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Kumpula, E. (2020). Vårdarnas patientnära arbete inom rättspsykiatrisk vård: det komplexa samspelet mellan samhällsskydd och vårdande utifrån genusperspektiv. (Doctoral dissertation). Västerås: Mälardalen University
Open this publication in new window or tab >>Vårdarnas patientnära arbete inom rättspsykiatrisk vård: det komplexa samspelet mellan samhällsskydd och vårdande utifrån genusperspektiv
2020 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Forensic psychiatric care (FPC) is characterized by the complex interaction between mental illness and the crime the patient has committed. For patient care, this means that male nursing staff are often assigned a superior position within FPC, while female nursing staff are presented as especially suited for providing the care itself. The overall aim was, from a gender perspective, to map patterns of patient care within FPC. Method: The dissertation is based on four qualitative studies. One is a literature study, while the other three adopt an ethnographic approach. The data in Study I consists of peer-reviewed articles that were theoretically analyzed. The Data in Study II consists of interviews that were analyzed by discourse psychology. The data in Study III consists of four focus groups. A thematic analysis was performed on the data. In Study IV, the data consists of observations, field notes and interviews, which were analyzed by thematic analysis. Results: Study I show that health in FPC can be perceived as a complex interplay between protecting society, constructions of masculinity and the physical body. Study II illustrates that nursing staff’s talk about patient care should not be separated from structures framing FPC. Study III illuminates that when nursing staff ignore gender in FPC, this may render invisible patients’ unique health needs linked to their life situation. Study IV reveals a pattern in how protecting society is constructed as superior to providing care. This result can be linked to a gender order that results in unequal conditions for nursing staff’s patient care. Conclusion: The results show how the dual goals are intertwined with nursing staff’s gender values, which affect the nurse-patient relationship and health-promoting activities. By constructing protection of society as having higher priority than care, a gender order is maintained that justifies categorization of patients. Failure to pay attention to the interaction between the dual goals and gender may lead to nursing staff overlooking patients’ individual situations and health needs.

Place, publisher, year, edition, pages
Västerås: Mälardalen University, 2020
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 309
Keywords
Ethnography, forensic psychiatric care, gender, health, health-promoting activities, patient care, nurse-patient relationship
National Category
Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-46709 (URN)978-91-7485-458-9 (ISBN)
Public defence
2020-03-06, Gamma, Mälardalens högskola, Västerås, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2020-01-15 Created: 2020-01-14 Last updated: 2020-01-28Bibliographically approved
Kumpula, E., Gustafsson, L.-K. & Ekstrand, P. (2019). Illuminating the gendered nature of health-promoting activities among nursing staff in forensic psychiatric care. Nursing Inquiry, Article ID e12332.
Open this publication in new window or tab >>Illuminating the gendered nature of health-promoting activities among nursing staff in forensic psychiatric care
2019 (English)In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, article id e12332Article in journal (Refereed) Epub ahead of print
Abstract [en]

When people in Sweden are sentenced and handed over to forensic psychiatric care (FPC), the authorities have overall responsibility for their health recovery. How nursing staff construct gender through their relations in this context affects their understanding of health promotion activities. The aim of this study was to illuminate, using a gender perspective, the understanding of nursing staff with respect to health promotion activities for patients. Four focus group interviews were conducted with nursing staff in two FPC clinics in Sweden. The study has a qualitative inductive design with an ethnographic approach. This study sheds new light on FPC in which its dual goals of protecting society and providing care are viewed from a gender perspective. When relationships within the nursing staff group and the nurse–patient relationship are justified by the goal of protecting society, gender becomes invisible. This might cause patients' individual conditions and needs for certain types of activities to go unnoticed. One of the implications of ignoring gender relations in nursing staff health promotion activities is that it risks contributing to gender stereotypes which impact on the nurse–patient relationship and the quality of care.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd, 2019
Keywords
focus group interviews, forensic psychiatric care, gender, health-promoting activities, nursing staff, adult, article, female, health promotion, human, interview, male, mental health care, nurse patient relationship, stereotypy, Sweden
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-46707 (URN)10.1111/nin.12332 (DOI)503365000001 ()31854012 (PubMedID)2-s2.0-85077026178 (Scopus ID)
Available from: 2020-01-14 Created: 2020-01-14 Last updated: 2020-03-16Bibliographically approved
Kumpula, E., Gustafsson, L.-K. & Ekstrand, P. (2019). Nursing Staff Talk: Resource or Obstacle for Forensic Psychiatric Patient Care?. Journal of Forensic Nursing, 15(1), 52-59
Open this publication in new window or tab >>Nursing Staff Talk: Resource or Obstacle for Forensic Psychiatric Patient Care?
2019 (English)In: Journal of Forensic Nursing, ISSN 1939-3938, E-ISSN 1556-3693, Vol. 15, no 1, p. 52-59Article in journal (Refereed) Published
Abstract [en]

