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This paper describes the ideas related to forensic practice with people with learning disabilities through a study that explores the apparent ‘truths’ about people with learning disabilities who are detained in forensic settings (referred to here as ‘the men’) and the staff who work with them by an analysis the dialogue contained in retrospective data from interviews and focus groups.The men in these settings are subject to intense stigma and disadvantage; socially and legally. Not only are they categorised as having a learning disability, but also have the added stigma of being offenders, and commonly having mental health issues that expose them to the worst of myths surrounding learning disability; such as the possibility of being viewed as ‘dangerous monsters and sex fiends’ (French & Swain, 2008). Similarly, but to a lesser degree, forensic nurses are stigmatised and subject to strict laws, policies and practices and stereotyped as prison wardens and ‘tough guys’. These ideas may be exposed and challenged through studying the discourses in the dialogue. Therefore, the general research questions included the following.• What are the discourses related to learning disability and forensic practice?• What ideologies underpin and justify forensic practice?This paper is primarily concerned with the way that the staff and the men experience the medium secure unit (MSU) and their views as to the advantages and disadvantages of secure care.The findings generally suggest that the men and the staff are very positive about their lives.They report that the men have many attributes and talents, and view having a learning disability as an advantage at times; the staff enjoy their work and have good relationships with the men. Paradoxically1, there are also negative discourses identified, some of which permeate from macro ideologies into policy and practice to justify the men's treatment in the MSU.The analysis showed that despite the certainty that many feel about the justifications for holding men with learning disabilities in secure settings, many paradoxes exist in the discourses in this setting, which question the validity of official knowledge in this area ‐ this is essentially a Foucauldian idea (Foucault, 1975). Foucault's ideas on the way that knowledge and practice may be challenged are important to this paper.

The forensic nursing role is complex, creates tensions within itself and is underpinned by core values, knowledge, skills and personal attributes; often referred to as ‘good nurse’ characteristics (Smith & Godfrey, 2002). Forensic nurses perform unique, multifaceted roles; they are viewed by patients as ‘a source of treatment, comfort and advice’, but also as ‘part of the system that deprives them of their liberty’ (United Kingdom Central Council for Nursing, Midwifery and Health Visiting & University of Central Lancashire (UKCC & UCLAN), 1999: 42). This is problematic both for nurses and patients. Although appearing as opposites, security and therapeutic characteristics of nurses can and do co‐exist in forensic nursing (Peternelji‐Taylor & Johnson, 1996). Through critical analysis of dialogue from interviews and focus groups, this paper depicts forensic practice with people with a learning disability through a study that explores apparent ‘truths’ about such people detained in forensic settings (here referred to as ‘the men’) and the staff who work with them. Beliefs about nursing characteristics were exposed through discourses present in dialogue between the men and the staff. General research questions included: (1) What are the discourses related to learning disability and forensic practice? (2) What ideologies underpin and justify forensic practice? (3) What in particular are the positive discourses? Related discussion is primarily concerned with the way that staff and men share relationships and with characteristics of the nursing staff. Findings generally suggest that the staff may be viewed as prison wardens, leading to relationships of mistrust. Paradoxically, there are also positive discourses identifying warm and therapeutic relationships and good nurse characteristics of the staff. This may have practice implications, such as enabling staff to hear positive views expressed by the men and begin to develop metrics of ‘good’ forensic nurse characteristics that may positively affect treatment.

Historically, people with learning disabilities have been the subjects of research, rather than true participants or contributors. Common approaches used to inform people with learning disabilities about research include simplifying information sheets and reading out the information. Literature to date suggests that little is known about what people with learning disabilities understand about research. This paper aims to address this issue.

A total of seven men and ten staff members were invited to become co‐researchers with two academic researchers from Northumbria University, over 20 months. Lessons learned can now be used to: educate other adults; show how it can be helpful; and how it can make a difference in the lives of people with learning disabilities. This study used a facilitated collaborative action research approach involving participants becoming researchers in their own right, enabling collaborative discussions, and using multiple ways of engaging with, presenting and collecting information. A longitudinal and recursive process added breadth and depth to the data.

