Tracey Markham, South Australian Prison Health Service - Working as a Nurse on the Inside - South Australian Prison Health


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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

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Tracey Markham, South Australian Prison Health Service - Working as a Nurse on the Inside - South Australian Prison Health

  1. 1. Tracey Markham, RN, MHN, Cert Forensics South Australian Prison Health
  2. 2. What do you Do?
  3. 3. The daydream is half true, but the questions end quickly and I receive a strange look when I say ‘I work in a prison’
  4. 4. 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……. 
  5. 5. The murder capital of Australia
  6. 6. S.A. Prison Health Service: Rural and Metropolitan Sites
  7. 7. Central Adelaide Local Heath Network SA Prison Health Service Organisational Chart
  8. 8.  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 …….
  9. 9. 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...
  10. 10. 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  Emergency - medication; high risk; chronic disease response  Triage  Medical  Nurse Clinic co-ordination led clinics  Professional practice and portfolio management
  11. 11. So, what is different?..............
  12. 12. Perceptions
  13. 13. 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.
  14. 14. Perception, Bias and Judgement
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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 
  19. 19. Current health challenges…. Mental health
  20. 20. Current health challenges….  Ageing
  21. 21. Environment Challenges  Working in someone else’s domain –  Security Vs Health care  Limited access to clients
  22. 22. 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.
  23. 23. Everyday items can be used as contraband. The health centre has items that can bring a high price in the prison black market
  24. 24. Everyday Items
  25. 25. 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.
  26. 26. 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
  27. 27. Relationships  Cardinal troubles of crossing boundaries with your patients – remain objective  Once burned in such a situation, it is easy to assume all inmates are looking for an angle when seeking health care  Our patient population and care environment can lead us to become sceptical and suspicious of patient complaints  The prison culture can value manipulation, deception, and secondary gain (prisoners and staff)  The other way we move out of therapeutic relationship is when we become under-involved with our patients  Healthcare staff can unwittingly get caught up in a ‘game’ inmates are playing e.g. splitting / favourites
  28. 28.  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.
  29. 29. Nurses who work in a correctional facility often work with little resources, respect or recognition
  30. 30. Freedom
  31. 31. Questions