Working under threat: Fear and nurse–patient interactions in a forensic psychiatric setting

Abstract

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.