The findings showed that the men required some training including; research, consent and ethics and benefited from opportunities they otherwise may not have been offered such as; intellectual stimulation; extra staff attention; being accredited for their work; realising their own capabilities; increased self‐esteem and confidence; pride in their achievements; skills development; and enjoyment. Importantly they have shown how valuable people with learning disabilities are to academic activity and research.

The results suggest that the fun, longitudinal, recursive and collaborative approach, was key to developing understandings of research for the men.

From this research a framework was developed for engaging similar populations in research – entitled Understanding Research, Consent and Ethics: A Participatory Research Methodology in a Medium Secure Unit for Men with a Learning Disability, including accessible information; and ten top tips for effectively involving people with a learning disability in research.

This study discovered how men with learning disabilities and living in a medium secure unit understand research, consent, and ethics and what enables them to learn about these concepts.

The management of violence and aggression is an important aspect of any service in the NHS and has been rightly tackled as a whole organisational approach. De-escalation is one such aspect of the organisation approach relating foremost to the safety of people and as such is a central part of relational security, personal safety and the therapeutic relationship.

The paper explores the evidence and policies around de-escalation.

The paper recommends that a randomised-controlled trial be designed, comparing different de-escalation techniques to establish an evidence base for this routine practice.

The paper is limited to discussing de-escalation as an approach and the policy that directs it, and does not consider individual theories on aggression and management. It makes recommendations for policy, research and practice.

There is a lack of high-quality evidence around de-escalation policy and principles which staff may believe is evidence-based practice because training is often mandatory. This obviously impacts upon the patient experience and aspects of safety. The paper is valuable to practitioners working in secure environments, or with offenders that may require management of violence and aggression.

There are many policies and guidelines from the government and from professional bodies that seems to have tailored off since 2005 (Muralidharan and Fenton, 2006; UKCC, 2002). Forensic staff are constrained by such guidance which is further complicated by debates concerning care/coercion and forensic environments, some of which is alluded to here.

The purpose of this paper is to examine the impact that research governance processes in the National Health Service (NHS) are having on the conduct of research that involves a national survey and to point to ways that existing processes may develop to facilitate such research.

The paper describes the experiences of a research team of seeking approval in 357 NHS organisations to carry out a national postal survey to investigate specialist services and specialist staffing for older people in England in the wake of recent policy developments. Through reflection on this experience, the team propose approaches for the development of existing research governance processes. The national survey was the first stage of the study, which was followed by a detailed investigation of the development of specialist service provision for older people in six case study sites across England. The national survey aimed to map specialist service provision for older people by identifying the range of service models, agency and professional involvements, and nature of the case load in statutory services (health and social care), independent and voluntary sector organisations.

Of the 357 NHS organisations approached for approval to carry out the survey within the organisation, this was achieved only in 247 organisations over 12 months. Many organisations were facilitative of the process; however, protracted and extensive approval processes in others led to long delays and redesigning of the research that was commissioned by the Department of Health.

The paper is of value in that it highlights processes and practices that hinder research and builds on those that work well.

The purpose of this paper is: to add to current understandings of how people with learning disability make informed choices in relation to participation in research; and to highlight both the competencies of people with learning disability in relation to participation in research and the impact of their involvement on the quality of that research.

A participatory/collaborative approach, designed to engage participants in both developing processes for data generation and participating in the analysis of that data, was employed.

The complexities of research and the implications of participation were poorly understood. Collaborative, recursive approaches are important for developing understanding. Participation in the research approach by people with learning disabilities enabled the generation of new understandings.

The small sample size means the collaborative, recursive approach, whilst researched in depth, has not been widely generalised. Whilst there have been some difficulties in taking this forward at the study site, a second phase with another 6 men with learning disability has been carried out. Four of the men from the original study acted as co‐facilitators. Although it was not formally evaluated it was considered to be a helpful way of raising issues in relation to participation in research.

There needs to be more careful consideration of the broader issues behind informed consent. A recursive approach to developing informed choice (rather than a single engagement) needs to be embedded in practice. Peer to peer collaboration should be recognised as an approach to developing informed choice about participation.

This paper will be of value to people researching with people with learning disability. It demonstrates that, given appropriate opportunities, people with learning disability can understand some of the more complex concepts in relation to participation in research and so should be involved. It offers clear insights about how this may be achieved and raises the importance of including people with learning disability as active research participants in matters that affect their own lives.