Dealing with ingrained dirt, matted hair, the laboured breathing of untreated asthmatics, drug induced disorientation, needle track marks and badly infected wounds can all be part of a day’s work for nurses assessing newly received prisoners.
Conversely, Corrections’ 205 (full-time equivalent) nurses might also find themselves working with well-educated, health-conscious prisoners concerned that their time in prison will clip their exercise regimes.
It’s not always a pretty scene but Rimutaka Prison nurse Jenny Shandand her team of 19 nursing staff take everything in their stride and remain committed to maintaining or improving the health and well being of their patients.
Jenny has no idea what crimes her patients have committed, and neither does she want to know.
“It’s the responsibility of the custodial staff to manage a prisoner’s sentence,” Jenny says. “My role is to ensure that prisoners’ primary healthcare needs are met and to help manage the Rimutaka Prison nursing team. Why the prisoner has been sentenced to prison does not come into the equation.
“I knew nothing about the patients I treated during my accident and emergency career but I feel a great deal safer in my current role than I did there. You never knew in A&E what level of aggression you might have to deal with or if security staff would be nearby.
“Safety begins with making sure we’re never alone with a prisoner and the corrections officers assigned to watch over us at Rimutaka Prison do a brilliant job.”
The wife of a corrections officer, Jenny joined the prison three years ago confident that her combined knowledge of the environment and A&E would be useful.
“In prison and A&E, we deal with a lot of ‘emergencies’ such as dislocated shoulders and fingers, heart attacks, fractured ankles, chest pain, asthma attacks, self harm and assault injuries.
“What sets prisons apart is that we also conduct comprehensive, confidential, thorough and far-reaching health assessments and screenings which include assessing the risk of suicide and self-harm, whether a prisoner has mental health issues, if he has drug and alcohol issues, if he’s taking regular medication and his family’s medical history.”
The nurse can then decide if the prisoner should be referred to other services. Prisoners are also actively encouraged to consider the hepatitis B screening and vaccinations currently offered by prisons.
Jenny admits that having to rely initially on information provided by corrections officers, possibly the Police and of course the prisoners themselves who are not always reliable, can make the assessment process challenging.
“We have information coming to us from three different sources whereas a GP or GP’s nurse generally has the advantage of knowing a patient’s medical background and of course, knowing that the patient is there voluntarily.
“You develop a sixth sense as to whether or not a prisoner is telling you the key things that will help you understand their medical background,” Jenny says. “We use assessment tools but it’s our intuition, observation and listening skills that are crucial.”
There is no denying that some prisoners are in bad shape when they enter prison – either through lifestyle factors and/or failure to access healthcare providers.
Rimutaka Prison Nurse Acting Team Leader Jenny Shand – satisfaction comes from seeing a prisoner walk out the gate in better shape than when they came in.
“Nurses treat prisoners politely and with respect and we expect prisoners to treat us likewise. We don’t tolerate rudeness or abuse but if it happens, we walk away.”
Many have mental health issues ranging from low level depression to those needing assessment under the Mental Health (Compulsory Assessment and Treatment) Act 1992.
But there are success stories among the 10,000 people a year seen by prison nurses and it’s these stories that the nurses thrive on. Jenny remembers well a gang member who had no idea he was diabetic until he underwent a medical assessment at Rimutaka.
He hadn’t seen a doctor for years and his lifestyle presented many risk factors – drugs, alcohol, poor diet, unemployment, poor housing and a family history of diabetes.
Jenny worked closely with the man who, while keen to change, believed he needed to remain “staunch” in front of his fellow gang members. To get around this Jenny would remove him from his unit and work with him out of sight in the health centre.
Over time the prisoner took ownership of his condition which extended to his keeping meticulous notes that enabled him, and Jenny, to monitor his condition.
Jenny says the man lost weight, got his blood sugars under control and to her delight, kept his side of the bargain. Following his release he was referred to a diabetic nurse and as far as Jenny knows, he’s still checking in there and making good progress.
Requesting special diets for those needing them, encouraging prisoners to take their medication, urging them to report to weekly clinics and reviewing prisoners’ treatment plans are all part a prison nurse’s day.
Jenny says every nurse at Rimutaka Prison is responsible for a unit, and within those units they run regular, weekly clinics where they monitor the treatment plans they’ve drawn up for prisoners in their care. Each prisoner agrees to his plan and how often it’s reviewed.
“Asking them to sign a treatment plan is asking them to take ownership which I’m pleased to say, most do. We give them the tools and 
information - it’s up to them to do their part.”
Prison nurses are also responsible for specific portfolios such as hepatitis, HIV Aids, mental health or around areas of special interest such as managing medical emergencies, infection control or health and safety.
For obvious reasons, Jenny was assigned the management of emergencies when she joined the team.
Now she’s acting team leader of the Rimutaka Prison Health Centre, her role involves managing the 19-person nursing team and ensuring prisoners receive care from a multi-disciplinary team including contracted and visiting staff such as medical practitioners, the regional forensic team, the dentist, physiotherapist and visiting specialists, and identifying any issues that may prevent prisoners from participating in work or exercise programmes.
“I get enormous satisfaction from seeing a prisoner walk out the gate in better shape than when they came in and knowing we’ve raised their awareness of the need to look after themselves.”
• Prisoners have higher health needs than the general population. The Ministry of Health’s Prisoner Health Survey 2005 (2006) shows most prisoners released from prison have improved health.
• Every offender entering prison has their health needs assessed, including whether they are a risk to themselves or others.
• Every prison has a health centre – Corrections must offer prisoners the same level of health care that is available outside the prison walls.
• Corrections provides primary health care to prisoners – including primary nursing, medical services. It also provides access to mental health and addiction services, dental care, public health and disability support services.
• Local District Health Boards provide secondary and tertiary health care services to prisoners (eg physiotherapy or surgery). Prisoners have the same eligibility to receive specialist care or treatment as any member of the public.
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ISSN 1178-8453