Search

The use of coercion in psychiatric and mental health nursing is a major challenge, which can lead to negative consequences for nurses and patients, including rupture in the therapeutic relationship and risk of injury and trauma. The concept of coercion is complex to define and is used in different ways throughout the nursing literature. This concept is defined broadly, referring to both formal (seclusion, restraint, and forced hospitalization), informal (persuasion, threat, and inducement), and perceived coercion, without fully addressing its evolving conceptualizations and use in nursing practice. We conducted a concept analysis of coercion using Rodgers' evolutionary method to identify its antecedents, attributes, and associated consequences. We identified five main attributes of the concept: different forms of coercion; the contexts in which coercion is exercised; nurses' justification of its use; the ethical issues raised by the presence of coercion; and power dynamics. Our conceptual analysis shows the need for more nursing research in the field of coercion to achieve a better understanding of the power dynamics and ethical issues that arise in the presence of coercion.

Current crop yield of the best ideotypes is stagnating and threatened by climate change. In this scenario, understanding wild plant adaptations in extreme ecosystems offers an opportunity to learn about new mechanisms for resilience. Previous studies have shown species specificity for metabolites involved in plant adaptation to harsh environments. Here, we combined multispecies ecological metabolomics and machine learning-based generalized linear model predictions to link the metabolome to the plant environment in a set of 24 species belonging to 14 families growing along an altitudinal gradient in the Atacama Desert. Thirty-nine common compounds predicted the plant environment with 79% accuracy, thus establishing the plant metabolome as an excellent integrative predictor of environmental fluctuations. These metabolites were independent of the species and validated both statistically and biologically using an independent dataset from a different sampling year. Thereafter, using multiblock predictive regressions, metabolites were linked to climatic and edaphic stressors such as freezing temperature, water deficit and high solar irradiance. These findings indicate that plants from different evolutionary trajectories use a generic metabolic toolkit to face extreme environments. These core metabolites, also present in agronomic species, provide a unique metabolic goldmine for improving crop performances under abiotic pressure.

HIV prevention has changed since the identification of AIDS in 1981, the discovery of HIV in 1983, and the rollout of HIV antibody testing in 1985. Since this time, HIV prevention changed from behavior modification to testing to treatment as prevention to chemoprophylaxis using HIV medications among HIV-negative persons. While these modifications have been heralded as public health successes, critical evaluations are needed. In this article, we present one such review in which we argue that HIV prevention, while previously disciplinary in the Foucauldian sense, has become controlling in the Deleuzian sense. In this way, the parameters of context are targeted and behavior change is less relevant. This highlights the importance of questioning public health "advancements" and using novel theoretical lens to do so.

HIV pre-exposure prophylaxis (PrEP) is an increasingly important part of the HIV prevention armamentarium. Issues with PrEP, however, include access. We propose that one way to surmount this issue would be to have nurses provide PrEP. Although clinical guidelines exist for PrEP, they are overwhelmingly not targeted to nonprescriber clinicians. In this article, we overview current U.S. and Canadian PrEP guidelines and provide explicit guidance about how nurses can provide PrEP, including the clinical pathways and medical directives we use in our clinic. We call nurse-led provision of PrEP, PrEP-RN (Pre-Exposure Prophylaxis–Registered Nurse) and feel it may be an important step forward in HIV prevention.

