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The Forensic Mental Health Nursing Standards of Practice That Is

Relevant/Significant to That Consumer

Student's Name

Institutional Affiliation

Course Number and Name

Instructor's Name

Date
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The Forensic Mental Health Nursing Standards of Practice That Is

Relevant/Significant to That Consumer

The foundation of efficient mental health treatment is the therapeutic nurse-patient

connection. This is especially true in forensic mental health settings, where patients frequently

have complicated requirements relating to mental illness, engagement in the criminal justice

system, and trauma or violent pasts. One of the most critical skills for forensic mental health

nurses is the ability to establish, manage, and acceptably end therapy partnerships. According to

Standard 5 of the Forensic Nursing Standards of Practice, forensic nurses use the nursing process

methodically to build, sustain, and end therapeutic interactions with forensic patients (Martin et

al., 2012). The use of this standard significantly impacts the treatment and results for consumers.

Engagement, treatment compliance, and recuperation are all facilitated by a restorative solid

organization. On the other side, the restorative environment can be antagonistically influenced,

and the nurse-patient relationship can be compromised by boundary infringement or improper

termination. This study examines past work examples and analyses how Standard five was used

on an inpatient forensic unit during the three stages of developing, preserving, and ending the

therapeutic nurse-patient connection. This paper talks about specific nursing interventions. There

will also be recommendations for enhancing forensic nursing practice about this standard and

areas of strength. Although it presents a significant barrier, meeting this criterion is essential to

providing this special demographic with moral, trauma-informed, recovery-focused treatment.

Case Study

Mike is a 32-year-old male Caucasian inpatient in a maximum-security forensic

psychological health facility. He has been diagnosed with bipolar-type schizoaffective disease.

His condition initially showed symptoms in his early 20s, oscillating between manic and
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depressive episodes and bouts of psychosis characterized by persecutory delusions,

hallucinations, and a disrupted mental process. He has a long history of acting violently, usually

during episodes of acute psychotic symptoms and when he is not taking his antipsychotic and

mood stabilizer prescriptions as directed. The consumer has reacted aggressively to his mistaken

views during these decompensated phases, snapping at those he believes to be persecutors.

His most recent admittance came after an episode six months prior in which, while in an

aggressively psychotic condition, he attacked an unknown person on the street. The consumer

assaulted the person without warning, seriously injuring him since he was consumed by

persecutory beliefs that this person was part of a plot to harm him (Freeman & Garety, 2014;

Sheffield et al.,2024). He was then taken into custody and determined to be too insane to stand

trial. His involuntary hospitalization in the secure forensic unit was the consequence of this.

At admission, the patient seemed reserved, suspicious, and uninformed about his

condition. To recover mental stability, he needed an involuntary medication order and a

progressive antipsychotic and mood-stabilizing medicine titration. Even though he was doing

better mentally, he continued to battle with occasional residual psychotic symptoms and grew

more involved in his therapy. Fostering a good friendship and building a therapeutic rapport has

been essential to supporting his ongoing recovery at the facility (Freeman & Garety, 2014).

Maintaining the Therapeutic Relationship

The therapeutic nurse-patient connection improved through regular, positive encounters during

the daily unit milieu, group therapy sessions, and one-on-one meetings as the consumer's mental

state stabilized with medication management (Shannon et al.,2023). The FMH nursing team

worked hard to include him in creating his personalized rehabilitation plan and establishing goals
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for therapy (Hancock et al.,2023). It aided his participation and buy-in with the therapeutic

process.

To assist the client in better comprehending his schizoaffective illness, the nature of his

symptoms, the function of medicines, and relapse prevention techniques, regular

psychoeducational sessions were offered (Shannon et al.,2023). He was asked to self-identify his

triggering circumstances and build individualized coping mechanisms, such as relaxation

methods, cognitive restructuring, and making use of social supports, by the nurses using

motivational interviewing techniques. Developing a therapeutic rapport was aided by validating

his subjective experience of the disease and its upsetting positive and negative symptoms

(Butcher et al.,2020).

The nursing team expertly used limit-setting and upheld appropriate boundaries when the

client still struggled with residual paranoia or receiving criticism (Kristoffersen, 2019). They

provided corrective experiences to mold more adaptable patterns of interpersonal interaction by

modeling pro-social attitudes and actions. The regular use of active listening, unconditional

positive regard, and a nonjudgmental attitude strengthened the therapeutic connection.

Additionally, the FMH nursing staff enabled the nursing staff enabled the consumers'

involvement in rehabilitation groups to enhance social, pre-vocational, and everyday living skills

(Shannon et al.,2023). Earned privileges allowed him to try applying these new coping

mechanisms more broadly with staff assistance as his functioning improved. The growing bond

between the FMH nurse and the patient gave him confidence and encouraged him to work

toward being discharged to a rehabilitation unit (Ma et al.,2023).

Terminating the Therapeutic Relationship

The consumer's treatment team started preparing for his transition to a reduced level of

care when his health stabilized, and he achieved notable progress toward his recovery objectives.

During his inpatient stay, the nursing team at FMH had candid conversations regarding ending

the intense therapeutic partnership. They worked with the customer to digest the upcoming

transition, confirming the critical part the nurse-patient relationship played in his recovery.

