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Health promotion as relational, practical, and structurally constrained work in forensic psychiatric care: a
Annette Björk1, Jelwa Basim2, Maria Sundberg3
1Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
Background:
Forensic psychiatric care involves balancing treatment and rehabilitation with strict legal and security requirements. Registered nurses play a central role in promoting health and supporting patients' everyday life in this context; however, their perspectives on health-promoting work within coercive institutional settings remain underexplored.
Aim:
To explore registered nurses' experiences of promoting health and supporting everyday life in forensic psychiatric care.
Methods:
A qualitative design with individual face-to-face semi-structured interviews was used. Fifteen registered nurses working in forensic psychiatric care in Sweden participated. The interview data were analysed using reflexive thematic analysis following Braun and Clarke, informed by relational perspectives on care and institutional power.
Results:
Three interrelated themes were created: (1) Dialogue as a foundation for participation, (2) Everyday practice as a vehicle for recovery, and (3) Navigating paradoxes within restrictive care. Registered nurses described dialogue as foundational for building trust, fostering motivation, and enabling patient participation while simultaneously being shaped by coercive conditions and institutional constraints. Everyday practices, including physical activity, shared meals, and structured routines, functioned as concrete vehicles for recovery, yeat remanined embedded within secitity oriented frameworks. Nurses also described ongoing tensions between health promotion, medication related side effects, and institutional risk management.
Conclusions:
This study suggests that registered nurses in forensic psychiatric care experience health promotion as relational, practical, and structurally constrained work within coercive institutional settings. Rather than functioning as a discrete intervention, health promotion appears as an embedded and negotiated aspect of everyday nursing practice. While registered nurses seek to foster participation and well-being, their efforts unfold within institutional arrangements primarily organised around security, risk management, and pharmacological stability. Strengthening organisational support and interprofessional collaboration may enhance the conditions for sustainable health-promoting practice in forensic psychiatric care.
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