Article Figures & Data
Tables
n (%) Gender Woman (cisgender) 70 (64.8) Man (cisgender) 29 (26.9) Prefer not to answer 9 (8.3) Ethnicity White/Caucasian 57 (52.8) Black 11 (10.2) Southeast Asian 10 (9.3) East Asian 9 (8.3) South Asian 6 (5.6) Multiracial 6 (5.6) Middle Eastern 2 (1.9) West Asian 1 (0.9) Prefer not to answer 6 (5.6) Professional Role Nurse 47 (43.5) Unit support/therapist 30 (27.8) Social worker 16 (14.8) Psychiatrist 8 (7.4) Psychologist 3 (2.8) Clinical extern 2 (1.9) Professional practice 1 (0.9) Psychometrist 1 (0.9) - Table 2
Existing Knowledge and Skills Related to Different Aspects of Recovery-Oriented Care among Forensic Staff
n (%) Excellent Good Unsure Fair Poor Existing knowledge and understanding of: Recovery-oriented care 27 (25.0) 57 (52.8) 13 (12.0) 11 (10.2) 0 (0) Recovery-oriented principles 19 (17.6) 60 (55.6) 14 (13.0) 13 (12.0) 2 (1.9) Recovery-oriented assessment tools in forensic care 15 (13.9) 39 (36.1) 12 (11.1) 28 (25.9) 14 (13.0) Strengths-based approach to care 41 (38.0) 48 (44.4) 9 (8.3) 7 (6.5) 3 (2.8) The practices that support recovery 21 (19.4) 59 (54.6) 12 (11.1) 13 (12.0) 3 (2.8) The practices that hinder recovery 19 (17.6) 56 (51.9) 16 (14.8) 13 (12.0) 4 (3.7) The benefits of shared decision-making with patients 47 (43.5) 49 (45.4) 5 (4.6) 7 (6.5) 0 (0) n (%) Very Confident Confident Moderately Confident Somewhat Confident Not at All Confident Not Applicable Ability to: Integrate recovery principles into care 16 (14.8) 49 (45.4) 28 (25.9) 13 (12.0) 2 (1.9) 0 (0) Identify strengths and protective factors 26 (24.1) 50 (46.3) 23 (21.3) 9 (8.3) 0 (0) 0 (0) Engage in shared decision-making 25 (23.1) 53 (49.1) 19 (17.6) 10 (9.3) 1 (0.9) 0 (0) Implement a recovery-oriented plan of care 17 (15.7) 46 (42.6) 24 (22.2) 16 (14.8) 4 (3.7) 1 (0.9) Integrate recovery-oriented assessment tools in forensic care 14 (13.0) 33 (30.6) 24 (22.2) 17 (15.7) 19 (17.6) 1 (0.9) n (%) Strongly Agree Agree Neutral Disagree Strongly Disagree Interested in learning more about specific recovery-oriented principles 48 (47.1) 45 (44.1) 8 (7.8) 0 (0) 1 (1.0) Education in recovery-oriented principles will help inform my practice 53 (52.0) 39 (38.2) 9 (8.8) 0 (0) 1 (1.0) Feel confident in supporting forensic patient recovery if receive education in recovery-oriented principles 44 (43.1) 40 (39.2) 18 (17.6) 0 (0) 0 (0) n (%) Yes No Received adequate education on recovery-oriented principles 43 (42.2) 59 (57.8) Willing to participate in education in recovery-oriented principles 98 (96.1) 4 (3.9) Power dynamics and different social categories affect ability to support the recovery of forensic patients in your clinical practice 44 (43.1) 58 (56.9) - Table 4
Comparison of Existing Knowledge and Skills Related to Different Aspects of Recovery-Oriented Care between Nurses and Other Health Professions
n (%) Excellent Good Unsure Fair Poor Existing knowledge and understanding of: Other Nurse Other Nurse Other Nurse Other Nurse Other Nurse Recovery-oriented care 16 (26.2) 11 (23.4) 33 (54.1) 24 (51.1) 7 (11.5) 6 (12.8) 5 (8.2) 6 (12.8) 0 (0) 0 (0) Recovery-oriented principles 12 (19.7) 7 (14.9) 35 (57.4) 25 (53.2) 6 (9.8%) 8 (17.0) 7 (11.5) 6 (12.8) 1 (1.6) 1 (2.1) Recovery-oriented assessment tools in forensic care 13 (21.3) 2 (4.3) 24 (39.3) 15 (31.9) 5 (8.2) 7 (14.9) 12 (19.7) 16 (34.0) 7 (11.5) 7 (14.9) Strengths-based approach to care 32 (52.5) 9 (19.1) 22 (36.1) 26 (55.3) 2 (3.3) 7 (14.9) 4 (6.6) 3 (6.4) 1 (1.6) 2 (4.3) The practices that support recovery 14 (23.0) 7 (14.9) 34 (55.7) 25 (53.2) 6 (9.8) 6 (12.8) 6 (9.8) 7 (14.9) 1 (1.6) 2 (4.3) The practices that hinder recovery 14 (23.0) 5 (10.6) 31 (50.8) 25 (53.2) 9 (14.8) 7 (14.9) 6 (9.8) 7 (14.9) 1 (1.6) 3 (6.4) The benefits of shared decision-making with patients 32 (52.5) 15 (31.9) 25 (41.0) 24 (51.1) 1 (1.6) 4 (8.5) 3 (4.9) 4 (8.5) 0 (0) 0 (0) n (%) Very Confident Confident Moderately Confident Somewhat Confident Not at All Confident Ability to: Other Nurse Other Nurse Other Nurse Other Nurse Other Nurse Integrate recovery principles into care 9 (14.8) 7 (14.9) 31 (50.8) 18 (38.3) 15 (24.6) 13 (27.7) 5 (8.2) 8 (17.0) 1 (1.6) 1 (2.1) Identify strengths and protective factors 19 (31.1) 7 (14.9) 27 (44.3) 23 (48.9) 13 (21.3) 10 (21.3) 2 (3.3) 7 (14.9) 0 (0) 0 (0) Engage in shared decision-making 17 (27.9) 8 (17.0) 29 (47.5) 24 (51.1) 12 (19.7) 7 (14.9) 2 (3.3) 8 (17.0) 1 (1.6) 0 (0) Implement a recovery-oriented plan of care 9 (14.8) 8 (17.0) 29 (47.5) 17 (36.2) 11 (18.0) 13 (27.7) 8 (13.1) 8 (17.0) 3 (4.9) 1 (2.1) Integrate recovery-oriented assessment tools in forensic care 10 (16.4) 4 (8.5) 21 (34.4) 12 (25.5) 14 (23.0) 10 (21.3) 6 (9.8) 11 (23.4) 9 (14.8) 10 (21.3) Domain Theme Subtheme Illustrative Quotes Knowledge Knowledge of recovery-oriented care Recovery-oriented principles An approach to care that is person-centered and recognizes the person and history beyond the diagnosis. Involves willingness to work in partnership with individuals to support them in creating a meaningful life and sense of identity, as defined by them. Recovery-oriented care focuses on hope, individual strengths and circumstances, choice, personal responsibility and independence, and social connection. Recognizes the need to advance recovery beyond the biomedical and promotes a holistic