as suffering, or as Cecilia put it: But he was easily diverted, so I don’t know how much sorrow was in that, or if it was a way to get attention. By diverting the patient’s attention, nurses could avoid approaching suffering. Even when there was a suspicion that the patient was suffering, nurses sometimes chose to disregard it. Furthermore, when patients failed to express suffering, nurses failed to acknowledge it, and it was not until something happened that the nurses understood the person was suffering.As a nurse, Johanna, has experienced this: Now, after it has happened, it is possible to see that he [who committed suicide] conveyed different, but small, messages about not feeling well. But there were too many people, and nobody received the whole picture; he didn’t give that much to a single person. Rather, he dropped a little here and a little there. This unawareness was interpreted as closing one’s eyes to suffering. Another way to close one’s eyes to suffering was also evident in data, namely the assumption that as the patient lacks insight into his/her illness, he/she does not suffer. Focusing on behavioural change instead of listening to the patient’s story was also understood as a way to ignore suffering. Nurses described how a more or less persuasive argument was used to motivate patients to accept the hospital’s rules and engage in different activities. A common staff approach was viewed as a means to providing a structure that could facilitate a patient’s adjustment to the hospital. If these rules were violated by a colleague, nurses understood this to be ‘unprofessional behaviour’. Explaining forensic care as a cause of suffering Another way to understand and approach suffering was to explain its causes in a way that makes it an inevitable part of daily life at the hospital. In this way, suffering was understood on a general level, rather than in relation to the patient as a unique person. Thus, being a subject of forensic care was itself understood as causing suffering, as Ann sees it: It is very offensive when someone tells you what you shall do, that things have to be right, that you are unable to decide what is best for you; I believe that that is incredible offensive, just to be here, to have us around, 24 hours a day, watching. The nurses are responsible not only for taking care of the patient but also for security. Thus there are regulations that must be followed, such as restrictions on personal freedom. These restrictions were considered a cause of suffering that could not be removed. Furthermore, more or less visible structures of power were assumed to contribute to patients’ suffering. Martin said, ‘The doors are opened by keys and codes, and we can’t prevent them from not feeling inferior.’ These structures of power were considered unavoidable, and nurses stated that patients did not have any other alternatives than to adjust to the regulations – or act out frustration and agony, thus contributing to a downward spiral of suffering and restrictions. Even when the nurses understood that patients experienced themselves as misunderstood, they nevertheless had to uphold the structures of power. To facilitate adjustment and avoid conflicts, they tried to convince the patient and teach him/her how to behave. Cecilia describe it as: Well . . . forcing and forcing. . . . But we tell them ‘this is how it is’, and ‘this is what will happen.’ And ‘this is how you should work.’ Thus, the nurses were aware that patients’ dignity could be violated by the restrictions, but they accepted that as an unavoidable part of life at the hospital. The fact that they needed to perform coercive acts in order to safeguard both the patient and co-patients and also themselves added to the patient’s earlier experiences of being neglected and abandoned and became an obstacle to a working alliance with the patient. This failure to establish trust is also related to nurses being suspicious and vigilant regarding patients’ motives and behaviours. That too was accepted as part of a professional attitude, while being ‘too soft’ was considered a sign of letting go of professionalism. Ascribing meaning to suffering Another way to approach the suffering patient was to ascribe meaning to suffering by striving to understand why the patient acted as he/she did and to facilitate the patient’s own understanding of his/her life and suffering. This made it easier for the nurse to relate to the patient, as behaviours that can be hard to acknowledge and accept became understandable. Thus the nurse, together with the patient, tried to find the sources of suffering. These sources were understood as related to the patient’s background and to earlier experiences, but also to the present situation, such as missing one’s family and not being able to communicate one’s suffering to others. This understanding also provided the basis for nurses as they strived to give answers to patients who sought to understand their personal misery. This was understood as a means to provide comfort and establish a platform for caring. It was also perceived as contributing to patients’ insight into their present situation. Furthermore, to understand why threat and violence appear was also a way to approach suffering, instead of simply disqualifying expressions of suffering as ‘bad behaviour’. Johanna has understtod this in her daily work as a nurse: Many of them have from an early age used this as a means to