Analysis of Prison Health and Palliative Care Studies

The assignment involves analyzing a set of studies related to prison health and palliative care. It begins with an introduction to the topic, including relevant statistics on prisoners' age and health issues. The document then presents a series of journal articles and books that explore various aspects of prison healthcare, such as end-of-life care, palliative care, and moral distress among healthcare professionals. A screening process is described, which involves evaluating studies based on their eligibility for inclusion in the analysis. Finally, the document concludes by providing an overview of the included studies, with a focus on those that will be used in a quantitative synthesis (meta-analysis).

Any Nursing Research Topic

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
Reflection of an area of nursing practice that requires improvement.........................................1
In depth the relevance of end of life care at justice health to a practice priority .......................2
Use of EBP for effective clinical decision making ....................................................................5
Literature search strategy ...........................................................................................................7
Comparison and contrast ...............................................................................................................10
CONCLUSION..............................................................................................................................11
REFERENCES..............................................................................................................................12

INTRODUCTION
End of life care is a nursing practice in which caution is provided to those people who are
on edge of dying and cannot be saved. It is very important to provide effective and better care
services to people so that their living standard can be enhanced. Many individuals specially old
aged people in jail suffer from severe diseases and incidents in their life, thus it is necessary for
the care professionals to provide high quality health services to improve outcome. In some cases,
palliative care is given to them in which acute pain is relieved. In recent times palliative care
practices are performed by professionals (Hadler and Rosa, 2018). The motive behind is to
ensure safe care services to terminally ill patients. This report will reflect on palliative care
practices and process of providing it. Assignment will include area of nursing at justice health
which needs improvement. It will also show how evidence based practice can help in making
better clinical decision
End of life care should be taken as priority issue for the country. Significant changes are
required to be made in the Australian prisons in order to ensure that growing population of
elderly prisoners have access to palliative care. Statistics shows that 2 out of 10 old aged
prisoners have died because of not receiving adequate treatment. More than 36% of the
individuals suffer from various chronic diseases.
Reflection of an area of nursing practice that requires improvement
EOC is provided to people who are suffering from severe diseases. But in recent times
there are many issues that are being faced by nurses in their practices. The major issue related to
health care professionals of justice health is related to management and effective decision
making. Moreover, issues are faced regarding use of EBP tool in providing palliative care to old
aged patients who are living in prison. Due to this managing practices in end of life care is
creating difficulties in providing care. (End of life experiences. 2016). It is the core responsibility
of health care provider to cure person, so that individuals in prison can live rest of their life
peacefully. There should be proper management in nursing through which EOC is practised.
There are many practices that are followed in nursing.

End of life care is given to those people whose condition have become critical and
incurable because of the disease. It is also provided to those individuals who face difficulties in
living a better life (Coast, 2014). Due to this they suffer from mixed feelings of committing
suicide. It has been said that palliative care has emerged in priority nursing practice which
requires improvement. The area in which this practice is followed is related to relive from pain
(The End of Life Framework. 2016). Furthermore, it requires improvements because there are
limited guidelines, policies to monitor effectiveness of patient care. Palliative care is provided by
health workers who are responsible for maintaining daily routine of patient. There are certain
standards in this which is followed. With this it is easy to determine requirement of resources
(Wegleitner, Heimerl and Kellehear, 2015). Practices involved in End of Life care are as
follows:-
 Palliative approach- It states that how life interventions are becoming less effective and
focus is on reducing suffering. Professionals adopts the use of approach which help in
determining needs of patients and families. The perspective of this approach consists of
death, bereavement, etc. are essential part of life.
 Palliative care- It aims at improving life of people by giving them relief from suffering
(Freudenberg and Heller, 2016). These practices are a systematic process of providing
palliative care. In this treatment of patient includes physical, psychological and spiritual
issues.
 Complementary care- This is provided for self-help and supporting patients and
families through volunteer care and therapies like massage.
The above practices are followed by professionals in palliative care. It will be useful in
fulfilling needs of patients and enhancing quality of life. Alongside this, if issues are solved by
using EBP tool it will be easy for health professional to take effective decisions. Also, efficiency
of nursing practice will enhance resulting in giving positive outcomes.
In depth the relevance of end of life care at justice health to a practice priority
Palliative care focuses on comforting old aged patients in jail to relieve them from pain.
At global level, different process is followed in nursing practice. Proactive palliative care is

