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Patientdelaktighet i rättspsykiatrisk vård: Vårdprocess och vårdvardag
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.ORCID iD: 0000-0002-7304-4771
2024 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Purpose: The overall purpose of this dissertation is to describe how patient participation can be understood in the context of high-security care in forensic psychiatry, where individuals are subjected to compulsory care.

Design and method: The dissertation is primarily based on a phenomenological foundation, employing a reflective lifeworld approach. Three studies were conducted using interviews, and one study utilized questionnaires with descriptive and comparative statistics.

Main result: In many ways, both patients and staff share a consensus regarding patient participation in forensic psychiatric care. From their respective perspectives, similar obstacles and challenges are described, while good care and the experience of participation are strongly linked to what occurs within the caring relationship. However, it cannot be ignored that participation is not solely about good treatment and meaningful relationships. Forensic psychiatric care is carried out under compulsion within a legal system that is difficult for patients to understand and may be perceived as unjust. Participation must therefore be understood from a broader perspective than just everyday care, as everyday care is part of a larger care process.

Conclusions: Caregivers and patients associate patient participation in a high-security forensic psychiatric environment with significant caring relationships. A strong caring relationship seems to partially compensate for many situations characterized by non-participation. The studies suggest that staff need support in understanding the complexities of forensic psychiatry in order to better support patients throughout the care process. Therefore, a clinical implication is to help caregivers understand the forensic psychiatric system themselves so that they can explain it to patients and engage in discussions about jurisprudence related to forensic care.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2024. , p. 85
Series
Linnaeus University Dissertations ; 545
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
URN: urn:nbn:se:lnu:diva-133033DOI: 10.15626/LUD.545.2024ISBN: 9789180822091 (print)ISBN: 9789180822107 (electronic)OAI: oai:DiVA.org:lnu-133033DiVA, id: diva2:1906497
Public defence
2024-11-08, Newton, hus C, Växjö, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2024-10-18 Created: 2024-10-17 Last updated: 2025-03-25Bibliographically approved
List of papers
1. An interview study of professional carers’ experiences of supporting patient participation in a maximum security forensic psychiatric setting
Open this publication in new window or tab >>An interview study of professional carers’ experiences of supporting patient participation in a maximum security forensic psychiatric setting
2020 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 41, no 3, p. 201-210Article in journal (Refereed) Published
Abstract [en]

Patient participation in forensic psychiatric settings seems to be complex by nature, and previous studies show that patients rate their participation as lower in this context compared to general psychiatric contexts. Studies on caregivers’ perspective could provide a clearer picture of the components and possibilities of patient participation in forensic psychiatry. The aim of the study is to describe carers’ experiences in supporting patient participation in a maximum security forensic psychiatric care setting. Twelve psychiatric caregivers were interviewed about how they support patients’ participation. The result shows that a complexity of patient participation emerges as a difficult act of balancing the paradoxical role of caring for the patient’s interests and development, while simultaneously representing and adhering to the rules and regulations of the system in which one is employed. In conclusion, it is suggested that participation is comprehended as an umbrella term and that focus is directed to conceptualising what caregivers can do in order to create positive patient-carer relationships, as well as what constitutes such a relationship.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-90280 (URN)10.1080/01612840.2019.1658833 (DOI)000498775600001 ()31765239 (PubMedID)2-s2.0-85075585931 (Scopus ID)
Projects
USEFOR
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01409
Available from: 2019-11-26 Created: 2019-11-26 Last updated: 2024-10-17Bibliographically approved
2. Patients’ Experiences of Participation in High-Security, Forensic Psychiatric Care
Open this publication in new window or tab >>Patients’ Experiences of Participation in High-Security, Forensic Psychiatric Care
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2022 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 43, no 7, p. 683-692Article in journal (Refereed) Published
Abstract [en]

The role of patient participation in forensic psychiatric care is unclear, but has been emphasised as important in recent research. This study aims to describe patients’ lived experiences of participation in high-security, forensic psychiatric settings. Sixteen patient interviews were performed in this phenomenological study and analysed with a Reflective Lifeworld Research approach (RLR). Results show that participation must be understood in relation to its opposite construct, non-participation. Participation can thus be explained as situations where non-participation is less visible. Actions to develop the training of patient-staff interactions for forensic psychiatric staff to promote patient participation are called for.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2022
Keywords
Forensic psychiatry, high security, participation, patient perspective, phenomenology
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-110222 (URN)10.1080/01612840.2022.2033894 (DOI)000752250900001 ()35130107 (PubMedID)2-s2.0-85124824641 (Scopus ID)2022 (Local ID)2022 (Archive number)2022 (OAI)
Projects
USEFOR
Funder
Medical Research Council of Southeast Sweden (FORSS), 2019-930801Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-01409Region Kronoberg, 2019- 933814Region Kronoberg, 2019- 930775
Available from: 2022-02-08 Created: 2022-02-08 Last updated: 2024-10-17Bibliographically approved
3. Forensic psychiatric patients’ experiences of participating in administrative court proceedings concerning the continuation of forensic psychiatric care
Open this publication in new window or tab >>Forensic psychiatric patients’ experiences of participating in administrative court proceedings concerning the continuation of forensic psychiatric care
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2023 (English)In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 14, article id 1151554Article in journal (Refereed) Published
Abstract [en]

