Tracey Markham, RN, MHN, Cert Forensics

South Australian Prison Health

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What do you Do?

The daydream is half true, but the questions end quickly and I

receive a strange look when I say ‘I work in a prison’

South Australia

City of Churches

City of Festivals

City of Gardens

Known for it’s fine wines

Known as the 20 minute city

Also known as…….

The murder capital of Australia

S.A. Prison Health Service: Rural and Metropolitan Sites

Central Adelaide Local Heath Network SA Prison Health Service

Organisational Chart

Nurses who work in correctional facilities realise

that inmates are ordinary individuals with health

care needs first and ‘criminals’ second

As a nurse working in a prison everyday is

different …….

In the prison environment nurses are

challenged to treat individuals that come

straight off the street and in many cases

have had no health care prior to

incarceration...

The Role of the Prison Health Nurse

Prison Nurses undertake the same tasks as they would in any community primary health care setting including:

Assessment – admission, ongoing, discharge

Management - medication; high risk; chronic disease

Emergency response

Triage

Medical Clinic co-ordination

Nurse led clinics

Professional practice and portfolio management

So, what is different?..............

Perceptions

Often heard

Prisoners get better access to, or a higher standard of healthcare than most people

Prisoners have the same access to the healthcare system as everyone.

All people in handcuffs are guilty and have been sentenced.

Prisoners don’t deserve healthcare – they are all guilty and deserve punishment

It doesn’t matter if they wait – they’re with an officer.

Prisons have a full range of modern hospital services with specialised healthcare staff who can provide whatever care is needed.

They shouldn’t be restrained at all in hospital – we can’t provide proper health care like that.

Health staff can see the prisoner whenever necessary, for any healthcare required.

People who have no choice must be satisfied with what they receive

– or else receive nothing at all (Anderson, W)

I need to know about this persons crime to give good healthcare.

Perception, Bias and Judgement

Daily Life of a prisoner

Unlock at 830 am

Lockdown at 1130am

Unlock at 1300pm

Lockdown at 1630pm

Daily access to the gym/weights, 30 – 40 mins

Daily access to the yard, 30 – 40 mins

S.A Prison population June 30 2013 – Australian Bureau of Statistics

Number of prisoners: 2266

Prisoner population increased 9% since 2012

Median aggregate sentence: highest in Australia (4.5 years)

Highest median age: 35.9 years

Males: 91% of population

Most common most serious offence: sexual assault (18%).

S.A.:highest proportion (34%) of unsentenced prisoners

S.A Prison population on average

175 patients were transferred between sites weekly

1593 patients were seen in nurse lead clinics weekly

267 patients were seen by a Medical Officer weekly

6904 patients were seen by nursing staff in a month

136 patients were referred for outpatient treatment in a month

7989 pathology requests were sent to IMVS – in a year

760 patients were admitted into the Health Centres

90 women were screened for cervical cancer

13 women were screened for breast cancer

1633 consults were provided by Mental Health Services

Prisoner Morbidity and Mortality

Chronic Disease

Cardiac / Respiratory Disease

Psychiatric

Musculoskeletal

Drug / Substance Abuse

Infectious Diseases BBV (35% Hep C positive)

STI

Ageing

Trauma inc. Deliberate harm to self or others Assault / Hanging / Slash-ups/ Falls.

Surgical Condition

ENT

Foreign body / ingestions / hoarding

Current health challenges….

Mental health

Ageing

Current health challenges….

Environment Challenges

Working in someone else’s domain –

Security Vs Health care

Limited access to clients

Nurses must be vigilant about safety. Especially personal safety.

As a nurse working in this environment you need to use all

senses, hearing, sight and even your sixth sense.

Everyday items can be used as

contraband.

The health centre has items that can

bring a high price in the prison black

market

Everyday Items

Always Remember DON’T… Make assumptions

Take items into a prison

Discuss with, or inform prisoners of planned/ approximate dates/ times of appointments/

procedures

Hand a prisoner any paper work related to their discharge and ongoing care.

Provide phone calls to a prisoner

Contact a prisoners family for any matter

Expect a prisoner to just be uncuffed

Ever be alone without an officer nearby

Tolerate verbal abuse or rudeness

Engage in conversation that may lead to taking sides, assumptions or reveal personal

information about yourself.

When planning / providing healthcare to prisoners.....

Actively Risk Manage

Balance care & security; confidentiality & reporting

Security always

– professional, personal, procedural, relational.

Set clear personal boundaries, zero tolerance approach

Resolve personal prejudices.

Be proactive!

Remember all stakeholders

Thorough planning / throughcare

Document!!

Maintain awareness for complacency

Advocate for excellent healthcare delivery

Relationships

Cardinal troubles of crossing

boundaries with your patients –

remain objective

Our patient population and care

environment can lead us to become

sceptical and suspicious of patient

complaints

The other way we move out of

therapeutic relationship is when we

become under-involved with our

patients

Once burned in such a situation, it is

easy to assume all inmates are

looking for an angle when seeking

health care

The prison culture can value

manipulation, deception, and

secondary gain (prisoners and staff)

Healthcare staff can unwittingly get

caught up in a ‘game’ inmates are

playing e.g. splitting / favourites

In every nurse-patient relationship there is a power

differential between the nurse’s authority and the

patient’s vulnerability.

This differential is accentuated when the patient is

also an inmate with limited freedom or rights.

E.g. in a normal health care situation, a patient could request a

different care provider or change practices if there was

discomfort or dissatisfaction. Inmates are generally limited to

the assigned care provider’s treatment.

Nurses who work in a correctional facility

often work with little resources, respect or

recognition

Freedom

Questions