Encounters with patients in forensic inpatient care : Nurses lived experiences of patient encounters and compassion in forensic inpatient care

Abstract: Background: Forensic psychiatry is characterised by compulsory care and long hospital stays, where nurses care for patients with severe mental illness, who often have committed crimes. The main objective is to rehabilitate the patient to once again become a part of society by improving mental health and decreasing the risk of criminal relapse. This is mainly achieved through encounters with the patients. Encountering patients in forensic psychiatry means coming face to face with suffering and the duality of caring, doing what is best for the patient and protecting society.Aim: The purpose of the study was to obtain a deeper understanding of encounters with patients with mental illness in forensic inpatient care as experienced by nurses.Method: This licentiate thesis consists of two studies (I, II), both conducted with a qualitative design. A total of 13 nurses working at a forensic psychiatric hospital in Sweden were recruited through a purposive sample to participate in the studies through narrative interviews. Study I was analysed with phenomenological hermeneutics in line with Lindseth and Norbergh (2004) in order to illuminate the lived experience of nurses’ encounters. Study II was a secondary supplementary analysis, which applied hermeneutics in line with Fleming, Gaidys, and Robb (2003) to gain a deeper understanding of nurses’ compassion in forensic psychiatry. The two studies were merged to provide a comprehensive understanding in this licentiate thesis.Findings: Study I illuminated the meaning of nurses’ lived experiences of encounters with patients with mental illnesses in forensic inpatient care, that is the nurses’ desire to do good despite being confronted with their own emotions as fear, humiliation, and disappointment. Encounters were also occasionally perceived as positive, awakening emotions of compassion, competence, pride, trust, satisfaction, and gratification regarding the patient’s recovery. However, a source of conflict was the struggle between doing what was best for the patient and protecting society. The study comprised of four themes: being frustrated, protecting oneself, being open-minded, and striving for control. Study II aimed to gain a deeper understanding of nurses’ compassion in providing forensic psychiatric inpatient care with three themes: recognising suffering and need for support, responding to patient suffering, and reacting to one’s own vulnerability. Abstracting to a main theme of being compassionate in forensic psychiatry which is described as an emotional journey, an ongoing inner negotiation between own vulnerability and expressions of suffering. This inner negotiation of making sense of patients’ plea and how they were perceived was crucial for determining the development of compassion rather than turning to control and rules as a means to protect oneself.Discussion: A interpretation of the studies (I, II) revealed two topics, being sensitive and responsive and keeping distance, which were reflected upon against the theoretical framework of Kari Martinsen. The studies showed that nurses faced a variety of encounters that forced them to face their own vulnerability and that trust could reduce power imbalances as well as help deal with societal, man-made constructs. The nurses’ encounters with incomprehensible expressions of suffering also show that nurses need to find a way to make room for “expressions of life”– taking a step back and turning their gaze inwards – in order to regulate their own emotions. This may better equip nurses to encounter patients with compassion and kindness rather than turning to norms and rules to protect themselves and guard their own vulnerability. Rather than distancing themselves from the patients, nurses can instead take a step back to come closer to their patients.