WHAT IS KNOWN ON THE SUBJECT?: Discussion and documentation of a patient's resuscitation status are essential aspects of any hospital admission, and yet, they seldomly occur in psychiatry. Nurses play an important role in resuscitation status determination by being an information broker, supporter and advocate. Persons with mental illness may be competent to engage in the determination of their resuscitation status and deserve the same respect and autonomy as other patients during this process. There are no published qualitative studies exploring healthcare providers experiences in initiating resuscitation status conversations in the psychiatric setting. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: An in-depth qualitative understanding of the complexity of resuscitation status determination in psychiatry. The shared experiences of nurses enacting their role in resuscitation status determination with patients admitted to psychiatry. The challenges of implementing a 'one-size fits all' approach to resuscitation status policies, and the ways in which depression and/or suicidal ideation influence the process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Role clarity and improved communication between providers about resuscitation status determination in psychiatry are needed. Hospital policies for resuscitation status determination must account for the psychiatric context to ensure patients' goals of care are known and upheld. Nurses working in psychiatry should initiate and more readily engage in resuscitation status conversations. ABSTRACT: Introduction Patients with mental illness experience stigma and marginalization, which affects the quality of their health care. In most settings, end-of-life decisions, including goals of care, must be discussed with all patients upon hospital admission, including determining cardiopulmonary resuscitation preferences in the event of a medical emergency. Despite this requirement, these conversations do not routinely occur in inpatient psychiatry. By default, patients become a 'full code status', mandating life-sustaining interventions. Aim To explore how and why resuscitation status conversations occur, or do not occur, in inpatient psychiatry from the perspectives of healthcare providers. Method Qualitative descriptive study using focus groups with nurses working in psychiatry. Results Nurses' experiences with initiating and engaging in resuscitation status conversations related to Working in Psychiatry, which represents the current practices and the participants' views of the nursing role; Caring for Psychiatric Patients, which describes how fluctuating competency and suicidality influence determination; and The Influence of Physical Health Status, which details how differences in physical health status affect how healthcare providers engage in resuscitation status determination. Discussion Although the importance of completing resuscitation status conversations with patients admitted to psychiatry was expressed by participants, they seldomly occur. There is ambiguity about when and how to determine patient wishes. Implications for practice Tailored strategies are needed to ensure patients' rights to self-determination are upheld when they are admitted to psychiatry. Nurses working in this setting would benefit from education, training and support to adequately initiate and engage in these conversations.

The various ways in which nurses relate and interact with patients, who are considered marginal, vulnerable, and in some ways "different," tend to revolve around the concept of othering. To date, much attention has been given to the immediate situation in which othering may take place, both in terms of process (occurring within interactions) and outcomes (exclusion and marginalization). Drawing on current literature from feminist studies and critical theory, we have drawn attention to broader historical, political, cultural, and social factors that come to shape nurse-patient relationships and propose a new dimension to the concept: structural othering.

Parent caregivers support the health and well-being of their adult children with schizophrenia. As a result, parent caregivers spend vast amounts of time providing care, which necessitates changes to their relationships and lives. In this qualitative study, the experiences of parent caregivers for adult children with schizophrenia were explored. Interpretive Description guided the study design, and data were collected through interviews with 12 English-speaking participants. Data were analyzed according to conventional content analysis. The themes "Uncertainty, Change, and Challenges" and "The Meaning of It All" help to articulate the participants' experiences. Overall, the participants reported tremendous distress in their roles. This was compounded by difficulties accessing and navigating the healthcare system and interactions with police. Effective strategies are needed to help parent caregivers cope within their role and gain access to timely and appropriate care.

Background and PurposeTrauma-informed care (TIC) acknowledges the lasting effects of trauma on individuals. The Attitudes Related to Trauma-Informed Care (ARTIC-35) scale was developed to examine healthcare providers' attitudes related to TIC. Here, we present an item-level analysis of the ARTIC-35 scale for use with nurses and compare our findings to the current ARTIC-35 structure.MethodsPrincipal components analysis, qualitative inter-item analysis, and qualitative intra-item analysis of the ARTIC-35.FindingsOur principal component analysis structure supported a nine-factor solution, inter-item qualitative analysis structure supported five subscales, and intra-item qualitative analysis identified 13 acceptable items and 22 items requiring revision for use with nurses.DiscussionWhen used with nurses, there are important considerations regarding scale validity and challenges with the design of the original ARTIC-35 scale.

