The Clinical Stabilization Framework (CSF): A Conceptual Model for Forensic Nursing Clinical Reasoning During Alcohol Withdrawal in Custody

BACKGROUND: Alcohol withdrawal is a common and potentially life-threatening presentation in custodial health care. Although structured assessment tools and evidence-based pharmacological interventions remain essential, they offer limited conceptual guidance on how forensic nurses integrate biological, psychological, pharmacological, relational, and environmental information during periods of acute instability. AIM: To introduce the Clinical Stabilization Framework (CSF) as a conceptual model supporting forensic nursing clinical reasoning during alcohol withdrawal in custody. METHODS: Synthesis of current evidence, national guidance, and advanced forensic nursing practice to articulate the multidimensional reasoning required during evolving withdrawal presentations. The CSF was developed as a practice-informed model to complement existing assessment and treatment approaches. RESULTS: The CSF conceptualizes stabilization as a dynamic process across five interacting domains: biological, psychological, pharmacological, relational, and environmental. The framework supports holistic assessment, therapeutic engagement, and multidisciplinary decision-making by enabling clinicians to interpret evolving information within restrictive custodial environments. CONCLUSION: The CSF provides a coherent conceptual approach to forensic nursing clinical reasoning during alcohol withdrawal. Although developed within custodial health care, the framework is not population-specific and may be transferable to other settings where withdrawal is managed. For the purposes of this article, forensic nursing refers to nursing practice delivered within custodial and other secure justice settings, where health care is provided at the interface of health and the criminal justice system. This includes nurses practicing within police custody suites, prisons, remand centers, immigration detention facilities, and secure forensic mental health units.