Mirva Sundqvist-Kekäläinen
Senior lecturer
University of Applied Sciences in Vaasa
Finland
Aila Vokkolainen
Nursing director
Vanha Vaasa Hospital
Vaasa, Finland
The 9th Nordic Symposium on
Forensic Psychiatry
25.8.2011 Lidingö
23.3.2016
Who do we treat?
What are we doing?
Who are we?
What is our nurses’ basic and continuing education?
23.3.2016
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Forensic psychiatric patients are mainly treated in two forensic psychiatric (state) hospitals in
Finland: Vanha Vaasa hospital in Vaasa and Niuvanniemi hospital in Kuopio
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Vanha Vaasa: 152 beds and 210 posts and Niuvanniemi: 296 beds and 540 posts
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Most of the patients in state hospitals are in involuntary care. They either have been found not
guilty by reason of insanity (homicides and other serious violent offences)
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or are too dangerous or difficult to treat in other hospitals.
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In addition to psychiatric treatment, annually approximately 30 forensic psychiatric
evaluations are given in Vanha Vaasa hospital.
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The primary duty of Vanha Vaasa hospital is to provide high quality treatment at a reasonable
price and to attend to the safeguarding of legal rights of patients and psychiatric examinees.
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Our hospital has agreed to take nursing students from local University of Applied Sciences to
do their clinical training there. Also medical students have the possibility to work at the
hospital and specialize in psychiatry or forensic psychiatry.
23.3.2016
•
“Criminal patients”: who are found legally
insane and not criminally responsible for their
crime(s) because of mental illness (57%)
•
Patients with violent and dangerous behaviors
•
Forensic psychiatric evaluation (courtordered) (3/148)
(difficult-to-treat and/or dangerous patients) (40%)
23.3.2016
•
Forensic psychiatric patients
• nearly all suffer from schizophrenia
• most patients are alcohol or drug addicts
• have been previously in psychiatric care many times
• most of the patients are admitted to involuntary
treatment (motivation)
• the hospitalization lasts for years (motivation)
• social skills are quite poor
23.3.2016
•
uncontrolled violence connected with psychotic symptoms
•
ethical dilemmas
•
don’t easily trust anybody
•
are sometimes frightening
•
mechanical restraint or seclusion are needed every now ant then
•
80 % are men
•
are selected and have multiple problems
23.3.2016
The main diagnosis 5.7.2011
Diagnose
Men
Women
n
%
F20.00-F20.09
ICD-10
Schizophrenia, paranoid type
50
10
60
41,7
F20.1-F20.14
Hebephrenic schizophrenia
10
2
12
8,4
F20.3-F20.39
Undifferentiated schizophrenia
30
5
35
24
F20.9
Schizophrenia, unspecified
1
0
1
0,7
F22.0-F22.9
Persistent delusional disorders
6
1
7
4,9
F23.3
Other acute predominantly delusional
psychotic disorders
2
0
2
1,4
F25.01-F25.9
Schizoaffective disorders
10
8
18
12,5
F29
Unspecified nonorganic
psychosis
1
0
1
0,7
F31.0-F31.2
Bipolar affective disorder
2
0
2
1,4
F84.9
Pervasive developmental
disorder, unspecified
1
0
1
0,7
Z04.6
General psychiatric examination,
requested by authority
4
1
5
3,6
All
117
27
144
100,0
23.3.2016
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We treat our patients in a holistic way which is
based on
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Legislation
National Current Care Guidelines
Our values:
1. Patient-orientedness
2. Respect for basic rights and human values
3. Fairness
4. Equality
5. Professionalism
6. overall economic efficiency
Multiprofessional teamwork
Feedback from our patients
23.3.2016
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Confidential therapeutic nurse-patient relationship
Psychosocial treatment (e.g. functional rehabilitation,
occupational therapy, physical exercises, music, art groups)
Community treatment
Biological treatment (medication, ECT)
Connections to society, studies, work try-out placements,
working life
The patient’s family or other significant people are very
important
Chaplain/ priest
Library etc.
