Search

Background: The number of patients who have experienced violence is increasing worldwide. These patients have specific psychosocial and forensic needs and can present unique challenges to the health care workers caring for them. Objective: To identify best practices for the care of patients with injuries from violence in the emergency department or inpatient setting. Methods: The framework for integrative reviews by Whittemore and Knafl was used to conduct a literature search in MEDLINE, CINAHL, and ProQuest Nursing and Allied Health databases. Fourteen qualitative, quantitative, and mixed-methods studies from peer-reviewed journals were included in the review. Results: Themes included identifying patients as survivors of intimate partner violence or child abuse, the need to collect forensic evidence, the need for emotional support of patients and their loved ones, support for health care workers caring for patients with injuries from violence, prevention of further violence, and the challenges of caring for patients with injuries from violence with concurrent substance use disorders. Best practices for these aspects of care are summarized on the basis of literature analysis. Conclusion: Screening procedures are needed to identify survivors of intimate partner violence and child abuse. Forensic evidence preservation policies should be in place. For survivors of sexual assault, a sexual assault nurse examiner should be available. Hospital systems should provide psychosocial resources for patients' and health care workers' mental health, implement violence reduction programs, and provide bias training. More research is needed to determine efficacy of care models and best practice. [ABSTRACT FROM AUTHOR]

Mortuary workers play a crucial role in ensuring the respectful, safe and dignified handling of human bodies. But despite of their irreplaceable role, there is prolonged neglect and under recognition of these mortuary staff in our country. It is in fact correct to say that mortuary workers were as important as nurses were to the Forensic Pathologists. The mortuary attendants assist in preparing bodies, specialized dissection and collecting specimens that were pertinent in performing meticulousautopsy techniques. Apart from this they also help in the examination of sexual offenders. These kind of diverse responsibilities makes them an integral part in the medicolegal system in India. There was only a few research done in regard to the mortuary staff. Understanding the work conditions and challenges faced by them will help in improving work environment. This will help in promoting the quality of work they offer and attract more eligible youth to take up this essential, yet risky profession. [ABSTRACT FROM AUTHOR]

Sexuality is a central part of being human, however, talking about sexual health is generally avoided in forensic psychiatry. The aim of this qualitative study was to explore how healthcare professionals experience talking about sexuality and sexual health with patients cared for in forensic psychiatry. Individual interviews were conducted with eighteen healthcare professionals from ten different forensic psychiatry care units in Sweden. The interviews were semi-structured, and the data was analyzed with qualitative content analysis. The findings showed the overarching theme "Balancing on a slack line". The conversations the healthcare professionals have about sexuality and sexual health with patients in this setting are affected by forensic psychiatry's dual mission; to provide care and at the same time protect patients and society. These conversations can be about opening up for having responsive conversations, but also closing conversations since the field of sexuality and sexual health is fraught with norms and preconceptions. To be able to conduct these conversations can be a challenge since the professionals can experience uncertainty due to a lack of competence, indicating that knowledge and resources are needed to facilitate conversations. In conclusion, the study indicates that there is a lack of support and structure for performing conversations about sexuality and sexual health in forensic psychiatry care, and there is a need for increased knowledge among healthcare professionals. In order to support staff, the forensic psychiatry services need to acknowledge the national guidelines for sexual and reproductive health and rights and to develop and adapt the local guidelines. [ABSTRACT FROM AUTHOR]

Aims: To describe a reflexive account of a mental health nurse as researcher undertaking a mixed methods study as part of a doctoral degree, with women in a secure forensic hospital. Design: A discursive paper that draws upon the primary author's experience of dual roles as a mental health nurse and a novice researcher, and relevant literature pertaining to positionality and reflexivity in the context of conducting mixed methods research. Methods: A mixed methods study was conducted within a secure forensic hospital in Australia, to identify factors associated with the frequency and duration of seclusion for women and, to explore their experiences of seclusion. Notes and a reflective diary were used to demonstrate the reflexive approach and strategies used throughout the study design and data collection stages of the research. Results: Women in the secure forensic hospital setting often have complex histories and experiences and are considered a vulnerable group, which can add additional challenges when undertaking research with this population. As a doctoral student with clinical experience in mental health undertaking research in the forensic hospital setting with women, positionality and the connection with reflexivity requires exploration to understand self and the influence on research. This understanding along with identified strategies to enhance reflexivity, supports the management of the dual nurse as researcher roles to enhance all stages of the research process. Conclusion: Doctoral nursing candidates undertaking clinical research in their area of clinical practice and at the location of previous employment, may experience challenges in relation to identity and the dichotomy of roles. Further challenges can be posed when research involves complex populations and/or controversial practices. Support to balance role conflict and maintain reflexivity is critical to understanding the role of self in research and to enhance credibility. Implications for the Profession and/or Clinical Practice: Women are a complex, yet minority population in forensic mental health settings, however the numbers of women being admitted to services is increasing. Future research may consider the use of the strategies explored here to enhance the reflexive process, and support future researchers in this field to conduct research that aims to support an often‐misheard population to better support health outcomes. Patient or Public Involvement: There was no patient or public contribution to this paper, however the study in which this paper is based on, is grounded in the experience of patients (women). [ABSTRACT FROM AUTHOR]

Abstract Background Forensic nursing, which merges healthcare and legal expertise to address trauma and violence, is vital yet often underrepresented in nursing education. Many nursing students lack knowledge in this field, underscoring the need for enhanced education to improve patient care and legal outcomes. This study aimed to assess university nursing students’ knowledge and attitudes towards forensic nursing, as well as identify factors influencing their knowledge. A mixed-methods design was conducted at a Saudi nursing college with a convenience sample of 250 students. The data were collected using a structured questionnaire comprising two parts. The quantitative part included demographic and academic characteristics, knowledge and opinions on forensic nursing, knowledge of forensic evidence, and attitudes towards forensic nursing. The qualitative part consisted of four open-ended questions about factors affecting forensic knowledge. Data analysis involved inferential statistics and content analysis. Results The study revealed that 80.4% of nursing students lacked prior knowledge of forensic nursing, and only 59.76% had some awareness of forensic evidence. A strong positive relationship was found between attitudes towards forensic nursing and knowledge of forensic evidence (r = 0.817, p

