The Forensic Psychiatric Network of Observation and Documentation: At the Intersection of Review Board Hearings and Nursing Practice.

ABSTRACT: Forensic psychiatric nursing is a specialty at the junction of two well-researched intersecting systems with two mandates: criminal justice and health care. Nurses' involvement at one of the systems' points of juncture, review board (RB) hearings, has largely been left unexplored. At RB hearings, a panel of legal and healthcare professionals determines if persons unfit to stand trial (UST) or not criminally responsible on account of mental disorder (NCR) represent significant threats to the safety of the public and orders conditions aimed at keeping the community safe. The aim of this article is to present the results of a critical ethnography that explored how psychiatric and public safety discourses construct the identity of persons UST or NCR during RB hearings as well as nurses' contribution to such identity construction. The main finding is that the forensic psychiatric structure leverages nursing interventions and documentation as evidence of deviancy, so that persons UST or NCR can be objectified and produced as dangerous. Structures sustaining the forensic psychiatric system inscribe nursing care within a disciplinary scheme, rendering the care-and-custody dichotomy insufficient to explain the complex processes at play in forensic psychiatry. These findings have implications for the practice of nurses working in forensic psychiatric settings and for that of other nurses who practice on the medicolegal borderland.

A critical ethnographic perspective on risk and dangerousness in forensic psychiatry.

In the Canadian forensic psychiatric context, the concepts of risk and dangerousness interact, intersect, and morph into the notion of significant threat to the safety of the public. Stemming from the results of a critical ethnography of the Ontario Review Board, this article unpacks the central role of forensic psychiatric nursing, as an example of a 'psych' discipline (e.g., psychiatry and psychology), in a system that is built to produce risky persons and to legitimize their detention and supervision. By using excerpt of interviews conducted with nurses, ethnographic observations of Review Board hearings, and other documentary artifacts, the findings illustrate how rationalizations of risk and dangerousness are contingent on space, time, and observer. Depending on the time of the assessment or on the health-care professional who performs it, different elements including, but not limited to, mental illness, interpersonal relationships, financial instability, and sexual vulnerability, are relied upon in very fluid, interchangeable, and discretionary ways to justify findings of dangerousness. Such a dynamic expands the reach of psychiatry's legitimacy at identifying risky conduct and controlling risky persons to domains very loosely associated with the notion of dangerousness. The work of Foucault and Castel provides the theoretical backdrop on which rests the discussion and the implications for nursing.

Rethinking dementia as a queer way of life and as 'crip possibility': A critique of the concept of person in person-centredness.

The concept of person-centeredness has become in many instances the standard of health care that humanises services and ensures that the patient/client is at the centre of care delivery. Rejecting a purely biomedical explanation of dementia that led to a loss of self, personhood in dementia could be maintained through social interaction and communication. In this article, we use the insights of queer theory to contribute to our current understanding of the care of those with dementia. We critically discuss the concepts of person and personhood that have become the cornerstone values of person-centred care for persons with dementia (PWD). Some critics, using queer theory as a theoretical approach, contend that person-centred care often (unwittingly) reproduces heteronormative roles in trying to sustain life histories. In doing so, they argue, regendering of PWD is sometimes enforced by care providers who try to safeguard this biographical continuity. Cultural theorist Linn Sandberg also mentions that other axes of domination such as race and class are not conceptualised in person-centeredness approaches, and neither are power asymmetries. Thus, in our article, we revisit the concept of person-centred care as a first step in proposing another way to think about 'beings with dementia' (to avoid the term person). Believing that queer theorists have fallen short in questioning the idea of person or personhood as such, we will build on and broaden Sandberg's critique by demonstrating that queer and crip theory can be understood as a fundamental critique of the (Western) subject and processes of subjectivation. We argue that dementia can be conceptualised as a radical break not only with gendered roles and embodiments, but with many of the norms that make us recognisable subjects. Conceptualising dementia in this way turns it into what Sandberg called an 'emancipatory space' and not merely a pathology.

Which lives are worth saving? Biolegitimacy and harm reduction during COVID-19.

