Thesis (MCur)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: No clear description exists in S.A. of the role and functions of a forensic psychiatric nurse. The researcher conducted a research project based on more than 20 years of practice experience to define and describe the role and functions of the forensic nurse practitioner. A non-experimental descriptive study was done. Questionnaires and checklists were compiled to determine the perceptions of forensic psychiatric patients/clients (n =24) and nursing staff (n = 15) .The nursing activities in a selected forensic psychiatric unit was evaluated through nonparticipative observation. Results indicated that: • Patients experienced their environment as isolated and has a need for better support by the nursing staff; • Nursing staff indicated their need for more specific training in forensic psychiatric nursing; and • A need exists for specific protocols and procedures to guide his/her practice. The recommendations are made that: • A special training program for forensic psychiatric nursing needs to be planned and implemented; and • Procedures and guidelines must be established to guide the practice of the nurse practitioner. / AFRIKAANSE OPSOMMING: Daar bestaan in S.A. geen duidelike omskrywing van die rol en funksies van die forensiese psigiatriese verpleegkundige nie. Die navorser het gegrond op meer as 20 jaar praktykervaring 'n navorsingsprojek gedoen om die rol en funksies van die verpleegpraktisyn te definieer en te omskryf. 'n Nie-eksperimentele, beskrywende studie is gedoen. Vraelyste en kontrolelyste is opgestel om die persepsies van forensiese psigiatriese pasiënte/kliënte (n=24) en verpleegpersoneel (n=15) te bepaal. Die verpleegaktiwiteite in 'n geselekteerde forensiese psigiatriese eenheid is deur nie-deelnemende observasie geëvalueer. Resultate het daarop gedui dat: • Pasiënte hulle omgewing as geïsoleerd ervaar en het 'n behoefte aan beter ondersteuning deur die verpleegpersoneel; • Verpleegpersoneel het aangedui dat hulle 'n behoefte het aan spesifieke opleiding in forensiese psigiatriese verpJeging;en • Daar 'n behoefte is aan spesifieke protokolle en prosedures om sy/haar praktyk te rig . Die aanbevelings word gemaak dat: • 'n Spesiale opleidingsprogram vir forensiese psigiatriese verpleging beplan en geïmplementeer word; en • Prosedures en riglyne daargestel moet word om die praktyk van die verpleegpraktisyn te rig.

To be sentenced to care in the forensic psychiatric services can be seen as one of the most comprehensive encroachments society can make on a person's life and being, as it entails a limitation of the individual's freedom but with no time limit. The aim of this dissertation is to describe caring in forensic psychiatry based on how it is experienced by those who perform the caring and by those are cared for in a maximum secure unit. A reflective lifeworld approach, based on phenomenological philosophy, has been applied. The data has been collected in interviews that have been analyzed by use of a meaning analysis searching for the essence of the phenomenon. The results of the research are presented in two empirical studies and a general structure based on the empirical findings. The dissertation also contains an excursus, a philosophical intermediate chapter containing further analysis of the results of the studies. The results show how the forensic psychiatric care is experienced as being non-caring by the patients with only small "pockets" of good care. Caring consists of corrective techniques that are unreflected and contradictory, where the conditions are determined by the caregivers and the ward culture. The correcting takes place through the modification of the patients' behaviour with the aim of the patients having to adapt themselves to the terms of the care provision. This care results in the patients trying, by use of different strategies, to adapt them-selves to the demands of the caregivers in order to gain privileges. At the same time the patients long to get away from the care system and are lacking real, meaningful and close relationships. To be the subject of care entails struggling against an approaching overwhelming sense of resignation and to care entails experiencing both power and powerlessness in performing the care. A destructive power struggle is being waged within forensic psychiatric care that suppresses the caring potential and true caring is thus elusive. The characteristics of forensic psychiatric care, based on the results of the research, are clarified in the dissertation's excursus. These include the corrective and disciplinary nature of forensic psychiatric care, its power and how this is materialized in care situations as well as the influence of tradition on current forensic psychiatric care in the light of the work of the French philosopher Michel Foucault. The dissertation shows that if the caring potential is to be able to be developed and form a caring nucleus for forensic psychiatric care then education levels need to be further developed. A caring culture and caring environment is needed where true caring can gain a foothold. In order for this to become a possibility the current caring culture and environment must be clarified, questioned and examined. The prevalent fundamental ideas in forensic psychiatric care have to be "jeopardized" and challenged by new scientifically based ideas on what constitutes true caring in this context.

Bakgrund: Begreppet personcentrerad har internationellt blivit vedertaget inom omvårdnadsvetenskap och används för att beskriva en vårdform där vården utgår från ett partnerskap med patienten. Engagemang, trygghet, tillit, att vara delaktig i planeringen av vården och en vårdande relation upplevs vara viktiga komponenter som främjar delaktigheten. För att öka förståelsen om delaktighetens och personcentreringens syfte inom den rättspsykiatriska vårdkontexten krävs studier som beskriver de mångfacetterade begreppen ur vårdarens och patientens perspektiv. Syfte: Att förstå upplevelser av delaktighet och personcentrerad vård hos patienter och personal på en rättspsykiatrisk avdelning och diskutera hur delaktighet kan möjliggöras. Design: Studien är en kulturanalys och ansatsen är hermeneutisk. Metod: Enskilda halvstrukturerade intervjuer med fyra vårdare och fyra patienter på en rättspsykiatrisk avdelning i Mellansverige genomfördes. Intervjuerna har bearbetats utifrån en kulturanalytisk hermeneutisk arbetsmodell i sju faser. Interna dokument från sjukhuset analyserades avseende delaktighet. Resultat: Oklarheter gällande vårdprocessen och rättspsykiatrins strukturer som är inte fullkomligt tydliga inverkar på upplevelsen av delaktighet. Konklusion: Personal och patienter har olika uppfattningar om strukturernas funktion. Personalen anser att patienternas delaktighet är en förutsättning för vårdprocessen. Patienter uttrycker osäkerhet kring vad som förväntas av dem. Identitet och tolkning av den egna rollen kan påverka delaktigheten hos patienter inom rättspsykiatri. / Background: The concept of person-centered care is internationally accepted in nursing science and describes a form of care with an active patient included in all aspects of care. Commitment, trust, and involvement in the planning of care and a caring relationship are perceived to promote participation. To increase understanding person-centering in the forensic psychiatric care context, studies on the multifaceted concepts from carers’ and patients’ perspectives are required. Aim: To understand experiences of participation and person-centered care among patients and staff in a forensic psychiatric ward and discuss how participation can be promoted. Method: Individual semi-structured interviews with four carers and four patients in a forensic psychiatric hospital in Central Sweden were conducted. A seven-phase cultural analysis model was used. Internal documents were analyzed for statements about participation. Design: The study is a cultural analysis with a hermeneutic approach. Result: Unclear care process and structures of forensic care affect the experience of participation. Conclusion: The perceptions of the function of the structures differ. Staff believe that patient participation is a prerequisite for the care process. Patients express uncertainty about what is expected of them. Identity and interpretation of one's own role can influence the participation of patients in forensic psychiatry.