Background: Forensic psychiatric patients require specialized care due to the unique challenges in forensic settings. Negative attitudes and beliefs towards mentally disordered offenders can lead to discrimination against patients and are related to worse outcomes. Forensic psychiatric nurses play a crucial role in the treatment of these patients. Aim: This study aimed to investigate the perceptions, attitudes, and beliefs of forensic psychiatric nurses and general medicine nurses towards psychiatric patients and to compare them between nurse groups. Method: The study was conducted with 46 nurses working in the High-Security Forensic Psychiatry Clinic (Mean age: 35.46, SD= 7.16) and 58 nurses working in other inpatient settings (Mean age:36.28, SD=8.78) aged between 18-65 between December 2020 and April 2021 in Turkey. Nurses in the forensic psychiatry clinic were required to have at least 6 months of experience in the clinic. Results: Forensic psychiatric nurses exhibited more positive attitudes towards patients (p<.0001), showing lower tendency to be socially distant (p=.009), higher trust (p<.0001), higher willingness to treat (p<.0001), lower tendency to perceive patients as threatening (p=.004), and more general positive attitudes. Significant relationships were found between some of the stigma-related scales we used and certain factors. For forensic nurses, being male (p=0.043) and single (p=,025), working long hours (p=.047), and having fewer children (p=.005) were related to more negative perceptions about delinquents. Insufficient knowledge about forensic psychiatry was linked to negative beliefs about mental disorders (p=0.017) and specifically the curability of mental disorders (p=0.008). Having more siblings was related to higher embarrassment about mental disorders (p=.043). For general nurses, having first-degree relatives who receive psychiatric treatment was related to perceiving patients as threatening (p=.021)) and negative perceptions about delinquents (p=.007). Being older was related to more positive beliefs about mental patients' dangerousness (p=.026). Having more siblings was associated with higher trust toward patients (p=0.002). Conclusions: These findings emphasize the importance of addressing stigmatization among healthcare professionals, particularly forensic psychiatry nurses and general nurses. Providing comprehensive training about mental disorders and forensic psychiatry and promoting empathy and understanding can enhance the quality of care for patients with mental illnesses and contribute to better mental health outcomes for society. [ABSTRACT FROM AUTHOR]

Background: Forensic nursing, which merges healthcare and legal expertise to address trauma and violence, is vital yet often underrepresented in nursing education. Many nursing students lack knowledge in this field, underscoring the need for enhanced education to improve patient care and legal outcomes. This study aimed to assess university nursing students' knowledge and attitudes towards forensic nursing, as well as identify factors influencing their knowledge. A mixed-methods design was conducted at a Saudi nursing college with a convenience sample of 250 students. The data were collected using a structured questionnaire comprising two parts. The quantitative part included demographic and academic characteristics, knowledge and opinions on forensic nursing, knowledge of forensic evidence, and attitudes towards forensic nursing. The qualitative part consisted of four open-ended questions about factors affecting forensic knowledge. Data analysis involved inferential statistics and content analysis. Results: The study revealed that 80.4% of nursing students lacked prior knowledge of forensic nursing, and only 59.76% had some awareness of forensic evidence. A strong positive relationship was found between attitudes towards forensic nursing and knowledge of forensic evidence (r = 0.817, p < 0.001), indicating that positive attitudes could predict 66.8% of the variance in forensic evidence knowledge. Key barriers included lack of support from upper management, insufficient resources, and concerns about faculty qualifications. Students recommended integrating forensic nursing into the curriculum, offering specialized programs, and promoting research and social media awareness campaigns. Conclusions: These findings underscore significant gaps in knowledge and misconceptions about forensic nursing among participants, emphasizing the critical need for education and awareness in this field. The study highlights the potential implications for integrating forensic nursing concepts into undergraduate curricula, enhancing faculty training, and utilizing diverse teaching modalities. Addressing these gaps will not only improve future nurses' competency in forensic nursing, but also contribute to better patient care. [ABSTRACT FROM AUTHOR]

AbstractIn this systematic review, we aimed to identify facilitating or hindering factors for patient participation in inpatient forensic psychiatric care. Ten studies, qualitative (n = 8), quantitative (n = 1), and mixed method (n = 1), were included. Findings were categorized using the European standard for minimum requirements for patient involvement in health care. We identified a supportive care relationship as an essential prerequisite for participation. This includes ensuring that patients feel trust, included in discussions, and seen as a person, beyond the index crime but with an understanding for their psychiatric illness. Patients’ transition phases through their illness and the forensic psychiatric care system initially appeared to negatively influence patient participation. However, as they approached their release from forensic psychiatric care, a positive shift in their willingness to participate in their care became evident. Factors such as stigmatization, safeguarding one’s own security, and the coercive forensic psychiatric care environment, were identified as factors significantly hindering patient participation. Moreover, patients perceived participation in care planning as confusing, as they felt excluded from influencing any care-related decisions. Staff, in contrast, were restrictive with information regarding patient care, which had additional negative effects on patients’ understanding of their situation. We conclude that future research is needed to examine clinical routines and strategies that may improve patient participation. Furthermore, more quantitative research is needed to examine the challenges for this specific patient population and environment. Future interventions should focus on improving the quality of relationships, information-sharing, and patient involvement in key elements of forensic psychiatric care. [ABSTRACT FROM AUTHOR]

Nursing staff engage readily with patients and associates in mental health/forensic inpatient settings. These settings are known to have instances of workplace violence directed towards staff and such violence includes racism. Racism is a form of workplace violence that must be better understood and supported within this complex setting. Completing a systematic review to coalesce preexisting research and suggested interventions can be beneficial to supporting nurses. Systematic review following PRISMA guidelines. CINAHL, PsycInfo, Medline, British Nursing Database and Web of Science databases were searched. Reviewers screened the papers for inclusion (29 articles out of 7146 were selected for inclusion) and completed the quality appraisal using the Mixed Methods Appraisal Tool. Subsequently, data extraction was completed, and findings were summarised through narrative synthesis. The way racism was conceptualised impacted how data was collected, reported and interpreted; racism was silenced or exposed depending on how studies were undertaken. If exposed, evidence indicates racism is a problem but is not always acknowledged or acted upon. Some evidence determined racism led to negative work‐related outcomes. The literature provided limited examples of interventions. These included changing education/orientation for staff, openly discussing racist events and better planning for patients among colleagues and management. Increasing diversity within the workforce requires more research exploring and addressing issues related to racism towards nurses. Narratives of racism being normalised and embedded in mental health/forensic settings need to be challenged. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Safewards was developed for acute mental health units, and while could be effective in forensic mental health services, there are some gaps in the model for such services, where factors including offending behaviour and longer term care can have an influence. What this paper adds to existing knowledge?: The importance of acknowledging and addressing responses related to offending behaviour in forensic mental health settings, while also understanding the vulnerability of the consumer group and responsibilities to the maintenance of professional boundaries.Enhancing collaboration with consumers/families/carers/supporters is important in a forensic mental health setting, and an important element of Safewards Secure. What are the implications for practice?: This study completes the development of Safewards Secure, designed to foster collaboration, address issues pertinent to forensic mental health settings to enhance implementation and acceptance of the model and reduce conflict and containment. Introduction: Safewards is a model developed for acute mental health settings designed to reduce conflict and containment; however, it requires adaptation to forensic mental health settings. Aim: To develop the Safewards Secure model, a model to assist forensic mental health services to reduce conflict and containment. Method: A literature review was conducted to elicit possible modifiers and adjustments to the interventions. A Nominal Group Technique was then used to engage forensic mental health experts who had experience implementing Safewards (n = 12) to seek feedback about the suggestions and reach consensus on the Safewards Secure model and interventions. Data were thematically analysed. Results: Experts reached consensus on all suggestions, however, did recommend minor additions and modifications. Two themes were also interpreted: Safewards Secure is just as much for staff as it is for consumers, and the proposed additions encourage more meaningful staff to consumer collaboration. Discussion: This study identified key challenges experienced by nurses working in forensic mental health settings, however, these challenges were not seen as insurmountable. The Safewards Secure model offers prompts and suggestions to encourage reflection, collaboration and a humanistic approach to care in forensic mental health settings. Implications for Practice: Addressing reactions to offending behaviour and encouraging more collaboration might assist in ensuring a more person‐centred approach to forensic mental health nursing care. [ABSTRACT FROM AUTHOR]

