An Innovative Nursing Management Solution to Improve Community-Based Health in Prisons: Modelling in Ireland for a Global Approach to Community-Based Health in Detention

Abstract

People deprived of their liberty are often vulnerable due to poor health and living choices. These can include drug addiction and associated blood-borne virus risks, amongst people who Inject Drugs (PID).

Prison populations also include people who have neglected their health, suffering chronic Non-Communicable Diseases (NCD) as well as being vulnerable to violence in prisons.

The nature of prisons requires its organisation into regimes in order to manage the large populations whilst also providing safe and secure custody. As a result, clinical care, drug administration, nursing interventions and mealtimes for both prisoners and staff must be managed according to tight time windows.

The role of nursing in Irish prisons needs to fit into the organisational regimes of the prison. Experience has indicated that the important nursing role in providing community-based health awareness is limited due to the existence of regimes.

Following an audit of prison healthcare in Irish prisons, the need to provide an innovative solution to community health and wellbeing awareness within the community was apparent.

A model originally developed within the Red Cross/Red Crescent Movement, using community members as peer educators was adapted, planned and implemented as action research in one prison and then extended to all prisons in Ireland over a five-year period.

This innovative nursing management solution required the adoption of the WHO (2007)’ whole prison’ approach to health and the organisational changes to effect it.

The theoretical underpinning of the project was based on systems theory, the fractal models of chaos theory and complex adaptive systems.

Following fifteen years of successful operation in Irish Prisons, a Global Hub for community-based health in Detention was established in Ireland. Using the Irish model, Community-Based Health in Detention was piloted in Northern Ireland, Wales (UK), Australian and Norwegian Prisons. Evaluations in Ireland and internationally identified the important value of training prison inmates as peer health educator volunteers linked to prison healthcare units.

This paper explores the development of a successful working model of peer health educators as an extension of nursing. It has resulted in reduced violence, increased health screening participation and increased self-esteem and mental health amongst prisoner peer educators. The use of the theoretical principles underpinning the Irish model in other jurisdictions is described.