Risk management by early recognition of warning signs in patients in forensic psychiatric care

Purpose: To clarify the concept of early recognition for the field of forensic nursing. The concept is based on the proposition that patient behavior deteriorating toward aggression is idiosyncratic but nevertheless reconstructable like a signature. Once reconstructed, this signature can be used to detect early signs of deterioration and thus prevent violent behavior. Concept: Early recognition is approached from the perspective of deteriorating behavior. Special attention is paid to the social and interpersonal factors related to the individual behaving violently. From this perspective, the thoughts, feelings, and behavior of the patient can indicate the onset of aggression, and early recognition of these warning signs can help thwart such deterioration. The aviation metaphor of a black box is used to emphasize the importance of attention to early warning signs. Patients in forensic care must draw upon their previous experiences (i.e., their own black boxes) to gain insight into their violent behavior and the warning signals for this. The emphasis is on the cooperation between the patient and the nurse in the application of risk management strategies. The Early Recognition Method provides an approach in which patients and nurses also gradually attune their perspectives on aggressive behavior. Conclusion: The concept of early recognition is important because it extends the idea of early intervention to include enabling patients to control their own behavior. Early recognition has strong practical implications for forensic nurses as it allows them to attenuate aggression by assisting patients with the detection of early warning signs. (C) 2008 Elsevier Inc. All rights reserved.