Survivors of intimate partner violence (IPV) often experience violent blows to the head, face, and neck and/or strangulation that result in brain injury (BI). Researchers reviewed the de-identified forensic nursing examination records of 205 women. More than 88% of women were subjected to multiple mechanisms of injury with in excess of 60% experiencing strangulation. About 31% disclosed various symptoms consistent with BI. Women experiencing strangulation were 2.24 times more likely to report BI-related symptoms compared to those who reported no strangulation. In conclusion, women experiencing IPV are prone to BI suggesting early screening and appropriate management are warranted. [ABSTRACT FROM AUTHOR]

Access to quality sexual assault (SA) care in rural communities is limited by challenges surrounding building and sustaining a skilled SA nurse examiner workforce. Telehealth can facilitate access to expert care while cultivating a local sexual assault response. The Sexual Assault Forensic Examination Telehealth (SAFE-T) Center aims to decrease disparities in SA care by providing expert, live, interactive mentoring, quality assurance, and evidence-based training via telehealth. This study examines multidisciplinary perceptions of pre-implementation barriers and SAFE-T program impact using qualitative methods. Implications for the implementation of telehealth programs to support access to quality SA care are considered. [ABSTRACT FROM AUTHOR]

Food aspiration is one of the major health risks for elderly people in nursing homes which could lead to death. Moreover, misconducts in pharmacotherapy may represent a potential risk of adverse drug reactions. It is reported here the toxicological evaluation of a combined death by food aspiration and acute escitalopram intoxication of a psychiatric subject, occurred in a nursing home. An 89-year-old man, suffering from dysphagia and Alzheimer's, was resident in a nursing home. He was fed with a liquid diet administered directly in mouth using a syringe. The man was also being treated with escitalopram 10 mg tablet. One evening, after receiving the meal in the usual way, the man complained of sudden illness. Carried to the emergency room, the man died about 3 h later with a diagnosis of cardiogenic shock subsequentially to ab ingestis. The histological findings revealed the presence of exogenous material, probably food, up to the finest bronchial branches. The toxicological examination revealed the presence of escitalopram and its main metabolite, desmethylcitalopram: in the blood 1972 ng/ml and 285 ng/ml, in the brain 4657 ng/g and 1025 ng/g, in the gastric content 2317 ng/g and 423 ng/g, in the lung 21,771 ng/g and 468 ng/g, respectively. The bad practice of the nurses to dissolve the escitalopram tablet in the liquefied food and to administer the therapy with a syringe directly into the mouth emerged thanks this investigation. Following food aspiration, escitalopram was absorbed by inhalation route, reaching high concentrations in blood and tissues. The death occurred due to a combined mechanism between food aspiration and the escitalopram toxic action. [ABSTRACT FROM AUTHOR]

To describe staff experiences with the use of videoconferences with forensic psychiatric outpatients during the COVID-19 pandemic. Semi-structured interviews with staff at forensic community services in the Region of Southern Denmark. Nine semi-structured staff interviews were conducted. Two main themes were identified through thematic analysis: Challenges due to technical uncertainty and the Use of videoconferences as support in clinical assessment and treatment. The second main theme also included a number of subthemes: Lack of opportunity for observation of a patient's overall situation; Compromise of nurses' professionalism; Limitation of disturbing stimuli means more focus on the conversation; Telephone contact vs. video contact—pros and cons; Expectations reflect attitudes; and Will professionalism be changed based on organizational and political perspectives? Staff opinions on use of videoconferences in psychiatric patients differed. The nurses in particular were concerned about whether professionalism could be maintained. Others experienced patients focusing more on the conversation when it took place via video because there were fewer disturbing elements. In general, expectations seem to influence attitudes toward using videoconferences. [ABSTRACT FROM AUTHOR]

Aim: To determine the association between nurse and institutional characteristics and perceived professional nurse knowledge and self‐efficacy of reporting child abuse and neglect. Design: A sample of N = 166 nurses were recruited to respond to the Reporting of Suspected Child Abuse and Neglect (RSCAN) survey. Methods: A multiple linear regression examined whether nurse characteristics and institutional characteristics were associated with the two RSCAN survey domain scores. Results: Perceived knowledge of a workplace child abuse and neglect protocol was associated with the knowledge subscale. Education and child abuse and neglect expertise were significant predictors of the self‐efficacy subscale. Nurses with a master's or higher degree and those who identified as being either forensic, paediatric or Emergency Department nurses, had less perceived institutional barriers to self‐efficacy of reporting child abuse and neglect. Conclusion: This study provides a preliminary insight into the institutional barriers and facilitators of nurses as child abuse and neglect mandated reporters. Implications for the profession and/or patient care: To encourage innovative education and collaborations to support nurses as fully informed child abuse and neglect mandated reporters. Impact: This research identifies the gaps and facilitators of nurses as child abuse and neglect mandated reporters to inform healthcare professionals and academic institutions on the importance of nurse education and experience in nurse knowledge and self‐efficacy in reporting suspected child abuse and neglect. Reporting methods: The authors of this study have adhered to relevant EQUATOR guidelines: STROBE. Patient or public contribution: There is no patient or public contribution as the study only looked at nurses. [ABSTRACT FROM AUTHOR]

