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 The 9th Nordic Symposium on Forensic Psychiatry 25.8.2011 Lidingö 20.4.2017

The Contents of this presentation Who do we treat? What are we doing? Who are we? What is our nurses’ basic and continuing education? 20.4.2017

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. 20.4.2017

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) 20.4.2017

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 20.4.2017

Challenges (continued) uncontrolled violence connected with psychotic symptoms ethical dilemmas don’t 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 20.4.2017

Diagnosis 20.4.2017 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 2 12 8,4 F20.3-F20.39 Undifferentiated schizophrenia 30 5 35 24 F20.9 Schizophrenia, unspecified 1 0,7 F22.0-F22.9 Persistent delusional disorders 6 7 4,9 F23.3 Other acute predominantly delusional psychotic disorders 1,4 F25.01-F25.9 Schizoaffective disorders 8 18 12,5 F29 Unspecified nonorganic psychosis F31.0-F31.2 Bipolar affective disorder F84.9 Pervasive developmental disorder, unspecified Z04.6 General psychiatric examination, requested by authority 4 3,6   All 117 27 144 100,0 20.4.2017

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 20.4.2017

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 patient’s family or other significant people are very important Chaplain/ priest Library etc. 20.4.2017

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 20.4.2017

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

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 -> 3,5 years) The studies are organized into degree programmes Different universities of applied sciences decide on the content and the curriculum

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

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

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)

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) Bachelor’s thesis (15 ECTS)

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

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

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

Continuation - Work with the handicapped - Elderly Care - Rehabilitation Elective studies 15 ECTS Registered nurse studies include 210 ECTS >Practical nurse studies include 180 ECTS

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

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

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

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

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” 20.4.2017

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 > 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) 20.4.2017

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 don’t have

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