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Respect in forensic psychiatric nurse-patient relationships: A practical compromise

Rose, Donald N. PhD, MN, BScN, RN1; Peter, Elizabeth PhD, BA, MScN, BScN, RN2; Gallop, Ruth PhD, MScN, BScN, RN3; Angus, Jan E. PhD, MScN, BScN, RN4; Liaschenko, Joan RN, PhD, FAAN5

Journal of Forensic Nursing: March 2011 - Volume 7 - Issue 1 - p 3–16
doi: 10.1111/j.1939-3938.2010.01090.x
Original Articles: ORIGINAL ARTICLE

The context of forensic psychiatric nursing is distinct from other psychiatric settings as, it involves placement of patients in secure environments with restrictions determined by the courts. Previous literature has identified that nurses morally struggle with respecting patients who have committed heinous offences, which can lead to the patient being depersonalized and dehumanized. Although respect is fundamental to ethical nursing practice, it has not been adequately explored conceptually or empirically. As a result, little knowledge exists that identifies how nurses develop, maintain, and express respect for patients. The purpose of this study is to analyze the concept of respect systematically, from a forensic psychiatric nurse's perspective using the qualitative methodology of focused ethnography. Forensic psychiatric nurses were recruited from two medium secure forensic rehabilitation units. In the first interview, 13 registered nurses (RNs) and two registered practical nurses (RPNs) participated, and although all informants were invited to the second interview, six RNs were lost to follow-up. Despite this loss, saturation was achieved and the data were interpreted through a feminist philosophical lens. Respect was influenced by factors categorized into four themes: (1) emotive—cognitive reactions, (2) nonjudgmental approach, (3) social identity and power, and (4) context. The data from the themes indicate that forensic psychiatric nurses strike a practical compromise, in their understanding and enactment of respect in therapeutic relationships with forensic psychiatric patients.

1Associate Professor, Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University Toronto, ON, Canada

2Associate Professor, Associate Dean, Academic Programs Member, Joint Centre for Bioethics, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

3Professor Emeritus, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

4Associate Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

5Professor, Center for Bioethics and School of Nursing, University of Minnesota, Minneapolis, MN

Correspondence Donald N. Rose, PhD, MN, BScN, RN, Associate Professor, Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, Canada M5B 2K3. Tel: 416-979-5000; E-mail:

Received: December 7, 2009; accepted: February 27, 2010

© 2011 Lippincott Williams & Wilkins, Inc.
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