l ' KLSON Preparing nurses to work eS . . , in the prison environment

Nurses who go to work in prisons begin their new career without having had any specific preparation for this unique and diverse role. The demands placed upon nurses are unlike any they will have experienced in their previous clinical posts. The work of a nurse in prison contains elements of both mental health nursing and practice nursing. The context in which this nursing occurs means that the nurse is presented with complex clinical and professional dilemmas. Consequently, few nurses start to work within this specialty with all of the core competencies required to be clinically effective and confident in their role. This article descrityes how this unmet educational need was addressed by the development of a diploma level module. The r.uigc i>t rules iirulcri.ikcn h\ nurses wurkini; in pnscnis i\ unlike >iny other nursing specialty. Ihe t.isks .issocKiteJ with pr.Ktice nursing, (lccup.uioiv ,il lu'.iltli, I lutp.iiKiits, ciinimunit\ or .icutc ps\».lii.itrK nursinu ,irc routine rci the i.l.i\ tniJay working o( nurses eiiiployed in prisons (Willmott, l'*''4). The skill mix of nurses working within a prison is unlike that found ui ih in Nl IS provision, with a niixture ot registered nurses anil prison healthcare officers who do not have a nursing hackground Hut may have received inservice training from the prison service and prison custody officers. ll(iui.\er. in the recruitment of nurses to wurk in prison health care, few candidates possess enough experience in all the related fields MK\ therefore nurses start work within this specialty without all the re(.|uired competencies. Therefore, nurse educators need to develop postregistration prugraniiiies that nut only liuild on nurses' existing skills and knowledge but also develop the nurses' understanding of the specific he.I Ith needs of prisoners and how to effectiveK offer he.ilth care withm prison environments. Ihe weaknesses in the existing educational development for healthcare professionals were highlighted in The Ititiirc L)r^;.viiZiUi<>ii I if I'rtson Health Care (Joint Prison Service and NHS Executive Working Group, 1994) which concluded that there are no clear developmental (jpportunities in place ft Nicola Evans The health needs of prisoners should he accurately assessed in order for care to be more focused and conse(.|uently effective in achieving positive health outcomes for people in prison. The |oint Prison Service/NHS Executive Working Group stipulated that the target for the completion of this health needs assessment should be ^ years and that the \enture should be a |Oint initiative between health authorities and respective prison governors (Joint Prison Service and NHS Executive Working Group, 1999). As cited by Sir David Kamsbotham (1*^96), in his discussion paper Patient or Prisoner, prisoners should be entitled to rhe same level of health care as that made available to society at large; therefore, the health needs assessment should plan for the same provision of care that these prisoners could expect in the NIIS. Several sniall studies have already been undertaken and the findings indicated that 9% of the male prison population and over .?0% of the female prison population reported sick daily (Smith, I9VS|. Additionally, the mental health, social functioning, and experience of pain were found to be significantly worse in a sample group of male prisoners than in the general population (Chambers et al. 1997). Statistically, most prisoners originate from lower socioeconomic groups where there is an associated lower level of health. Farrington (I'J'^5) has suggested thar there could be a causal relationship between offending behaviour and physical ill health. In a study commissioned by the Department of Health, Singleton et al (19yS) found that 40"o of female prisoners and 2()'''o of male prisoners had been seen by psychiatric services in the 12 months before entering prison. Therefore, the prison population has a potentially high need for comprehensive healthcare services equipped to deal with both physical and psychiatric conditions. As Towl (1*^99) has already identified, through exploration of data associated with self-inflicted deaths, there are differences between the suicide rates of different types of 1324 HKI I IM I Jol'KS.M t>^ NuKslNi., , Viu X, No 19 PREPARING NURSES TO WORK EFFECTIVELY IN THE PRISON ENVIRONMENT pr i son . N o siiiculis h.ivc hi-cn iccDnki l in ( I |HI I p r i sons whereas i l u r c .in.' hi,i;ln.i r . m s of sm ciJi-N in IOLMI ii-m.nul pr isons. iVkMsiiring tlu' lri.'i.)iienc\ o t siiicKlal . l t tcinpts within .1 c i is toJial cstabl is l iment is Ity n o mc i i i s .1 V.IIKI nicthoil 1)1 de te rmin ing level ot iK-.iltli l u x J . \i docs , h o u e x e r . Jemoi is i r . i te tli.it hi . i l ih n t c J s (luctii.ite lu'twei-n lnst iui t ions .niJ tli.it the)' .ire associated \\ Ith c m i ronmenta l vari.ililes such as the r)'pe of prison (i.e. local remand or dispersal), the prison's category and the tvpe of prisoners the prison houses iLhaniliers et al, IV4"). l>iic pcrspecti\e taken of a prison eiuironnient is that it rephcates the patterns of societ\ at large; however, this perspective is disputed by Reed and Lyne (194S) who note that within prisons there are high levels of mental disorder, drug misuse and general poor health, and thar 53-5.Vi. of prisoners arc usmg illicit substances before their detention in prison or that they start using illicit substances to cope with prison life once detained (Wright. 1997). Additionally, \.^"n of male prisoners and 1.1 "'i> of female prisoners suffer troni pswhosis (Ramsbotham, l'-''-'h). The prevalence of hepatitis C, is a particular issue among iniecting drug users. .Addressing communicable diseases, including the prevention of human immunndeficieiic\ virus and other sexualK transmitted diseases, is one central task of health care in prisms. In l"̂ '*̂ ,̂ Glenochil prison witnessed an acute outbreak of hepatitis B and human ininiunodeficiencv virus (Hl\' | seroconversion among its population, resulting in suspicions that prisoners had been sharing injecting equipment (McCiomish and McComish, 1997). The distribution of Condoms within prisons is still not supported by the Prison Ser\ lcc, thus denying the recognition that sexual activity occurs in penal institutions both in terms of consenting sexual acts, and acts of male rape (Rogers, 1997).