Intervening against the patient’s wishes: pro re nata medication and the phenomenological experience of nurses working in a forensic psychiatry environment

In forensic psychiatry environments, nurses are regularly confronted with the use of restrictive measures such as chemical restraints and are forced to constantly navigate between care and social control. The debate over the ethics of coercion and the use of control measures for violence in psychiatric settings is far from resolved. The objective of this study is to understand the ethical experience of nurses in a Canadian forensic psychiatry environment when administering PRN (when required) medication against the patient’s will. The experiences of 14 nurses are analyzed from a critical ethical perspective through interpretive phenomenological analysis. Across the three main categories-certainties, paradoxes, and learning-the results show that nurses must simultaneously commit their allegiance to the patient, to the justice system, and to the culture of the “total” institution. These multiple allegiances generate paradoxes that affect the way nurses actualize their professional role.