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
The 9th Nordic Symposium on Forensic Psychiatry
Lidingö

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
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

7. 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

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 patient’s 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 bachelor’s 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 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

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)
Bachelor’s 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
>Practical 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 , 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 > 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 don’t have

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