Illuminating the gendered nature of health‐promoting activities among nursing staff in forensic psychiatric care

Abstract

When people in Sweden are sentenced and handed over to forensic psychiatric care (FPC), the authorities have overall responsibility for their health recovery. How nursing staff construct gender through their relations in this context affects their understanding of health promotion activities. The aim of this study was to illuminate, using a gender perspective, the understanding of nursing staff with respect to health promotion activities for patients. Four focus group interviews were conducted with nursing staff in two FPC clinics in Sweden. The study has a qualitative inductive design with an ethnographic approach. This study sheds new light on FPC in which its dual goals of protecting society and providing care are viewed from a gender perspective. When relationships within the nursing staff group and the nurse–patient relationship are justified by the goal of protecting society, gender becomes invisible. This might cause patients' individual conditions and needs for certain types of activities to go unnoticed. One of the implications of ignoring gender relations in nursing staff health promotion activities is that it risks contributing to gender stereotypes which impact on the nurse–patient relationship and the quality of care.

Subordinated masculinities: A critical inquiry into reproduction of gender norms in handovers and rounds in a forensic psychiatric care

“…Along those lines, a remarkable finding was that the staff seldom reported physical violence among the patients, although most of them had been committed to forensic care for perpetrating violent crimes. It is also interesting in relation to other studies were staff talk about patients as not trustworthy and violent (Kumpula et al, 2019).…”

“…Kumpula et al. (2019) also observed that care staff talked about themselves as parents and that they mobilised correction, discipline and control as tools for use in caring for patients. However, such limits always concern more than the behaviour of patients, because, as Butler (2007) has stressed, staff are also performing masculinity, especially a type of masculinity that prioritises acting with authority and purpose and, in that way, draws a line between rationality and madness, between “us” and “them” (Foucault, 2017).…”

“…According to Kumpula et al. (2019), it can be understood as the patient's body then becomes an object for correction, and staff's bodies becomes tools for controlling disturbing behaviour.…”

“…For example, Kumpula and Ekstrand (2012) found that the care offered by male staff was built on social and cultural ideas of masculinity. By doing things together the relationship would become deepened which could be a benefit for the care but, if staff are unaware of how they construct gender in daily care they are at risk to reproduce generalised knowledge about the men they care for (Kumpula, Ekstrand, & Gustavsson, 2019). Mercer and Perkins (2014) examined how staff and patients talked about pornography and found that there was a collective talk and shared discourses that made it possible for male staff and patients to relate to each other as men but also marginalise female nurses.…”

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“…Losing compassionate and empathetic nursing care when providing for patients with mental health problems in forensic settings can hinder the nurse-patient relationship by depersonalizing it [1]. Psychiatric forensic nursing involves complex relations between mental health care and the criminal justice system [2]. Often, forensics nurses care for those who have committed violent crimes.…”