The aim of this paper is to describe the development of a nurse led interprofessional workshop specifically for the prison setting from the understanding of dementia by prison, health and social care professionals and prisoners, to enable a prison-wide approach to support prisoners with dementia.
The world’s prison population is aging. Older prisoners are the fastest growing group in prisons across the UK, Australia and the United States of America (House of Commons, 2018; Australian Bureau of Statistics, 2017; Bureau of Justice Statistics, 2016). The health and social care needs of older prisoners are complex as they develop long term conditions, such as dementia, at an earlier age than expected (Sharupski et al. 2018). Factors that contribute to the poor health of prisoners include: unhealthy lifestyles and poor engagement with healthcare, low educational attainment, higher rates of a mental health illness and traumatic brain injuries, alongside poor nutrition and lack of exercise in the prison setting (Maschi et al. 2012).
Aging prisoners with dementia present unique challenges in the prison setting. An important element is recognising and supporting rather than reprimanding prisoner’s behaviours that are beyond their control. However, prison staff report a lack of education and training to develop their skills to identify and support prisoners with dementia (Dillon et al. 2018). Traditionally, training of staff has focused on self-harm and suicide, with a limited focus on dementia (Masters et al. 2016; Bedard et al. 2016). Dementia education has only occurred within specific initiatives such as the Special Needs Program for Inmate-Patients with Dementia (Hodel and Sanchez, 2012).
There remains a need for a system-wide approach of dementia education within prison settings. This approach requires the development of a relevant and specific nurse led interprofessional dementia education workshop. This paper presents the development of a prison specific dementia education workshop for prison, health and social care professionals and prisoners.
Methods:
A three phase prospective development of an education dementia workshop in a category C male prison in the South of England, UK. Phase 1 and 2 involved understanding staff and prisoners knowledge of dementia, barriers and current initiatives to support prisoners with dementia. Phase 3 involved the development and implementation of a two hour nurse led interprofessional dementia education workshop from information gained from phase 1 and 2.
Results:
Phase 1: The Dementia Knowledge Assessment Scale (Annear et al. 2017), which consists of four domains of causes and characteristics, risk factors and health promotion, communication and behaviour, and care considerations, the sum total score of correct answers is 50. This scale was completed by healthcare professionals (n=13), substance misuse counsellors (n=5), offenders management unit officers (n=7) and senior managers within the prison (n=8). Total mean scores were: healthcare professionals 23.62, substance misuse counsellors 25.80, offenders management unit officers 16.15, and senior managers 19.75. The results demonstrate a basic understanding of dementia across the four domains measured.
Phase 2: Open ended questions regarding barriers and initiatives to support prisoners with dementia were completed by health and social care professionals (n=20), prisoners (n=76), and prison officers (n=15). Staff and prisoners identified four barriers: 1) bullying by other prisoners, 2) the prison regime, with extended periods of time behind locked doors, 3) the physical environment of the prison with stairs, slopes, and the high level of noise, 4) lack of communication between prison staff and health and social care professionals. Current prison initiatives identified included: prisoners trained to provide social care and groups for prisoners over the age of 50 within the gym, education, and a group called ‘diversity’ which involved activities and a social environment.
Phase 3: A two hour dementia education workshop was developed from the understanding and misunderstandings of dementia by staff and prisoners across the four domains identified in the Dementia Knowledge Assessment Scale. Barriers and initiatives were included and comprehensively addressed. The workshop is interactive with the inclusion of videos, handouts and group activities, and has been delivered to groups of healthcare professions (n=3), prisoners (n=5), senior managers (n=1), and offenders management unit officers (n=1). The workshop has developed through this process with minor amendments to adapt to all the needs of those supporting prisoners with dementia.
Conclusion:
A two hour dementia education workshop has been developed from the knowledge of prison, health and social care professionals and prisoners to provide an understanding of dementia and how to support prisoners with dementia in the closed environment of a prison. The two hour dementia workshop was received well by all staff and prisoners who fully engaged in the process with informed discussions, which challenged any misconceptions. A limitation of the workshop is the development and implementation in only one prison in the UK, this is to be addressed and the workshop to be implemented and evaluated in another two prisons in the UK.