care.[17,19] It is striking that initiatives applied during care provision to patients with mental disorders in psychiatric units and patients in general psychiatric departments are different. As well as medical processes, FPNs should have knowledge about criminology and legal responsibilities.[1,18,21,24] FPNs have the responsibility of being aware of laws, patient rights and legal proceedings that affect patients. However, FPNs mostly adopt medical roles and have negative perceptions about their legal roles. Kutlu et al. stated that FPNs discussed mental disorders more easily, while they avoided discussing issues about crime.[7] A study by Mason et al. determined that nurses in high security hospitals took on legal roles more while nurses in hospitals with medium or low level security took on mostly medical roles.[12] As the security levels of forensic units increase, nurses stress legal roles more due to stigmatization, fears about patients or stress. FPNs report that the patient group with whom they have the most difficulties have personality disorders. It is hard to provide care to patients with personality disorders.[19] Patients who are refractory and have serious mental and personality impairments are considered difficult. Mental health nurses have negative attitudes mostly towards patients with personality disorders, but they also consider patients who especially use substances, display disruptive behaviors such as self-injury and suicide attempts as distant and strange. They perceive these patients as angry and manipulative and have difficulty showing empathy for them.[25] There are more patients with these characteristics in forensic psychiatry clinics, and nurses find their knowledge about providing care to these patients inadequate. Therefore, nurses’ knowledge levels about personality disorders, other mental disorders and legal processes may be improved by providing in-service training programs, so that FPNs may be ensured to feel more competent in their fields. It was determined that the nurses in the study by Koskinen et al. felt more competent in patient care, observation, providing help and teaching after one year of education.[15] It is also important that people who are professionally experienced in providing care to psychiatric patients and/or have adequate knowledge and skills in their field, and at least bachelor’ s degree should be employed so that nurses who work in these units feel more competent.[4] The consensus achieved as a result of the study by Newman et al. determined that FPNs have roles not only associated with the mental condition and legal proceedings of patients, but also with their physical health.[24] When many patients are admitted to forensic psychiatric units, they have physical problems as well as psychological problems.[1] Appropriate holistic care should be provided by focusing especially on patients’ existing problems such as alcohol-substance abuse, and the physical problems they induce, nutritional disorders, tendency to infection or infections, injuries to themselves and the environment because of thought disorder. Moreover, patients may be ensured to benefit from health-promoting educational programs when they are cognitively ready for them. Conclusion This review study determined that there are limited number of studies of FPNs, that education, practices and studies are needed in this field to determine and identify the roles and responsibilities of FPNs and to develop evidence-based practices. Since FPNs should have a number of additional skills (such as criminal behavior management and security), forensic psychiatric nursing is a subspecialty of psychiatric nursing; however, it is different because it provides care to 164 Psikiyatri Hemşireliği Dergisi - Journal of Psychiatric Nursing 2017;8(3):157–164 a more challenging patient group: both the guilty and victims in forensic psychiatric units. Therefore, their other responsibilities are assessing mental and physical health of patients, rehabilitation, establishing therapeutic relationships, providing security for personnel, patients and their relatives, preventing violence and aggression, performing and managing risk assessment, assessing alcohol and substance abuse, preparing and applying appropriate care plans with a multidisciplinary team after receiving patient histories, administering treatments, managing emergencies and following patients’ legal proceedings, guiding newly-graduated or student nurses and supporting them. While doing these thing, FPNs also need some characteristics such as flexibility and leadership. FPNs should have knowledge about mental illnesses and their treatment in terms of medical care and knowledge about the laws regarding people with mental disorders. They also should be able to balance medical and legal processes as medical nurses providing care and legal experts. The limited number of published studies have shown that, especially because of the differences between the legal systems of countries, the roles and responsibilities of FPNs are not clear both in Turkey and in the world, and thus, nurses working in this field frequently experience dilemmas about their roles. The frequently encountered dilemmas were defined as: confidence vs therapy, violence management and dangerousness, confidence vs. fear, transference vs. countertransference, win vs. lose, use vs. abuse, success vs. failure. Although there