cerebral ischemia which is given to person after cardiac arrest. Along with this, national level
efforts should be made to create policies (Bossaert Perkins, Askitopoulou, Raffay, Greif,
Haywood, Mentzelopoulos, Nolan, Van de Voorde, Xanthos and Georgiou, 2015). This will
be useful in determining requirements and making it priority.
Palliative care is a practice that is globally followed in nursing. Basically psychiatrists are
involved in this as they are able to analyse mental stability of person. It is care service that is
usually provided to old age people. It is the duty of government to lay down some rules to
enhance end of life care (National Palliative Care Standards. 2018). Moreover, international
agencies are involved in promoting palliative care at global level for the patients who are
suffering in prisons. Developing guidelines at global level create a base on providing end of life
care. The people of African culture suffers a lot in EOC. It is because of inappropriate
guidelines. Apart from this, there is no proper process of providing palliative care to them (Katz
and Johnson, 2016). Thus, this reason has enforced in making changes in nursing practices.
End of life care is associated with illness such as cancer. Due to this many old aged
people behind the bar dies every year. Hospitals provide episodic care to reduce the chanced of
death from cancer. In a study it was found that almost 40% average people die due to cancer.
Therefore, government palliative care has become practice priority which requires alterations at
global level. Policy and guidelines are developed that has focused on listening patients (Denzin
and Giardina, 2018). Development of policies has led to decline in death of people from cancer
in Australia. This is a global issue in which health professionals are focused on developing
nursing practices.
Research shows that end of life care can be complicated specially behind the bars. Nurses
at justice health needs an improvement in decision making process and managing tasks while
treating old aged patients who lives in prison. It is often seen that often service users behind the
bars remain untreated. It can be because of negative attitude of nurses towards the prisoners.
Health-care professionals at justice health provides end of life care to old aged prisoners
by including multidisciplinary team in it. This includes workforce like psychiatrists,
psychologist, physicians, nurses, dietician and many more. Dietician keeps a check on the meal

taken by elderly citizens. They encourage them to go for healthy diet. They not only provide
supplements in diet but also analyse that kitchen was stocked with hospice patients preferred
food. Nurses at justice health is also involved in providing spiritual and psychological
counselling to assist patients in coping up with the prospect of death and dying. They also
identify their needs and wants in order to give them better care.
Illustration 1: Prison facts and statistics
(Source: Prison facts and statistics, 2016 )

Use of EBP for effective clinical decision making
EBP is a clinical practice that is followed in providing care services to patients by taking
effective decisions. It was introduced in 1992 which was spread to all health professionals and in
educational field. EBP is based on three principles which is applied while taking decision
(Palliative and End of Life Care. 2014). It has been observed that EBP helps in identifying the
needs of people so that effective care can be provided. With this it becomes easy for nurses to
take proper decision to derive positive health outcome of the old aged patients living behind the
bars (Steptoe, Deaton and Stone, 2015). EBP is an integration of clinical expertise, values, etc.
that helps in delivering effective care services. It also highlights the need to gain knowledge
from experience. By this wider group of people can be approached. It is stated that end of life
Illustration 2: Prisoners age
(Source: Australian institute of criminology, 2018)

