and Klopper (2010), this could be understood as an expression of compassion fatigue. Thus, creating distance from suffering could be understood as a protective stance, adopted when nurses are unable to be present when encountering suffering patients. However, if nurses distance themselves not only from suffering but also from the sufferer, patients’ suffering might increase as a result of alienation (sf Younger 1995). Nurses can also distance themselves from suffering by focusing on the causes of suffering, rather than on the suffering patient. By accepting suffering as an inevitable aspect of forensic psychiatric settings, the nurse’s role changes from caregiver to guardian of safety. As suffering is accepted as a reality of the daily life and routines of the hospital, the nurse does not have to engage in alleviating it and can focus on formal and standardized care. The relation is characterized as a ‘contact’, with limited intersubjectivity as nurses rely on their role and focus on ‘being there’ (Fredriksson 1999). As suffering is viewed as a ‘natural’ and inevitable aspect of the specific context, it is not customary to address it on a personal level. If this is predominant in the caring culture, nurses who acknowledge that the patient is suffering are challenged to either approach the suffering from the standpoint of the patient or relinquish his/her own abilities to alleviate it and adjust to the system. The latter could be understood as a lack of autonomy, as the nurse tends to adjust to the demands of the culture rather than focusing on patients’ individual needs (Fredriksson & Eriksson 2003, Enarsson et al. 2008). Nurses can also ascribe meaning to suffering by focusing on the patient from an outside perspective. Thus a nurse tries to understand a patient’s suffering based on his/her own knowledge and understanding of what can cause suffering in people’s lives, and strives to provide an answer to the patient’s ‘Why?’ However, the answer to this existential question must arise out of the patient’s own understanding and meaning-making process, and cannot be delivered from the outside (Fredriksson & Eriksson 2001). By taking the standpoint of an expert who has the competence to make assessments in regard to a patient’s suffering and how it could be alleviated, the nurse remains in a somewhat distant position. In contrast, being present in suffering demonstrates how nurses adopt what could be described as a reflective openness and responsiveness (Dahlberg et al. 2008). Thus they place themselves not only in a non-judgemental position (cf Rose et al. 2011), but in a ‘notknowing’ position, in order to be able to see the person and acknowledge his/her uniqueness and individual needs. This kind of presence is understood as ‘being with’ the patient (Fredriksson 1999). Caring relationships are defined by inter-subjective ‘connection’ rather than being task oriented. In this mode of relating, suffering is not always understood, and nurses struggle to be with the suffering patient without having a fixed solution. When nurses are able to connect to patients and compassionately be with them in suffering without trying to explain or alter their behaviour, a mutual understanding of the patients’ suffering arises. This understanding can facilitate a patient’s reconciliation with his/her story of life and suffering, as it allows for patients to ascribe a personal meaning to their suffering (Fredriksson & Eriksson 2001). Presence as ‘being with’ appears to be primarily rooted in compassion, and an ability to be with the patient and sensitive to the patient’s needs. Understanding the patient is not a prerequisite for this stance; rather, it develops as a mutual understanding arises from presence and a caring communion. When the themes are related to each other and re-contextualized, the specific challenges associated with alleviating suffering in forensic care become apparent. Patients in these settings are indeed subject to the will of others, and nurses who have the courage to provide care from a ‘not-knowing’ position contribute to a shift in power, setting the stage for the patient’s ability to reclaim the power to ascribe meaning to his/her life. This may be controversial and give rise to conflicts among peers, as it could mean that they exceed the cultural norms. If discordance appears amongst colleagues regarding how to understand and alleviate patients’ suffering, a nurse can experience insecurity and ethical conflicts, torn between longing for security and unity with his/her fellow nurses and advocacy for the patients (Enarsson et al. 2008). Thus, it is not only patients who are struggling with suffering; nurses, too, are involved in a struggle, in which they can feel forced to take sides with their colleagues or advocate for the patients’ perspective. Depending on the nurse’s stance, this can contribute to the nurse adopting a role that diverges from his/her self-image and caring values, thus undermining his/her sense of self-esteem and autonomy or leading him/her to continue striving to balance asymmetric relationships. Furthermore, balancing on an ethical edge instead of being supported by colleagues when confronted with patients’ suffering might contribute to compassion fatigue (Knobloch Coetzee & Klopper 2010). A possible interpretation is that taking the distant ‘expert-position’ is not only a consequence of adapting to cultural values, but also a coping strategy to compensate for