RETRACTED ARTICLE: The omnipresence of risk and associated harms in secure and forensic mental health services in England and Wales

Markham, Sarah

doi:10.1057/s41285-021-00167-z

Cited by 4 publications

(3 citation statements)

References 55 publications

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“…According to the participants, being able to articulate and understand how nursing-decisions are made is important because it underpins ongoing care provided to patients. This may be particularly so in a setting where the inherent risks such as the presence of complex challenging and offending behaviour, can often result in a tendency to be risk-adverse, which can then influence clinical-thinking and impact on personcentred care (Maguire et al 2012;Markham 2021). The CRC is reliant on critical-thinking, and when engaging in critical-thinking it encourages nurses to be clear, analytical, accurate and objective when discussing and documenting care (Levett-Jones 2018; Paul & Elder 2007).…”

Section: Discussionmentioning

confidence: 99%

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

Maguire

Garvey

Ryan

et al. 2021

Int J Mental Health Nurs

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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.

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Section: Discussionmentioning

confidence: 99%

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

Maguire

Garvey

Ryan

et al. 2021

Int J Mental Health Nurs

View full text Add to dashboard Cite

show abstract

“…It is the offending behaviour that differentiates FMH consumers from consumers in general mental health settings, and therefore, nurses working in FMH settings must be able to work with consumers to address offending issues (as well as attending to the holistic needs of the consumer), and to be aware of any potential issues that may be associated with the consumers offending behaviour (Maguire et al., 2023; Markham, 2021). Interestingly, there was suggestion from the experts that FMH consumers are not always viewed by nurses as a vulnerable group of people, who may have also experienced trauma and adversity.…”

Section: Discussionmentioning

confidence: 99%

A Nominal Group Technique to finalise Safewards Secure model and interventions for forensic mental health services

Maguire,

Harrison,

Ryan

et al. 2023

Psychiatric Ment Health Nurs

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Accessible SummaryWhat is known on the subject? Safewards was developed for acute mental health units, and while could be effective in forensic mental health services, there are some gaps in the model for such services, where factors including offending behaviour and longer term care can have an influence. What this paper adds to existing knowledge? The importance of acknowledging and addressing responses related to offending behaviour in forensic mental health settings, while also understanding the vulnerability of the consumer group and responsibilities to the maintenance of professional boundaries. Enhancing collaboration with consumers/families/carers/supporters is important in a forensic mental health setting, and an important element of Safewards Secure. What are the implications for practice? This study completes the development of Safewards Secure, designed to foster collaboration, address issues pertinent to forensic mental health settings to enhance implementation and acceptance of the model and reduce conflict and containment. AbstractIntroductionSafewards is a model developed for acute mental health settings designed to reduce conflict and containment; however, it requires adaptation to forensic mental health settings.AimTo develop the Safewards Secure model, a model to assist forensic mental health services to reduce conflict and containment.MethodA literature review was conducted to elicit possible modifiers and adjustments to the interventions. A Nominal Group Technique was then used to engage forensic mental health experts who had experience implementing Safewards (n = 12) to seek feedback about the suggestions and reach consensus on the Safewards Secure model and interventions. Data were thematically analysed.ResultsExperts reached consensus on all suggestions, however, did recommend minor additions and modifications. Two themes were also interpreted: Safewards Secure is just as much for staff as it is for consumers, and the proposed additions encourage more meaningful staff to consumer collaboration.DiscussionThis study identified key challenges experienced by nurses working in forensic mental health settings, however, these challenges were not seen as insurmountable. The Safewards Secure model offers prompts and suggestions to encourage reflection, collaboration and a humanistic approach to care in forensic mental health settings.Implications for PracticeAddressing reactions to offending behaviour and encouraging more collaboration might assist in ensuring a more person‐centred approach to forensic mental health nursing care.

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“…To aid prediction, according to Rose (1998), led to risk categorised in terms of low, medium or high from the 1970s onwards. Initially conceived to lessen conflation of dangerousness and hospital admissions, it may result in anxieties explored by the Risk Society, for seeing all patients as a risk raises fears about the omnipresent threat of adverse events (Markham, 2021; Rose, 2002). Douglas adds accusation of irresponsibility can occur when critical of the certainty of risk prediction tools, for they come with “a spurious claim to be scientific” (1992, p. 14).…”

Section: Risk Concerns and Mental Health Carementioning

confidence: 99%

The risk of risk management: adopting critical theories to explore clinical risk concerns in mental health care

Deering

Williams

2021

MHSI

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Purpose The purpose of this paper is to outline several critical risk theories and explore their application to risk concerns in mental health care. This will contribute to the on-going debate about risk management practices and the impact these might have on recovery and social inclusion. Notably, while risks like suicide can be therapeutically addressed, risk management may involve paternalistic practices that exclude the participation needed for recovery. Design/methodology/approach A viewpoint of key risk theories will be presented to provide a critical eye about some clinical risk concerns in mental health care. Implications for recovery and social inclusion will then be discussed alongside direction for practice and research. Findings Clinical concerns seemed to involve difficulties with uncertainty, holding onto expertise, and the othering of patients through risk. These concerns suggest the patient voice might become lost, particularly within the backdrop of clinical fears about blame. Alternatively, a relational approach to risk management could have merit, while patient expertise may develop understanding in how to improve risk management practices. Originality/value Clinical concerns appear more than managing potential harms; it can involve appraising behaviours around societal norms, explaining to an extent why mental illness might be addressed in terms of risks. While the points raised in the paper support existing findings about risk management, the underlying reasons drawing on the critical risk theories are less explored.

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RETRACTED ARTICLE: The omnipresence of risk and associated harms in secure and forensic mental health services in England and Wales

Cited by 4 publications

References 55 publications

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

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

A Nominal Group Technique to finalise Safewards Secure model and interventions for forensic mental health services

The risk of risk management: adopting critical theories to explore clinical risk concerns in mental health care

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