'Difficult' Patients: Disciplinary Power and Nursing Practice in Forensic Hospital Settings.

Area of Science:

• Forensic Mental Health Nursing
• Psychiatric Nursing
• Criminal Justice Mental Health

Background:

• Forensic mental health settings serve individuals in the criminal justice system with psychiatric conditions.
• Antisocial personality disorder (ASPD) presents unique challenges for nurses, often perceived as difficult to treat.
• Canadian high-security forensic hospitals house patients, many with psychotic disorders, but also a subset with ASPD.

Purpose of the Study:

• To critically examine forensic mental health nursing practices with patients diagnosed with ASPD.
• To explore the challenges and strategies nurses employ when working with this patient population.
• To analyze nursing practices through the theoretical lens of Michel Foucault's concept of disciplinary power.

Main Methods:

• Qualitative study utilizing discourse analysis methodology.
• Examination of nursing practices in a Canadian high-security forensic hospital.
• Analysis of nurse participants' descriptions of challenges and strategies.

Main Results:

• The forensic hospital environment functions as a disciplinary space with constant patient observation and normalization attempts.
• Patients with ASPD frequently violate rules, causing frustration for nursing staff.
• Tensions arise between strict rule adherence and flexible approaches to improve nurse-patient relationships.

Conclusions:

• Nursing practice with ASPD patients involves navigating a disciplinary environment.
• Strategies must balance adherence to rules with therapeutic flexibility for better patient relationships.
• Proposals for practices both within and outside the disciplinary order are needed for effective care.