Abstract
Positive deviance (PD) is an intentional act of breaking rules in order to serve the greater good.1 PD in nursing is intentional and honorable behavior that departs or differs from an established norm and contains elements of innovation, creativity, and/or adaptability; it also involves risk for the nurse.1 Nurses who use PD practice differently and more effectively to provide patient-centered care.2 Although professional standards guide patient care and lay the groundwork for best practices, they are not enough to guide many nursing decisions that involve multiple levels of uncertainty and risk in their practice; therefore, nurses may need to respond resourcefully to meet patient needs and may employ the concept of PD to help guide those actions.1 Forensic nurses (FNs) experience role conflict when lines are blurred between advocacy and duty.3 This initial project phase aimed to understand behaviors and strategies used by FNs when encountering barriers to providing person-centered care.
A narrative literature review was conducted to synthesize available evidence regarding the use of the PD in the delivery of forensic nursing care. In consultation with a medical librarian, a pragmatic approach worked forward from the definition of PD in nursing nursing1,2 and backward from contemporary sources of information extracted from published health, education and nursing literature. A narrative review allows the inclusion of a wide variety of studies to provide an overall summary, with interpretation and critique.4 Narrative reviews can also provide insights into advancing the field or current evidence viewed from different or unusual perspectives.5
There is extensive literature documenting the impact of sexual assault. There is also a sizable volume that discusses positive deviance in healthcare and nursing. However, this lack of literature evidence specific to PD in FN is an important aspect to explore with research. Violence, especially intimate partner violence and sexual violence, is a sustained global public health issue.6 This project is vital to advancing nursing science as the lifelong physical and mental health sequelae may be extensive for those who experience sexual assault.7 The next project phase focuses on identifying and amplifying assets to enhance quality, reducing errors, and improving patient outcomes by articulating lessons from those who exhibit exceptional practices and implement successful strategies in their practice.
Notes
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Extend reference list available in the attached slide deck.
This presentation is part of a project funded by the Texas A&M University College of Nursing Dean’s Faculty Seedling Award (2025).
References:
1. Gary JC. Exploring the concept and use of positive deviance in nursing. Am J Nurs. 2013;113(8):26-34. doi:10.1097/01.NAJ.0000432960.95762.5f
2. Gary JC. The wicked question answered: Positive deviance delivers patient-centered care. Dimens Crit Care Nurs. 2014;33(3):142-150. doi:10.1097/DCC.0000000000000038
3. Cole J, Lindhorst T, Strout TD. Defining the boundaries: How sexual assault nurse examiners (SANEs) balance patient care and law enforcement collaboration. J Interprof Care. 2024;38(4):618-626. doi:10.1080/13561820.2023.2300000
4. Sukhera J. Narrative reviews: Flexible, rigorous, and practical. J Grad Med Educ. 2022;14(4):414-417. doi:10.4300/JGME-D-22-00480.1
5. Green BN, Johnson CD, Adams A. Narrative Reviews: Flexible, Rigorous, and Practical. J Grad Med Educ. 2022;14(4):453-457. doi:10.4300/JGME-D-22-00216.1
6. World Health Organization. Violence against women. Updated March 25, 2024. Accessed November 12, 2025. https://www.who.int/news-room/fact-sheets/detail/violence-against-women
7. Lindbak T, Lerdal A, Hjelde J, Heir T. Sexual Assault and the Association With Health, Quality of Life, and Self-Efficacy in the General Norwegian Population. J Interpers Violence. 2022;37(19-20):NP17849-NP17872. doi:10.1177/08862605211046401
Sigma Membership
Phi Iota
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Literature Review
Research Approach
Other
Keywords:
Positive Deviance, Positive Psychology, Forensic Nursing, Outcomes (Health Care), Improving Patient Outcomes, Ethics
Recommended Citation
Gary, Jodie C.; Charles, Laurie; and Onyemobi, Jaeda, "Exploring Positive Deviance in Forensic Nursing Literature" (2026). International Nursing Research Congress (INRC). 123.
https://www.sigmarepository.org/inrc/2026/presentations_2026/123
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-04
Exploring Positive Deviance in Forensic Nursing Literature
Toronto, Ontario, Canada
Positive deviance (PD) is an intentional act of breaking rules in order to serve the greater good.1 PD in nursing is intentional and honorable behavior that departs or differs from an established norm and contains elements of innovation, creativity, and/or adaptability; it also involves risk for the nurse.1 Nurses who use PD practice differently and more effectively to provide patient-centered care.2 Although professional standards guide patient care and lay the groundwork for best practices, they are not enough to guide many nursing decisions that involve multiple levels of uncertainty and risk in their practice; therefore, nurses may need to respond resourcefully to meet patient needs and may employ the concept of PD to help guide those actions.1 Forensic nurses (FNs) experience role conflict when lines are blurred between advocacy and duty.3 This initial project phase aimed to understand behaviors and strategies used by FNs when encountering barriers to providing person-centered care.
A narrative literature review was conducted to synthesize available evidence regarding the use of the PD in the delivery of forensic nursing care. In consultation with a medical librarian, a pragmatic approach worked forward from the definition of PD in nursing nursing1,2 and backward from contemporary sources of information extracted from published health, education and nursing literature. A narrative review allows the inclusion of a wide variety of studies to provide an overall summary, with interpretation and critique.4 Narrative reviews can also provide insights into advancing the field or current evidence viewed from different or unusual perspectives.5
There is extensive literature documenting the impact of sexual assault. There is also a sizable volume that discusses positive deviance in healthcare and nursing. However, this lack of literature evidence specific to PD in FN is an important aspect to explore with research. Violence, especially intimate partner violence and sexual violence, is a sustained global public health issue.6 This project is vital to advancing nursing science as the lifelong physical and mental health sequelae may be extensive for those who experience sexual assault.7 The next project phase focuses on identifying and amplifying assets to enhance quality, reducing errors, and improving patient outcomes by articulating lessons from those who exhibit exceptional practices and implement successful strategies in their practice.
Description
The first phase of a larger project yields what is known about positive deviance in forensic nursing through a narrative literature review. It is vital to understand how forensic nurses can improve patient outcomes and possibly prevent negative health sequelae in the amplification of successful practices.