Training for forensic nursing

1
Training for forensic nursing

• Mirva Sundqvist-Kekäläinen
• Senior lecturer
• University of Applied Sciences in Vaasa
• Finland
• Aila Vokkolainen
• Nursing director
• Vanha Vaasa Hospital
• Vaasa, Finland

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The Contents of this presentation

• Who do we treat?
• What are we doing?
• Who are we?
• What is our nurses basic and continuing
  education?

3
Forensic psychiatric patients

• Forensic psychiatric patients are mainly treated
  in two forensic psychiatric (state) hospitals in
  Finland Vanha Vaasa hospital in Vaasa and
  Niuvanniemi hospital in Kuopio
• Vanha Vaasa 152 beds and 210 posts and
  Niuvanniemi 296 beds and 540 posts
• Most of the patients in state hospitals are in
  involuntary care. They either have been found not
  guilty by reason of insanity (homicides and
  other serious violent offences)
• or are too dangerous or difficult to treat in
  other hospitals.
• In addition to psychiatric treatment, annually
  approximately 30 forensic psychiatric evaluations
  are given in Vanha Vaasa hospital.
• The primary duty of Vanha Vaasa hospital is to
  provide high quality treatment at a reasonable
  price and to attend to the safeguarding of legal
  rights of patients and psychiatric examinees.
• Our hospital has agreed to take nursing students
  from local University of Applied Sciences to do
  their clinical training there. Also medical
  students have the possibility to work at the
  hospital and specialize in psychiatry or forensic
  psychiatry.

4
Forensic psychiatric patients (continued)

• Criminal patients who are found legally insane
  and not criminally responsible for their crime(s)
  because of mental illness (57)
• Patients with violent and dangerous behaviors
  (difficult-to-treat and/or dangerous patients)
  (40)
• Forensic psychiatric evaluation (court-ordered)
  (3/148)

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Challenges

• Forensic psychiatric patients
• nearly all suffer from schizophrenia
• most patients are alcohol or drug addicts
• have been previously in psychiatric care many
  times
• most of the patients are admitted to involuntary
  treatment (motivation)
• the hospitalization lasts for years (motivation)
• social skills are quite poor

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Challenges (continued)

• uncontrolled violence connected with psychotic
  symptoms
• ethical dilemmas
• dont easily trust anybody
• are sometimes frightening
• mechanical restraint or seclusion are needed
  every now ant then
• 80 are men
• are selected and have multiple problems

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Diagnosis
The main diagnosis 5.7.2011 The main diagnosis 5.7.2011
ICD-10 Diagnose Men Women n
F20.00-F20.09 Schizophrenia, paranoid type 50 10 60 41,7
F20.1-F20.14 Hebephrenic schizophrenia 10 2 12 8,4
F20.3-F20.39 Undifferentiated schizophrenia 30 5 35 24
F20.9 Schizophrenia, unspecified 1 0 1 0,7
F22.0-F22.9 Persistent delusional disorders 6 1 7 4,9
F23.3 Other acute predominantly delusional psychotic disorders 2 0 2 1,4
F25.01-F25.9 Schizoaffective disorders 10 8 18 12,5
F29 Unspecified nonorganic psychosis 1 0 1 0,7
F31.0-F31.2 Bipolar affective disorder 2 0 2 1,4
F84.9 Pervasive developmental disorder, unspecified 1 0 1 0,7
Z04.6 General psychiatric examination, requested by authority 4 1 5 3,6
  All 117 27 144 100,0
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Treatment methods

• We treat our patients in a holistic way which is
  based on
• Legislation
• National Current Care Guidelines
• Our values
• 1. Patient-orientedness
• 2. Respect for basic rights and human values
• 3. Fairness
• 4. Equality
• 5. Professionalism
• 6. overall economic efficiency
• Multiprofessional teamwork
• Feedback from our patients

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Treatment methods (continued)

• Confidential therapeutic nurse-patient
  relationship
• Psychosocial treatment (e.g. functional
  rehabilitation, occupational therapy, physical
  exercises, music, art groups)
• Community treatment
• Biological treatment (medication, ECT)
• Connections to society, studies, work try-out
  placements, working life
• The patients family or other significant people
  are very important
• Chaplain/ priest
• Library etc.

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Forensic psychiatric personnel in Vanha Vaasa
hospital

• We have 210 posts
• 3 senior psychiatrists
• 7 psychiatrists
• 3 psychologists
• Nursing staff
• 3 chief nurses
• 9 ward sisters and 9 assistant ward sisters
• 74 nurses (RN)
• 45 mental health nurses
• 3 social workers
• 2 occupational therapists, 1 physical exercise
  instructor and 7 functional therapists
• 1 medical laboratory technologist/ biomedical
  scientist
• 1 farmacist
• The rest of the posts (44/210) are located in
  support service units

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BASIC NURSING EDUCATION

• Degree studies give a higher education
  qualification and practical skills
• They comprise core and professional studies,
  free- choice studies and a bachelors thesis
• Studies include clinical placement periods
• Students are practicing in many places e.g.
  hospitals, health care centres

