updated: 2019-12-04

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Axelsson, Anna KarinLindroth, Malin

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