and palliative care requires multidisciplinary team for decision making, thus evidence generated
will be valid. This gives blueprint to enhance quality of care. EBP has enabled in taking effective
decision in palliative care. Care professionals at justice health are taking effective decisions that
has improved nursing practices.
End of life care is generally given to patients who has suffered loss, grief, depression,
etc. It helps in overcoming certain situation so that person can live a better life (Ferrell, Malloy
and Virani, 2015). Care is given by discussing with families so that holistic needs of patient can
be addressed. Palliative care is provided by a specially-trained team of doctors, nurses and other
specialists who work together with a patient's doctors to provide an extra support. With this
curative treatment can be provided alongside. In addition, general practitioners and residential
care facilities experience a unique set of challenges which reduce their capacity to provide
optimal care at end of life. The inception of the Regional Palliative Care teams, significant
milestones have been achieved in providing a coordinated approach to palliative care for rural
and remote patients at global level (Statewide strategy for end of life care. 2015). In EBP there
are five steps that is followed. These are as follows:-
 Ask a question- It relates to the information related to prevention, diagnosis, therapy, etc.
in end of life care.
 Find information/evidence to answer question- Here, information is collected to answer
the question which comprise patient centred information. It helps in taking decisions
accordingly.
 Critically appraise the information/evidence- in this the information is evaluated to
analyse validity of info, impact of practice followed, its applicability, etc. in nursing
practice.
 Integrate appraised evidence with own clinical expertise and patient's preferences- The
above results are integrated in nursing practice according to patient’s needs which differ
according to circumstances, values and unique biology.

 Evaluate- in this it is evaluated that whether the above practices can be applied or
implemented in nursing practice or not.
Training and education is provided to deal with end of life care. Discussions must be take
place between professionals and patients that will help in providing guidance in EBP (Whitehead
Herbertson, Hamric, Epstein and Fisher, 2015).
Clinical question
In order to design a clinical question a formula is used. It helps in describing all elements
through which question is framed. For this PICO method is used that is as follows
Abbreviation Description
P It refers to population that is taken in formulating clinical
question. Here, the population taken is old age prisoners.
I It refers to the measures that are taken. In this intervention
taken is EBP
C The comparison will be done without involving EBP
O The final outcome obtained from this will be effective
decision making in providing end of life care to prisoners.
Thus, the question framed from this is what is the role of EBP in effective decision taking
in providing end of life care to old age prisoners?
The old age prisoners are taken because palliative care is usually provided to them. EBP
is taken in intervention because it will help in making effective decision by evaluating all key
concerns of End of Life care. With the help of this method it is easy to analyse in depth
information to improve health outcome for end of life care across the globe.

Literature search strategy
There are many synonyms that are used to analyse data and information for this given
topic. It helped in collecting data in effective manner. The strategies used are as follows: -
Keywords- In this specific keywords were EBP, palliative care, end of life, prison, aged people,
prison, justice health.
Inclusive – In order to select specific research article related to topic, certain things were
considered. First of the topic was included, then background of study was studied at global level.
Exclusive – There were some things that were excluded while selecting research articles. The
abstract, research and introduction was excluded during research. Also, there were some
keywords which were excluded from the search like young people, health-care professionals,
nurses.

Prisma flow chart
Iden
tifica
tion Records identified through
database searching
(n = 100 )
Additional records identified
through other sources
(n = 10 )
Records after duplicates removed
(n = 50 )
Records excluded
(n = 35 )
Full-text articles assessed
for eligibility
(n = 5 )
Scree
ning
Full-text articles excluded,
with reasons
(n = 15 )
Records screened
(n = 50 )
Inclu
ded
Eligibi
lity
Studies included in
quantitative synthesis
(meta-analysis)
(n = 5 )

Comparison and contrast
A research was conducted by Lionel 2018 with aim of assessing number and
characteristics of prisoners requiring palliative care in French prisons. Method used was PARME
study. From results it was identified that estimated annual prevalence of ill prisoners that
required end of life care was 15.2 per 10000. 441 out of 44 of them were eligible for permanent
release and 33 out of 44 requested suspension.
Another research was conducted by Maschi, 2014 to identify elements of end-of-life
services in prison, and what factors create barrier to implementation. Secondary method was
used to collect data in which inductive and deductive analysis was done. The results obtained
was elements of practices are multi-disciplinary teams, staff training, etc. Obstacles identified
were mistrust between staff and prisoners, safety concerns, etc.
The aim of research done by Rachel 2016 is to determine the current state of science and
suggest implications for nursing practice. The method used was PRISMA. Results obtained were
care was provided by staff. There is insufficient data to characterize the patients needs and the
quality of end of life care they provide.
Turner 2018 research was conducted with aim to improve quality of end of life care for
prisoners. Participatory method was used in which interview were taken. It was concluded there
is double burden due to increase in age and infirmity.
In research done by Turner and Marian 2016 it was identified that most people in prison
are above age of 50. there are several issues due to which older prisoners has increased. Also,
there are practical and emotional challenges faced by staff in providing end of life care in prison.
By comparing above research it is said that research done by (Lionel 2018) gave brief
results about what ill prisoners are given EOL according to their characteristics. It also evaluated
that sick prisoner require more care was twice high as based on age and sex. Also, research done
by (Maschi, 2014) gives brief overview of elements and factors in providing EOL in prison.
With this improvements can be made in removing barriers.

