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Tuesday, September 21, 1999 Published at 17:42 GMT 18:42 UK


Nurses 'confused' about prison work

Prisoners have more complex healthcare needs nowadays

Standards of nursing in prison vary widely and many nurses are confused about their role, according to a wide-ranging report.

The UKCC, the body responsible for regulating nursing, says standards that do exist are often not based on practical research or on nurses' own experience of prison working, are poorly monitored and are developed as a reaction to incidents or inquiries rather than as a way of meeting clients' needs.

It blames political sensitivities and media scares for a defensive approach to care, rather than one based on "considered research".

The interim report, prepared for the UKCC by researchers from the University of Central Lancashire, states that auditing of standards is "haphazard or minimal".

The report will form the basis of the UKCC's policy agenda on prison nursing for the next five years.

More complex needs

Prison nursing has become more complex in the past 10 years, with an increase in patients with multiple problems.

For example, the number of beds for mentally disordered offenders in England has increased significantly and many are stuck in the system because of a lack of throughput into less secure accommodation.

More patients are homeless or have drug or alcohol problems than in the past and there has been a threefold increase in the number of people prosecuted for sexual offences in the past 10 years, says the report.

The largest group of prisoners are those with a history of violence against the person.

The report says nurses face "a role conflict" in reconciling their responsibilities for therapeutic care and maintaining security.

Part of the problem is that prison health care has developed out of the prison service rather than the NHS.

This means priorities can be skewed towards security concerns and risk management rather than individual health needs.

And it has left nurses "unclear and confused" about their role.

The UKCC wants a clearer definition of their responsibilities and improved training and support.

It says continuing professional development is often "ad hoc", training does not tackle day-to-day realities and complexities and areas such as the management of challenging behaviour is unclear.

This means nurses often do not know how much they can intervene to restrain a patient who may be putting them at risk.

The report recommends that national standards be developed in this area.

Personality disorder

It also states that nurses face particular difficulties in dealing with people with personality disorders.

"Their disorders are ill-defined, their treatment is often haphazard and the outcomes for them, in relation to clinical targets, are poorly understood and progress difficult to measure," it states.

The full report will be published in October.

Martin Narey, head of the Prison Service, told the BBC's Today programme that efforts were being made to improve health care in prison.

He added that a report launched in March by Home Secretary Jack Straw and Health Secretary Frank Dobson looked at bringing the NHS and the Prison Service closer together and recommended improvements in areas such as mental health care.

Mr Narey said health workers in prison were facing "quite extraordinary" problems. Eighty per cent of prisoners had drug problems, 60% had alcohol problems, 40% had a mental illness and 30% had a history of self-harm.

"It is quite a difficult population," he said. "But I am confident we will make measurable progress in the next six months."

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