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Nursing Staff Talk: Resource or Obstacle for Forensic Psychiatric Patient Care?
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.ORCID iD: 0000-0001-5670-6908
Department of Health Sciences, Swedish Red Cross University College, Sweden.
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. Vol. 15, no 1, p. 52-59
Keywords [en]
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: urn:nbn:se:mdh:diva-43057DOI: 10.1097/JFN.0000000000000227ISI: 000480698100009PubMedID: 30640200Scopus ID: 2-s2.0-85061968513OAI: oai:DiVA.org:mdh-43057DiVA, id: diva2:1303806
Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2020-01-14Bibliographically approved
In thesis
1. Vårdarnas patientnära arbete inom rättspsykiatrisk vård: det komplexa samspelet mellan samhällsskydd och vårdande utifrån genusperspektiv
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

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Kumpula, EsaGustafsson, Lena-Karin

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