Primary Healthcare Nursing: The Prison Nurse

Introduction

Primary healthcare (PHC) nursing is the most common role that nurses take in Australia. Though there are a number of general practice and advanced practice nurses, the demand for PHC nurses is higher and their roles more common in most populations. Notably, PHC entails the first contact between the patient population and the healthcare system and thus the role entails diagnosing and treating patients prior to referrals, facilitation of prevention endeavors, antenatal and postnatal care, and health advocacy among other roles (Payer, Taylor, & Barnes, 2016). Though primary healthcare nurses often anticipate working in various environments with varied challenges, few ever fancy the role of the prison nurse. This is largely due to the perceived dangers associated with it given that it primarily entails providing care to incarcerated individuals. However, those who take up the role as primary healthcare nurses in the prison environment find themselves in an exciting, unique and quite safe environment. Security is provided by wardens and management while their nursing roles are more engaging that in other settings (Kinghorn & Halcomb, 2017). This paper discusses various elements characterizing the role of a prison nurse.

Key Attributes

The prison nurse has several attributes. First, they are required to have normative nursing qualifications such as an Associate’s or Nursing Diploma/ Degree just like other PHC nurses in other environments. In Australia and most parts of the world, there are generally no exemptions or additions in terms of the threshold of professional qualification for prison nurses in comparison with other PHC nurses (Kinghorn & Halcomb, 2017). They undergo the same training, certifications and registration and only differ in the environments and the population they serve. Their roles include diagnosing, treating and provision of care to incarcerated persons, offering drug and substance abuse rehabilitation, advocacy, setting up policies, rehabilitation and palliation, health promotion among other care related services (Kinghorn & Halcomb, 2017). In addition, they are supposed to maintain safety guidelines in their correctional facility and carry out assorted administrative medical duties like maintaining patient records. As it emerges, the prison nurse has quite a number of roles which may supersede those of a regular nurse.

There are several reasons why a prison nurse is considered to be a primary healthcare nurse. First, prison nurses are trained in the same way as other nurses offering primary care in other environments and have absolutely no deviances in qualifications. Secondly, they are also found at the position of initial contact between the patient population and the healthcare system (Bond, 2015). Incarcerated persons receive primary care from prison nurses which means that the only difference emerges in the population in context but all the other features of primary care apply. In essence, lots of perceptions of difference between primary healthcare nursing and prison nursing are hinged on the uniqueness of the patient population involved and rather not the roles taken. More importantly, prison nurses are engaged in health promotion and dealing with health inequities, which are some of the most profound roles of the PHC nurse. The prison environment creates several inequities in access and quality of care, with freedom of choice deterred and access to some elements of care such as tranquil for psychological healing missing (Payer, Taylor, & Barnes, 2016). Therefore, the nurse has quite a number of advocacy issues to address. In the end, prison nursing mirrors primary healthcare to a large extent.

Patient Demographics

Prisons are unique in that inmates who reside therein have often committed crimes that call for lengthy sentences. They are different from jails in regards to the length of the time served behind bars which also means that prisoners pose a larger security risk to others and the healthcare staff taking care of them than in any other setting (Bond, 2015). In most cases, the characteristics of a prison population depend on the gravity of their crimes, with maximum security prisons harboring the most notorious violent offenders. Some specialty prisons consist of inmates with special problems such as mental illness, HIV/AIDS, physical disabilities among others. By 2016, there were 38,845 prisoners in Australia, with an imprisonment rate of 108 per 100,000 persons (Payer, Taylor, & Barnes, 2016).  Elsewhere, 22% of the population was taken in for activities that are intended to cause injury while 14% of them were illicit drug offenders. The statistics also indicate that the males were the largest constituents of the prison population, with around 92% (35,745 prisoners). In terms of geographical distribution, the Aboriginal and Strait Islander region contributed to over a quarter of the prison population (27%). It is important to note that the Aboriginal and Strait Islander people already face a number of health inequalities ranging from access and equity of care as well as a heavy burden of chronic diseases (Payer, Taylor, & Barnes, 2016). It is also important to note that prisoners are at risk of communicable diseases due to overcrowding, poor access to medical care and irresponsible sexual and drug abuse behaviors. 