Background and purpose Depression is a major health concern encountered by nurse practitioners working in an array of health care settings. Many current guidelines and articles on this topic recommend using the Patient Health Questionnaire-9 (PHQ-9) as a screening tool. Nurse practitioners should have a sophisticated knowledge of this tool. Methods Review of the criteria for diagnosing depression as well as depression screening tools. Database search of EMBASE, CINAHL, and MEDLINE for articles about the PHQ-9. Discussion of how the instrument is used in the clinical setting. Conclusions The PHQ-9 is a free tool that nurse practitioners can use to screen patients in the primary care environment. Screening will detect more instances of depression, which is often missed in this population of patients. Implications for practice Nurse practitioners can and should use the PHQ-9 when screening for depression. However, they should do so with full knowledge and awareness of its strengths and limitations.

The provision of HIV medications to HIV-negative persons after exposure to HIV is known as postexposure prophylaxis (PEP). Because this prevention strategy is primarily only available in emergency rooms, we piloted a nurse-led community-based PEP program in Ottawa from September 2013 through August 2015. As part of evaluating this program, we conducted qualitative interviews with persons who initiated PEP. Twelve men who had engaged in condomless anal sex with other males participated. Thematic analysis of the interview transcripts highlighted that PEP was considered unmentionable because the participants’ saw it as proof of past behavior that was perceived negatively. Our results thus revealed that PEP was stigmatized, which made our participants reluctant to answer health care professionals’ “questions” about why they needed PEP. To do so was to be exposed to stigma. The use of PEP for our participants was a balance between wanting to minimize the risks of HIV acquisition against the risks of disclosing the unmentionable. We take these findings to mean that clinicians and health service policy workers should move PEP into community clinics (decentralizing it from hospitals, and increase the involvement of nurses); aim to provide all required PEP services in community settings (consolidate PEP provision in these clinics); and ensure PEP services are streamlined to remove extraneous data collection (meaning history and exam tools should be standardized to minimize needless questions that may impede PEP access). Together, these recommendations may increase patients’ access to PEP, and maximize its HIV prevention effects.

Social media is an emerging tool used by researchers; however, limited information is available on its use for participant recruitment specifically. The purpose of this article is to describe the use of Facebook and LinkedIn social media sites in the recruitment of nurses for an online survey, using a 5-week modified online Dillman approach. Within 3 weeks, we exceeded our target sample size ( n = 170) and within 5 weeks recruited 267 English-speaking nurses ( n = 172, Facebook; n = 95, LinkedIn). Advantages included speed of recruitment, cost-efficiency, snowballing effects, and accessibility of the researcher to potential participants. However, an analysis of the recruited participants revealed significant differences when comparing the sociodemographics of participants recruited through Facebook and LinkedIn, specifically relating to the characteristics of sex, age, and level of education. Differences between Facebook and LinkedIn as recruitment platforms should be considered when incorporating these strategies.

Engaging knowledge users (KUs) as research team members throughout the research process helps generate relevant knowledge and may improve uptake of research results. The purpose of this article is to describe how an integrated knowledge translation (iKT) approach was embedded within a master’s thesis project comprising a mixed-methods systematic review. KUs were engaged in four distinct phases of the systematic review process, including (1) proposal development; (2) development of the research question and approach; (3) creation of an advisory panel; and (4) an end of study meeting to interpret findings and plan dissemination of findings. The extent of each KU’s engagement on the research team fluctuated during the study. Challenges included maintaining the same KUs throughout the project and maintaining the scope of the project to align with a master’s thesis. Our suggestions for optimizing graduate student iKT projects include having regular team meetings and periodically checking in with team members to encourage reflection on overall engagement and progress of the project. Overall, KUs helped create a research project designed to address their needs and provided input on how results might translate into implications for clinical practice, education, academic policy, and future research within their respective contexts.