Forensic mental health professionals are frequently exposed to inpatient aggression, which may negatively affect their physical and mental health. Current studies offer limited insight into how this may affect staff-patient interactions in the aftermath of aggression. A qualitative study was conducted to explore professionals' experiences with exposure to aggression. Thirteen semi-structured interviews and three focus groups were conducted with 25 professionals working in a high secure forensic mental health unit. A thematic analysis was conducted in consensus among three researchers. Five main themes were generated in the analysis: exposure to different forms of aggression, factors that shape the impact of aggression, emotional reactions, managing emotional reactions, and managing relationships with patients. These themes form a complex interplay. Feelings of anger and fear, intrusive memories, and avoidant or agitated behavior toward patients are frequently reported, affecting both the personal and professional lives of participants. Interpersonal relationships between team members can promote or hinder adequate management of feelings that arise after exposure to aggressive incidents. The tremendous impact that exposure to inpatient aggression may have on professionals, and the way that they care for their patients requires more attention. [ABSTRACT FROM AUTHOR]

Forensic mental health services play a key role in the diversion, treatment, rehabilitation, and supervision of offenders with mental health problems in Europe. Private sector providers are increasingly commissioned to provide secure care for service users. Questions have been raised about the effectiveness of the private sector providers. A sample of 229 patients from low, and medium secure psychiatric services in the United Kingdom was analyzed to determine differences in restrictive practices, adverse service user incidents, and service user characteristics between service users admitted to private sector or publicly funded hospitals. Service users with a diagnosis of a personality disorder, and those who had multiple psychiatric diagnoses were disproportionately placed in the private sector. Greater prevalence of seclusion, physical restraint, verbal aggression toward staff, physical violence toward staff and other service users, property damage, and self-harm were observed in private sector service users. Further attention is warranted around the decision-making processes that allocate people to private versus publicly funded care, potential sources of bias in admission characteristics should be taken into account when interpreting poorer clinical outcomes in the private sector. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Health Academics / Sağlık Akademisyenleri Dergisi is the property of Journal of Health Academics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is a growing body of international research investigating the impact of patient suicide on mental health professionals. The experience of losing a patient to suicide can have a significant and, in some cases, long-lasting (negative) impact on mental health professionals. However, the nature and extent of the impact on prison staff or forensic mental health professionals in particular is less clear. This narrative review summarises both quantitative and qualitative studies and key findings in this area, focusing on the above professions. A literature search was conducted using PsychInfo and Google Scholar, covering the period from 2000 onwards. The vast majority of findings relate to mental health professionals in general. We were unable to identify any published reports on the responses of forensic psychiatric staff. The majority of identified studies in the prison context are qualitative. Studies fromGerman-speaking countries are particularly scarce in both the prison and mental health contexts. We conclude that there is a profound lack of knowledge about the impact of client/patient suicide on the subgroups of (German) prison and forensic psychiatric staff. Clearly, more research is needed on both the nature and extent of the impact, as well as on the specific organisational and supportive factors that help to mitigate the negative effects of suicide. [ABSTRACT FROM AUTHOR]

Accessible Summary What is known on the subject What the paper adds to existing knowledge What are the implications for practice Introduction Aims Method Results Discussion Implication for Practice Secondary traumatic stress (STS) is the indirect traumatisation of a person through the stress of helping or knowing about other's trauma. Burnout is gradual exhaustion in response to long‐term work‐related stress. Both have negative psychological, physiological and/or organisational consequences; however, the existing research in forensic health care professionals (FHCPs) is limited. One study explored STS in FCHPs and found that lower psychological flexibility (ability to adapt) was a predictor of greater STS. Existing research on burnout in FHCPs suggests that individual differences, such as the ways in which we cope (talking to people vs. using substances), may predict burnout levels. Prevalence findings add to the recent evidence base, which also found moderate levels of burnout. However, this study is the first to find high levels of secondary traumatic stress in FHCPs. Similar to existing literature, the study's findings suggest that FHCP's with lower levels of psychological flexibility and more maladaptive coping strategies may experience greater STS and burnout symptoms, while staff who use more adaptive coping strategies may experience less burn‐out. Unexpectedly, staff who reported a more anxious attachment style were burnt‐out; however, there are limitations to this finding. Policies and practices in forensic settings should reflect the risk of STS and burnout. Practices or interventions should enhance adaptive coping strategies and psychological flexibility, such as Resilience Enhancement Programmes or Acceptance and Commitment Therapy (ACT). Secondary traumatic stress (STS) and burnout literature in inpatient forensic health care professionals (FHCPs) is limited, despite the psychological, physiological and organisational consequences.This study aimed to further this limited evidence base, investigating predictors of STS and burnout in FHCPs.98 healthcare professionals working in two UK forensic inpatient settings completed measures assessing: burnout, STS, psychological flexibility, coping style, attachment style and a demographic questionnaire recording length of service and the sex of staff.Results indicated high STS and moderate burnout levels. The main predictors of STS and burnout were poorer psychological flexibility and greater maladaptive coping styles, whereas lower burnout was predicted by greater adaptive coping styles and an anxious attachment style.This study has contributed towards a limited evidence base and indicates poorer psychological flexibility and greater maladaptive coping may be risk factors for STS and burnout in FHCPs, whereas greater maladaptive coping may be a protective factor.The findings suggest that interventions such as Acceptance and Commitment Therapy (ACT) and coping skills interventions, may offer protective benefits to inpatient forensic healthcare professionals. [ABSTRACT FROM AUTHOR]