approach to support that is trauma aware and culturally competent and recognizes impact of social determinants of health. (Peer Support Worker) Knowledge of secure recovery Balancing recovery and risk Things have to be done a certain way as far as risk and I mean, you know, keeping things moving along to a point but at the same time trying to personalize things as much as you can too. (Allied Health 2) Lack of shared understanding of secure recovery What does secure recovery look like for the client, how the team perceives secure recovery, but also at the systems level with leadership - what their goals or deliverables are, in terms of data. So I think how we define secure recovery and what that looks like for each level is important to acknowledge…what that looks like for each person at the micro and macro level are sometimes not so congruent. (Allied Health 5) Skills Integrating recovery-oriented principles into care Developing a therapeutic alliance The ability to build a therapeutic alliance with a client is so key and for them to actually trust you…where they really have grown to trust whoever their case manager is, or the clinician on the unit, that’s where I’m seeing clients being able to move forward and really be able to, you know, really implement those strategies of secure recovery. (Allied Health 7) Collaborative goal setting So the way I’ve always worked is you’re working within a forensic lens. So to me the disposition is always the go-to. So these are kind of the things that you’re obliged to ensure are in place. So then from there trying to help the person build, you know, recovery goals that are personally meaningful, but in the sense, in a larger socially appropriate way…so it’s kind of tailoring things to the person. (Allied Health 2) Promoting empowerment So in every option when you’re engaging people give some level of autonomy not, you know, like your IM is due today I’m going to come and give it as opposed to like what time would you like your IM today? You know, so to give like choice like even if it isn’t like full choice but to give people a feeling of empowerment in even in small aspects everyday. (Nurse 1) Fostering connection, hope, and optimism Programming generally is so important like having things that bring clients together on a unit, like not just risk – like risk-based programming is so important and we put a lot of effort on that. But there’s also, you know, programs that are designed to create community with clients so they can support one another, programs to support relationship building and trust with staff, and just opportunities to build within themselves as well. (Allied Health 3) Acknowledging power imbalances I just treat people like they’re people and not like a patient, you know, I’m gonna talk to you like you’re an adult because you’re an adult. I don’t care that you’re in this hospital, and like, I’m not gonna talk down to you, you know, and I think that I find that patients appreciate that…They’re not treating me like someone who has power. (Allied Health 8) Integrating recovery-oriented assessment tools Inconsistent integration of recovery-oriented assessment tools Are we really using it (the DUNDRUM) as a shared goal setting tool, as a shared understanding of what’s important in treatment and showing how that translates into your treatment plan and the goals that we’re working on right now? I think there’s some gaps there where it’s like, “the client did the DUNDRUM, there’s their numbers.” It’s like, what do those numbers mean? (Allied Health 3) Education Needs Training and development Comprehensive orientation to secure recovery and training Yeah, as someone who did the incoming training for the last few months, we did not have any training on secure recovery or how to implement it in the forensic setting. The only real forensic training was morning long, here’s what the forensic system is. But not how to work with people in it, what’s really expected from your specific role? It’s very much, as has been said, on the job learning. (Allied Health 6) Training in methods and competencies that will improve the delivery of secure recovery Addictions training across the board would be helpful. I mean, yeah, because we’re all just grasping at straws half the time. I feel like, especially with these guys who have been here for fifteen plus years and the substance use…that’s literally what’s keeping them here. (Allied Health 8) Opportunities for ongoing skill development Having a group that we meet and having time during work hours to actually do it, like, but where we can get together and discuss difficult cases. So you don’t feel like you’re on your own or even where you can get resources or different things to help, you know, help within the work. (Allied Health 2) Policies and procedures Standardized policies and procedures Say we had like a booklet or like case studies of like, okay, like there’s a specific client, this is like…they got an absolute discharge at assessment. This is what each discipline has done to support secure recovery, like what techniques, what strategies…a timeline because it’s, it’s different for each one. So like, to have like a guide of what that may look like, what’s been done, but we’re kind of just all figuring it out as we go. (Allied Health 5)
