Prisoners as Patients The Experience of Delivering Mental Health Nursing Care in an Australian Prison

Historical Context of Custodial Health Nursing in New South Wales, Australia

Australia's prison healthcare originated during the establishment of the colony of New South Wales by Britain in 1788. Initially managed by the Colonial Medical Service, the history and healthcare of the penal settlement has been well documented in government records, academic works, museum displays, and fictional dramatizations. This article explores the origins and historical development of the nursing care of prisoners in Australia, starting with the original Australian prisoners, the convicts of colonial New South Wales. Largely overlooked in historical and academic studies, custodial health nurses are rarely mentioned or acknowledged for their contribution to the health of the colony. However, their expertise as healthcare professionals has continued to grow and is explored within the context of today's health landscape.

Improving the care of older persons in Australian prisons using the Policy Delphi method

There are currently no internationally recognised and approved processes relating to the care of older persons with dementia in prison. This research aimed to develop tools and procedures related to managing the care of, including the identification and assessment of, older persons with dementia who are imprisoned in New South Wales, Australia. A modified approach to the Policy Delphi method, using both surveys and facilitated discussion groups, enabled experts to come together to discuss improving the quality of care provision for older persons with dementia in prison and achieve research aims.

Contextualising professional ethics: the impact of the prison context on the practices and norms of health care practitioners

Health care is provided in many contexts-not just hospitals, clinics, and community health settings. Different institutional settings may significantly influence the design and delivery of health care and the ethical obligations and practices of health care practitioners working within them. This is particularly true in institutions that are established to constrain freedom, ensure security and authority, and restrict movement and choice. We describe the results of a qualitative study of the experiences of doctors and nurses working within two women's prisons in the state of New South Wales (NSW), Australia. Their accounts make clear how the provision and ethics of health care may be compromised by the physical design of the prison, the institutional policies and practices restricting movement of prisoners and practitioners, the focus on maintaining control and security, and the very purpose of the prison and prison system itself. The results of this study make clear the impact that context has on professional practice and illustrate the importance of sociology and anthropology to bioethics and to the development of a more nuanced account of professional ethics.

Seclusion reduction in a forensic mental health setting

Seclusion has become a contentious practice and initiatives have commenced to reduce or eliminate its use. This paper presents the initiatives that were introduced during a seclusion reduction project that was undertaken at an Australian forensic hospital. These initiatives are based on the six core strategies that have been successfully used in North America to reduce seclusion. However, there are challenges (patient characteristics, prisoner culture and ensuring safety) and opportunities (longer admissions, higher staff-patient ratio, staff confidence, sound risk assessment and management) that can influence projects to reduce seclusion in a forensic hospital. During this project, the frequency (mainly multiple seclusions of patients) and duration of seclusion events were reduced but there was less reduction in the number of patients that were secluded. It is possible that the strategies were successfully supported by the identified opportunities to reduce the frequency and duration of seclusion but the challenges were significantly powerful in the early period of admission to prompt the need for seclusion. Reducing seclusion in a forensic hospital is a complex undertaking as nurses must provide a safe environment while dealing with volatile patients and may have little alternative at present but to use seclusion after exhausting other interventions.

An ethnographic study of forensic nursing culture in an Australian prison hospital

Forensic nurses are faced with unique challenges in their attempt to deliver nursing care in a custodial environment. * The impact of such challenges on the cultural dynamic of forensic nursing and consequently on healthcare delivery is largely unknown. * The aim of this ethnographic study was to explore the nursing culture within an Australian prison hospital and the migration of the culture over a 12-month period. * At the end of the study, the nursing culture was found to be one of hope, although with no clearly articulated vision of nurse-hood or patient-hood and model within which to practice nursing. * The ability to articulate practice is central to the development of mental health nursing in any context. Abstract Forensic nurses are faced with unique challenges in their attempt to deliver nursing care in a custodial environment. The impact of such challenges on the cultural dynamic of forensic nursing and consequently on healthcare delivery is largely unknown. The aim of this ethnographic study was to explore the nursing culture within an Australian prison hospital and the migration of the culture over a 12-month period. At the end of the study the nursing culture was found to be one of hope, although with no clearly articulated vision of nurse-hood or patient-hood and model within which to practice nursing.

The health promoting prison (HPP) and its imperative for nursing

The World Health Organisation's (WHO) Ottawa Charter for Health Promotion in 1986 provided the catalyst from which the Health Promoting Prison (HPP) movement emerged. Here, an extensive review of the available prison-related health literature provides the basis for critical discussion and recommendations for nursing services and prison-related health care. The findings suggest that current prison-based nursing services are seriously neglected and woefully lacking in structure and resources. This article recommends strategies for reform that includes nurses who practice in all settings, and not just prison-based nurses. If nurses wish to be at the forefront of future HPP strategies, they must first embrace the radical health promotion reforms that are emerging from the current literature. Building sustainable group capacity into prison-based health care, through developing social interaction, cohesion, participation and political action can only benefit the community at large and further emphasise the health promotion role of nursing.

Conceptualizing nursing research with offenders: another look at vulnerability

In this article, vulnerability is examined as it applies to the conduct of nursing research with offenders. As a group, offenders present with a multitude of acute and chronic physical and mental health care needs; they are subject to discrimination, stigmatization, and marginalization; and as such, they often experience dual, multiple, or overlapping vulnerabilities. As research participants, they are especially vulnerable to coercion, as a direct consequence of their dependency status within the correctional system. Embracing a research agenda that focuses on offenders as a vulnerable population is fraught with ambiguities not generally encountered in other settings. The ethical conduct of research with vulnerable populations reflects a contemporary research problem that requires ongoing discourse within the nursing community and the health care community at large.