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Continuation

• The extent of studies in a University of Applied
  Sciences is generally 210-240 study points (ECTS)
• This means 3,5- 4 years of full- time study
  (Nurses, Bachelor of Nursing 210 study points -gt
  3,5 years)
• The studies are organized into degree programmes
• Different universities of applied sciences decide
  on the content and the curriculum

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Continuation

• E.g In the University of Applied Sciences in
  Vaasa students can choose between different
  advanced studies
• Psychiatric Nursing
• Perioperative Nursing
• Medical and Surgical Nursing
• Paediatric and Adolescent Nursing

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Continuation

• The Ministry of Education and Culture approves
  the degree programmes
• The ministerial decision statement must include
  the name of the degree programmes, the study
  points and the different alternatives for
  advanced studies

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Continuation

• Full registration and qualification as a nurse
  requires that nursing education meets the minimun
  standards
• The requirements for recognition of
  professional qualifications are followed by
  European Parliament and Council (Directive
  2005/36/EY)

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The Contents in Nursing studies

• 210 studypoints include core and professional
  studies (103 ECTS) and
• Different alternatives for advanced studies (107
  ECTS)
• The professional studies are
• Advanced studies in nursing (10 ECTS)
• Free- choice studies (7 ECTS)
• Clinical placement (75 ECTS)
• Bachelors thesis (15 ECTS)

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Continuation

• The Advanced studies in Psychiatric Nursing
  include
• clinical placement (20 ECTS)
• expertise in psychiatric nursing (6 ECTS)
• health care entrepreneurship (4ECTS)

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Practical Nurse studies(vocational degree)

• Practical nurses ( mental health nurses, upper
  secondary level)
• Studies 180 ECTS, (that means 3 years of
  studies,) includes 60 ECTS specialization
  studies
• Studies are arranged by schools on the upper
  secondery level, vocational schools, adult
  education schools and apprenticeship education
• There are several different alternatives for
  advanced studies

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The Contents of studies into practical nurse

• Professional studies (75 ECTS)
• Supporting growth and development (22,5 ECTS)
• Caring and nursing (30 ECTS)
• Supporting rehabilitation (22,5 ECTS)
• Training programs (45 ECTS)
• Emergency Care
• Children and youth
• Mental health- and substance abuse work
• Nursing and caring
• Dental assistant

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Continuation

• - Work with the handicapped
• - Elderly Care
• - Rehabilitation
• Elective studies 15 ECTS
• Registered nurse studies include 210 ECTS
• gtPractical nurse studies include 180 ECTS

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Special Vocational degree in Psychiatric Nursing
for Practical Nurses

• Special degree in Mental Health Nursing (2 years
  of studying)
• Students can study and work simultaneously
• Studying at school 2-4 days/ month
• Studies include also distance learning and
  clinical placement
• The education is meant for practical nurses who
  want to deepen their knowledge in psychiatric
  nursing
• At least five years job experience is needed

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The structure of the studies

• Required studies
• Basics of Psychiatric Nursing
• Methods in Psychiatric Nursing
• Professionalism in Psychiatric Nursing

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Continue..

• Elective studies
• Psychiatric rehabilitation
• Psychiatric Nursing among the elderly
• Paediatric and Adolescent nursing
• Psychiatric Nursing among intoxicant abusers
• Forensic psychiatric nursing
• Entrepreneurship

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Continuation

• It is possible to do this education as on
  apprenticeship education
• In the end of the studies the student must show
  she/he skills for the profession (competence-
  based qualification)
• Registered nurses advanced in psychiatring
  nursing
• Practical nurses trained in mental health and
  substance abuse work
• Practical nurses trained into special vocational
  degree in psychiatric nursing

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Continuing training in Vanha Vaasa hospital
(examples)

• 1) Therapeutic nurse-patient relationship
  Interactional course
• 11 x 3 hours , 10-12 participants in one group
  (psychologists, chief nurse)
• 2) Aggression management (Interactional
  management of an aggressive patient/situation)
  a-3- day course for nursing staff and 1 day for
  support service personnel both theoretical and
  practical training (psychologist, chief nurse and
  two nurses)
• 3) Cognitive-behavioral therapy basic course 12
  days theory (specialists from different fields),
  3 days clinical seminars and 16 times (1,5 hrs)
  small group supervision and a final project

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Continuing training (cont.)

• Lectures from different special areas (e.g.
  psychiatric and somatic diseases, drugs, taking
  lab samples)
• Studies in Pharmacology
• Continuing events organized by other
  organizations
• As our aim is
• Being, doing, practising together with patients
  and supporting them in their problematic areas of
  life gt Our nurses need to train skills and have
  knowledge in many areas (risk management,
  legislation, ethics, the use of self, the
  therapeutic appreciation of control and social
  balance in nursing)

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Discussion

• We have advanced studies for nurses and practical
  nurses only in psychiatric nursing
• Should we have studies in a degree for a
  forensic psychiatric nursing?
• At the moment we dont have

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Conclusion

• Who do we treat?
• What are we doing?
• Who are we?
• What is our nurses basic and continuing
  education?
• Tack