Despite the promise to save every life, the COVID-19 pandemic has exposed social and racial inequalities, precarious living conditions, and engendered an exponential increase in overdose deaths. Although some lives are considered sacred, others are deliberately sacrificed. This article draws on the theoretical work of Foucault and scholars who further developed his concept of biopolitics. While biopolitics aims to ameliorate the health of populations, Foucault never systematically accounted for the unequal value of lives. In the name of saving the biological lives of people who use drugs (PWUD) during the pandemic, the harm reduction movement has emphasized the need for safe supply, decriminalization, and housing; governments have started implementing these measures, which were previously rejected as utopian and unrealistic. Paradoxically, the use of drugs itself, and therefore the increased risk of death from overdose or other medical sequelae, is the only way PWUD can achieve enough visibility to be recognized as a life worth saving. The humanitarian rationale of harm reduction concerns itself with the biological life and stipulates social and political rights in the name of its sacredness. This is what anthropologist Fassin and others called biolegitimacy-the recognition of life reduced to its physiological, biological essence.

(Re)construction identitaire et pratique infirmière en psychiatrie légale : réflexion critique sur les commissions d'examen.

Introduction : The caritative impact of nursing care provided in forensic mental health settings is rarely questioned.Context : Caritative nursing care is indirectly regulated by the Review Board (RB), a para-judicial court which ensures public safety.Objective : This study presents a critical reflection on the political and social effects of the RB, forensic psychiatry hospitals and practices of forensic mental health nurses.Method : The reflection is centered on the concepts of biopower, degradation ceremonies, moral career and identity (re)construction.Results : ‘Therapeutic’ nursing practices are useful for disciplinary purposes in the forensic psychiatric hospital, insofar as they permit the identification and management of dangerous persons. However, the practices also fall within the biopolitical scope of the RB, since they assist the latter in ensuring public safety.Discussion : The forensic psychiatric environment can prove problematic for nurses, requiring a double allegiance, whereby their responsibilities to patients (consent and confidentiality) and to the institution (protection of the public) can lead to tension.Conclusion : The analytical framework of the study allows for a reassessment of other presumed processes in psychiatric environments, which nonetheless constitute just as many rituals of identity (re)construction.

Humanitarian reason and the movement for overdose prevention sites: The NGOization of the Opioid "Crisis".

In August 2017, a group of activists erected in Ottawa's downtown a tent as a first overdose prevention site as a response to what the public and the activists perceived as an epidemic-a devastating wave of opioid and fentanyl overdoses in Canada. The Ontario premier was urged to declare an emergency that would provide increased funding for harm reduction and also send a message to survivors and families that the lives of their loved ones mattered. Thus, the discourses around the so-called opioid crisis used a language of moral sentiments to legitimate political action. This "new humanitarianism" is considered a priori as good, but in this article, I ask what is politically at stake if we base our actions on the logic of humanitarian reason. The new universalism of humanitarian organizations is based on the individualism of human rights and thus on a moral imperative that replaces the political. Initiatives like the OPS movement often fill the gaps in social services in the absence of the state and address social problems as emergencies and public health issues, thereby transforming them into medical problems-performing the medicalization of sociopolitical problems. This is what I call the NGOization of the opioid crisis. This form of humanitarianism is a universalism of the temporal present without any universal promise for a better future or the amelioration of human conditions-it is a humanitarianism of emergency. What characterizes new humanitarianism is that it responds to situations of suffering that are the result of increasing inequality and injustices without addressing the root causes of this suffering. Not addressing these causes means to be complicit in perpetuating the inequalities and to restrict visions of possible alternatives.

Governing through lifestyle-Lalonde and the biopolitical management of public health in Canada.

