Alison Ingelhearn reminds us that everyone, whatever they may have done, can expect compassionate care
As a student adult nurse, some three decades ago, I was asked to take the vital signs of a young man who had been brought into A&E handcuffed to a prison officer. I recall feeling uncomfortable with this, but not knowing why. Maybe it was because he didn’t quite fit my picture of what a patient was supposed to be.
Until this point, the patients I had seen had been frail, older people, children or cheerful post-operative Geordies with a generous supply of Murray mints in the bedside locker. It wasn’t for me or anyone else in the A&E team to know why he was in prison, but our curiosity was piqued. Today, I reflect back on this particular man and ask myself — did I withhold warmth and kindness because I could not suspend my judgement of him as someone who had done something bad?
In 2006, following a career break, I returned to practice as a forensic mental health nurse. This was a move which profoundly changed my nursing practice, values and beliefs. Forensic nurses are concerned with the care of people who are in contact with the criminal justice system. This can be at any point — at the police station, or court, on prison healthcare wings, secure wards and also in special hospitals for those rare people whose mental health difficulties may be linked to their offending behaviour.
Forensic healthcare is most commonly associated with mental health care. However, many other kinds of care can be provided in a forensic setting. If we think of end-of-life care, typically we think of hospices rather than prisons. Compassionate and skilled nursing practice is also needed in prison.
Conversations around compassionate care tend to centre on vulnerable people. The view among some sections of the public seems to be that people who have committed crimes — such as murder, rape and infanticide — are not vulnerable, but culpable, pernicious and so in some way, less deserving of compassion.
How do we nurse those who have done terrible things? In a profound way, it is vital to accept that feelings of revulsion about what this person has done are normal and human. Recognising these difficult feelings in oneself is a first step.
In forensic healthcare, nurses are expected to undertake regular peer reflective practice — in some settings this may be weekly. Peer reflective practice helps the team express what is happening and also seek strategies to manage their approach to the individual. It is important to bear in mind that prisoners have their story. Although the public view may differ, prisoners are often vulnerable in unseen ways. Additionally, we take our own life experiences, values and emotions and transfer them into the nursing situation, often unconsciously.
Knowing and understanding yourself as a whole — as I did back in 1985 — is a key attribute. It is key not only for specialist forensic nurses, but for anyone who offers nursing care to people in the criminal justice system.
As humans, we have a tendency to see people as deserving or undeserving of our kindness. It’s easier and more comfortable to stick to this black and white thinking.
The reality for nurses is that we can’t avoid — consciously or unconsciously — caring with kindness for people who may have done ‘bad things’. The Code of Conduct does not offer exemption on this point. We care for everyone or no one.
Alison Inglehearn is primary care mental health liaison nurse at Leeds and York Partnership Foundation Trust.
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