Nina Turner, a senior respiratory nurse, and Helen Jefford, a specialist physiotherapist in chronic obstructive pulmonary disease (COPD), developed the first prison pulmonary rehabilitation course whilst working for Oxleas NHS Foundation Trust.
With fitness instructors at HMP Maidstone Vaughan Hill, Ian Watson, Shane Donnelly and Grant Dyer, Nina and Helen developed an educational and exercise programme to improve the fitness levels and the self-management of prisoners with COPD. Canterbury Christ Church University helped with the data analysis.
Nina and Helen addressed major health inequalities in the prison. For example, there was no screening programme for COPD and no access to pulmonary rehabilitation. Approximately 90% of prisoners at Maidstone smoked. Nina screened 276 patients with spirometry and picked up many undiagnosed patients. The consequences were detrimental to quality of life and a significant financial burden to the NHS. The cost per A&E visit from a prison is £1,139.57 due to technicalities involved with moving prisoners.
“We felt empathetic towards patients not receiving a service and whose lives have a huge amount of restrictions in place. Integrated working with experienced prison staff and other healthcare professionals was key to making this project work,” said Nina, adding, “Collaborative working and evidence-based guidelines meant the course ran smoothly and effectively and a second group was able to attend following the first successful pilot.”
The work addressed the 6Cs as the care involved meant that the patient was at the centre of the service, which led to an improvement in the quality of their lives. All the patients who needed this evidence-based programme of care had immediate access to it.
Reflecting on the programme, Nina said: “Without each other to drive the programme forward it would not have delivered the results that it did. Our work has improved prison healthcare and proved this service can be provided. All prisoners are entitled to the same access to healthcare as other people outside prisons. Our work addressed a major health inequality within the management of COPD patients.”
Wilf Bardsley, Director of Nursing at Oxleas NHS Foundation Trust, said: “Nina only qualified three years before setting this project up but worked tirelessly with others to ensure that the prisoners in her care have access to screening, diagnosis and a pulmonary rehabilitation programme. All of these are steps towards improving the care of prisoners with chronic lung disease.”
Marie Batey, Head of Acute and Older People at NHS England, added: “We were struck by a number of factors in this account of care. Firstly, compassion towards a potentially marginalized group was clearly demonstrated here. Secondly, Nina and Helen have shown tremendous confidence and insight to develop a new approach and see it through. Their work is inclusive, encouraging, commendable, and is all about delivering care at the point of need”.
Nina and Helen are now making a ‘how to’ pack for any enthusiastic prison nurses wanting to set up pulmonary rehabilitation.
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