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Background: International studies show that adults with intellectual and developmental disabilities (IDD) are disproportionately represented in the criminal justice and forensic mental health systems; however, it is difficult to capture their involvement across systems in any one jurisdiction. Aims: The current study aimed to estimate the prevalence of IDD across different parts of the criminal justice and forensic mental health systems in Ontario and to describe the demographic and clinical profiles of these individuals relative to their counterparts without IDD. Methods: This project utilised administrative data to identify and describe the demographic and clinical characteristics of adults with IDD and criminal justice or forensic involvement across four sectors: federal correctional facilities, provincial correctional facilities, forensic inpatient mental health care and community mental health programmes. Questions were driven by and results were contextualised by a project advisory group and people with lived experience from the different sectors studied, resulting in a series of recommendations. Results: Adults with IDD were over‐represented in each of the four settings, ranging from 2.1% in federal corrections to 16.7% in forensic inpatient care. Between 20% (forensic inpatient) and 38.4% (provincial corrections) were under the age of 25 and between 34.5% (forensic inpatient) and 41.8% (provincial corrections) resided in the lowest income neighbourhoods. Medical complexity and rates of co‐occurring mental health conditions were higher for people with IDD than those without IDD in federal and provincial corrections. Conclusions: Establishing a population‐based understanding of people with IDD within these sectors is an essential first step towards understanding and addressing service and care needs. Building on the perspectives of people who work in and use these systems, this paper concludes with intervention recommendations before, during and after justice involvement. [ABSTRACT FROM AUTHOR]

In the Canadian forensic psychiatric context, the concepts of risk and dangerousness interact, intersect, and morph into the notion of significant threat to the safety of the public. Stemming from the results of a critical ethnography of the Ontario Review Board, this article unpacks the central role of forensic psychiatric nursing, as an example of a 'psych' discipline (e.g., psychiatry and psychology), in a system that is built to produce risky persons and to legitimize their detention and supervision. By using excerpt of interviews conducted with nurses, ethnographic observations of Review Board hearings, and other documentary artifacts, the findings illustrate how rationalizations of risk and dangerousness are contingent on space, time, and observer. Depending on the time of the assessment or on the health‐care professional who performs it, different elements including, but not limited to, mental illness, interpersonal relationships, financial instability, and sexual vulnerability, are relied upon in very fluid, interchangeable, and discretionary ways to justify findings of dangerousness. Such a dynamic expands the reach of psychiatry's legitimacy at identifying risky conduct and controlling risky persons to domains very loosely associated with the notion of dangerousness. The work of Foucault and Castel provides the theoretical backdrop on which rests the discussion and the implications for nursing. [ABSTRACT FROM AUTHOR]

Documenting patient care is an important part of mental health services. The documentation is expected to be accurate, relevant, and informative for all future readers as it provides details about patients and the care they are receiving. Language can produce positive or negative emotions in individuals, and these emotions can influence their thoughts and actions. Considering this, nursing documentation can impact the future care of patients. In this study, our aim was to analyse the language and words nurses use when documenting about their patients. Through a qualitative review of notes transcribed by mental health nurses in a forensic setting (n = 55), we explored the adjectives and verbs used across a subsection of their documentation over a three‐month period. More specifically, we identified the most common words used, looked for patterns in use, and examined the emotional weight – or valence – of word choice. Examination of valence scores of the adjectives and verbs in the notes indicates that while nurses describe their patients in a rather neutral manner overall, some words and phrases are ambiguous and/or repetitive, and have the potential to negatively influence the perceptions of the reader regarding the patient. Clinical implications of patient care are discussed in the context of bias management. Nurses need to consider how word choice is linked to negative prosody and the need to provide additional information to avoid ambiguity. Without such care, notes can be subject to misinterpretation by readers leading to undue labels, stigma, and bias. [ABSTRACT FROM AUTHOR]

In Ontario, Canada, there is a need for an easily accessible training for forensic nurse examiners on the provision of care for abused older adults. In this study, our objective was to develop and evaluate a novel elder abuse nurse examiner e-learning curriculum focused on improving the care provided to older adults. The curriculum was launched on an online learning management system to forensic nurses working across Ontario's hospital-based violence treatment centers in June 2019 and evaluated using pre- and post-training questionnaires that measured self-assessed changes in knowledge and skills-based competence related to providing elder abuse care. There were significant improvements pre- to post-training in self-reported knowledge and competence across all core content domains: Older Adults and Abuse; Documentation, Legal, and Legislative Issues; Interview with Older Adult, Caregiver, and Other Relevant Contacts; Initial Assessment; Medical and Forensic Examination; and Case Summary, Discharge Plan, and Follow-Up Care. As the curriculum enhanced the knowledge and skills associated with caring for abused older adults, it may have implications for training forensic nurse examiners and associated staff working in more than 25 countries internationally. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Our aim was to examine the notes produced by nurses, paying specific attention to the style in which these notes are written and observing whether there are concerns of distortions and biases. Background: Clinicians are responsible to document and record accurately. However, nurses' attitudes towards their patients can influence the quality of care they provide their patients and this inevitably impacts their perceptions and judgments, with implications to patients' care, treatment, and recovery. Negative attitudes or bias can cascade to other care providers and professionals. Design: This study used a retrospective chart review design and qualitative exploration of documentation using an emergent theme analysis. Methods: We examined the notes taken by 55 mental health nurses working with inpatients in the forensic services department at a psychiatric hospital. The study complies with the SRQR Checklist (Appendix S1) published in 2014. Results: The results highlight some evidence of nurses' empathic responses to patients, but suggest that most nurses have a style of writing that much of the time includes themes that are negative in nature to discount, pathologise, or paternalise their patients. Conclusions: When reviewing the documentation of nurses in this study, it is easy to see how they can influence and bias the perspective of other staff. Such bias cascade and bias snowball have been shown in many domains, and in the context of nursing it can bias the type of care provided, the assessments made and the decisions formed by other professionals. Relevance to Clinical Practice: Given the critical role documentation plays in healthcare, our results indicate that efforts to improve documentation made by mental health nurses are needed and specifically, attention needs to be given to the writing styles of the notation. [ABSTRACT FROM AUTHOR]

