Abstract
Aim: To examine which prisoners' health issues can be effectively managed by a nurse-led clinic approach in prison settings.
Background: The nurse-led clinic approach is commonly used to manage diverse health issues in primary health care and has shown positive impact on patients' health outcomes. People detained in the prison environment usually have a higher risk of having both communicable and noncommunicable diseases compared to people in the general population. The prison, as a primary healthcare provider, plays an important role in maintaining and improving prisoners' health during their imprisonment, and in minimising health inequity in the prisoner population. Most literature regarding nurse-led clinics in prison settings discuss an intervention or a model of care for a single health issue, with no review study undertaken which has summarized the effectiveness of a nurse-led clinic approach for the management of prisoners' diverse health issues. Subsequently, there is a need to review what is known or unknown about the topic from a research perspective to gain a better understanding about prison-based nurse-led clinics and their applications and effectiveness in prison settings.
Method: An integrative review was chosen as the methodology for this dissertation. This was achieved using the integrative process from Whittemore and Knafl (2005).
Results: 15 studies were included for the current review. The findings show that prison-based nurse-led clinics are effective in the management of HCV infections, STIs, Pap screening for cervical cancer, stress management and transferring acutely mentally unwell patients to hospital level of care. Core elements of effective nurse-led clinics in prison settings include appropriate nursing skills to respond to the diversity of health needs, organizing nurse-led clinics that suit prison contexts, agreed clinical pathways for particular health issues and opportunity to engage hard-to-reach populations for diagnosis and treatment. Identified key challenges facing nurse-led clinics in prison settings are loss of follow-up, maintaining prisoners' confidentiality and prisoners' avoidance of engaging with nurse-led clinics.
Conclusions: The nurse-led clinic approach is feasible and applicable to manage prisoners' particular health issues in prison if appropriate health outcome measures can be used to evaluate the effectiveness of nurse-led clinics for the management these issues. Competent nurses are required for working at nurse-led clinics, who must also have specialized skills to manage prisoners' particular health issues and who demonstrate clinical leadership to improve prisoners' health outcomes and health inequity. Nurses who practice in New Zealand prisons need to demonstrate specific nursing competencies regarding culturally safe nursing practice and the Treaty of Waitangi principles in Māori health to reflect their response to Treaty obligations. To support an effective nurse-led clinic approach in prison, the prison nurses' employers are required to encourage prison nursing staff's professional development and build connections with other service providers who are also involved in prisoner's care to support the continuity of care.