Online video games and patient-staff power relations. A qualitative study of care and custody in forensic psychiatry.
Morten Deleuran Terkildsen, Harry G Kennedy, Christian Jentz and 1 others
PMID 34897910WHAT IT FOUND
In a forensic ward, playing video games together let patients and staff relate as equal players.
Staff still held all power over rules and treatment goals. This split allowed connection without surrendering clinical control or safety.
Key findings
01Power during gameplay was distributed based on skill, allowing patients to lead and staff to follow, creating a sense of equality.
02Staff retained exclusive power over the organization of the intervention, including setting rules, deciding participation, and documenting progress.
03Patients accepted this asymmetry in organizational power, recognizing staff's clinical role, which allowed therapeutic relationships to form without challenging ward security.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Small sample size (6 patients, 3 staff) from a single ward limits generalizability. The group had already established their dynamic before the study began, so the process of negotiating power during initial integration was not observed. The study did not measure clinical outcomes like reduced aggression or improved social skills, only perceptions of power relations. Staff participants were one educator and two nurse assistants, not registered nurses, which may influence how 'professional knowledge' was defined.
Declared interests
Funded by the Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry. Authors declared no conflicts of interest.
The easy way to misread this
Do not assume this video game intervention was proven effective for reducing violence or improving mental health. This study only describes how power was negotiated between patients and staff during the activity; it did not measure clinical outcomes or efficacy.