CONCLUSION
From this report it is concluded that EOL care should be provided to people at global
level. Proper guidelines need to be developed at global level for implementing in nursing
practice. It will create a great impact on improving end of life care of old age prisoners at justice
health. Moreover, the process in palliative care needs to be improved to implemented in nursing
practice worldwide. The EBP process is successful in taking proper decisions. Through this end
of life care is delivered in easy way. At last PICO method is used to frame a clinical based
question in which all elements related to prisoners health are considered.

REFERENCES
Books and journals
Almgren, G., 2017. Health care politics, policy, and services: a social justice analysis. Springer
publishing company.
Bossaert, L.L., Perkins, G.D., Askitopoulou, H., Raffay, V.I., Greif, R., Haywood, K.L.,
Mentzelopoulos, S.D., Nolan, J.P., Van de Voorde, P., Xanthos, T.T. and Georgiou, M.,
2015. European Resuscitation Council Guidelines for Resuscitation 2015: Section 11. The
ethics of resuscitation and end-of-life decisions. Resuscitation, 95, pp.302-311.
Coast, J., 2014. Strategies for the economic evaluation of end-of-life care: making a case for the
capability approach. Expert review of pharmacoeconomics & outcomes research, 14(4),
pp.473-482.
Denzin, N.K. and Giardina, M.D., 2018. Introduction. In Qualitative Inquiry in the Public
Sphere (pp. 9-22). Routledge.
Ferrell, B., Malloy, P. and Virani, R., 2015. The end of life nursing education nursing consortium
project. Annals of palliative medicine, 4(2), pp.61-69.
Freudenberg, N. and Heller, D., 2016. A review of opportunities to improve the health of people
involved in the criminal justice system in the United States. Annual review of public
health, 37, pp.313-333.
Hadler, R.A. and Rosa, W.E., 2018. Distributive Justice: An Ethical Priority in Global Palliative
Care. Journal of pain and symptom management, 55(4), pp.1237-1240.
Katz, R.S. and Johnson, T.A. eds., 2016. When professionals weep: Emotional and
countertransference responses in palliative and end-of-life care. Routledge.
Morse, J.M., 2016. Qualitative health research: Creating a new discipline. Routledge.
Steptoe, A., Deaton, A. and Stone, A.A., 2015. Subjective wellbeing, health, and ageing. The
Lancet, 385(9968), pp.640-648.

Wegleitner, K., Heimerl, K. and Kellehear, A. eds., 2015. Compassionate communities: case
studies from Britain and Europe. Routledge.
Whitehead, P.B., Herbertson, R.K., Hamric, A.B., Epstein, E.G. and Fisher, J.M., 2015. Moral
distress among healthcare professionals: Report of an institution‐wide survey. Journal of
Nursing Scholarship, 47(2), pp.117-125.
Journals
Lionel, P. 2018 Prevalence and characteristics of prisoners requiring end-of-life care: A
prospective national survey Journal of National institute of health, pp. 6-16
Maschi, T. 2014 Palliative and end-of-life care in prisons: a content analysis of the literature.
Journal of Palliative Medicine, vol.32 (1) 6-16
Rachel, K 2016 End of life care behind bars: A systematic review . Journal of Palliative
Medicine, vol.116 (3) 25-36
Turner, M. 2018. Ageing and dying in the contemporary neoliberal prison system: Exploring the
‘double burden’ for older prisoners Journal of Social Science & Medicine, pp. 161-167
Turner, M. and Marian P., 2016. Palliative Care in UK Prisons: Practical and Emotional
Challenges for Staff and Fellow Prisoners. Journal of Correctional Health Care, pp. 57-65