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Nursing Staff Talk

Resource or Obstacle for Forensic Psychiatric Patient Care?

Kumpula, Esa, RN1; Gustafsson, Lena-Karin, RN2; Ekstrand, Per, RN3

doi: 10.1097/JFN.0000000000000227
Original Articles

ABSTRACT 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.

Author Affiliations: 1School of Health, Care and Social Welfare, Mälardalens University Västerås;

2School of Health, Care and Social Welfare, Mälardalens University Eskilstuna, Sweden; and

3Department of Health Sciences, The Swedish Red Cross University College.

The authors declare no conflict of interest.

Correspondence:Esa Kumpula, RN, School of Health, Care and Social Welfare, Mälardalens University, S-721 23 Västerås, Sweden. E-mail:

Received May 16, 2018; accepted for publication November 30, 2018.

© 2019 by the International Association of Forensic Nurses. All rights reserved.
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