Nurses leading care in custody suite environments: a qualitative study from Scotland

Screening for mental disorders in police custody settings

Mental disorders are overrepresented in the criminal justice system, and this applies equally to police custody. These environments are complex and often pressured, and the acuity of the situation, combined with underlying mental disorders, comorbid medical problems and substance misuse, can lead to behavioural disturbance and increased psychiatric risk. Police custody may also present an opportunity to identify and signpost people with mental disorders and vulnerabilities who are ordinarily hard to reach by standard health services. This article considers the purposes of mental health screening of detainees in police custody. It gives an overview of research into screening for a range of psychiatric disorders and vulnerabilities (including substance misuse and traumatic brain injury) and summarises data on deaths in and immediately following release from custody. Given the inadequacy of statutory screening procedures in some jurisdictions, the authors offer a pragmatic evidence-based protocol to guide screening for mental disorders in custody detainees.

Structures, processes and outcomes of health care for people detained in short-term police custody settings: A scoping review

BACKGROUND

People detained in short-term custodial settings can require health care that may necessitate transfer to an Emergency Department (ED). What and how health care is delivered to detainees in short-term custodial settings may influence their health outcomes.

OBJECTIVE

The aim of this scoping review was to synthesise and critically appraise the evidence on health care delivered to detainees in short-term custody settings.

DESIGN

A scoping review was undertaken. Five online databases (CINAHL, PubMed, Medline, Embase and Criminal Justice Database) were searched from January 2010 to May 2020. Data extracted pertained to the structures, processes and outcomes of health care delivery. The Mixed Methods Assessment Tool was used to quality appraise the studies. Deductive analysis was used to sort the findings into structures, processes and outcomes of health care delivery and then thematic analysis was undertaken to synthesise these findings.

RESULTS

In total, 37 studies with varied designs were included in this review; 3 randomised control trials, 4 quantitative comparative studies, 21 quantitative descriptive studies, 8 qualitative studies and 1 mixed methods study. Studies were mainly from westernised countries. The quality of evidence varied across studies. Health care delivery structures had a strong focus on the identification of mental illness, with processes predominantly comprising health assessment screening on arrival to the short-term custodial setting. Outcomes (at the detainee and organisation level) included increased identification of substance misuse issues and improvement of health conditions, alongside inadequate assessment/identification of physical and mental health issues for detainees.

CONCLUSION

Gaps in evidence identified limited international perspectives as most studies originated from the US, a focus on detainee conditions/symptoms and limited long-term research within the area of health care in short-term custodial settings. Literature regarding health care delivery in short-term custodial settings focused predominantly on mental illness identification. Understanding the nature of health care delivery in short-term custodial settings further through research into specific roles such as the custody nurse is required to develop targeted interventions that address the needs of the detainee on a comprehensive level.

What works, for whom and under what circumstances? Using realist methodology to evaluate complex interventions in nursing: A scoping review

BACKGROUND

The Medical Research Council's (MRC) framework recommends basing every evaluation of a complex intervention on a theory that explains WHY an intervention works instead of focusing exclusively on the identification IF an intervention works. Theory-based evaluation approaches such as realist evaluations are promising in this respect. The aim of this scoping review is to examine current scientific literature with regard to the use of realist methodology in studies that evaluate complex nursing interventions. We also seek to answer the question whether realist evaluation studies of complex nursing interventions are embedded in the Medical Research Council's framework.

METHODS

A systematic database search in MEDLINE and CINAHL supplemented with snowballing techniques and a hand search in relevant nursing journals were performed between January and February 2018 and updated in July 2019. Both authors independently screened the title / abstract of studies that were initially identified and appraised the full texts if inclusion criteria were fulfilled. Inclusion criteria were the explicit use of realist methodology and a focus on the development or evaluation of complex nursing interventions. Results were summarized narratively.