Post-secondary students are at a heightened risk of psychosis, yet little is known about this population. The aim of this study was to conduct a mixed-methods systematic review of psychosis among post-secondary students, including student characteristics, overall prevalence, risk factors, interventions, and their reported experiences. Procedures were modelled on the Joanna Briggs Institute approach, while PRISMA guided conduct and reporting. A librarian created a systematic search of nine databases, and quality was assessed using JBI Critical Appraisal Tools. We pooled and analysed data according to objectives and recorded data using synthesis tables and narrative summaries. 26 articles published between 2006 and 2018 are included. The average age of participants was 21 years, and most identified as female and Caucasian. The prevalence of psychosis was often measured in a way that limited comparison across studies. Risk factors associated with symptoms of psychosis included substance use, depression, and younger age. Other risk factors trending towards a relationship included racial discrimination and anxiety. Protective factors included self-esteem and self-concept clarity. Five interventions were studied, with mixed results, and only three studies reported on the experience of students. While five promising interventions are identified, inadequate testing and replication limit confidence in their effectiveness and there is a notable deficit in qualitative evidence exploring the experiences of these students. Integrating knowledge on risk factors, interventions, and experiences of students with psychosis will help tailor and facilitate their health care while protecting their right to education.

Postexposure prophylaxis (PEP) for HIV prevention involves giving antiretroviral medications to HIV-negative people to prevent seroconversion after HIV exposure. Available literature suggests this intervention is >80% effective. Accordingly, we implemented a nurse-led PEP program in two sexually transmitted and HIV testing clinics. As part of evaluating this project, we undertook semistructured interviews with participants who accessed PEP to understand their experiences. Twelve men participated: all were HIV-negative males who sought PEP for condomless anal sex with men. Unique to this article is the presentation of the participants' descriptions of the “side effects” they experienced. Notably, the main side effect they described related to emotional distress. Simply put, having to take a medication for 28 days forced reflection and introspection on their sexual decision-making. We feel HIV prevention workers should consider this emotional reaction when designing interventions, and ensure they provide adequate preparation and support to patients.

Background High-quality and relevant nursing education is needed to ensure graduates meet entry to practice competencies. Despite the important role of curricula in the development of nurses and the nursing profession, there does not appear to be a consistent or widely accepted approach to nursing curriculum renewal. Objective To identify and synthesize existing curriculum renewal/redesign practices, create an aggregated logic model depicting an evidence-informed process for nursing curriculum renewal, and stimulate dialogue about how to keep nursing curricula relevant in an ever-changing healthcare context. Design An integrative review, modeled on the Joanna Briggs Methodology of Systematic Reviews, of the available published articles, including empirical research and discussion articles. Data sources We searched for quantitative, qualitative, and non-research literature (English and French) on full nursing programs or curriculum revisions for pre-licensure nursing students enrolled in an undergraduate or associate degree program. Databases included CINAHL, Nursing and Allied Health, and Medline from January 2010 to January 2017. We then did a hand search for articles from January 2017 to April 2019. Synthesis Extracted data were synthesized into an aggregated logic model based on Yin's method of cross-case analysis. Data included information about the internal context, the external context, drivers, the preparatory phase, the active phase, outcomes, and evaluation methods of the described curriculum renewal process. Results Twenty articles were included, which were published between 2010 and 2018. The resulting logic model, The Ottawa Model for Nursing Curriculum Renewal, includes information on the context, process and outcomes of the renewal process, and how and when to evaluate curricula. Conclusion This synthesis aids in defining the process of curriculum renewal for undergraduate nursing education. It stimulates systems level thinking and reveals gaps, such as the need for further research into curriculum evaluation. The Ottawa Model for Nursing Curriculum Renewal is a usable template to aid educators undertaking their own process of curriculum renewal.

