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Training for forensic nursing

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Mirva Sundqvist-Kek l inen Senior lecturer University of Applied Sciences in Vaasa Finland Aila Vokkolainen Nursing director Vanha Vaasa Hospital – PowerPoint PPT presentation

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Title: 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

2
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)

5
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

6
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

7
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
8
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

9
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.

10
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

11
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

12
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

13
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

14
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

15
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)

16
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)

17
Continuation
  • The Advanced studies in Psychiatric Nursing
    include
  • clinical placement (20 ECTS)
  • expertise in psychiatric nursing (6 ECTS)
  • health care entrepreneurship (4ECTS)

18
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

19
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

20
Continuation
  • - Work with the handicapped
  • - Elderly Care
  • - Rehabilitation
  • Elective studies 15 ECTS
  • Registered nurse studies include 210 ECTS
  • gtPractical nurse studies include 180 ECTS

21
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

22
The structure of the studies
  • Required studies
  • Basics of Psychiatric Nursing
  • Methods in Psychiatric Nursing
  • Professionalism in Psychiatric Nursing

23
Continue..
  • Elective studies
  • Psychiatric rehabilitation
  • Psychiatric Nursing among the elderly
  • Paediatric and Adolescent nursing
  • Psychiatric Nursing among intoxicant abusers
  • Forensic psychiatric nursing
  • Entrepreneurship

24
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

25
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

26
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)

27
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

28
Conclusion
  • Who do we treat?
  • What are we doing?
  • Who are we?
  • What is our nurses basic and continuing
    education?
  • Tack
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