Introduction: Previous studies show that both staff and patients describe patient participation as a challenge in forensic psychiatry. One reason may be that the forensic psychiatric process is difficult to understand and is experienced as being slow and complex. The proceedings in an administrative court are a core element in forensic psychiatric care as it constitutes the legal authority that legitimizes the deprivation of liberty. A better understanding about how patients experience these proceedings can contribute with important knowledge about how forensic psychiatric care can be understood from a patient perspective. The aim of the study was to describe patients’ lived experiences of participating in oral hearings in an administrative court concerning the continuation of their forensic psychiatric care.

Materials and methods: This is a phenomenological study performed in a Swedish context with a total of 20 interviews conducted with a Reflective Lifeworld Research (RLR) approach.

Results: The results reveal three themes; A significant, correct but meaningless formality; An imbalance of power within the hearings; and Existential and practical disorientation.

Conclusion: The findings show how these court proceedings concerning the continuation of forensic psychiatric care are often experienced as challenging. This is partly due to the care structure in forensic psychiatry and that the purpose of the hearings is difficult to comprehend and is perceived as unjust by patients. Another challenge is of a more existential dimension, where the main character in a hearing is most likely in a situation that would be stressful for anyone. However, the focus on danger can make this experience even more intense. An increased transparency on this legal process along with more discussion and education for both patients and staff is called for based on the results.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
administrative court proceeding, forensic psychiatry, patient perspective, phenomenology, psychiatry
National Category
Psychiatry Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-119848 (URN)10.3389/fpsyt.2023.1151554 (DOI)000959018400001 ()37009104 (PubMedID)2-s2.0-85151943917 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018–01409Medical Research Council of Southeast Sweden (FORSS), 2019–930801Region Kronoberg, 2019-933814Region Kronoberg, 2019-930775
Available from: 2023-03-18 Created: 2023-03-18 Last updated: 2024-10-17Bibliographically approved
4. Self‐Reported Perceptions of Patients and Staff on Participation and Verbal and Social Interactions in High‐Security Forensic Psychiatric Care in Sweden
Open this publication in new window or tab >>Self‐Reported Perceptions of Patients and Staff on Participation and Verbal and Social Interactions in High‐Security Forensic Psychiatric Care in Sweden
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2025 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 32, no 2, p. 263-275Article in journal (Refereed) Published
Abstract [en]

Introduction: Studies suggest that experiences of patient participation, as described by both patients and staff, are associated with a significant caring relationship of high quality.

Aim: This study aimed to investigate staffs' and patients' self-reported perceptions on participation and the frequency and importance of verbal and social interactions in high security forensic psychiatry.

Method: The questionnaire Verbal and Social Interactions (VSI) was used together with the subscale Participation from Qualityin Psychiatric Care (QPC). The study was conducted at a large forensic psychiatric clinic in Sweden.

Results: Staff and patients rated the frequency of VSI differently while reporting the same perceived degree of patient participation. All categories of VSI were significantly correlated with perceived level of participation with medium or small effect size for the patients.

Discussion: Patients' perceived participation seems to depend on verbal and social interaction within the specific categories ‘Showing interest in the patients’ feelings, experiences, and behavior’ and ‘Helping the patients establish structure and routines in their everyday life’. There was, however, a negative association for the latter.

Implications for Practice: The results give a better understanding of what kind of interactions that affect patients' perceived level of participation.

Relevance Statement: Patient participant is a prioritised area for development in forensic psychiatry. The study contributes to a better understanding of what types of interactions that affect the perceived level of participation, while at the same time, it shows important similarities and differences between patient and staff perspectives

Place, publisher, year, edition, pages
John Wiley & Sons, 2025
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-132735 (URN)10.1111/jpm.13105 (DOI)001312376600001 ()2-s2.0-85204089680 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2024-09-24 Created: 2024-09-24 Last updated: 2025-03-13Bibliographically approved

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