Forensic mental health nursing is a specialty area of practice requiring specific knowledge and skills to work collaboratively with consumers. The Clinical Reasoning Cycle has been recognised as a potential framework to support nursing practice; however, it has been identified that adaptations are required to enhance utility in a forensic mental health services. The aim of this study was to explore and finalise a version of the cycle for forensic mental health nursing practice. Focus groups and interviews were used to explore adaptations with staff from a state‐wide forensic service and forensic mental health nursing academics. Data were thematically analysed. Four main themes were interpreted: (1) allegiance to the Nursing Process, (2) moving the cycle from page to practice, (3) working as a team, or not, and (4) implementation will be a marathon and not a sprint. While nursing academics were more in favour of updating the Nursing Process to ensure contemporary practice is captured, staff from the service were supportive of the adapted cycle but emphasised the need to ensure collaboration with the consumer and their supporters. The adapted cycle was seen to articulate the contribution of forensic mental health nursing care, and support for a nursing‐specific cycle was embraced by other disciplines, despite some hesitation from nurses. Prior to implementation there is a need to ensure the merits of the cycle are clearly articulated, along with a range of resources and specific contextual information to ensure the cycle can be successfully applied to enhance nursing practice and consumer care. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this qualitative study was to explore the subjective experiences of consumers and staff members regarding the availability of electronic nicotine delivery systems (ENDS) in inpatient mental health units. Methods: Mental health consumers and staff members (n = 16) from rehabilitation and forensic inpatient units were interviewed in 2022. Thematic analysis of the transcripts was undertaken. Results: Our study identified four themes: The high salience of nicotine use in inpatient units, delivering nicotine in a resource scarce environment, weighing up the harms of ENDS as a smoking cessation tool, and a need for fair and consistent policy. Conclusions: The main positive aspects identified were recognition of rights of consumers, a relative harm reduction compared to tobacco use, and ENDS as a positive factor in the therapeutic relationship. The main challenges identified were resourcing issues, ENDS being a potential source of tension and conflict and a lack of overarching policy guiding their use. [ABSTRACT FROM AUTHOR]

The Croatian Academy of Sciences and Arts has developed an Applied Genomics Development Strategy to promote the use of genomics in Croatia. The strategy focuses on areas such as biomedicine, biosafety, and forensic genomics, and emphasizes the need for ethical guidelines and a legal framework. It also highlights the importance of interdisciplinary collaboration, education, and international cooperation. The document also includes a list of scientific articles covering various topics in genetics and genomics, providing valuable insights into the field and its applications in medicine and research. [Extracted from the article]

Transgressive incidents directed at staff by forensic patients occur frequently, leading to detrimental psychological and physical harm, underscoring urgency of preventive measures. These incidents, emerging within therapeutic relationships, involve complex interactions between patient and staff behavior. This study aims to identify clusters of transgressive incidents based on incident characteristics such as impact, severity, (presumed) cause, type of aggression, and consequences, using latent class analysis (LCA). Additionally, variations in incident clusters based on staff, patient, and context characteristics were investigated. A total of 1,184 transgressive incidents, reported by staff and targeted at staff by patients between 2018-2022, were extracted from a digital incident reporting system at Fivoor, a Dutch forensic psychiatric healthcare organisation. Latent Class Analysis revealed six incident classes: 1) verbal aggression with low impact; 2) verbal aggression with medium impact; 3) physical aggression with medium impact; 4) verbal menacing/aggression with medium impact; 5) physical aggression with high impact; and 6) verbal and physical menacing/aggression with high impact. Significant differences in age and gender of both staff and patients, staff function, and patient diagnoses were observed among these classes. Incidents with higher impact were more prevalent in high security clinics, while lower-impact incidents were more common in clinics for patients with intellectual disabilities. Despite limitations like missing information, tailored prevention approaches are needed due to varying types of transgressive incidents across patients, staff, and units. [ABSTRACT FROM AUTHOR]

Forensic anthropology (FA) as a specialized discipline has been practised in multi-lingual Switzerland for over a decade. A variety of expertise regarding osteological assessments as well as facial image comparison (FIC) is provided by different centres. Nevertheless, information is lacking about the awareness of FA and its benefits for forensic investigations among forensic stakeholders. Therefore, a survey was sent to Swiss anthropologists (AN) and related professions (police officers, prosecutors, and forensic pathologists) to assess three main aspects: (1) the experience of working (biological/forensic) anthropologists within FA; (2) how FA is perceived by other professions within the legal system; and (3) identify gaps (if any) in understanding of FA with the aim to suggest avenues for improvement if necessary. The results show that awareness of FA varies by occupation and cantonal regions. In areas where close collaborations between forensic anthropologists (FAs) and other stakeholders have been formally established, be it with focus on osteological analyses or FIC, the awareness of FA competencies was superior to areas where this was not the case. An overwhelming majority of forensic actors expressed interest in continuing education related to the role of FA. These findings indicate that facilitation of communication and collaboration leads to improvement in the awareness of the competencies of FAs and their contribution to forensic investigations. [ABSTRACT FROM AUTHOR]

To explore mental health staff's responses towards interventions designed to reduce the use of mechanical restraint (MR) in adult mental health inpatient settings. We conducted a cross-sectional, questionnaire-based survey. The questionnaire, made available online via REDCap, presented 20 interventions designed to reduce MR use. Participants were asked to rate and rank the interventions based on their viewpoints regarding the relevance and importance of each intervention. A total of 128 mental health staff members from general and forensic mental health inpatient units across the Mental Health Services in the Region of Southern Denmark completed the questionnaire (response rate = 21.3%). A total of 90.8% of the ratings scored either 'agree' (45.2%) or 'strongly agree' (45.6%) concerning the relevance of the interventions in reducing MR use. Overall and in the divided analysis, interventions labelled as 'building relationship' and 'patient-related knowledge' claimed high scores in the staff's rankings of the interventions' importance concerning implementation. Conversely, interventions like 'carers' and 'standardised assessments' received low scores. The staff generally considered that the interventions were relevant. Importance rankings were consistent across the divisions chosen, with a range of variance and dispersion being recorded among certain groups. [ABSTRACT FROM AUTHOR]

Copyright of Fenerbahce University Journal of Health Sciences (FBU-JOSH) / Fenerbahçe Üniversitesi Sağlık Bilimleri Dergisi is the property of Fenerbahce University Journal of Health Sciences (FBU-JOSH) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Forensic nursing is a specialized area of nursing that combines nursing knowledge with legal and forensic aspects. Forensic nurses play a crucial role at the intersection of healthcare and the legal system. Discussing violence has become a major topic, especially in the health context, due to the global growth of violence, making it a priority for discussion in public health. Therefore, it is essential that the nursing professional is qualified to work in this area, offering their respective contributions to know how to intervene and recognize these situations, knowing which steps to follow and how to proceed in the most varied contexts presented, in addition to a thorough look and a rich in details paying attention to quality service, the environment, exposure, safety and reliability. The objective is to analyze the topic regarding forensic nursing with regard to violence against women, aiming at health promotion. This study highlighted opinions about forensic nursing, reflecting on thoughts and perspectives of the specialty, covering everything from the concepts that are pillars on the subject to other aspects. In this article, the authors had the opportunity to explore the topic a little more and bring knowledge to future readers, since one of the limitations of the study is the lack of knowledge of this specialty, and also of its professional performance. [ABSTRACT FROM AUTHOR]