In 1974, the Liberal government of Pierre Trudeau released a "green paper" known as the Lalonde Report, after the health minister at that time. The report formulated perspectives on health and the main concepts and ideas developed in it, particularly the concept of "lifestyle," which became the foundation of public health policies in many different European countries and the United States. The concept of "lifestyle" connected personal behaviour and habits to the individual health condition; people were not dying due to a lack of access to medical care but because they lived a life prone to personal risk taking. Furthermore, what is seldom discussed is that this report not only propagated the (neo)liberal view of citizens as autonomous rational actors (homo oeconomicus), with personal responsibility for their health, but it was a first step in the transformation of Medicare and went far beyond the question of health promotion. Health was no longer something that happened to a person but was created through personal choice and, therefore, one had to assume responsibility for one's behaviour. Using Foucault's definition of government as the "conduct of conduct," we will demonstrate that the Lalonde report must be understood as a specific "technology of government" and contributed to a neoliberal transformation of health care despite the fact that the Canadian system of Medicare was based on the idea of universality, meaning citizens had equal access to health care independent of their socio-economic situation. As we will demonstrate, the Lalonde report undermined this foundation and initiated a profound reorientation, not only of the healthcare system, but even more importantly, it radically changed the way we think about our behaviour around health-related issues. We will also discuss how the making of the report contributed to the redefinition of politics and demonstrated a lack of concern with liberal-democratic decision-making processes.

Nursing history as philosophy-towards a critical history of nursing.

Mainstream nursing history often positions itself in opposition to philosophy and many nursing historians are reticent of theorizing. In the quest to illuminate the lives of nurses and women current historical approaches are driven by reformist aspirations but are based on the conception that nursing or caring is basically good and the timelessness of universal values. This has the effect of essentialising political categories of identity such as class, race and gender. This kind of history is about affirmation rather than friction and about the conservation of memory and musealization. In contrast, we will focus on how we imagine nursing history could be used as a philosophical, critical perspective to challenge the ongoing transformations of our societies. Existing reality must be confronted with strangeness and the historically different can assume the function of this counterpart, meaning present and past must continuously be set in relation to each other. Thus, critical history is always the history of the present but not merely the pre-history of the present - critique must rather present different realities and different certainties. In this paper, we use this approach to discuss the implementation of the nursing process (NP) in Germany. The nursing process appears to be a technology that helped to set up an infrastructure - or assemblage - to transform nursing interventions into a commodity exchangable between consumers and nurses in a free market. In our theoretical perspective, we argue that NP was a step in the realization of the German ordoliberal program, a specific variety of neoliberalism. In order to implement market-orientation in the healthcare system it was necessary to transform hospitals into calculable spaces and to make all performances in the hospital calculable. This radically transformed not just the systems, but the ways in which nurses and patients conveived of themselves.

The Use of the Delphi and Other Consensus Group Methods in Medical Education Research: A Review.

PURPOSE: Consensus group methods, such as the Delphi method and nominal group technique (NGT), are used to synthesize expert opinions when evidence is lacking. Despite their extensive use, these methods are inconsistently applied. Their use in medical education research has not been well studied. The authors set out to describe the use of consensus methods in medical education research and to assess the reporting quality of these methods and results. METHOD: Using scoping review methods, the authors searched the Medline, Embase, PsycInfo, PubMed, Scopus, and ERIC databases for 2009-2016. Full-text articles that focused on medical education and the keywords Delphi, RAND, NGT, or other consensus group methods were included. A standardized extraction form was used to collect article demographic data and features reflecting methodological rigor. RESULTS: Of the articles reviewed, 257 met the inclusion criteria. The Modified Delphi (105/257; 40.8%), Delphi (91/257; 35.4%), and NGT (23/257; 8.9%) methods were most often used. The most common study purpose was curriculum development or reform (68/257; 26.5%), assessment tool development (55/257; 21.4%), and defining competencies (43/257; 16.7%). The reporting quality varied, with 70.0% (180/257) of articles reporting a literature review, 27.2% (70/257) reporting what background information was provided to participants, 66.1% (170/257) describing the number of participants, 40.1% (103/257) reporting if private decisions were collected, 37.7% (97/257) reporting if formal feedback of group ratings was shared, and 43.2% (111/257) defining consensus a priori. CONCLUSIONS: Consensus methods are poorly standardized and inconsistently used in medical education research. Improved criteria for reporting are needed.

Neoliberalism and the government of nursing through competency-based education.

