suffering. To engage in alleviating suffering is a struggle that demands courage and the strength to reflect on its character and consequences. To encounter suffering patients means that nurses are confronted with patients’ suffering as well as their own reactions while being present for those patients. If suffering is not seen or encountered, there is a risk that even actions taken with the best of intentions will hurt the patient. Keywords: Caring, forensic psychiatry, nurse-patient relations, psychiatric nursing, trust INTRODUCTION Being a patient in a forensic psychiatric setting often means being forced to adjust to circumstances that differ from ordinary life. Forensic psychiatric care is a specific context. It is regulated in part by different laws than those governing health care in general, but nevertheless, the same basic principles apply. Thus, even though there is a responsibility to protect not only the patient but also society, there is also a legal as well as an ethical and professional responsibility to treat patients with respect, to provide the best possible care, and to promote patient participation as much as possible (ICN 2012). The ICN code of ethics for nurses states that one of the four fundamental responsibilities is to alleviate suffering (ICN 2012). According to Fredriksson and Eriksson (2001), patients in psychiatric care suffer when they do not understand what is happening to them, when things are perceived as unacceptable, and when they fear or experience insecurity concerning their future. Furthermore, patients may suffer from guilt, shame and other experiences related to the crime, as well as from various psychiatric symptoms (Jacob et al. 2009). Drevdahl (2013) argues from a perspective grounded in Paul Ricoeur’s ethics that suffering includes not only physical or mental pain, but the destruction of the capacity to act, experienced by the individual as a violation of integrity. In this perspective, suffering becomes a broader concept involving illness, the care itself, and life as a whole as causes. As these experiences can be difficult to talk about with caregivers, patients might communicate their suffering nonverbally, for example, through anger or violent behaviour (Pereira et al. 2005). If nurses lack patience and understanding in such situations, patients adjust their behaviour in order to gain benefits (Hörberg et al. 2012) and hide their suffering for fear of misunderstanding and rejection (Hostick & McClelland 2002). Not being able to express suffering verbally also contributes to the development of destructive emotions (Carlén & Bengtsson 2007) and to a perception of the nurse as a guard rather than a caregiver (Hörberg et al. 2004). Therefore, in forensic psychiatry, nurses are challenged to establish safe, trusting relationships with patients. When nurses feel that they are in a safe environment, they can approach patients in a way that enables caring relationships and therapeutic interventions directed at alleviating suffering. Then the encounter can be transformed into a learning experience, through which patients are able to ascribe meaning and gain a new perspective on their suffering (Hörberg et al. 2012). However, when nurses are socialized into a context where patients are presented as potentially dangerous, they tend to distance themselves from patients (Jacob & Holmes 2011). A distant position can block nurses’ understanding of patients’ expressions of suffering, so that instead of facilitating patients’ understanding of and reconciliation with suffering, they might focus on restrictions and fostering interventions (Hörberg et al. 2004, Martin & Street 2003). The nurse-patient relationship is also challenged when nurses need to carry out interventions – for instance, implementing restrictions – in order to protect the patient and other persons from harm. On those occasions, nurses justify the infliction of suffering here and now with the perceived benefits in a longer perspective (Hummelvoll & Severinsson 2002). This can affect the care given and also be stressful for nurses, who are torn between their desire to maintain a caring relationship with the patient and the need to diminish or eliminate the risk of violence towards themselves and others (Livingstone et al. 2010). This motivates further research into forensic psychiatric nurses’ experience of nursing care as a way to relieve suffering. Therefore, the aim of this study was to explore how nurses in forensic psychiatric care understand and approach patients’ suffering. MATERIAL AND METHODS This study employed a qualitative design, where transcribed interviews were subject to hermeneutic inquiry. Data collection Six nurses, five women and one man, from two different forensic psychiatric units in Sweden participated. The unit’s security level was high in a national classification system with three levels (low, high and very high). The nurses were 27 to 49 years old and their experience as forensic psychiatric nurses ranged from two to 15 years. An interview guide with open-ended questions was used, starting with the introductory question, “Tell me about a situation in which you and your colleagues succeeded/failed in understanding a patient’s suffering?”, followed by questions such as, “How do you think patients experience being cared for in the forensic setting?” and “Do you think care can change depending on the understanding of the patient’s