The objective of this article is to examine the tensions that exist between care and custody in correctional environments by presenting the (im)possibilities of psychiatric nursing practice within this context. The analysis will be guided by empirical data obtained from a qualitative research conducted in a correctional setting. Semistructured interviews with nurses were conducted and used as the primary source of data for analysis. This article will explore the contextual characteristics of psychiatric nursing practice in correctional settings, describe the alienating effects of this context on nursing practice, theorize nurses’ experience using Festinger’s theory on cognitive dissonance, and, finally, explore how some nurses engage in the reconstruction of their care to counter the effects of working in correctional settings. [ABSTRACT FROM AUTHOR]

(2011) Journal of Nursing Management 293-301 Drawing on the works of Erving Goffman and Michel Foucault, this article presents part of the results of a qualitative study conducted in a forensic psychiatry setting. For many years, behaviour modification programmes (BMPs) have been subjected to scrutiny and harsh criticism on the part of researchers, clinicians and professional organizations. Nevertheless, BMPs continue to be in vogue in some 'total' institutions, such as psychiatric hospitals and prisons. Discourse analysis of mute evidence available in situ was used to critically look at behaviour modification programmes. Compelling examples of behaviour modification care plans are used to illustrate our critical analysis and to support our claim that BMPs violate both scientific and ethical norms in the name of doing 'what is best' for the patients. We argue that the continued use of BMPs is not only flawed from a scientific perspective, but constitutes an unethical approach to the management of nursing care for mentally ill offenders. Nurse managers need to be aware that BMPs violate ethical standards in nursing. As a consequence, they should overtly question the use of these approaches in psychiatric nursing. [ABSTRACT FROM AUTHOR]

Background: Transgender (trans) persons experience high rates of sexual victimization, often face discrimination by healthcare providers, and may have unique and diverse needs post-victimization. However, there remains a lack of comprehensive trans-specific training among healthcare professionals, including nurses., Objectives: Our primary objective was to develop and evaluate a novel curriculum for its efficacy in improving the competence of forensic nurses in providing sensitive, informed, and appropriate healthcare services for trans survivors of sexual assault., Methods: The curriculum was evaluated among forensic nurses working in sexual assault treatment centres across Ontario, Canada. Forty-seven nurses participated in this study, all of whom were selected by their respective programs to receive in-depth formal Sexual Assault Nurse Examiner training. Changes in participants' perceived expertise and competence in providing trans-affirming care were assessed on a 5-point Likert scale (5 being the highest level) using pre- and post-training questionnaires. Participants were asked to indicate their level of agreement with 31 competency-based statements, which were organized thematically into four domains: Initial Assessment, Medical Care, Forensic Examination, and Discharge and Referral. A clinical vignette assessed participants' demonstrated competence in providing care across four questions., Results: Participants level of expertise improved significantly from pre- to post-training (Mean [M] = 1.89, Standard Deviation [SD] = 0.84 vs. M = 3.47, SD = 0.62, p< 001), as well as their competence across all content domains: initial assessment (M = 3.79, SD = 0.63 vs. M = 4.70, SD = 0.31, p < .001), medical care (M = 3.33, SD = 0.73 vs. M = 4.69, SD = 0.33, p < .001), forensic examination (M = 3.40, SD = 0.75 vs. M = 4.72, SD = 0.35, p < .001), and discharge and referral (M = 3.62, SD = 0.80 vs. M = 4.59, SD = 0.40, p < .001). There were also significant improvements in competence associated with the clinical vignette pre- to post- training (M score = 2.13, SD = 1.06 vs. M score = 3.23, SD = 0.87, p < .001)., Conclusions: The success of this curriculum may have relevance to the more than 5000 members of the International Association of Forensic Nurses who practice and support forensic nursing across the globe, as well as to other healthcare professionals., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A major challenge faced by Forensic Program management teams is to balance their budgets due to the unpredictability of the forensic patient population, particularly in the context of managing staffing costs where the hospital is not the "gatekeeper" and does not have control over who is admitted and when. In forensic mental health, the justice system, either via the courts, or review boards, determines who is ordered for admission to hospital for assessment or treatment and rehabilitation. Hospitals have little, if any, recourse but to admit these mentally disordered offenders. This typically results in increased levels of staffing with concomitant overtime costs. The literature suggests that clustered float pool nurses develop enhanced relationships with staff and patients, thereby enabling them to attain specialized clinical expertise to treat specific patient populations, promoting safer, high quality care, and overall are more cost effective. Forensic nursing is recognized as a mental health subspecialty. The "Forensic Float Nurse" concept was piloted to provide readily available, highly adaptable, skilled forensic nurses to assist in times of unpredictably heavy workloads and/or unplanned staffing shortages. A significant reduction approaching 50% in overtime was achieved. Heuristic implications of this finding are presented., (© 2012 International Association of Forensic Nurses.)