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Nursing offenders with learning disabilities in environments of varying security


Nursing offenders with learning disabilities in environments of varying ... (High secure in early'90s) was so draconian in every was just hideous' C ' ... – PowerPoint PPT presentation

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Title: Nursing offenders with learning disabilities in environments of varying security

Nursing offenders with learning disabilities in
environments of varying security
  • What are the key differences?
  • Andy Lovell, Reader, University of Chester
  • Anne Kingdon, Consultant Nurse, Cheshire Wirral
    Partnership Trust

  • Closure of long stay hospitals and development of
    care in the community (Better Services for the
    Mentally Handicapped 1971, The Jay Report 1979,
    NHS Community Care Act 1990).
  • Development of small, short stay, well staffed
    RSUs (2000 beds) (Butler Report 1975)
  • Mentally Disordered Offenders needing care and
    treatment should receive it from health and
    social services. 1,500 RSU beds needed including
    for minority groups (Reed Report 1993/4)
  • Mansell Reports (1993, 2007) failure to develop
    services locally will give rise to out of area
    placements and result in re-institutionalisation
    through emergency admissions and diversion from
    prisons (1993). reactive models of service
    provision and commissioning has meant that the
    development of adequate local expertise and
    infrastructure has not come to fruition (2007).
  • No One Knows Prison Reform Trust report suggest
    that 20-30 of prisoners have learning
    difficulties or disabilities (7 approx have
    intellectual disabilities) that interfere with
    their ability to cope within the criminal justice

Contextual factors
  • Changing ideas around how people with learning
    disabilities offending behaviour should be
    cared for.
  • Re-negotiating the boundaries between secure
    environments prison, high, medium low secure.
  • Prison reports about learning disabled population
  • Emerging debate around the relationship between
    learning disability and secure settings,
    particularly individuals requiring long-term
    support and care.
  • Increasing acceptance that community packages can
    be provided for people with complex needs and
    risks including offending behaviour.

The Study
  • Question What are the skills, knowledge
    attitudes required by qualified learning
    disability nurses working in differing areas of
    security (high, medium low) and community
  • Definition of competence profession?

  • Qualitative approach designed to elicit the views
    of those engaged in working directly with
    offenders with learning disabilities.
  • Qualitative research is concerned with
    constructions of reality its own constructions
    and in particular those constructions it meets in
    the field or in the people it studies (Flick,
    1998 11).
  • Sources of data collection 6 focus groups 24
    subsequent individual interviews with nurses
    currently working with those whove offended or
    are considered at risk of offending.
  • Sample purposively selected from different
  • Access facilitated locally.

  • University of Chester Research Ethics Committee.
  • IRAS (Integrated Research Application System,
    formerly NRES).
  • Local Clinical Governance procedures applied and
    were variable.

Key ethical issues
  • Satisfaction of ethics committees
  • Access to varying levels of security
  • Consent
  • Anonymity / Confidentiality
  • Level of rigour the higher the level of
    security, the greater the level of protectiveness

Sample population
Registered Nurses working with people with
learning disabilities and forensic needs
  • Community community nurses in learning
    disability services, including liaison workers,
    those designated with forensic role nurses
    working with offenders.
  • 4 x Low Secure Services including 2 x NHS and 2 x
    Independent sector services.
  • 1 x NHS Medium Secure.
  • High secure Rampton.

Completed outstanding data
  • Community 2 focus groups 10 interviews
    complete / 3 interviews outstanding.
  • Low secure 2 focus groups 8 interviews
    complete / 2 interviews outstanding.
  • Medium 1 focus group 5 interviews complete.
  • High secure 1 focus group 4-6 individual
    interviews outstanding.

Data analysis Thematic analysis (following Braun
Clarke, 2006)
Thematic analysis
Thematic analysis
Emerging themes
  • Role confusion and/or articulation problems
  • Born not made (personality traits
  • Professional expertise language
  • Discrete cultures within different spheres of
  • Institutional legacy
  • Service users are changing
  • Working with others
  • Tensions

Theme 1 role confusion / articulation
  • …feel slightly more dissociated from (the) role
    and (have) started to get confused about the
    whole process C
  • we stay away from…the idea that everybody with a
    forensic background should be looked after by a
    forensic nurse, because with some of our
    clients…the forensic behaviour wasnt the most
    pressing need C
  • Oh God, Im rubbish at articulating stuff like
    that C
  • …its not cut and dried, its a really difficult
    thing to define L

Theme 2 born not made
  • Im not sure how much formal knowledge is
    there…I know this isnt something thats talked
    about very often…and is certainly frowned upon in
    nursing, but a lot of it comes down to your
    intuition as well C
  • Statements not everyone can do this job its
    not for everyone secure unit?

Theme 3 the language of expertise
  • …they (staff working in other levels of
    security) couldnt work in this field because of
    the offences some of our clients have committed
  • I think some people also feel quite out of their
    depth…theyre just so afraid, how do we manage
    them? M
  • …some of them feel they havent got the skills
    to manage them, or the knowledge M

Theme 4 discrete cultures according to level of
  • The other thing thats quite common in high
    secure services…is that you can become
    desensitised to the offending behaviour, so
    behaviour that you would normally see as not
    being normal almost becomes normal C
  • (In community nursing) its a totally different
    way of looking at things, theres a professional
    culpability there in terms of if anything goes
    wrong it falls down to me really…I do a lot more
    around defensible practice than I did in secure
    services C
  • I think the ward staff must get naffed off quite
    frankly with the community staff, I mean all bar
    two here have been seconded to do a degree C

Theme 5 the institutional legacy
  • (High secure in early90s) was so draconian in
    every way…it was just hideous C
  • I wanted to prevent people getting there, that
    was my next thing, that there should be more
    being done within the community to prevent people
    ending up in this (HS) environment C
  • …youre talking about a place where if staff
    didnt like you they undid the wheel nuts on your
    car C

Theme 6 the service users are changing
  • …there is an awful lot of our client group that
    are involved with alcohol and drugs…it makes
    things a little more chaotic…vulnerable to
    exploitation by people in the community.
  • Other quotes that reflect this.

Theme 7 working with others
  • I think its about understanding that youre
    working with a bunch of professions you have no
    understanding about C
  • Sometimes they talk a completely different
    language C
  • …you have to be able to use the appropriate
    language and also to help other people translate
    the language C

Some initial thoughts characteristics of varying
forensic environments
Initial thoughts (cont.)
Key References
  • Braun.V Clarke.V (2006) Using thematic analysis
    in psychology. Qualitative Research in
    Psychology. 3 77-101
  • Flick.U (1998) An Introduction to Qualitative
    Research. London Sage