vulnerability by turning to control and rules or they became sensitive and compassionate. The nurses' narratives revealed an inner negotiation between their own reactions to a patient's expression and the care that was professionally expected and personally wanted. This negotiation reflected their response to their own suffering as much as their response to the patient's suffering. “It feels sad when you don't reach them. It feels hopeless when you have tried so much, and it is useless… with some patients it may take several years before they trust you… But enduring and staying in it can make you come closer to each other in the end.” The emotional journey and inner negotiation are further described in the themes and subthemes. First theme: recognizing suffering and need for support The first theme reflected what the nurses recognized as suffering and a need for support. The nurses described being in a complex environment with contradictory tasks, caring, guarding, and protecting while at the same time connecting with the patients and alleviating suffering. Despite the complexity, nurses viewed each patient as different. Expressions that made impressions forced them to turn their eyes inward and face emotions that were triggered. Suffering is obvious Feelings of compassion were easily aroused when the nurses perceived that a patient was really in need of help. Sometimes these expressions were clear and obvious, such as when a patient threatened to end his or her own life. One nurse talked about a female patient who expressed suicidal thoughts: “She wanted to change her life; she told me she wanted to live. She didn't want to die. You could see she was withdrawn, from the beginning she didn't want to share, but she trusted me. We formed some kind of bond.” Other times the patient's expression of suffering was not so visible, in which case the expression was interpreted based upon the nurse's professional experience caring for patients with mental illness. Once a good relationship was established, it awoke a feeling of being wanted and needed, giving the nurse a sense of success. “He was often walking down the hall with his hood down, staring at the floor. He often turned to me and eventually we had a good relation after all…when you have managed to reach someone, you feel needed and you want to do good.” Suffering is hidden Sometimes a patient would not show any desire to be helped or cared for. Instead, such a patient would withdraw and spend most of their time alone in his/her room, leaving nurses wondering how to approach the patient. In these situations, nurses expressed that the patient's suffering was evident to them. However, when the patient kept their distance, that is, when the patient does not want contact with the nurse, it was hard to comprehend what they wanted and what the expression of suffering stood for. Having the patient at a distance made it hard to communicate and establish a relationship, as getting to know the person is the essence of being compassionate. One nurse said: “Some patients just lay in their bed or keep their distance. It's apparent that they aren't feeling well, I can see that. But it's almost impossible getting to know them when they don't want to speak to you.” Other patients were perceived as unwilling to take part in some sort of daily activity. Not being able to get close to the patient obstructed the nurse's ability to understand the patients suffering. These caring encounters were seen as negative and a foundation of frustration, constantly repeating caring activities without getting any response. “One thing that's difficult is when the patient is hiding from us. Some of them just stay in their rooms, making it hard to reach them. Of course, they feel bad, but it makes it hard to know how to help them, like we don't have the right tools, it's frustrating.” Suffering is frightening At times, nurses found themselves in situations where their very existence was threatened. When the patient's expression of suffering was provocative and threatful, nurses experienced feelings of insecurity and fear. “You have to remember that you're dealing with patients with a severe mental illness, but every time I talk to this patient he either focuses on how bad I am as a person or he's angry about something. It just doesn't make any sense.” Being confronted by violence and intimidation awoke a sense of Table 1 Overview of main theme, themes, and subthemes. Main theme Being compassionate in forensic psychiatry - an emotional journey Themes Recognizing suffering and need for support Responding to patients suffering Reacting to one's own vulnerability Subthemes Suffering is obvious Complying with the patient Becoming persistent Suffering is hidden Persuading the patient Becoming resigned Suffering is frightening Adapting oneself to the patient Feeling shame L. Hammarström, et al. Archives of Psychiatric Nursing 34 (2020) 435–441 437 anxiety and fear within the nurse. Not being able to decipher the patient's suffering could end up in nurses finding themselves in situations they do not know how to handle. “I remember this time, this guy wasn't feeling good. He was very psychotic at the moment. I tried to talk to him, I was calm and collected and approached him. Without warning, he jumped me; I didn't see it coming and I got scared.” Second theme: