ABSTRACT
Introduction
Nursing staff often struggle with balancing care and security in forensic settings, which can lead to over- or under-involvement. These are a cause for concern as this can directly impact therapeutic relationships.
Aim
To systematically review and synthesise qualitative evidence relating to nursing staff and patient perceptions of over- and under-involvement experienced.
Method
Of 465 studies identified, twelve were included in the review. A thematic synthesis of included studies exploring therapeutic relationships, including therapeutic over- and under-involvement, was conducted.
Results
Three analytical themes were developed from the data: (1) The importance of trust in therapeutic interactions; (2) Implications arising from power imbalances and staff’s lack of confidence or experience; and (3) The importance of relational security.
Discussion
Therapeutic relationships are influenced by factors such as gender, experience, trust, communication style and empathy. Over-involvement occurs when patients become overly reliant on certain staff members, whereas under-involvement can lead to feelings of loneliness, lack of autonomy and distrust.
Implications for Practice
This systematic review highlights the need for individualised care, effective communication and well-defined boundaries to create a safe and effective therapeutic environment.
Recommendations
Further research is required to explore the experiences of over- and under-involvement based on staff characteristics, participant gender and security levels within forensic care.