23.3.2016
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We have 210 posts
◦ 3 senior psychiatrists
◦ 7 psychiatrists
◦ 3 psychologists
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Nursing staff:
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3 chief nurses
9 ward sisters and 9 assistant ward sisters
74 nurses (RN)
45 mental health nurses
3 social workers
2 occupational therapists, 1 physical exercise instructor and 7 functional therapists
1 medical laboratory technologist/ biomedical scientist
1 farmacist
The rest of the posts (44/210) are located in support service units
23.3.2016
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Degree studies give a higher education
qualification and practical skills
They comprise core and professional studies,
free- choice studies and a bachelor’s thesis
Studies include clinical placement periods
Students are practicing in many places e.g.
hospitals, health care centres
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The extent of studies in a University of
Applied Sciences is generally 210-240 study
points (ECTS)
This means 3,5- 4 years of full- time study
(Nurses, Bachelor of Nursing 210 study points
-> 3,5 years)
The studies are organized into degree
programmes
Different universities of applied sciences
decide on the content and the curriculum
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E.g In the University of Applied Sciences in
Vaasa students can choose between different
advanced studies
Psychiatric Nursing
Perioperative Nursing
Medical and Surgical Nursing
Paediatric and Adolescent Nursing
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The Ministry of Education and Culture
approves the degree programmes
The ministerial decision statement must
include the name of the degree programmes,
the study points and the different alternatives
for advanced studies
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Full registration and qualification as a nurse
requires that nursing education meets the
minimun standards
The requirements for recognition of
professional qualifications are followed by
European Parliament and Council (Directive
2005/36/EY)
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210 studypoints include core and
professional studies (103 ECTS) and
Different alternatives for advanced studies
ECTS)
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The professional studies are:
Advanced studies in nursing
Free- choice studies (7 ECTS)
Clinical placement (75 ECTS)
Bachelor’s thesis (15 ECTS)
(10 ECTS)
(107
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The Advanced studies in Psychiatric Nursing
include:
clinical placement (20 ECTS)
expertise in psychiatric nursing (6 ECTS)
health care entrepreneurship (4ECTS)
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Practical nurses ( mental health nurses, upper
secondary level)
Studies 180 ECTS, (that means 3 years of
studies,) includes 60 ECTS specialization
studies
Studies are arranged by schools on the upper
secondery level, vocational schools, adult
education schools and apprenticeship
education
There are several different alternatives for
advanced studies
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Professional studies (75 ECTS)
Supporting growth and development
Caring and nursing (30 ECTS)
Supporting rehabilitation (22,5 ECTS)
(22,5 ECTS)
Training programs (45 ECTS)
- Emergency Care
- Children and youth
- Mental health- and substance abuse work
- Nursing and caring
- Dental assistant
- Work with the handicapped
- Elderly Care
- Rehabilitation
Elective studies 15 ECTS
Registered
nurse studies include 210 ECTS
>Practical nurse studies include 180 ECTS
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Special degree in Mental Health Nursing (2
years of studying)
Students can study and work simultaneously
Studying at school 2-4 days/ month
Studies include also distance learning and
clinical placement
The education is meant for practical nurses
who want to deepen their knowledge in
psychiatric nursing
At least five years job experience is needed
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Required studies:
Basics of Psychiatric Nursing
Methods in Psychiatric Nursing
Professionalism in Psychiatric Nursing
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Elective studies:
Psychiatric rehabilitation
Psychiatric Nursing among the elderly
Paediatric and Adolescent nursing
Psychiatric Nursing among intoxicant abusers
Forensic psychiatric nursing
Entrepreneurship
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It is possible to do this education as on
apprenticeship education
In the end of the studies the student must
show she/he skills for the profession
(competence- based qualification)
Registered nurses advanced in psychiatring
nursing
Practical nurses trained in mental health and
substance abuse work
Practical nurses trained into special
vocational degree in psychiatric nursing
1) Therapeutic nurse-patient relationship: Interactional course:
11 x 3 hours , 10-12 participants in one group
(psychologists, chief nurse)
2) Aggression management (”Interactional management of an
aggressive patient/situation): a-3- day course for nursing
staff and 1 day for support service personnel; both theoretical
and practical training (psychologist, chief nurse and two
nurses)
3) Cognitive-behavioral therapy: basic course; 12 days theory
(specialists from different fields), 3 days clinical seminars and
16 times (1,5 hrs) small group supervision and ”a final
project”
23.3.2016
Lectures
from different special areas (e.g. psychiatric and
somatic diseases, drugs, taking lab samples)
Studies in Pharmacology
Continuing events organized by other organizations
As our aim is
* Being, doing, practising together with patients and supporting
them in their problematic areas of life > Our nurses need to
train skills and have knowledge in many areas (risk
management, legislation, ethics, the use of self, the therapeutic
appreciation of control and social balance in nursing)
23.3.2016
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We have advanced studies for nurses and
practical nurses only in psychiatric nursing
Should we have studies in a degree for a
forensic psychiatric nursing?
At the moment we don’t have
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Who do we treat?
What are we doing?
Who are we?
What is our nurses’ basic and continuing
education?
Tack