Abstract
The research area of this study examines the impact of the author’s contribution to the development of Forensic Mental Health Nursing (FMHN) over a 40-year career. This retrospective analysis hopes to capture the impact of the author upon the role development of a distinct FMHN role, including a range of skills, knowledge and areas of practice undertaken by such nurses. However, the word count limitations of this study and specific advice from the University of Bolton have necessitated an approach that focuses upon only two case studies to be illustrative of the contribution to this specialist role. These case studies include the implementation of an integrated clinical pathway (ICP) into mental health, and the development of a programme of multi-professional plurality training in the very specialist forensic field to support its operation. Historically there has been a gap in knowledge and function of forensic teams. The development and use of ICPs in mental health care is rare, and the associated need for a shared understanding of the approach by multi-professional teams is essential for success in the nursing care and treatment of mentally disordered offenders. Additional contributions made by the author to Forensic Mental Health Nursing are detailed in the accompanying Portfolio of Evidence.
The aim was specifically to investigate how the contribution of the author positively impacted upon the implementation, operation and success of the model used, with particular attention to the development of the role of FMHNs. The methods used to investigate and evidence this, were the use of an evocative autoethnographic study in the form of a Critical Commentary. This used reflection from a 40-year career to review and evaluate the success of efforts to enhance the role and skill set of FMHNs and integrate them fully into multi-professional teams.
The paper contains a selective review of the general FMHN literature, followed by more specific literature, to support the evidence provided in the two illustrative case studies. These are presented as chapters and include a retrospective evaluation of Forensic Plurality Training (a multi-professional training and development programme for new and existing staff in the forensic field), and the use of an Integrated Clinical Pathway model in forensic mental health to co-ordinate and enhance teamwork and patient recovery. This is supported by a Portfolio of Evidence, which contains additional work by the author. This includes research to measure and reduce clinical violence. The implementation of nurse independent prescribing. Initiatives to improve the clinical environment of forensic hospitals and other material, such as professional testimonies from colleagues and significant leaders in the field.
The key findings were the increased impact of FMHNs within the speciality and the teams that they were part of. The FMHN role has been transformed from that of ‘passive custodians and deliverers of others’ instructions’, into modern and fully integrated clinical professionals with a unique identity and function. The exemplar case studies are demonstrative of the impact such initiatives play in the enhancement of the nursing contribution to the wider team, thus reflecting ways to promote and facilitate this. The significance of these findings is that since the closure of the large Victorian era asylums, FMHNs have risen to the challenge of de-institutionalisation, and adapted their role into more diverse modes of care delivery. As a result, they have extended and expanded their skills and operational functioning into new and exciting areas of multi-professional practice and have become a key feature of contemporary forensic practice.