RESULTS

A total of 28 articles from 22 studies, published between 2010 and 2019, were included. The majority of the studies included originate in the UK. Realist methodology was used by a variety of nursing disciplines, including midwifery, community / public health, critical care, palliative care, gerontological nursing, psychiatric nursing / mental health, and infection control. Study designs included case studies and realist reviews; two studies were conducted alongside a randomized controlled trial. All studies included used more than one method to develop their results; the majority of methods were qualitative by nature. Thirteen of the studies included aimed to develop a theory about what works, for whom and under what circumstances regarding the investigated complex nursing intervention. One study was clearly embedded in the Medical Research Council's framework.

CONCLUSION

Realist evaluation broadens the methodologies that have traditionally been used in nursing. Conceptual clarity on its principal tenets is still needed, as well as the methods used to assess them. Nursing scientists should be more critical when using novel methodology and contribute to academic debates about limitations. Embedding realist evaluations into the Medical Research Council's framework is in its infancy in nursing and needs more contributions in order to develop a common academic position within the profession. Tweetable abstract Realist methodology in nursing - review of the use, methods, limitations and embedding into the Medical Research Council's framework.

Exploring the Delivery of Healthcare in the Police Detention Center Through Remote Presence Technology

INTRODUCTION

There is overwhelming evidence to support the delivery of high-quality health service at a lower cost with the use of advanced technologies. Implementing remote presence technology to expand clinical care has been fraught with barriers that limit interprofessional collaboration and optimal client outcomes. In Canada, government ministries responsible for correctional services, policing, and health are well positioned to link federal, provincial, and regional services to enhance service delivery at the point of care for individuals detained within the justice system. Using remote presence technology to link the detention center with relevant health services such as the emergency room has the potential to open up a new care pathway.

RESEARCH QUESTION

The key research question was how a new intervention pathway for individuals detained in police service detention centers could be implemented.

RESEARCH DESIGN

Utilizing an exploratory qualitative research design, interviews were undertaken with 12 police service and six healthcare participants. Data were transcribed and thematically analyzed.

FINDINGS

Four main themes emerged and included role conflict, risk management, resource management, and access to services. A number of collaborative learning partnerships were identified by the participants.

IMPLICATIONS

These themes reveal important facilitators and barriers to attending to the health needs of detainees within the police detention center through the utilization of remote presence.

Contextualising health screening risk assessments in police custody suites - qualitative evaluation from the HELP-PC study in London, UK

Background

In the UK, police custody officers have a responsibility to screen for health morbidity and vulnerability among detainees. This study aimed to develop an understanding of the barriers to performing effective health screening in police custody suites, understand the impact of screening tools on practice within the custody suite, and to identify factors that could hinder or facilitate the future implementation of a new screening intervention in this environment.

Methods

A qualitative study was conducted alongside a quantitative evaluation of a novel screening tool. Qualitative methods included observation of the custody environment, semi-structured interviews with police staff, and elicitation of comments from detainees about their experiences of screening. Data were analysed inductively using thematic analysis. Normalization Process Theory (NPT) was used to inform data collection and as a framework for higher level analysis of findings.

Results

Five overall constructs were identified that develop understanding of the integration of health screening within custody: the workability of risk assessment screening tools; the effect of the custody environment and the people therein; shifts in professional roles and interrelationships amongst staff; cultural responses to risk and liability in police work; how infrastructure, knowledge and skills can impact on detainee safety.

Conclusions

Health and risk assessment screening in police custody is a complex and demanding activity which extends beyond the delivery of a screening tool. Professional roles, the demanding environment and police culture impact on the overall process. Recommendations for improved integration of health and risk assessment screening in wider police custody practice are proposed.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5271-6) contains supplementary material, which is available to authorized users.