Although forensic psychiatric care is located at the intersection of health care and the Swedish legal system, nursing research has not yet evaluated how language is context bound or its consequences for understanding patient care. The aim of this study was to explore how nursing staff talk about patient care in Swedish forensic psychiatric care and the implications for the care given to patients. The theoretical framework is based on social constructionism and sheds light on how language use can be understood as a social action. Twelve interviews were conducted with nursing staff working in forensic psychiatric settings. The questions focused on patient care in relation to activities, security, relationships with patients, and rules and routines. The results show that nursing staff assignments are encouraging them to use various interpretative repertoires to make meaning about their practice. The three interpretative repertoires were "taking responsibility for correcting patients' behavior," "justifying patient care as contradictory practice," and "patients as unpredictable." However, although forensic psychiatric care emphasizes both security and care, nursing staff's use of these interpretative repertoires provided multiple interpretations that lead to contradictory ways of understanding patient care. These findings show that talk itself can be understood as problematic in various situations. A possible implication for clinical forensic nursing practice might be that the nurse-patient relationship does not support patients' best interests. For example, when language endows the patient with certain characteristics, this talk is justified and given meaning by its context and thus has an influence on a patient's individual need for care.

Place, publisher, year, edition, pages
Lippincott Williams and Wilkins, 2019
Keywords
Forensic psychiatric care, interpretative repertoires, nursing staff, patient care, talk, adult, article, conceptual framework, forensic nursing, human, interview, language, mental health care, mental patient, nurse patient relationship, responsibility, aged, female, health personnel attitude, male, mental hospital, middle aged, Sweden, young adult, Attitude of Health Personnel, Hospitals, Psychiatric, Humans, Interviews as Topic, Nurse-Patient Relations, Nursing Staff, Hospital
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-43057 (URN)10.1097/JFN.0000000000000227 (DOI)000480698100009 ()30640200 (PubMedID)2-s2.0-85061968513 (Scopus ID)
Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2020-01-14Bibliographically approved
Kumpula, E., Ekstrand, P. & Gustafsson, L.-K. The interplay between security and gender in forensic psychiatric care: an ethnographic study among nursing staff. Journal of Forensic Nursing
Open this publication in new window or tab >>The interplay between security and gender in forensic psychiatric care: an ethnographic study among nursing staff
(English)In: Journal of Forensic Nursing, ISSN 1556-3693Article in journal (Refereed) Submitted
Abstract [en]

The fact that violence affects nursing staff’s ability to care for patients in Forensic Psychiatric Care (FPC) has been well documented. What has not been adequately addressed is how the interaction between security and gender affects the care given the patients. The aim was to illuminate, from a gender perspective, patterns of nursing staff´s views on security and its consequences for care in FPC. This study adopts an ethnographic approach and the data consists of field notes from participatory observations and interviews with nursing staff at two different FPC clinics in Sweden. Data was processed with thematic analysis. The results showed that when protecting society is given higher priority than care, it should not be separated from nursing staff´s values about gender.  For the female nursing staff this means that the care was linked to a mothering role, whereas male nursing staff duties were not linked to a fathering role. The latter’s focus on security created obstacles for the nurse-patient relationship, which were not experienced to the same extent by female staff. Making gender invisible in FPC creates unequal conditions for nursing staff’s tasks, which can lead to difficulties in achieving improved health for patients.

Keywords
ethnography, forensic psychiatric care, gender, nursing staff, thematic analysis, security
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-46708 (URN)
Available from: 2020-01-14 Created: 2020-01-14 Last updated: 2020-01-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3237-2998

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