A thesis of clinical research and practice: Part A: [Using a Trauma-Informed Care Framework to Explore Social Climate and Borderline Personality Disorder in Forensic Inpatient Settings: A Conceptual Review]; Part B: [Staff Experiences of Social Climate and Interpersonal Relationships on Forensic Wards Caring for Patients with BPD]; Part C: Summary of Clinical Practice and Assessments
Creators: name: Rodwell, Devon
Publisher: name: University of Surrey
Year: 2023

description: Forensic inpatient settings are extremely difficult spaces to work and reside in. Social
description: climate is a term used to describe the physical, social and emotional conditions that contribute
description: to how staff and patients perceive and experience the forensic environment. Tensions between
description: risk of violence, safety and therapeutic care can lead the social climate of forensic wards to be
description: challenging. On forensic wards caring for patients diagnosed with Borderline Personality
description: Disorder (BPD), the social climate is considered to be especially difficult. The early trauma
description: and interpersonal difficulties typically experienced by individuals with BPD can act as barriers
description: to therapeutic relationships in secure settings, which in turn affect the broader social climate.
description: Sadly, ruptures in therapeutic relationships can influence staff in forensic settings to respond
description: to the distressed emotions and behaviours of patients with BPD in ways that are unhelpful and
description: potentially traumatising in their own right. This thesis aimed to explore how the experiences
description: and behaviours of patients with BPD and the staff who support them on secure wards, can
description: influence the social climate of forensic settings.<br>
description: <br>
description: Part A of this thesis presents a conceptual review that uses a Trauma-Informed Care
description: (TIC) framework to critique the physical, social and emotional conditions of social climate in
description: forensic settings caring for patients with BPD. The review suggests that for patients with BPD,
description: previous trauma likely influences their perceptions of and responses to the social climate of
description: forensic settings, leading aspects of the ward environment to be experienced as retraumatising.
description: The review advocates that implementation of TIC on forensic wards caring for patients with
description: BPD could evoke positive shifts in the social climate, working to reduce the risk of
description: retraumatisation. Part B of the thesis presents a Reflexive Thematic Analysis exploring
description: interpersonal relationships and social climate on forensic wards caring for patients with BPD,
description: from the perspective of ward staff. Six interrelated themes were generated; three describe
description: relational cycles that occur between ward staff and patients with BPD, and three describe
description: systemic factors that influence the wider context within which ward staff operate. From these
description: themes, a model (SCOFS-BPD) was developed to summarise how factors in the wider forensic
description: system and the interpersonal relationships between staff and patients with BPD on forensic
description: wards influence one another, affecting staff experiences of the social climate of forensic
description: settings.<br>
description: <br>
description: It is important to share that the development of this research was not uncomplicated,
description: and several barriers were met by the author which led the project to be revisited. Firstly, the
description: initial proposal for the research included a second qualitative empirical study which aimed to
description: explore the experiences of interpersonal relationships and social climate of forensic settings,
description: from the perspective of forensic patients with BPD. Despite the study being considered a
description: valuable contribution to the literature and receiving ethical approval, barriers to recruitment
description: faced by the author led to the project being discontinued. This outcome was disappointing, as
description: the author’s motivation for the project was to provide a space for the voices of forensic patients
description: with BPD to be heard within research. It is thus hoped that with a longer timeframe, this study
description: can be revisited at a later date. This being said, the relinquishment of this study gave way to
description: the conceptual review in this thesis, which is considered an equally valuable contribution to
description: the literature. Secondly, difficulties were also experienced by the author in recruiting ward staff
description: to participate in the research. Despite many attempts to encourage recruitment and earn the
description: trust of staff across participating forensic units, the author was faced with apprehension and
description: some hostility from ward staff. This led the author to gain an ethical amendment that allowed
description: the recruitment of participants through other means, such as social networking sites. The
description: clinical implications of these issues are reflected on throughout the papers in this thesis.<br>