A review of prison health and its implications for primary care nursing in England and Wales: The research evidence

Faculty of Health and Social Care, University of the West of England, Glenside, Blackberry Hill, Stapleton, Bristol, UK.
Journal of Clinical Nursing (Impact Factor: 1.26). 08/2007; 16(7):1201-9. DOI: 10.1111/j.1365-2702.2007.01799.x
Source: PubMed


To provide a systematic overview of the policy and practice literature concerned with the primary healthcare needs of prisoners in England and Wales and to address the implications of these health needs for nurses working in prisons.
The recent reorganization of the prison healthcare system, which has brought prison health services in England and Wales within the National Health Service, has major implications for the role of prison nurses. Nurses in prisons are increasingly providing services to promote the health of prisoners, in addition to making assessments of health need and treating health problems.
The review examined literature from 1995 to date using standard review techniques adapted to be both sensitive and inclusive and with high recall because of the unexplored nature of primary health care in prisons.
Findings are identified in three main areas: the general health needs of prisoners, health promotion and chronic disease management. In all these areas, the health needs of the prison population are much greater than the community as a whole, resulting in a high demand for primary care services in prison. However, the prison setting can militate against providing good primary care services in prison.
More research has been carried out into the health needs of prisoners than into the provision of primary care nursing services in prisons. Further research is needed into primary care nursing in prison to meet the health needs of prisoners effectively.
With the reorganization of prison health services, health provision in prisons is increasingly primary care focused. This presents new challenges to nurses working in prison to provide a primary care service, which meets the identified health needs of prisoners.

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    • "World-wide rate of imprisonment per 100,000 ranges from 30 as obtained in India to about 750 as in the United States.[1] In Nigeria, the prison population was put at 46,000 with about 65% awaiting trial.[2] Prisoners often come from disadvantaged backgrounds, have low levels of education, poor nutrition, limited physical activity and worse health outcomes after release than the general population due to conditions before and during incarceration.[3456] Added to this, the health status of prisoners is not routinely incorporated into data and reports that summarize the state of the nation's health,[7] leading to lack of planned health services for them by relevant health bodies. "
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    ABSTRACT: Background: The aim of this study is to determine the oral health status of a sample of prisoners at the Federal Prison in Enugu. The health status of inmates in the prison system needs to be incorporated into data and reports that summarize the state of the nation's health; this will encourage the provision of health care to prisoners and foster development of the nation's health. Subjects and Methods: The study involved 230 inmates of the Federal Prison in Enugu. An interviewer-administered questionnaire was used to gather data on the demographic characteristics of the participants, social habits, methods and frequency of cleaning the mouth. Intraoral examination was carried out to determine caries and periodontal statuses employing decayed missing and filled teeth (DMFT) index and community periodontal index of treatment needs respectively. The proportions of participants with other soft and hard tissue conditions were also recorded. Frequency distribution tables with mean values were generated for categorical variables and non-parametric test was used to relate DMFT values with frequency of cleaning the mouth. Results: Among the participants, 67.0% (154/230) had decayed teeth or tooth missing due to caries. None of the decayed teeth was restored yielding a 0.0% (0/230) index of restorative provision. Spearman correlation (rho) between ranks of DMFT and frequency of cleaning the mouth was -0.32 (95%CI=-0.43 to -0.19). 5.2% (12/230) participants had community periodontal index (CPI) score of 0 and 94.8% (218/230) had CPI of 1, 2, 3 or 4. Also, 56.1% (129/230) had extrinsic stains on their teeth and 17.3% (40/230) presented with fractured teeth. Conclusion: More than half of the participants were affected by dental caries and periodontal health was compromised in the majority of them. Measures to improve their oral health and the establishment of dental health-care facility in the institution are strongly encouraged.
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    • "Mental health nurses are the healthcare professionals who are usually the first to intervene in clinical practice or asked for advice on the care of service users who Sandy and Shaw 65 present with self-harming behaviours [13]. Added to this, most of the care of this service user group in secure environments is offered by mental health nurses [41]. The quality of care offered by this professional group depends, in part, on their attitudes towards self-harm [17]. "
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    ABSTRACT: The aim of this study is to develop an understanding of the attitudes of mental health nurses towards self-harm in secure forensic environments. Self-harm is a common behaviour among people with mental health problems, often causing distress to the individuals involved. There is a differential perception between professionals and service users of the underlying motives for self-harming behaviours. This gulf in perception appears to have an impact on the care provided to service users. It causes concern among mental health nurses, whose role it is to safeguard people with mental health problems. What is less clear from the literature is the experience and attitudes of nurses to self-harm in secure settings. This study adopted a multi-method phenomenological approach, and was conducted in secure environments within a large mental health Trust in England. Data were collected using a semi-structured interview schedule. This involved 25 individual interviews and six focus groups. The data were analysed using Interpretative Phenomenological Analysis. Mental health nurses have mixed attitudes towards self-harm, but mainly negative ones, which in the main relate to the impact of self-harm and to limited knowledge and skills. These findings have implications for effective care provision. Routine education about self-harm should be provided for mental health nurses in secure settings in order to develop their attitudes, confidence and competence in care provision. Offering more training and support for mental health nurses may result in enhanced relationships with service users and thus, appropriate and effective care provision.
    Full-text · Article · Aug 2012
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    • "A high proportion of Justice Health clients have poor health and complex healthcare needs [37]. Further, many of the individual and socio-political determinants of violence are disproportionately common in prisoner populations [37,38]. The organisation therefore prioritises the work safety of its employees, which is evidenced by the existence of a range a workplace policies, procedures and systems to reduce the risk of workplace violence among staff, including a policy of zero tolerance of violence in the workplace [39], a framework for effective incident management and prevention [40] and the Incident Information Management System (IIMS) [41]. "
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    ABSTRACT: Background Little is known about workplace violence among correctional health professionals. This study aimed to describe the patterns, severity and outcomes of incidents of workplace violence among employees of a large correctional health service, and to explore the help-seeking behaviours of staff following an incident. Methods The study setting was Justice Health, a statutory health corporation established to provide health care to people who come into contact with the criminal justice system in New South Wales, Australia. We reviewed incident management records describing workplace violence among Justice Health staff. The three-year study period was 1/7/2007-30/6/2010. Results During the period under review, 208 incidents of workplace violence were recorded. Verbal abuse (71%) was more common than physical abuse (29%). The most (44%) incidents of workplace violence (including both verbal and physical abuse) occurred in adult male prisons, although the most (50%) incidents of physical abuse occurred in a forensic hospital. Most (90%) of the victims were nurses and two-thirds were females. Younger employees and males were most likely to be a victim of physical abuse. Preparing or dispensing medication and attempting to calm and/or restrain an aggressive patient were identified as ‘high risk’ work duties for verbal abuse and physical abuse, respectively. Most (93%) of the incidents of workplace violence were initiated by a prisoner/patient. Almost all of the incidents received either a medium (46%) or low (52%) Severity Assessment Code. Few victims of workplace violence incurred a serious physical injury – there were no workplace deaths during the study period. However, mental stress was common, especially among the victims of verbal abuse (85%). Few (6%) victims of verbal abuse sought help from a health professional. Conclusions Among employees of a large correctional health service, verbal abuse in the workplace was substantially more common than physical abuse. The most incidents of workplace violence occurred in adult male prisons. Review of the types of adverse health outcomes experienced by the victims of workplace violence and the assessments of severity assigned to violent incidents suggests that, compared with health care settings in the community, correctional settings are fairly safe places in which to practice.
    Full-text · Article · Aug 2012 · BMC Health Services Research
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