Background: International studies show that adults with intellectual and developmental disabilities (IDD) are disproportionately represented in the criminal justice and forensic mental health systems; however, it is difficult to capture their involvement across systems in any one jurisdiction. Aims: The current study aimed to estimate the prevalence of IDD across different parts of the criminal justice and forensic mental health systems in Ontario and to describe the demographic and clinical profiles of these individuals relative to their counterparts without IDD. Methods: This project utilised administrative data to identify and describe the demographic and clinical characteristics of adults with IDD and criminal justice or forensic involvement across four sectors: federal correctional facilities, provincial correctional facilities, forensic inpatient mental health care and community mental health programmes. Questions were driven by and results were contextualised by a project advisory group and people with lived experience from the different sectors studied, resulting in a series of recommendations. Results: Adults with IDD were over‐represented in each of the four settings, ranging from 2.1% in federal corrections to 16.7% in forensic inpatient care. Between 20% (forensic inpatient) and 38.4% (provincial corrections) were under the age of 25 and between 34.5% (forensic inpatient) and 41.8% (provincial corrections) resided in the lowest income neighbourhoods. Medical complexity and rates of co‐occurring mental health conditions were higher for people with IDD than those without IDD in federal and provincial corrections. Conclusions: Establishing a population‐based understanding of people with IDD within these sectors is an essential first step towards understanding and addressing service and care needs. Building on the perspectives of people who work in and use these systems, this paper concludes with intervention recommendations before, during and after justice involvement. [ABSTRACT FROM AUTHOR]

Background: Violence in inpatient settings is recognised as a worldwide issue, with inpatient intellectual disability services having higher rates than other mental health settings. Violence results in injury and illness, lack of confidence in the organisation and staff burnout. These combined effects have a negative impact on the ability of services to provide therapeutic environments. Attempts to manage violence tend to focus on the individual. This is only one part of the solution. Situational risk factors for violence within secure settings can be identified and modified to reduce violence rates. The role of situational risk factors in rates of institutional violence requires consideration in addition to individual patient risk assessment and management. Aims: To discuss an illustrative case study of a ward experiencing high levels of violence, resulting in staff burnout and low morale. To describe how assessing and addressing the relevant situational risk factors led to demonstrable reductions in violence and improvements in the service provided. Methods: This case study demonstrates the practical application of assessing and managing situational risk factors for violence in a locked intellectual disability ward in order to effectively reduce levels of violent incidents. A description of the violence and critical issues faced by the ward is provided, noting key elements of the timeline of events and the application of the Promoting Risk Intervention by Situational Management (PRISM) process to address these. Results: The PRISM protocol enabled a comprehensive assessment and understanding of situational factors relevant to the violence rates in the ward. The recommendations following the analysis enabled the management team to identify areas for immediate and long‐term action. Practical steps to address issues such as improving soundproofing were implemented quickly whilst other issues required changes over the longer term. Significantly, reduced levels of violence were observed within a 2‐month period of immediate steps being taken, with further gains achieved over the longer term. Conclusion: This paper provides the only example of the use of the PRISM protocol in an intellectual disability inpatient setting. The reduction in violence seen in this unit provides 'real world' evidence that addressing situational factors for institutional violence can be effective in intellectual disability inpatient settings, with beneficial outcomes for patients and staff. Whilst individual patient risk assessment and risk management are key components of forensic mental health care, situational risk factors for violence are highly relevant to rates of violence within secure care settings. Structured assessment of situational risk factors should be considered when inpatient settings experience persistent high levels of violence. Further research on the impact of assessing situational risk factors in forensic mental health settings (including intellectual disability services) would help to develop the existing evidence base. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) have been consistently linked to interpersonal violence and are highly prevalent in correctional populations, particularly in men who perpetrate (sexual) violent behavior. Although exposure to ACEs is common in men who perpetrate interpersonal violence, less is known about the differences between men who commit sexual versus non-sexual violence. This cross-sectional study reports on the differences in prevalence of adverse childhood experiences in Dutch men who committed sexual offenses (N = 29) versus those who committed (non-sexual) violent offenses (N = 29), all who have been mandated to forensic clinical care. Drawing on data from a RCT-study among male forensic psychiatric inpatients with cluster B personality disorders from seven forensic hospitals in the Netherlands, the study explored potential differences in ACEs, and its relationship to treatability in the first year of forensic treatment. No significant differences were found in prevalence of childhood abuse and neglect among men convicted for sexual offenses versus those convicted for violent offenses. In our study, ACEs were not predictive of risk relating to treatability at the start of forensic treatment. Our findings suggest that taking into account trauma histories is of equal importance for both offending groups. Implications regarding trauma-informed forensic care are discussed. [ABSTRACT FROM AUTHOR]

Background: Forensic psychiatry is often associated with long admissions and has a high cost of care. There is little known about factors influencing length of stay (LOS), and no previous systematic review has synthesised the available data. This paper aims to identify factors influencing the LOS in forensic psychiatry hospitals to inform care and interventions that may reduce the length of admissions. Methodology: A systematic review was conducted by searching major databases, including PubMed, EMBASE and PsycInfo, from inception until May 2022. Observational studies conducted in forensic hospitals that examined associations between variables of interest and LOS were included. Following data extraction, the Newcastle‒Ottawa Scale was used for quality appraisal. No meta-analysis was conducted due to heterogeneity of information; a quantitative measure to assess the strength of evidence was developed and reported. Results: A total of 28 studies met the inclusion criteria out of 1606 citations. A detailed quantitative synthesis was performed using robust criteria. Having committed homicide/attempted homicide, a criminal legal status with restrictions, and a diagnosis of schizophrenia-spectrum disorders were all associated with longer LOS. Higher Global Assessment of Functioning (GAF) scores were associated with a shorter LOS. Conclusion: High-quality research examining factors associated with LOS in forensic psychiatry is lacking, and studies are heterogeneous. No modifiable characteristics were identified, and thus, practice recommendations were not made. There is an increasing necessity to understand the factors associated with longer admissions to inform care and increase success in reintegration and rehabilitation. This paper provides recommendations for future research. [ABSTRACT FROM AUTHOR]