Using critical realistic evaluation to support translation of research into clinical practice

A challenge that speech-language pathologists (SLPs) face is the translation of research into clinical practice. While randomised controlled trials (RCTs) are often touted as the "gold standard" of efficacy research, much valuable information is lost through the process; RCTs by nature are designed to wash out individual client factors and contexts that might influence the outcome in order to present the "true" impact of the intervention. However, in the area of behavioural interventions, the interaction of client factors and contexts with the treatment agent can substantially influence the outcome. This paper provides an overview of the theoretical background and methods involved in critical realistic evaluation (CRE) and discusses its current and potential application to speech-language pathology. CRE is based on the premise that a behavioural intervention cannot be evaluated without considering the context in which it was provided. While the ways in which contextual aspects and treatment mechanisms interact may seem endless, CRE methodology attempts to operationalise them into hypotheses to be empirically tested. Research based on these principles has the potential to support clinical translation of research outcomes and reduce the costs of unsuccessful treatment attempts for SLPs, clients and the service provider.

Police custody health care: a review of health morbidity, models of care and innovations within police custody in the UK, with international comparisons

This paper is a scoping review of the available evidence regarding health care issues in police custody. It describes the types and prevalence of health disorders encountered in custody and provides an overview of current practice and recent innovations in police custody health care. In contrast to the health of prisoners, the health of police custody detainees has, until recently, received little academic or clinical attention. Studies on health care in police custody identified for this review are limited to a few geographical jurisdictions, including the UK, continental Europe, North America, and Australia. There are significant health concerns among police detainees including acute injury, chronic physical health problems, mental and cognitive disorders, and the risks associated with drug and alcohol intoxication or withdrawal. There is some evidence that deaths in police custody have reduced where attention has been paid to the latter issue. Police personnel continue to experience difficulties identifying detainees with health issues relevant to their safe detention, but research shows that the use of evidence-based screening tools improves detection of such morbidities. Innovations in police custody health care mainly relate to detainees with mental disorders, including improved identification of illness, timely access to mental health services, the protection of the rights of mentally disordered detainees, and the diversion of mentally disordered persons from the criminal justice system into appropriate health and social care interventions. There is a lack of rigorous research relating to interventions for physical health problems, protecting those at risk of substance withdrawal, and detainees with preexisting or peri-arrest injures. Research to improve the health of police custody detainees requires greater priority, focusing on case identification and service redesign to address high levels of morbidity and to facilitate health promotion and prevention activities.

Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review

BACKGROUND

Despite considerable evidence showing the importance of the nursing and midwifery workforce, there are no systematic reviews outlining how these cadres are best supported to provide universal access and reduce health care disparities at the primary health care (PHC) level. This review aims to identify nursing and midwifery policy, staffing, education and training interventions, collaborative efforts and strategies that have improved the quantity, quality and relevance of the nursing and midwifery workforce leading to health improvements for vulnerable populations.

METHODS

We undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The quality of retrieved papers was appraised using standard tools. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to analyse the interventions and findings of included studies using a conceptual framework.

RESULTS

Thirty-six papers were included in the review, the majority (25) from high-income countries and nursing settings (32). Eleven papers defined leadership and governance approaches that had impacted upon the health outcomes of disadvantaged groups including policies at the national and state level that had led to an increased supply and coverage of nursing and midwifery staff and scope of practice. Twenty-seven papers outlined human resource management strategies to support the expansion of nurse's and midwives' roles that often involved task shifting and task sharing. These included approaches to managing staffing supply, distribution and skills mix; workloads; supervision; performance management; and remuneration, financial incentives and staffing costs. Education and training activities were described in 14 papers to assist nurses and midwives to perform new or expanded roles and prepare nurses for inclusive practice. This review identified collaboration between nurses and midwives and other health providers and organizations, across sectors, and with communities and individuals that resulted in improved health care and outcomes.

CONCLUSIONS

The findings of this review confirm the importance of a conceptual framework for understanding and planning leadership and governance approaches, management strategies and collaboration and education and training efforts to scale up and support nurses and midwives in existing or expanded roles to improve access to PHC for vulnerable populations.