Exploring adaptations to the clinical reasoning cycle for forensic mental health nursing: A qualitative enquiry |
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| Authors: | Tessa Maguire RN GD FBS GD FMHN MMentHlthSc PhD Loretta Garvey RN PhD Jo Ryan RN BEd GC VRAM Tracy Levett-Jones RN DipHSc BN Masters Education & Work PhD Michael Olasoji RN PhD Georgina Willetts RN BN PhD |
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| Institution: | 1. Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Victoria, Australia;2. Centre for Academic Development, Federation University, Berwick, Victoria, Australia;3. The Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, Victoria, Australia;4. The University of Technology Sydney, School of Nursing & Midwifery, Ultimo, New South Wales, Australia;5. School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia;6. Institute Health and Wellbeing, Federation University Australia, Melbourne, Victoria, Australia |
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| Abstract: | Forensic mental health nurses (FMHN) provide care to address the needs of people who have mental illnesses across a range of diverse settings. The Clinical Reasoning Cycle (CRC) has been identified as a potential framework to assist FMHNs; however, adaptations were required to reflect the unique nature of the clinical setting. This study aimed to explore adaptations made to determine suitability prior to implementation in practice. Nominal Group Technique was used to explore suggested adaptations determined from a previous study and reach a consensus on the changes. Fourteen senior nurses from a state-wide Forensic mental Health (FMH) service participated. A consensus was reached for two proposed changes. Data were analysed using thematic analysis. Three main themes were interpreted from the data; FMH adaptations are warranted, the focus of the CRC, and who owns the cycle? Nurses in this study considered the need to include offence and risk issues due to the impact these factors have on the therapeutic relationship and cognitive bias; however, they also identified the need to focus on recovery-oriented care while engaging in clinical reasoning. Nurses in this study also expressed some reluctance for nursing to ‘own' the model, due to concern that ownership may cause division among the team or result in inconsistency in care. However, some participant's suggested the CRC with adaptations assisted FMH nurses to articulate their specialist skills and knowledge to others and highlight the nursing contribution to care. Further work is needed to finalize adaptations with a focus on engaging the consumer carer workforce and interdisciplinary team. |
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| Keywords: | clinical judgement consumer forensic psychiatric nursing nominal group technique professional identity |
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