Health issue: Drug and Substance Abuse

Given the demographics of the Australian prison setting, drug and substance abuse is a major health concern. This is apparent from the large number of prisoners (14%) who are sentenced due to drug offences. Sentencing is not tantamount to cessation and such individuals maintain their cravings and abuse tendencies within the prison setting (Bond, 2015). They smuggle drugs into their cells, sale them to fellow abusers and act under their influence to make prisons unsafe. The need for drug rehabilitation is also precipitated by the harsh prison conditions with overcrowding, lack of adequate medical care, traumatizing living conditions among other factors leading incarcerated persons into drug abuse (Payer, Taylor, & Barnes, 2016).  The PHC nurse must intervene to offer rehabilitation services given that it acts as a prevention measure for a number of communicable diseases in the prison setting. HIV/AIDS, mental illnesses among others can be prevented through drug rehabilitation and promotion of behavioral change. Additionally, drug and substance abuse is in itself a serious health problem capable of causing loss of life, chronic conditions and chaos within the prison setting. The PHC nurse must therefore intervene to avert such situations.

Resources for health Promotion

Realizing the high incidence of drug and substance abuse in prison settings, there are several resources/initiatives that have been put in place to mitigate. One of them is guidance and counseling for recovering addicts who have made a decision to quit such behavior (Kinghorn & Halcomb, 2017). Nurses, psychologists and other health professionals are involved in this regard, helping such individuals to cope with withdrawal effects and build new character. There are also role models within the prison settings that help individuals in their recovery from addictive behavior. These two initiatives are related to creation of supportive environments as a health promotion strategy in the Ottawa Charter.  Counseling at the individual or group level and the presence of role models together creates a supportive environment for recovering addicts. Elsewhere, some prisons have adopted a comprehensive drug strategy to help prevent, identity and rehabilitate where necessary (Bond, 2015). Such frameworks are highly desirable as they aim at offering sustainable solutions to the drug and substance abuse problem. The initiative relates to the reorientation of health services towards prevention of illness and health promotion in the Ottawa charter. Therefore, guidance and counseling, use of role models and adoption of a drug strategy are all initiatives for health promotion in prison settings.

PHC Responses

With respect to drug and substance abuse in prisons, the PHC nurse should advocate for more humane conditions for prisoners and offer care and offer wellness education. By advocating for humane conditions, they shall be less prisoners resorting to drug and substance abuse for solace (Bond, 2015). Those who are recovering shall also have a supportive environment for the same. Elsewhere, wellness education is a preventive measure that shall reduce the number of incarcerated persons abusing drugs and other substances in perfect knowledge of the dangers of the same. The following goals, objectives and strategies apply:

Response	Goals and Objectives	Strategies
Advocacy for Humane Conditions	Prevention of Drug and Substance abuse behaviorCreate a supportive environment for recovering addictsCurtail the spread of drug and substance abuse behavior amongst inmates	Ensuring there is less overcrowding in the cellsIncreasing access to careTreating prisoners in a humane manner both while seeking treatment and when in their normal activities
Wellness Education	Increase capacity of prisoners for self careCreate awareness on the dangers of drug and substance abusePromote healthy lifestyles and cessation of drug behaviors.	Offering personal and group guidance and counselingDistributing posters, pamphlets and other educational materials to the cell areas

Conclusion

It is apparent that the role of the prison nurse is quite unique but takes the shape of the primary healthcare nurse. Prison nurses have the same training as other regular nurses in Australia but serve a different population (incarcerated persons) that have special needs. As it emerges, drug and substance abuse is a major health concern in Australian prisons affecting around 14% of the offenders. Nurses can play a role in advocacy for humane conditions and offering wellness education to address the problem, leveraging on guidance and counseling, role models and drug strategies that are found in such environments. 

References

Bond, J. (2015). Researching Correctional Health Care–Better Health for a Brighter Future. International Specialized Skills Institute, 112.

Kinghorn, G., & Halcomb, E. (2017). Correctional nursing. An Introduction to Community and Primary Health Care, 335.

Payer, H., Taylor, A., & Barnes, T. (2016). Who’s missing? Demographic impacts from the Incarceration of Indigenous people in the Northern Territory, Australia. In Crime, Justice & Social Democracy: Proceedings of the 3rd International Conference (Vol. 1, pp. 27-36).