Competency has become a key concept in education in general over the last four decades. This article examines the development of the competency-based movement with a particular focus on the significance it has had for nursing education. Our hypothesis is that the competency movement can only adequately be understood if it is analyzed in relation to the broad societal transformation of the last decades-often summarized under the catchword neoliberalism-and with it the emergence of managerial models for Human Resource Management (HRM) for the reorganization of social services. Classical professions, which were characterized under welfarism by an esoteric knowledge based on ethical norms, have now become marketable commodities that can be evaluated in the same way as other commodities. We want to underline that while this development is still under way, it is the concept of competency that was the decisive political instrument enabling this profound change. With the widespread implementation of competency-based education that now governs nursing knowledge, the development of a critical, oppositional perspective becomes more challenging, if not entirely impossible. We will be focusing primarily on nursing education in Canada, although we maintain that it has relevance for nursing internationally.

The use of Delphi and Nominal Group Technique in nursing education: A review.

OBJECTIVES: Consensus methods are used by healthcare professionals and educators within nursing education because of their presumed capacity to extract the profession's' "collective knowledge" which is often considered tacit knowledge that is difficult to verbalize and to formalize. Since their emergence, consensus methods have been criticized and their rigour has been questioned. Our study focuses on the use of consensus methods in nursing education and seeks to explore how extensively consensus methods are used, the types of consensus methods employed, the purpose of the research and how standardized the application of the methods is. DESIGN AND DATA SOURCES: A systematic approach was employed to identify articles reporting the use of consensus methods in nursing education. The search strategy included keyword search in five electronic databases [Medline (Ovid), Embase (Ovid), AMED (Ovid), ERIC (Ovid) and CINAHL (EBSCO)] for the period 2004-2014. We included articles published in English, French, German and Greek discussing the use of consensus methods in nursing education or in the context of identifying competencies. REVIEW METHOD: A standardized extraction form was developed using an iterative process with results from the search. General descriptors such as type of journal, nursing speciality, type of educational issue addressed, method used, geographic scope were recorded. Features reflecting methodology such as number, selection and composition of panel participants, number of rounds, response rates, definition of consensus, and feedback were recorded. RESULTS: 1230 articles were screened resulting in 101 included studies. The Delphi was used in 88.2% of studies. Most were reported in nursing journals (63.4%). The most common purpose to use these methods was defining competencies, curriculum development and renewal, and assessment. Remarkably, both standardization and reporting of consensus methods was noted to be generally poor. Areas where the methodology appeared weak included: preparation of the initial questionnaire; the selection and description of participants; number of rounds and number of participants remaining after each round; formal feedback of group ratings; definitions of consensus and a priori definition of numbers of rounds; and modifications to the methodology. CONCLUSIONS: The findings of this study are concerning if interpreted within the context of the structural critiques because our findings lend support to these critiques. If consensus methods should continue being used to inform best practices in nursing education, they must be rigorous in design.

Health prevention in the era of biosocieties: a critical analysis of the 'Seek-and-Treat' paradigm in HIV/AIDS prevention.

On 18 November 2014, the United Nations launched an urgent new campaign to end AIDS as a global health threat by 2030. With its proposed strategy, the UN follows leading scientists who had declared the failure of former prevention strategies and now were promoting a 'Seek and Treat for Optimal Prevention' (STOP) approach as the most cost-effective response to the pandemic to meet the goal of 'an AIDS-free generation'. STOP combines antiretroviral therapy and routine HIV screening to find persons unaware that they are HIV-positive, because research has shown that people consistently change their behaviour (i.e. increase condom use, have fewer partners) after an HIV diagnosis. AIDS activists have broadly criticized this strategy on different levels. In this article, we go beyond these criticisms and try to analyse the political rationalities behind this 'new' strategy. We believe that it is necessary to put the rationale underpinning the STOP programme into the context of broader societal transformations that can best be captured as the development of advanced liberal societies and the new emphasis on self-controlling or self-responsibility rather than on disciplining behaviour.

The Long Way Toward Cooperation: Nurses and Family Physicians in Northern Germany.

To better understand why cooperation between health care professionals is still often problematic, we carried out 25 semistructured face-to-face expert interviews with physicians and nurses in different rural and urban areas in northern Germany. Using Mayring's qualitative content analysis method to analyze the data collected, we found that doctors and nurses interpreted interprofessional conflicts differently. Nursing seems to be caught in a paradoxical situation: An increasing emphasis is placed on achieving interprofessional cooperation but the core areas of nursing practice are subject to increasing rationalization in the current climate of health care marketization. The subsequent and systematic devaluation of nursing work makes it difficult for physicians to acknowledge nurses' expertise. We suggest that to ameliorate interprofessional cooperation, nursing must insist on its own logic of action thereby promoting its professionalization; interprofessional cooperation cannot take place until nursing work is valued by all members of the health care system.

