Working on the inside

When looking for a change of job, more nurses are discovering careers beyond hospital walls. Linda Belardi speaks to one nurse whose degree found her behind bars.

The most rewarding aspect of Kerry Irwin’s job as a prison nurse is earning the trust of her patients.
Although her role as a registered nurse at the Lithgow Correctional Centre can be mentally and physically demanding, Irwin enjoys interacting with her patients and developing a rapport with the inmates.

Once a relationship of trust is developed, Irwin can make a real difference to the health standards of this high-need population.

A health and fitness program established by the correctional facility has seen notable improvements in patient health and wellbeing.

Through habitual physical activity combined with group educational sessions, the clinical team has seen a reduction in the risk factors associated with the development of chronic disease.

The results of the program have been promising with benefits to self esteem, increased movement and higher rates of smoking cessation.

Social benefits such as increased camaraderie and interracial harmony have also contributed to the positive emotional and psychological wellbeing of prisoners.

The rural-based facility conducts regular screening clinics for the significant Koori population to encourage them to close the gap in their life expectancy compared to the non-indigenous inmates.

Indigenous Australians currently make up more than 50 per cent of the all male, 330 bed Lithgow prison. A clinical nurse consultant specialising in population health is also employed to help address the disparities in their health status. The area of health promotion and awareness is critical to the role of prison nurses.

Cultural awareness and knowledge is also needed to facilitate positive interaction between nurse and patient. “Being aware of these things can help diffuse situations. For example, Aboriginal men, as a rule, don’t like women asking personal questions regarding their health. That’s men’s business, so one has to use other means to glean information,” says Irwin.

The United Nations standard minimum rules for the treatment of prisoners states that each prisoner should have the same standard of health care as private citizens.

Due to the complexity of the health profile of many inmates, there is an increasing demand for multi disciplinary case management, utilising the expertise of social workers, clinical psychologists,

Aboriginal health workers and Aboriginal liaison officers.

A significant part of Irwin’s daily routine is dedicated to working with various health professionals to meet the particular healthcare needs of the prisoners.

High rates of mental illness and disability are common in prisons disability are common in prisons across Australia. Other significant health problems relate to substance and alcohol abuse, communicable disease, trauma and deaths in custody.

Suicide risk assessment and the prevention and management of infectious disease are priorities for nurses.

Prison nurses require broad generalist health knowledge, drawing from a range of specialities including primary health, emergency care and mental health.

The ultimate goal when caring for an ageing prison population is to encourage self-reliance, says Irwin. Medications are delivered to patients who are unable to access the onsite clinic due to limited mobility or poor health status.

Due to the unique prison environment, an external clinic is considered the optimal arrangement to preserve the autonomy and quality of prison health services.

An independent health team also helps to sustain professional integrity and fosters links with the broader health community.

Greater collaboration will not only lead to better health outcomes but also reduce the isolation of prison nurses from the broader profession.

The dual arrangement of providing clinical care and criminal justice can lead to unique ethical tensions, says Irwin.

“There is always a fine line between providing healthcare and security. In a maximum security centre security overrides everything,”

Retaining ownership of their nursing practice and their ethic of caring within an environment of correction, compliance and segregation is vital.

Irwin’s interaction with inmates and the prison system is mediated by her responsibilities as a nurse and her role to provide care.

When responding to subversive, manipulative or uncooperative behaviours, Irwin works within the bounds of her profession. If there is an escalation of aggression, Irwin automatically seeks advice from colleagues or the custodial officers when appropriate.

“Custodial officers are always within sight or sound of nurses when interacting with patients.”

They have nurse safety as a priority and will liaise with the clinical team if they have any information that may affect our interaction with a patient, says Irwin.

Nurses have to be discerning and observant in their critical assessment of a clinical situation, says Irwin.

The majority of Irwin’s patients respect her position as a nurse and the skills and clinical knowledge she can offer. Others, however, identify her behaviour as an instrument of control and authority particularly when prisoners perceive their needs are not being met.

Prison nurses utilise the full range of nursing skills including assessment, mental health expertise, medication administration and personal communication skills.

For career information in the NSW criminal justice system go to www.justicehealth.nsw.gov.au.

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