Nursing in prisons: understanding educational needs through a case study approach

Abstract

The health of people in British prisons is subject to scrutiny and comment by several agencies. These include the Home Office – who hold responsibility for services – penal reformers, prisoner representation groups, the media and providers of healthcare within prisons. Nurses make up the largest workforce within the latter group, and are employed outside the NHS. The aim of this research was to explore the educational needs of nurses working in a prison, and to map findings against a nation-wide scoping study of prison nurses’ role commissioned by the UK Central Council for Nursing, Midwifery and Health Visiting (UKCC). Very little research exists on the educational aspects of healthcare provision in prisons, although the nature of ill-health presentations is well documented. The UKCC study is unique, and enables comparison between national findings and this research, which took place in a single location. The objectives of the study were to investigate: the clinical and educational background of nurses working within prisons; the tasks and responsibilities of their role and how they were prepared for them; their perceived educational needs, including the content and structure of any proposed programme, and finally to estimate the degree of match between these findings and the UKCC national findings. Using a case study of one group of nurses working in a prison, data collection methods included a biographical timeline exercise and semi-structured interviews. Content and thematic analysis of transcripts was undertaken, followed by documentary analysis of Nursing in Secure Environments (UKCC 1999). Both sets of findings were then compared for commonalities, anomalies and gaps. Findings revealed that there is no recognized, accredited qualification for a specialist prison nursing role. Induction programmes do not exist in all institutions, and continuing professional development occurs haphazardly according to the individual nurse, with little evidence of strategic planning in order to meet the health needs of people in prison. The implications for practice are diverse, and the opportunities for improvement are enormous. The educational needs of prison nurses are inseparable from the epistemological and ontological assumptions different agencies have about the way in which a society should, or could, treat those who break its rules.