Exploration of the utility of the Nursing Process and the Clinical Reasoning Cycle as a framework for forensic mental health nurses: A qualitative study

Abstract

Forensic mental health nursing (FMHN) is a specialized field, designed to meet the needs of people who have a serious mental illness across the criminal justice system, inpatient services and community. Frameworks can assist assessment, planning, intervention, documentation and evaluation of nursing care. However, there is no prior research investigating frameworks in FMHN. This study aimed to explore the Nursing Process (NP) and the Clinical Reasoning Cycle (CRC), with nurses, to determine a suitable framework for use service-wide. A Nominal Group Technique was used to facilitate exploration of the two frameworks, where open-ended verbal and written responses collected from a Nominal Group were thematically analysed, and the participants voted on their preferred framework. Seventeen nurses from a state-wide forensic mental health (FMH) service participated. The four main themes were as follows: challenges to current practice, limitations of the NP, perceived benefits of the CRC and addressing implementation. Consensus was reached with the nurses selecting the CRC as the framework of choice. This is the first study to explore frameworks to guide practice in FMHN. Nurses in this study considered the CRC to be a suitable framework for novice through to expert, offering a contemporary framework to guide nursing care in complex FMH settings. Some adjustments to the existing cycle were suggested to emphasize recovery-oriented practice, and inclusion of family and carers. Any changes to the cycle warrant exploration with the interdisciplinary team and consumer carer workforce.

Using the Nominal Group Technique to determine a nursing framework for a forensic mental health service: A discussion paper

“…The theming of ideas was a collaborative and iterative process that again enabled all to participate, for a more detailed description of the data collection methods please see Maguire et al . 2022).…”

“…This paper describes how the research team modified the traditional Nominal Group Technique to explore the most suitable nursing framework for the nurses across Forensicare, where the Clinical Reasoning Cycle was selected by the participants in this study (see Maguire et al . 2022). We outline the modifications, the process, and data collection.…”

“…The Delphi technique is one such method that has been used more often in social sciences (Keeney et al 2001), than perhaps nursing research. Delphi studies are designed to engage participants in a staged approach, with several Delphi rounds, where each round builds on results from previous rounds, as participants work towards achieving consensus (Maguire et al 2022;McKenna 1994). One of the important aspects of this process includes Delphi members making their decisions independently from others in the group (Jorm 2015), and for this reason, Delphi members identities are not known among the group.…”

“…Concern has also been expressed that the Nursing Process does not necessarily focus on patient‐centred care (Maguire et al . 2022).…”

“…Furthermore, the Nursing Process while providing a simple framework, has been criticized for being too nursing focused, and not necessarily capturing features of care provided in complex settings, such as forensic mental health. Concern has also been expressed that the Nursing Process does not necessarily focus on patient-centred care (Maguire et al 2022).…”