Although professional practice in forensic psychiatric environments is, in our opinion, extremely complex and requires the input of different disciplines, conceptual or theoretical models guiding this practice remain rare or poorly adapted. In this article, we propose an interdisciplinary model of practice to correct this deficiency. The objectives of this article are: to report on the literature review conducted; to report, as faithfully as possible, on our general consultation process with employees practicing in a forensic psychiatric institution; and, finally, to propose an interdisciplinary practice model resulting from this general consultation within the organization.

The objective of this brief report is to present an overview of the main benefits and key characteristics of an individualized physical activity program delivered by an assertive community treatment team in Ottawa, Canada. A mixed-method case study was conducted over a 9-month period. Findings revealed significant reductions in weight, BMI and waist circumference (p

This is a qualitative evidence synthesis on the experiences of parents caring for their adult child with schizophrenia. The Joanna Briggs Methodology for systematic reviews guided the study and standard systematic review procedures were followed. Content analysis was used to synthesize findings from the five studies included into the following categories: 'Resources,' 'Loss,' 'Psychological Distress,' 'Effects on Family,' and 'Framing the Experience.' Findings suggest that parent caregivers struggle to navigate services and need greater support to protect their mental and physical health. From a research perspective, factors influencing parents' abilities to stay engaged in caregiving warrant further exploration.

Background:Psychiatric nurses are regularly confronted with the uses and effects of control interventions such as mechanical restraints. Although there are evident tensions in the literature regarding the use of mechanical restraints, very little research has focused on the lived and embodied experience of their use, whether from the patient’s perspective or the perspective of nursing staff responsible for their application.Research aims:(1) to gain access to the bodily phenomenon of being placed in mechanical restraints; (2) to give voice to the intimate experiential understanding of this experience; and (3) through phenomenological interpretation, to understand the subjective processes and meaning-making of this experience.Research design:For this research, we adopted a distinctly ethics-oriented application of the methodology known as interpretative phenomenological analysis, that is, the interpretive dimension of the research focused on ethical practice in mental healthcare – one that is informed by experiential accounts of the lived body.Participants and research context:A total of 40 in-depth semi-structured, nondirected interviews with both nurses (n = 21) and patients (n = 19) we conducted to meet the aims of this article. Participants were recruited from an inpatient psychiatric unit of a Canadian general hospital.Ethical considerations:The research received research ethics board clearance from both the hospital where the study took place and the University of Ottawa.Findings:The comparative analysis is presented under the following headings: (1) context of care, (2) meaning of quality of care, (3) emotional reactions and nurse–patient relationship, (4) meeting the needs and (5) need for alternatives.Discussion/conclusions:The research findings are discussed in light of current literature and implications for practice.

The use of mechanical restraints in psychiatric settings is currently the subject of ethical controversy. However, both patients' and nurses' voices are absent in the debate over this controversial intervention. The objective of this qualitative study was to examine the experience of psychiatric nurses using mechanical restraints. Twentyone nurses working on either the acute psychiatric inpatient unit and/or the emergency psychiatric unit of a university affiliated Canadian hospital participated in semi-structured interviews, which were then transcribed, coded and analyzed using the interpretative phenomenological analysis (IPA) method. Three main themes were identified : 1) Practice setting ; 2) Mechanical restraint process ; and 3) Resorting to mechanical restraints. These results highlight the organizational and emotional challenges faced by psychiatric nurses. Foucault and Goffman's work were the primary theoretical sources that guided the critical analysis of this qualitative research.

