An exploratory study investigating the impact of the procedures used to manage patient substance misuse on nurse–patient relationships in a medium secure forensic unit

Accessible summary•  This study investigated the perspectives of mental health nurses working in a medium secure unit, regarding the impact of the security procedures used to manage patient substance misuse on nurse–patient relationships. •  Data from the interviews were analysed and revealed that the participants perceived that the intrusive nature of the procedures was detrimental to their relationship with patients. Both the relative degree of intrusion posed by the procedure, and the communication skills of nurses were important factors in determining the extent and duration of negative effects on relationships. •  A number of recommendations were made to improve policy and practice in relation to the application of the procedures. Firstly, that the use of partial strip searching should be minimized. Secondly, that unit managers should ensure consistent application of urine drug screening policies and that responsibility for undertaking the procedures should be spread evenly throughout nursing teams to avoid patients ‘splitting’ teams into ‘good’ and ‘bad’ nurses; Finally, that staff should receive further training in both substance misuse and communication skills.Abstract The role conflict experienced by forensic psychiatric nurses between their therapeutic responsibilities and their responsibility to operationalize security procedures is well established in the literature. There has been less investigation into how this role conflict is played out specifically in the management of inpatient substance misuse in forensic units. This study, therefore, aimed to explore the views of nurses working in one medium secure unit of the impact of the procedures used to manage substance misuse (partial strip searching, room searching, canine searching, ‘pat’ (or ‘rubdown’) searching, urine drug screening) on their relationships with patients. Ten interviews of registered mental health nurses working in a medium secure unit in the Northwest were carried out. The interview data were transcribed verbatim and framework analysis used to identify emergent themes. The impact of the procedures on nurse–patient relationships was reported as largely negative by the participants. They reported that the intrusion of the procedures had a detrimental effect on their relationships with patients. The relative degree of intrusion posed by each of the procedures was an important factor in determining the extent and duration of damage to nurse–patient relationships, as was the communication skills of the nurse conducting the procedure.