{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:46:32Z","timestamp":1788306392603,"version":"build-2803163510"},"reference-count":55,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing Inquiry"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Nurses practicing in forensic mental health hospital settings work with patients involved in the criminal justice system who are also diagnosed with psychiatric illnesses. Nurses work towards collaborative and therapeutic relationships with patients with an eventual goal of recovery and successful discharge to the community. Though the majority of patients in these settings in Canada are diagnosed with psychotic disorders, a smaller proportion may be diagnosed with antisocial personality disorder (ASPD), a patient population often described as \u2018difficult\u2019 or even \u2018untreatable\u2019 by nurses. In this paper, we offer a critical examination of forensic mental health nursing practice with this patient population, based upon a qualitative study, using discourse analysis methodology of nursing practices in a Canadian high security forensic hospital setting. Nurse participants described those challenges faced and strategies employed when working with patients diagnosed with ASPD, and who had been found not criminally responsible on account of mental disorder (NCRMD). Michel Foucault's poststructuralist concept of disciplinary power provides the theoretical lens in which both patient behaviours deemed \u2018difficult\u2019 and nursing practices are interrogated. Our findings indicate that the secure forensic mental health hospital environment represents a highly disciplinary space, wherein constant observation of patients occurs, and attempts are made to \u2018normalize\u2019 behaviours deemed abnormal. Patients diagnosed with ASPD regularly violate hospital rules and behavioural expectations, leading to frustration amongst nursing staff. Tensions existed in proposed strategies for working with these patients between strict adherence to unit rules and the disciplinary order, and a willingness to loosen these rules in attempts to improve nurse\u2013patient relationships. The nursing implications of these opposing strategies are critically examined, with proposals for practices that exist both within and outside the disciplinary order are offered.<\/jats:p>","DOI":"10.1111\/nin.70004","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T07:01:24Z","timestamp":1741590084000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["\u2018Difficult\u2019 Patients: Disciplinary Power and Nursing Practice in Forensic Hospital Settings"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8997-2284","authenticated-orcid":false,"given":"Jim A.","family":"Johansson","sequence":"first","affiliation":[{"name":"College of Health Sciences, Faculty of Nursing, Edmonton Clinic Academy Building University of Alberta Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Peternelj\u2010Taylor","sequence":"additional","affiliation":[{"name":"College of Nursing, Health Sciences Building University of Saskatchewan Saskatoon Saskatchewan Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/02668734.2015.1025425"},{"key":"e_1_2_11_3_1","first-page":"29","volume-title":"Jeremy Bentham: The Panopticon Writings","author":"Bentham J.","year":"1995"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12113"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2011.03970.x"},{"key":"e_1_2_11_6_1","volume-title":"Report From the Conflict and Containment Reduction Research Programme","author":"Bowers L.","year":"2011"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/JFN.0b013e31827a9293"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1108\/mhsi-08-2014-0024"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/070674371506000307"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1049732304266820"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/14999013.2021.2023708"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1037\/ser0000731"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2016.0053"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","unstructured":"Criminal Code R.S.1985 c. 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