Background The risk of optic disc haemorrhages on visual outcome in idiopathic intracranial hypertension (IIH) is unknown. We report the type and frequency of optic disc haemorrhages and other funduscopic abnormalities at baseline in the study eye of the 133 subjects enrolled in the Idiopathic Intracranial Hypertension Treatment Trial completing 6 months of follow-up. Methods We reviewed optic disc photographs to tabulate the frequency and type of optic disc haemorrhages, other funduscopic abnormalities and papilloedema grades of the study eye at baseline and analyse if their presence is associated with a poor visual outcome. Results 27.2% of subjects had nerve fibre layer haemorrhages in at least one eye. Five of seven, 71% of subjects that met criteria for treatment failure, had nerve fibre layer haemorrhages in at least one eye (Fisher9s exact test: p=0.02). There was a good correlation between presence of nerve fibre layer haemorrhages and Frisen grade (Spearman9s correlation, p=0.002; r=0.271). Subjects with nerve fibre layer haemorrhages had a higher cerebrospinal fluid pressure (40.0 mm water, p=0.04). There was poor correlation between nerve fibre layer haemorrhages at baseline and the perimetric mean deviation change at 6 months. Cotton wool spots were present in 4% of subjects, exudates in 3% and pseudodrusen in 4%. Conclusions Nerve fibre layer haemorrhages are common in patients with IIH with mild visual loss and correlate with the severity of the papilloedema. They occur more frequently in treatment failure subjects and therefore may be associated with poor visual outcomes. Trial registration number NCT01003639, Post-results.

The objective of this paper is to present the results obtained from a qualitative research study conducted in a forensic psychiatric setting and to explore the dual role associated with being both "agents of care and agents of social control." Following the narratives provided by nurses working in this field, the analysis that follows will problematize the rhetoric of therapy in forensic psychiatric nursing. In order to support the analysis, this article comprises four sections. The first section will briefly review the study's methodological considerations. Using a combination of Foucault and Goffman's work, the second section provides an empirical contextualization of correctional environments and their effects on nursing care. The third section explains the effects of having a contradictory mandate of care and custody from Festinger's (1957) theory of cognitive dissonance. Lastly, the fourth section provides a critique of disciplinary interventions in forensic psychiatric nursing, as it is explained by the participants.

The purpose of this article is to present the results of a study conducted in a Canadian medium-security forensic psychiatric facility. The primary objective of this qualitative research was to describe and comprehend how fear influences nurse-patient interactions in a forensic psychiatric setting. Eighteen semistructured interviews with nurses were used as the primary source of data for analysis. In brief, the results from this research indicate, as other researchers have demonstrated, that within this highly regimented context, nurses are socialized to incorporate representations of the patients as being potentially dangerous, and, as a result, distance themselves from idealistic conceptions of care. Moreover, the research results emphasize the implication of fear in nurse-patient interactions and particularly how fear reinforces nurses' need to create a safe environment in order to practice. A constant negotiation between space, "at risk" bodies and security takes place where nurses are forced to scrutinize their actions in order to avoid becoming victims of violence. In parallel, participants also described how being able to self-identify with patients enabled therapeutic interventions to take place. However, exposure to the patient's criminal history fostered negative reactions on the nurses' part, which impede nursing work.

This paper reports the results of a study on the identification and management of violence on a psychiatric ward and in the psychiatric emergency of a Quebec hospital. The purpose of this exploratory and descriptive study was to examine patients' and nurses' perceptions and strategies for identifying and managing patient aggression and violence. Results show that the type of setting influences the way aggressive behaviour issues are perceived and managed. The types of behaviours deemed aggressive or risky also vary between the two units. Moreover, patients and nurses are similarly described by all participants as susceptible to being violent and to being a victim of violence. Prevention of aggression and violence remains a significant challenge in psychiatric nursing, where administrative and environmental constraints, the growing complexity of clinical profiles, divergent interprofessional approaches to care, and collective feelings of apprehension and vulnerability interact.

The objective of this article is to examine the tensions that exist between care and custody in correctional environments by presenting the (im)possibilities of psychiatric nursing practice within this context. The analysis will be guided by empirical data obtained from a qualitative research conducted in a correctional setting. Semistructured interviews with nurses were conducted and used as the primary source of data for analysis. This article will explore the contextual characteristics of psychiatric nursing practice in correctional settings, describe the alienating effects of this context on nursing practice, theorize nurses' experience using Festinger's theory on cognitive dissonance, and, finally, explore how some nurses engage in the reconstruction of their care to counter the effects of working in correctional settings.

