tracey markham, south australian prison health service - working as a nurse on the inside - south...
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Tracey Markham, Associate Clinical Sevice Coordinator - Clinical Care Systems, South Australian Prison Health Service, Central Adelaide Local Health Network, SA Health presented this at the 2nd Annual Forensic Nursing Conference. This is the only national even of its kind promoting research and leadership for Australia's Forensic Nursing Community. The program addresses future training of forensic nursing examiners, forensic mental health consmers, homicide and its aftermath, ethical dilemmas in clinical forensic medicine, child sexual abuse, providing health care to indigenous patients in the forensic arena and more. To find out more about this conference, please visit http://www.healthcareconferences.com.au/forensicnursingTRANSCRIPT
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Tracey Markham, RN, MHN, Cert Forensics
South Australian Prison Health
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What do you Do?
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The daydream is half true, but the questions end quickly and I
receive a strange look when I say ‘I work in a prison’
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South Australia
City of Churches
City of Festivals
City of Gardens
Known for it’s fine wines
Known as the 20 minute city
Also known as…….
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S.A. Prison Health Service: Rural and Metropolitan Sites
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Central Adelaide Local Heath Network SA Prison Health Service
Organisational Chart
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Nurses who work in correctional facilities realise
that inmates are ordinary individuals with health
care needs first and ‘criminals’ second
As a nurse working in a prison everyday is
different …….
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In the prison environment nurses are
challenged to treat individuals that come
straight off the street and in many cases
have had no health care prior to
incarceration...
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The Role of the Prison Health Nurse
Prison Nurses undertake the same tasks as they would in any community primary health care setting including:
Assessment – admission, ongoing, discharge
Management - medication; high risk; chronic disease
Emergency response
Triage
Medical Clinic co-ordination
Nurse led clinics
Professional practice and portfolio management
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So, what is different?..............
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Perceptions
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Often heard
Prisoners get better access to, or a higher standard of healthcare than most people
Prisoners have the same access to the healthcare system as everyone.
All people in handcuffs are guilty and have been sentenced.
Prisoners don’t deserve healthcare – they are all guilty and deserve punishment
It doesn’t matter if they wait – they’re with an officer.
Prisons have a full range of modern hospital services with specialised healthcare staff who can provide whatever care is needed.
They shouldn’t be restrained at all in hospital – we can’t provide proper health care like that.
Health staff can see the prisoner whenever necessary, for any healthcare required.
People who have no choice must be satisfied with what they receive
– or else receive nothing at all (Anderson, W)
I need to know about this persons crime to give good healthcare.
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Perception, Bias and Judgement
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Daily Life of a prisoner
Unlock at 830 am
Lockdown at 1130am
Unlock at 1300pm
Lockdown at 1630pm
Daily access to the gym/weights, 30 – 40 mins
Daily access to the yard, 30 – 40 mins
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S.A Prison population June 30 2013 – Australian Bureau of Statistics
Number of prisoners: 2266
Prisoner population increased 9% since 2012
Median aggregate sentence: highest in Australia (4.5 years)
Highest median age: 35.9 years
Males: 91% of population
Most common most serious offence: sexual assault (18%).
S.A.:highest proportion (34%) of unsentenced prisoners
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S.A Prison population on average
175 patients were transferred between sites weekly
1593 patients were seen in nurse lead clinics weekly
267 patients were seen by a Medical Officer weekly
6904 patients were seen by nursing staff in a month
136 patients were referred for outpatient treatment in a month
7989 pathology requests were sent to IMVS – in a year
760 patients were admitted into the Health Centres
90 women were screened for cervical cancer
13 women were screened for breast cancer
1633 consults were provided by Mental Health Services
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Prisoner Morbidity and Mortality
Chronic Disease
Cardiac / Respiratory Disease
Psychiatric
Musculoskeletal
Drug / Substance Abuse
Infectious Diseases BBV (35% Hep C positive)
STI
Ageing
Trauma inc. Deliberate harm to self or others Assault / Hanging / Slash-ups/ Falls.
Surgical Condition
ENT
Foreign body / ingestions / hoarding
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Current health challenges….
Mental health
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Ageing
Current health challenges….
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Environment Challenges
Working in someone else’s domain –
Security Vs Health care
Limited access to clients
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Nurses must be vigilant about safety. Especially personal safety.
As a nurse working in this environment you need to use all
senses, hearing, sight and even your sixth sense.
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Everyday items can be used as
contraband.
The health centre has items that can
bring a high price in the prison black
market
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Everyday Items
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Always Remember DON’T… Make assumptions
Take items into a prison
Discuss with, or inform prisoners of planned/ approximate dates/ times of appointments/
procedures
Hand a prisoner any paper work related to their discharge and ongoing care.
Provide phone calls to a prisoner
Contact a prisoners family for any matter
Expect a prisoner to just be uncuffed
Ever be alone without an officer nearby
Tolerate verbal abuse or rudeness
Engage in conversation that may lead to taking sides, assumptions or reveal personal
information about yourself.
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When planning / providing healthcare to prisoners.....
Actively Risk Manage
Balance care & security; confidentiality & reporting
Security always
– professional, personal, procedural, relational.
Set clear personal boundaries, zero tolerance approach
Resolve personal prejudices.
Be proactive!
Remember all stakeholders
Thorough planning / throughcare
Document!!
Maintain awareness for complacency
Advocate for excellent healthcare delivery
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Relationships
Cardinal troubles of crossing
boundaries with your patients –
remain objective
Our patient population and care
environment can lead us to become
sceptical and suspicious of patient
complaints
The other way we move out of
therapeutic relationship is when we
become under-involved with our
patients
Once burned in such a situation, it is
easy to assume all inmates are
looking for an angle when seeking
health care
The prison culture can value
manipulation, deception, and
secondary gain (prisoners and staff)
Healthcare staff can unwittingly get
caught up in a ‘game’ inmates are
playing e.g. splitting / favourites
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In every nurse-patient relationship there is a power
differential between the nurse’s authority and the
patient’s vulnerability.
This differential is accentuated when the patient is
also an inmate with limited freedom or rights.
E.g. in a normal health care situation, a patient could request a
different care provider or change practices if there was
discomfort or dissatisfaction. Inmates are generally limited to
the assigned care provider’s treatment.
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Nurses who work in a correctional facility
often work with little resources, respect or
recognition
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Freedom
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Questions