Prison nursing: unlocking the potential for better health of prisoners
Healthcare for prisoners in the United Kingdom (UK) used to be the responsibility of the prison service and those providing the care were prison officers with a nursing or health background. There was heavy reliance on doctors and on a medical model of service provision. While prisoners were often referred to services provided by the National Health Service (NHS), healthcare in prisons did not keep pace with health developments outside its walls.
The government working group that had been set up to address this unacceptable situation, recommended that ‘prisoners access the same quality and range of health services as the general public receives from the NHS’ (The Joint Prison Service and National Service Executive Working Group 1999, p. i). It was in 2002 that health care in UK prisons became the responsibility of the NHS. It is important to chart the changes that such a policy brings and how nurses are addressing the health needs of prisoners.
This challenge is partly taken up by Powell et al. (2010) in this issue of JAN, who explored staff views and experiences of providing care for prisoners in 12 UK prisons of all security categories. Through interviews and focus groups, they provide useful insight into the ‘day to day processes’ in care provision, as well as the contextual issues which impact on the work of these nurses.
Powell et al. (2010) report that nurses in most of the prisons in the study ‘undertook the reception process’ (health screening) and some had limited prescribing roles. These tasks were traditionally carried out by doctors. Nurses also reported that they wanted a more significant role in health needs assessment, drug prescription, health promotion and rehabilitation. However, unlike their counterparts on the other side of prison walls, there were real dilemmas in achieving these goals. For example, nurses expressed their views that prisoners should be given more responsibility for their own health care (p6). Putting this into practice in a context in which prisoners have little choice over sanitation, diet, recreation and overcrowding (Levy 1997), provides its own challenge.
There are many in the general population who believe that ‘doing time’ in prison could be an opportunity for improving the health or prisoners and for rehabilitation in relation to tobacco, drugs and alcohol dependence (Levy 1997). Many prisoners come from deprived communities with little education or skills, and were most probably, involved in risk-taking behaviour at an early age. Prisons may be their only opportunity to change their lifestyle and improve their health and their chances of re-integrating into the wider society.
Powell et al. (2010) also reported the barriers nurses faced when trying to introduce new and innovative approaches to health problems such as lack of sleep and depression. However, the ‘custodial’ ethos of prisons does not always ‘sit comfortably’ with nurses’ concept of ‘care’ and often this leads to frustration. It is encouraging, however, to note that ‘despite these frustrations, many nurses spoke of not being able to do their job if it were not for the support and co-operation of prison officers’ (p. 1262). Despite the struggle faced by prison nurses, they seem to be enthusiastic about their work and ‘in general expressed job satisfaction in meeting prisoners’ very high levels of health needs in the new organisational environment’ (Powell et al. 2010, p. 1262).
Health is a basic human right that should not be denied to anyone. Prison is yet another frontier that nurse pioneers have boldly gone into. They need the help and support of those who practice outside prison walls. Powell et al. (2010) are to be commended for finding out how our colleagues are faring in such difficult circumstances. Future studies should take up the challenge of demonstrating what difference prison nursing makes to the health of prisoners. Comparison of what is happening in different countries with regard to the health care of prisoners, and the role of nurses, also would be enlightening.