The aim of this paper is to explore the relationship between mandatory HIV testing and the institutional management of inmates in U.S. prisons. Mandatory HIV testing has been largely overlooked by the nursing community even though it has important human rights and ethical implications. Drawing on the work of Goffman (1990) on the inner workings of total institutions, the present article critically examines the deployment of mandatory HIV testing in U.S. prisons. To set the stage, we define mandatory HIV testing and describe the methods of HIV testing currently used in U.S. prison settings. Then, we provide a brief overview of the concept of total institution and the mortification process. Finally, we expand on the relationship between mandatory HIV testing and much larger institutional objectives of total control, total structuring, total isolation, and separation of inmates from society (as summarized by Farrington, 1992). And lastly, we provide a brief discussion on the implications of mandatory HIV testing (as a method of HIV testing) from a nursing perspective.

The purpose of this paper is to engage with the readers in a theoretical reflection on nursing practices in forensic psychiatric settings. In this paper, we argue that practices of exclusion in forensic psychiatric settings share some common ground with Agamben's description of sovereign power and, consequently, the possible creation of zones of exception in this environment. The concept of exception is, therefore, purposely used to shift our thinking, highlight the political forces surrounding exclusionary practices in forensic psychiatric nursing, and explore the ethical tensions that arise for nurses who become entangled in the control of these zones of exception. We argue that ethical and political discussions regarding this phenomenon are necessary if we wish to further understand the complexities of this field of practice and promote constructive change.

Recent research results have shown that nursing practice in correctional psychiatric settings is difficult since institutional functionning and correctional culture threaten fundamental socioprofessional standards of care.The aim of this paper is to present the results of a research conducted in a Canadian correctional facility between 2006 and 2009 with nurses providing psychiatric care.This research highlights the challenges faced by the nursing staff who see their professional practice constrained by correctional prerogatives.we believe that the results of our research are paramount if we wish to understand the specificities of this complex field of nursing.

Forensic psychiatric nurses work with individuals who may evoke feelings of empathy as well as feelings of disgust, repulsion, and fear. The main objective of this theoretical paper is to engage the readers in a theoretical reflection regarding the concepts of abjection and fear since they both apply to the experiences of caring for mentally ill individuals in forensic psychiatric settings. Our contention is with the potential impact of feelings such as disgust, repulsion, and fear on the therapeutic relationship and, more particularly, with the boundaries imposed on this relationship when these feelings are unrecognized by nurses. Acknowledging that patients may evoke feelings of disgust, repulsion, and fear is essential if nurses wish to understand the implications of these emotions in the therapeutic process. In forensic psychiatric settings, caring for so-called "monsters" in the face of abjection and fear is not an easy task to achieve given the lack of theoretical understanding regarding both concepts. Given the actual state of knowledge in forensic nursing, we argue that theoretical (conceptual) analyses, as well as ethical and political discussions, are paramount if we wish to understand the specificities of this complex field of nursing practice.

Udgivelsesdato: 2008-Sep The humanist school of thought, which finds resonance in many conceptual models and theories designed to guide nursing practice, needs to be understood in the context of the total institution, where the individual is subjected to a mortification of the self, and denied autonomy. This article will engage in a critical reflection on how humanism has influenced nursing theorists and the subsequent production of conceptual models and theories, especially as they relate to the field of forensic psychiatric nursing. Although humanism provides optimism for nurse-patient relations, this article explores the incapability of such a philosophy to acknowledge the power relationships between individuals and its inability to explain the day-to-day realities experienced in forensic nursing, where the possibility of interpersonal violence reshapes nursing care. The tidal model will be discussed in detail as an example of a recently developed humanistic nursing model. Viewed from this perspective, it is clear that humanistic philosophy and its subsequent models of care are in discordance with the highly specialized field of forensic nursing.