The consumer and the FMH nurses collaborated extensively to assess and strengthen the

customer's relapse prevention strategy. They made sure he was aware of his early warning

indicators of decompensation, the significance of taking his medicine as prescribed, and how to

use coping mechanisms while under duress. The FMH nurses assisted in placing the client in

contact with psychosocial supports such as group therapy, peer support programs, case

management, and community-based resources. Before the patient was released, the outpatient

psychiatric team was consulted. Harvey et al. (2023) state that while mental health treatments for

individuals with psychosocial impairments vary by nation, they are commonly provided by the

non-governmental (NGO) and clinical sectors. As a result, the FMH nursing team could start

transmitting the therapeutic rapport and orienting the community caregivers to the customer's

requirements. Before leaving inpatient care, the patient might become used to the new treatment

team.

The nurses acknowledged the outstanding strides the patient had made in taking control

of his condition during this shift. They gave him optimism about his potential for success in the

community with the right resources. They also set reasonable expectations about how the nurse-

patient relationship would evolve following discharge to the rehabilitation unit. The nurses

handled the end of the therapy partnership with compassion and closure. They acknowledged the
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customer's conflicting feelings of anxiety and exhilaration. Preparing for this next phase of his

rehabilitation journey involved clear communication about crisis services (Sulisna et al.,2023).

Recommendations

Get instruction in rapport-building, de-escalation, and therapeutic communication

strategies designed specifically for forensic populations. Developing a therapeutic alliance and

having advanced therapeutic communication skills are essential for working well with consumers

in forensic mental health (Moyles et al., 2023). Numerous of these people have involved criminal

justice systems, complicated trauma histories, and a higher risk of violence. Providing

specialised training for forensic nursing practice is crucial. Rapport-building training should

cover techniques for swiftly gaining the trust and cooperation of often wary, suspicious, or

antagonistic customers (Scafide et al., 2023). It is important to employ strategies such as

validation, motivational interviewing, and trauma-informed treatment concepts. Role-playing

situations can offer hands-on training. To avoid and defuse attacks, hostility, and violent

behaviour, FMH nurses must also undergo thorough verbal de-escalation training (Baig et al.,

2018). This should encompass de-escalation theoretical models, the recognition of behavioural

and physiological escalation patterns, verbal and nonverbal de-escalation techniques, and

personal safety procedures. Simulated de-escalation activities in authentic forensic environments

reinforces these skills.

Prior to release, have the FMH nurse introduce the outpatient team to emphasise

continuity of treatment (Wolfe, 2021). It is important to provide a smooth and uninterrupted

transfer of care for forensic inpatients to outpatient treatment environments. If appropriately

utilised, the therapeutic alliance formed during the inpatient stay can aid in bridging this

transition (Geese & Schmitt, 2023). Before the patient leaves the hospital, the inpatient nurses
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should assist them in acquainting themselves with the outpatient treatment team responsible for

their care. This "warm handoff" enables the cautious transfer of the therapeutic rapport that has

been built throughout the inpatient stay.

The FMH nurse can provide important background data about the patient's treatment

plan, advancement, areas that still need attention, and successful engagement strategies (Maguire

et al., 2023). This aids the new outpatient providers in settling in and equips them with the

necessary knowledge to initiate their own therapeutic partnership. Crucially, the client has the

opportunity to familiarise themselves with their new team in a secure setting prior to their release

from therapy (Lorien et al., 2024). The inpatient nurse is able to monitor the consumer's comfort

level by closely observing the introductions. They can calm any fears and reassure the client

regarding the outpatient team's credentials.

Provide guidelines for appropriate contact limits following the termination of therapy

interactions. Despite the need for a clear start and finish to the therapeutic nurse-patient

interaction, forensic consumers may find it difficult to make this shift, particularly following a

lengthy inpatient stay. In order to preserve proper professional boundaries after discharge, clear

procedures are required (Atkins et al., 2023). Organisations should establish policies regarding

acceptable correspondence or cards from customers, as well as the last termination visits they

request (Close et al., 2023). They should state a reasonable period of time, such as 30 to 60 days

after release. It should be against policy for nurses to make first contact. Permitted interactions

have to have a distinct therapeutic goal, including handling termination or guaranteeing access to

outpatient care (Kociolek et al., 2023). Guidelines distinguish this from social motives or the

exploitation of former patients to meet demands related to housing and employment. Making

contact just for the advantage of the nurse is unethical. Policies ought to specify how to reply
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when patients ask for the nurse's direct contact details. They should forbid sharing personal

phone numbers, email addresses, or home addresses to maintain professional boundaries. They

should also prohibit consenting to communicate on social media or through connections on

websites like LinkedIn.

Conclusion

In forensic mental health settings, the establishment, maintenance, and proper termination

of the therapeutic nurse-patient connection are critical. It calls for specific abilities in rapport-

building, de-escalation, and therapeutic communication with this intricate group of patients. It is

crucial to give forensic nurses targeted training in these areas. Involving the outpatient treatment

team in a "warm handoff" at the end of the inpatient therapy partnership helps guarantee

continuity of care. To preserve proper professional boundaries, it's also necessary to have precise

regulations about permissible post-discharge communication. Meeting the norms around the

therapeutic alliance is difficult, but it's necessary if you want to provide forensic mental health

patients with moral, trauma-informed, recovery-focused therapy. Nurses with strong therapeutic

interaction skills can successfully include patients in their care and facilitate their shift to

community-based care. Maintaining this level raises the bar for forensic nursing practice quality.
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