Aims: The aims of the study were to determine the types and prevalence of forensic mental health nurse exposure to patient aggression and explore the impact of these exposures on their physical and mental health and work absences. Design: Cross-sectional survey conducted January to April 2020. Methods: All 205 nurses working in an Australian high-security inpatient forensic mental health hospital were invited to participate. An online survey included the Perception of Prevalence of Aggression Scale to measure respondent exposure to types of patient aggression, and the SF-36v2 to measure mental and physical health. Absence from work and other work and individual characteristics were also explored. Results: Sixty-eight respondents completed the survey. Verbal abuse was the most experienced aggression type, followed by physical violence and observing violence, patient self-harming behaviours and sexual violence. Nurses who worked in acute units experienced significantly more exposure to overall aggression than nurses in non-acute units. Higher level of aggression was associated with number of days sick leave taken and days off due to aggression or violence. Higher level of aggression was associated with poorer mental health, and patient self-harming behaviour was associated with poorer physical health. Conclusions: Nurses in acute units experience higher levels of inpatient aggression and are therefore at increased risk of being impacted by the exposure. Findings indicate a psychological impact of exposure to frequent aggression and potential for an accumulative effect of exposure to traumatic events on nurse well-being. Nurses who are victim of, or witness, physical violence are most likely to take time off work. Impact: This study provides further evidence that forensic mental health nurses are frequently exposed to various forms of patient aggression. For some nurses, this exposure to patient aggression negatively impacted their mental and physical health. Employing organizations should therefore prioritize provision of formal support for nurses. No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To investigate the current status of experience and support of nurses as second victims and explore its related factors in nurses. Design: A sequential, explanatory, mixed-method study was applied. Methods: A total of 406 nurses from seven tertiary hospitals in China were chosen as participants between September to October 2023. The Chinese version of the Second Victim Experience and Support Questionnaire (SVEST), Somatic Complaints of Sub-health Status Questionnaire (SCSSQ) and Generalized Anxiety Disorder (GAD-7) were applied to collect quantitative data. Eight nurses were selected for a qualitative study through in-depth interviews. Through interpretive phenomenological analysis, the interview data were analysed to explore the experience and support of nurses as second victims. Results: Practice distress (15.74 ±  4.97) and psychological distress (15.48 ±  3.74) were the highest dimensions, indicating Chinese nurses experienced second victim-related practice and psychological distress. Nurses with different gender, age, education, marital status, income, working hours, professional titles, and unit types have different levels of second victim-related experience and support (p <  0.05). In addition, the score of SVEST was positively associated with SCSSQ (r =  0.444) and GAD-7 (r =  0.490) (p <  0.05). This qualitative study found that the experience and support of nurses as second victims included nurses' perceptions and needs for patient safety events; psychological, physical and practice distress of nurses; and nurses and hospitals coping style after patient safety events. Discussion: Our findings suggest that nurses who are second victims of patient safety events experience severe practice and psychological distress, indicating that nursing managers should pay attention to psychological and practice distress of nurses after patient safety events and provide effective preventive measures. [ABSTRACT FROM AUTHOR]

Objective: to identify the markers of violence against older adults from the nurses' perspective. Method: a qualitative study conducted between June and September 2021 in the state of Paraíba (Brazil), with the participation of nine nurses in two focus groups. The empirical material was transcribed in full and transformed into a text corpus with similarity analysis. Results: in the central core of the maximum tree, it was possible to observe terms common to more than one typification of violence, such as: “cycle of violence”, “trust”, “dominate”, “psychological distress”. In physical violence: “fractures”, “break” and “throw”; in psychological violence: “threat”, “fear”, “shame”, “injury”, “vaginal discharge” and “vaginal”; in financial violence: “withdrawal”, “dependence” and “take”; in neglect: “lack”, “supply” and “hygiene”; and in abandonment: “depression”, “loneliness” and “sadness”. Conclusion: this research values Nursing as a science and profession, especially in the forensic area, by investigating violence against older adults. The nurses' perception makes the Nursing Process more reliable and useful in identifying, reporting and solving incidents.

Abstract Background Emergency department nurses often deal with victims of violence and trauma. In the emergency department, the main focus is on saving lives and stabilizing patients' conditions. The next important task is to preserve any valuable evidence that could potentially help identify a crime. It is important to describe how nurses currently practice in the emergency department and perceive their role in caring for forensic patients. This study aimed to investigate the frequency of performance and perception of the importance of forensic nursing role behaviors among emergency department nurses as well as the correlation between mean scores of performance and perception. Methods This is a cross-sectional correlational descriptive study. This non-observational survey study used a questionnaire to investigate the frequency of performance and perception of the importance of forensic nursing role behaviors among 274 emergency department nurses. Results The total mean scores for frequency of performed behaviors and their perceived importance were 2.36±0.65 and 4.23±0.64 respectively. The overall mean scores of importance were significantly higher than frequency. There was a significant correlation between the frequency of performance and perception of the importance of twenty-eight items (twenty-four positive correlations and 4 negative correlations) (p

This article provides a commentary on a randomized controlled trial that examines the visibility of inflicted bruises using alternate light. The authors agree on the importance of identifying injuries in cases of physical violence, particularly in individuals with darkly pigmented skin. However, they raise concerns about the methodology and interpretation of the study, including the use of a novel bruise visibility score and the clinical meaningfulness of the improvements observed. The authors caution against relying on alternate light as a tool to detect bruises and highlight the limitations of its use in forensic practice. Additionally, the article mentions that George Mason University has received a significant donation to address interpersonal violence, and the International Association of Forensic Nurses has developed a toolkit to assist in documenting cases of strangulation. [Extracted from the article]

This document is a corrigendum for an article titled "The totalising nature of secure and forensic mental health services in England and Wales." The corrigendum acknowledges errors in the original article and provides corrected sentences for those errors. The errors include instances of text overlap without appropriate acknowledgement of the original source. The corrigendum does not change the scientific conclusions of the article. [Extracted from the article]

The article offers information on a courtroom experience involving a physician-in-training's testimony about treating a victim of sexual assault. Topics include the courtroom setting, the physician's interaction with the perpetrator, and the challenges faced in providing care and testimony in such cases.