Understanding 'caring' through biopolitics: the case of nurses under the Nazi regime.

These days, discussions of what might be the 'essence' or the 'core' of nursing and nursing practice sooner or later end in a discussion about the concept of care. Most of the 'newer' nursing theories use this concept as a theoretical core concept. Even though these theoretical approaches use the concept of care with very different philosophical foundations and theoretical consistency, they concur in defining care as the essence of nursing and thereby glorify goodness as the decisive characteristic of nursing. These theoretical approaches neglect the fact that nursing is above all a profession with a societal task and is characterized by an asymmetrical power relation between nurses and their patients. Based on the results of a research project that analysed the role nurses played in the killing of psychiatric patients in Germany during the Nazi regime, I demonstrate that an approach based on the concept of care is not able to explain how nurses were able to commit crimes of such atrocity. These crimes were bound to an emotional investment that sustained the production of 'life unworthy of living'. In the case of nurses under the Nazi regime, certainly a kind of sadism was at issue that can only be explained if we recognize that the social bond is characterized by a certain tension; 'goodness' that caring theories assign to the social bond always coexists with the capacity for destruction. Using the Foucauldian theoretical framework of biopower and biopolitics enables one to analyse violence and power as integral parts of nurses' practice. Seen from this perspective, the killing of patients was part of a biopolitical programme and not a relapse into barbarism. The concept of care obscures the political agenda of nursing and does not provide a critical and political framework to analysing nursing practice.

Expanding our understanding of sovereign power: on the creation of zones of exception in forensic psychiatry.

The purpose of this paper is to engage with the readers in a theoretical reflection on nursing practices in forensic psychiatric settings. In this paper, we argue that practices of exclusion in forensic psychiatric settings share some common ground with Agamben's description of sovereign power and, consequently, the possible creation of zones of exception in this environment. The concept of exception is, therefore, purposely used to shift our thinking, highlight the political forces surrounding exclusionary practices in forensic psychiatric nursing, and explore the ethical tensions that arise for nurses who become entangled in the control of these zones of exception. We argue that ethical and political discussions regarding this phenomenon are necessary if we wish to further understand the complexities of this field of practice and promote constructive change.

Shock Therapies as Intensification of the War against Madness in Hamburg, Germany: 1930-1943.

German psychiatric practice between 1930 and 1945 was characterizedby the interplay of different technologies that aimed to influence the conduct ofthe patient. Nurses, as the delegated representatives of the psychiatrists' power,were strategically positioned to influence patient behaviour using a broad rangeof disciplinary measures. An in-depth qualitative analysis of a medical recordfrom a Hamburg asylum highlights the different shock treatments used on thepatient, demonstrating that they were used randomly and primarily as a meansof discipline for "bad" behaviour, sometimes leading to patient deaths. The articleconnects the results of the analysis with the international discussions amongpsychiatrists on how shock therapies were presumed to operate.

Nurses, medical records and the killing of sick persons before, during and after the Nazi regime in Germany.

During the Nazi regime (1933-1945), more than 300,000 psychiatric patients were killed. The well-calculated killing of chronic mentally 'ill' patients was part of a huge biopolitical program of well-established scientific, eugenic standards of the time. Among the medical personnel implicated in these assassinations were nurses, who carried out this program through their everyday practice. However, newer research raises suspicions that psychiatric patients were being assassinated before and after the Nazi regime, which, I hypothesize, implies that the motives for these killings must be investigated within psychiatric practice itself. An investigation of the impact of the interplay between the notes left by nurses and those by psychiatrists illustrates the active role of the psychiatric medical record in the killing of these patients. Using theoretical insights from Michel Foucault and philosopher Giorgio Agamben and analyzing one part of a particularly rich patient file found in the Langenhorn Psychiatric Asylum in the city of Hamburg, I demonstrate the role of the record in both constructing and deconstructing patient subjectivities. De-subjectifying patients condemned them to specific zones in the asylum within which they were reduced to their 'bare life'--a precondition for their physical assassination.