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The study examined how nursing staff in a secure forensic unit make judgements about female patients' level of risk and whether a patient's lack of engagement in therapy was a salient factor. Results indicate that staff accounted for the following historical factors when making judgements: past aggression, substance misuse, symptoms of psychosis and personality disorder, and the following clinical factors: lack of insight, non‐compliance and lack of motivation. A positive therapeutic alliance between patient and key‐worker, high levels of self‐confidence in staff members, a supportive nursing team and an institution with good procedural security were perceived to be protective factors.

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