Nurses perspectives of factors that influence therapeutic relationships in secure inpatient forensic hospitals

Background
The therapeutic relationship is synonymous with mental health nursing and is fundamental wherever nursing care is provided. With the transformation from ‘punishment’ to ‘treatment’ of the mentally disordered offender, mental health nurses working in secure hospital facilities are the primary carers for this service-user group. This literature review examines, from a nurses perspective, factors influencing the formation and maintenance of therapeutic relationships in secure forensic settings.

Methods
A systematic search of literature, using a range of electronic databases, was conducted focusing on nurse-patient therapeutic relationships in forensic settings. All relevant articles were CASP quality appraised. Eight articles met the criteria for review inclusion. A meta-aggregative thematic approach to data analysis and synthesis was carried out identifying themes, and the production of an ‘action’ policy statement.

Findings and implication for practice
Nine themes were identified; seven categorized as internal/ interpersonal factors and two categorized as external/ environmental factors. Some of the themes are also interconnected. Synthesis of findings resulted in the production of the following recommended statement: To ensure the value of the therapeutic relationship, nurses working in secure inpatient forensic hospitals should be aware of their intrapersonal constructs surrounding the patient populations. To facilitate this the external working environment must be conducive to both a safe and supportive atmosphere. The synthesized statement highlights the support that forensic mental health nurses need to fulfil their role as a therapeutic carer to a forensic patient population.