- Forensic psychiatric nurses experience violence and ethical dilemmas as routine, multidimensional aspects of practice, shaped by constant risk and emotional responses such as fear.
- Nurses continually balance therapeutic care, control, patient rights and institutional security while managing multiple roles and striving to determine appropriate actions.
- Structural deficits including inadequate environments, staff shortages and limited training escalate dilemmas and require structured institutional support, violence management training and clinical supervision.
J Psychiatr Ment Health Nurs. 2026 Sep 1. doi: 10.1111/jpm.70198. Online ahead of print.
ABSTRACT
INTRODUCTION: Forensic psychiatric nursing is a distinct field in which caregiving, security, legal responsibility and ethical decision-making processes are closely intertwined.
AIM/QUESTION: This study aimed to explore in depth the experiences of forensic psychiatric nurses regarding violence and ethical dilemmas encountered in clinical practice.
METHOD: A qualitative phenomenological design was employed. Data were collected through semi-structured, in-depth individual interviews with 18 nurses working in forensic psychiatry units. The interviews were analysed using Colaizzi’s phenomenological analysis method.
RESULTS: The findings revealed that nurses experienced violence and ethical dilemmas as routine and multidimensional aspects of their professional lives. Two main themes emerged from the analysis: ‘Balancing Safety, Care, and Ethics’ and ‘Support Needs and Expectations’. Within the first theme, participants described experiences related to managing multiple roles simultaneously, providing care under constant risk, striving to determine appropriate actions, and making sense of their experiences. The findings demonstrated that nurses continuously attempted to balance therapeutic care with control, patient rights with institutional security and professional values with emotional responses including fear and anxiety. Furthermore, participants emphasized that structural factors such as inadequate physical environments, staff shortages, and limited training opportunities contributed to experiences of both violence and ethical dilemmas.
DISCUSSION: The study highlights the need for structured institutional support for forensic psychiatric nurses, particularly in violence management, ethical decision-making processes, and clinical supervision.
IMPLICATIONS FOR PRACTICE: Strengthening these areas may contribute to both staff well-being and the quality of patient care.
PMID:42678058 | DOI:10.1111/jpm.70198
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