suffering?” The participants were encouraged to speak as freely as possible, and follow-up questions were asked to explore participants’ reasoning. The interviews lasted between 23 and 56 minutes and were recorded and transcribed verbatim. Analysis and interpretation The hermeneutic approach in this study was inspired by Ricoeur’s (1991, 1995) hermeneutics and his idea about interpretation as a movement between explanation and understanding. This approach has been used and developed in previous studies (Fredriksson & Lindström, 2002; Wiklund, Lindholm & Lindström, 2002). This dialectical relationship contributes to a scientific approach to interpretation, as it comprises systematic means not only for analysis but also for bridling the researchers’ preconceptions. The first step focused on repeated and thorough readings of the interview transcripts in order to obtain a first, naïve understanding of the text. The researchers strived to remain open to the text, and to interpret the message of the text as a whole. This step conveyed a first understanding of the meaning of the text on a descriptive level. In the second step this naïve interpretation was challenged by a systematic and rigorous analysis, focusing on the structure of the text. By dividing the text into meaning units, which were then condensed, the text was de-contextualized and ‘interrogated’ in order to explain the meaning. This was accomplished by relating similar meaning units to each other in the formation of sub-themes and themes, thus relating parts to the whole. Finally, in the third step, the themes were critically reflected upon in relation to each other, to the naïve interpretation and to theory, with the aim of opening up a new world beyond the text. Ethical considerations The study was conducted in compliance with the ethical guidelines of the Declaration of Helsinki (World Medical Association 1964/2013). All participants were informed of the study’s aim, as well as confidentiality and voluntary participation, and gave their oral and written consent prior to the interviews. In line with the Swedish Ethical Review Act the study was subject of an ethical seminar at the university, and approved by the heads of the forensic hospitals. FINDINGS The presentation of findings follows the three analytical steps presented above, thus making the interpretive process transparent. Naïve reading This first interpretive step gave rise to a naïve understanding of nurses in forensic care as having opposing views in regard to understanding and approaching patients’ suffering. Both the patient’s background and issues relating to power within the forensic hospital were recognized as sources of suffering, but they were approached in different ways, either by focusing on the suffering patient, by focusing on the patient’s problems or by viewing suffering as inevitable in forensic care. These opposing views were also described as a potential source of conflict among the staff with regard to how patients’ suffering could be relieved. This study found conflicting opinions focusing either on caring and alleviating suffering or on guarding and fostering patients. Structural analysis The structural analysis indicated that forensic nurses’ ways of understanding and approaching patients’ suffering could be understood in light of four themes, ‘ignoring suffering’, ‘explaining forensic care as a cause of suffering’, ‘ascribing meaning to suffering’ and ‘being present in suffering’, and their supporting sub-themes (table 1). The four themes are presented under the subheadings below, while sub-themes are under lined in the text. TABLE 1: Structural analysis Theme Sub-theme Ignoring suffering To disregard suffering Closing one’s eyes to suffering Focusing on behavioural change Explaining forensic care as a cause of suffering Being a subject of forensic care Structures of power Failure to establish trust Ascribing meaning to suffering To find the sources of suffering To give answers To understand why threat and violence appear To see behind the façade Being present in suffering To never abandon the patient To invite patients to communion To allow the patient to set the pace Creating possibilities for growth Ignoring suffering One way to deal with suffering was to avoid it by ignoring it and thereby create a distance to it. Sometimes the nurses chose, or were forced by the circumstances, to disregard suffering. This was evident when patients suffered in silence, as nurses tended to prioritize more expressive patients. When this occurred, silent patients became almost invisible, as the nurses’ attentions were focused on patients regarded as ‘troublemakers’. Suffering was also disregarded when nurses experienced the patient as lacking insight into his/her problems or behaving inappropriately. In such cases, the patient could be abandoned while the nurse waited for him/her to adjust to ‘reality’, i.e., the context, and its demands. Thus, the responsibility to initiate a conversation about suffering was placed on the patient, rather than regarding conversations about suffering as a part of nursing care. If a patient expressed anger towards a nurse, the cause was attributed to illness, rather than to the nurse’s demeanour, and the patient’s anger was not taken seriously. If the patient expressed suffering, for example, by crying, this might also be seen as a means of getting attention rather than