Nursing in secure and forensic psychiatry: contexts, contributions and concepts

This thesis details a body of empirical knowledge about issues key to the effective delivery of forensic and secure psychiatric care and treatment: differentiation between firesetters, tobacco smoking in secure psychiatric care, prevalence and management of violence and aggression, medication administration and delegation, and outcomes measurement. The work was conducted in the context of UK provision of secure and forensic services, specifically the independent sector, and in the context of the professional discipline of forensic psychiatric nursing and its extant evidence base. The empirical work is presented in relation to these contextual elements in order to demonstrate that it comprises a coherent and related body of knowledge. It constitutes a contribution to the current knowledge base per se, and is congruent with available definitions of forensic psychiatric nursing and of its related evidence base. Specifically, it fuses general psychiatric nursing knowledge with specialist knowledge of secure and forensic concepts. Exploration of the body of work in relation to its contexts raises practical and theoretical questions about current conceptualizations of forensic psychiatric nursing. There is a relative lack of evidence of effectiveness compared with the growing theoretical literature on the role of the forensic psychiatric nurse, and there are apparent differences between nursing roles in different levels of security such that it is not clear what precisely constitutes a forensic psychiatric nurse. It is proposed that the contexts used to examine the published research submitted in support of the thesis offers a new way to understand the psychiatric nursing role in the secure and forensic care arena. Explication of these contexts, or dimensions of practice, are made and mapped to produce a zonal model of secure and forensic nursing. The zonal model is a way of understanding how the research submitted in support of the thesis makes a contribution to a coherent field of practice. It also facilitates a redefining of the forensic psychiatric nursing role as one of advanced practice within a framework of expert knowledge of the secure and forensic dimensions in which it operates, requiring an understanding and translation of the best research evidence from any relevant field into practice, containing elements of expanded practice and wider knowledge of the political and sociocultural context in which practice occurs. The implications of the model for future research and development are addressed.