Managing pain in prison: staff perspectives

Abstract

Purpose – The purpose of this paper is to present the findings of one part of a larger study, funded by the National Institute for Health Research, which explored the management of pain in adult male prisoners in one large category B prison in England. In this paper, the authors focus on the attitudes and perceptions of prison staff towards pain management in prison. Design/methodology/approach – A qualitative design was utilised to explore the staff perceptions of pain and pain management in one adult male prison. Questionnaires were provided for all staff with prisoner contact, and a follow up focus group was undertaken to further explore questionnaire data. Findings – The questionnaire and focus group findings demonstrated that staff had a good awareness of pain and pain management in prison, with both physical and emotional pain identified. The frequency of approaches by prisoners to staff for pain relief was noted to be high, whilst awareness of how the prison environment could potentially exacerbate pain was discussed. The acquisition of analgesia by prisoners for secondary gain was identified as a challenge to both assessing levels of pain and providing pain relief in prison, illustrating the complexity of providing care within a custodial culture. The effect on staff of caring for prisoners found to be confrontational and deceitful was significant for participants, with feelings of anger and frustration reported. Research limitations/implications – This study was undertaken in one adult male category B prison with a very high turnover of prisoners. Staff working in other types of prison, for example, higher security or those more stable with longer sentenced prisoners could provide alternative views, as may staff caring for younger offenders and women. The challenges to undertaking research in prison with staff who can understandably be reluctant to engage in reflection on their practice cannot be underestimated and impact significantly on available methodologies. Originality/value – This qualitative research is the first of its kind to offer the perspectives of both health care professionals and prison staff working with prisoners complaining of pain in an English prison. It provides the groundwork for further research and development.

Prescription of pain medication in prisons: A comparative analysis of younger and older male prisoners

“…According to the principle of equivalence of care, health care should be of the same quality in prison as in the community . Prisoners, however, live in an environment where the delivery of health care faces several challenges and the provision of equivalent care is difficult . Notably, pharmacotherapy in prisons is complicated by concerns about in‐cell accumulation, diversion, and misuse of medications .…”

Does compassion matter in custodial care?

“…The use of deceit to manipulate the system and exploit staff for more comfortable and protective prison conditions as a mean of surviving harsh prison conditions by some prisoners is not uncommon (Cornelius ; Elliott & Verdeyen ) with staff reporting feeling of anger and frustration to care for these prisoners (Walsh et al . ). It can be argued that maintaining a compassionate attitude for all prisoners irrespective of their crimes and behaviours while keeping one's personal feeling in check can be a challenging endeavour.…”

“…Walsh et al . () argued that there is an understandable reluctance on part of staff working in prison to engage in the reflection of their practice which makes interpretive research in this area a testing endeavour. The compassionate nurse attempts to recognize, acknowledge, and deal with what is behind the patient (prisoner) without compromising their professionality.…”

Non-cancer pain clinic in three English prisons: understanding prisoner needs and prescribing practice in relation to chronic non-cancer pain (CNCP)

“…Prison staff therefore and prescribers especially, may be subjected to a variety of threats and intimidation to prescribe medication against their better judgment, requiring a carefully calibrated operational and clinical response (Public Health England, 2013; Levy, 2012). Although prison staff have awareness of CNCP issues, the numbers of prisoners that approach prison officers for help in accessing pain relief has been considered problematic and a barrier for developing meaningful responses (Walsh et al ., 2014).…”