Background: Introduction of guidance by the National Institute for Health Research has led to an increase in participation by people with 'lived experience' of mental health problems. However, some researchers have questioned the extent to which involvement has been meaningful, expressing concerns that involvement is impeded by the structure and culture of academia. A prior review of literature to 2016 provided little evidence of active engagement. Aims: To find out from published literature how patient and public involvement in designing and or conducting research has been used in forensic mental health settings, prisons or probation since the last review period. Methods: A systematic scoping review of research published in academic journals between 2016 and February 2023 was completed using terms for research activity, involvement of people with experience of receiving services and health or justice systems to search three databases: MEDLINE, EMBASE and PsycINFO. We used the Guidance for Reporting Patient and Public Involvement in Research Tool to support data extraction and to summarise our own service user involvement in this study. Results: From 675 unique titles retrieved, 17 were eligible for inclusion, covering 16 unique studies. Most of the included research was by/with people who had prison experience. Only two studies had been conducted by/with people who had experience of secure hospital wards/forensic mental health services. Details of how people with lived experience had contributed to the research were scarce, but in 8 studies they had been involved throughout and included in the authorship group. Conclusion: Whilst this review identifies pockets of good practice, meaningful engagement in forensic mental health research seems to remain rare, at least as reported in papers published in academic journals. Further research is required into whether this reflects real limits on inclusion, as we suspect, or such full integration that such reporting is not regarded as necessary or desirable, which we doubt. We urge journal editors to routinely ask authors to include information about how people with lived experience have been involved in any published research and the nature and extent of the influence they had. This may help to develop the evidence base and guard against tokenistic involvement. [ABSTRACT FROM AUTHOR]

Aim Design Methods Reporting Method Results Conclusion Implications Impact Patient or Public Contribution This study aimed to gain insights into forensic nurses' perspectives and approaches to behavioural crisis situations, comparing them to disciplines traditionally involved in first‐line behavioural crisis response.This study used a descriptive, qualitative exploratory design and was informed by Systems Theory.The study was carried in the United States, between 2022 and 2023. Data were gathered through four focus groups: police officers (n = 12), co‐response (mental health) clinicians (n = 13), sexual assault nurse examiners (n = 6) and correctional nurses (n = 4). Thematic analysis was performed.The Standards for Reporting Qualitative Research (SRQR) guidelines were used.Findings revealed temporal themes in crisis response: (1) Searching for Historical Information; (2) Safety and Acting at the Present Scene; and (3) Future Strategies and Interventions. Common priorities (e.g. safety and de‐escalation) were identified across groups. Notably, nurses demonstrated a comprehensive approach, addressing physical and mental health assessments, substance involvement, and physical injury evaluation.This study proposes the creation of a novel nursing role within first‐line multidisciplinary teams (MDTs) for crisis response—the Nurse‐Police Assistance Crisis Team (N‐PACT). Nurses bring expertise and comprehensive assessment skills to enhance crisis responses, particularly in cases involving mental health emergencies, medical crises, and drug‐related incidents.Forensic nurses, with their diverse competencies and comprehensive training, are highly valuable assets within MDTs. Their expertise extends to proficiently conducting mental and physical assessments, ensuring safety and adeptly navigating situations that intersect with the legal system.The N‐PACT concept can improve outcomes and streamline the allocation of resources, particularly considering the number of police calls involving behavioural crises.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Emergency department nurses often deal with victims of violence and trauma. In the emergency department, the main focus is on saving lives and stabilizing patients' conditions. The next important task is to preserve any valuable evidence that could potentially help identify a crime. It is important to describe how nurses currently practice in the emergency department and perceive their role in caring for forensic patients. This study aimed to investigate the frequency of performance and perception of the importance of forensic nursing role behaviors among emergency department nurses as well as the correlation between mean scores of performance and perception. Methods: This is a cross-sectional correlational descriptive study. This non-observational survey study used a questionnaire to investigate the frequency of performance and perception of the importance of forensic nursing role behaviors among 274 emergency department nurses. Results: The total mean scores for frequency of performed behaviors and their perceived importance were 2.36±0.65 and 4.23±0.64 respectively. The overall mean scores of importance were significantly higher than frequency. There was a significant correlation between the frequency of performance and perception of the importance of twenty-eight items (twenty-four positive correlations and 4 negative correlations) (p<0.05). The frequency of performed behaviors positively correlated with participants' type of shift worked and their personal experiences of legal and judicial claims. The female gender of respondents positively correlated with behaviors' perceived importance. Conclusion: The study revealed a significant discrepancy between the frequency of forensic nursing role behaviors performed and their perceived importance in the emergency department. This gap emphasizes the pressing requirement for forensic nursing subjects to be incorporated into graduate and undergraduate nursing curricula, as well as ongoing training programs and courses. It is crucial to establish and implement forensic nursing protocols for the care of trauma victims, and to foster collaboration between healthcare systems, law enforcement, and forensic investigators to streamline the process. [ABSTRACT FROM AUTHOR]

Nurses working in correctional and forensic mental health settings face unique challenges in the provision of care to patients within custodial settings. The subjectivities of both patients and nurses are subject to the power relations, discourses and abjection encountered within these practice milieus. Using a poststructuralist approach using the work of Foucault, Kristeva, and Deleuze and Guattari, this paper explores how both patient and nurse subjectivities are produced within the carceral logic of this apparatus of capture. Recognizing that subjectivities are fluid and dynamic, and capable of change, Deleuze and Guattari's concept of deterritorialization will illustrate opportunities for resistance, where nurses can begin to practice outside the dominant carceral logic (and restrictions) of the system. [ABSTRACT FROM AUTHOR]

This study describes and examines the impact of a novel Reflective Practice program tailored to the multidisciplinary clinical workforce at an inpatient forensic mental health setting. Surveys assessing wellbeing, self-efficacy and reflective practice capacity were administered to all clinical staff prior to commencement of the Reflective Practice program, as well as six months post-implementation. Interviews were also conducted with key clinical stakeholders to obtain detailed feedback regarding the impact of the program across the organization following six-eight months of implementation. Staff who participated in post-implementation surveys reported significantly higher confidence in their work when compared to staff at baseline, while clinical stakeholders observed improvements in the cohesion of the multidisciplinary team. In spite of the limitations of the pragmatic study design and small sample size, results suggest the novel Reflective Practice program offers an acceptable model for adoption in an inpatient forensic mental health setting, with potential to improve the wellbeing, learning and morale of a forensic mental health workforce. The findings also highlight the need to support practice development and wellbeing in early career clinicians, where low confidence and high stress are predominant. [ABSTRACT FROM AUTHOR]

The effect of medium secure care on reoffending is unknown; adequate control groups cannot be identified and exposure to reconviction may be confounded by onward placement and by legal restrictions. Retrospective analysis of convictions for an England and Wales National Cohort of adults discharged from 35 medium secure services during 1997/8. Data were retrieved from the Offenders Index and from each service. Reconviction risk for 711 cases was estimated using Offending Groups Reconviction Scale-2 (OGRS-2). Reconviction (any standard list offense) served as the sole outcome during a uniform six-year follow up. Reconviction outcomes were highest following transfer to prison, reduced by further secure care whilst restriction orders were effective in reducing convictions only in those at high risk. Substantial reductions in reconvictions were observed across the full range of criminogenic risk after control of the above confounding. OGRS-2 proved a useful assay for estimating the effects of secure services on reconvictions. Analysis of more contemporary samples using the current methods and more recent versions of OGRS is warranted. [ABSTRACT FROM AUTHOR]