How do people in prison feel about opt-out hepatitis C virus testing?

The prison population is central to the campaign to eliminate hepatitis C virus as a public health threat. In the UK, this has led to the introduction of a national 'opt-out' policy, requiring people in prison to be tested for HCV unless they decline, with a target to test 75% of those admitted. However, in a representative prison estate in the East Midlands of England (20,000 prison entrants per annum) testing rates were only 13.4%. This qualitative study explains why the rates of test uptake are so far short of target. This qualitative study examines the experiences of 45 people in prison about hepatitis C virus testing in an English category C (low security) prison. The data collection method was semi-structured interviews. The data were coded and analysed according to the research questions, and interpretation of the data was aided by the use of a thematic network approach. The themes Fear, Insufficient Knowledge, Stigma, Privacy, Choice and Prison Life emerged as the principal barriers to test uptake. Test Uptake Facilitators that promoted testing were identified by participants and benefits presented of prison health care being a Health Farm. In order to increase hepatitis C virus test uptake, significant changes and flexibility in the timing, location, and staff deployed to test are required. Providing information to people in prison about hepatitis C virus transmission and treatment may reduce fears and enable the test uptake target to be met and sustained.

Prison officers' views about hepatitis C testing and treatment: a qualitative enquiry.

AIMS AND OBJECTIVES: To explore the views of prison officers in an English category B male prison about people in prison being tested and treated for hepatitis C. BACKGROUND: Hepatitis C testing and treatment in English prisons remain low with the reasons being poorly understood. Prison officers are in continuous contact with prisoners so might observe factors that may influence people in prisons' choice in whether to accept hepatitis C testing and treatment. DESIGN: A qualitative design within an interpretative framework was employed. METHODS: Semistructured interviews were conducted with 10 prison officers at an English male category B prison. The interviews were audiorecorded and transcribed at the prison. RESULTS: Four themes emerged Safeguarding, Stigma, Confidentiality and Education. Hepatitis C testing and treatment were supported in principle but if a person in prison poses a threat to the overall security of a prison, any health issues that are not immediately life threatening will be overridden, irrespective of the financial or health consequences. The prison officers respected people in prisons' confidentiality regarding health matters, but this could be compromised during violent incidents. All of the prison officers displayed limited knowledge about hepatitis C. CONCLUSIONS: This qualitative enquiry illustrates that prison security transcends health. This suggests that health providers may need to offer greater flexibility and collaboration across the network of National Health Service hospitals to maintain continuity in treatment if a prisoner is moved to a different establishment or liberated. RELEVANCE TO CLINICAL PRACTICE: This study introduces the notion that prison security staff may have a potential role in promoting or discouraging hepatitis C testing and treatment by the ways in which their knowledge impacts on their interactions with people in prison. Engaging this staff group in educational opportunities should be a component of commissioned hepatitis service delivery in prisons.

The construction of context-mechanisms-outcomes in realistic evaluation.

AIM: To discuss the construction of context-mechanisms-outcomes (CMOs) developed as part of a realistic evaluation study of two aggression management training programmes. BACKGROUND: Realistic evaluation draws on theories and methods derived from the social sciences. It provides a distinctive account of the nature of programmes and how they work. Realistic evaluation is a form of evaluation that is driven by theory, and was based by Pawson and Tilley ( 1997 ) on the philosophy of critical realism. Critical realism is an important perspective in modern philosophy and social science, but it is largely absent in the field of healthcare research. REVIEW METHODS: This paper provides a critical discussion on the construction of CMOs as part of a realistic evaluation study. DATA SOURCES: This paper draws on the personal experiences of the author in using realistic evaluation to evaluate training in aggression management. DISCUSSION: Realistic evaluation stresses four key linked concepts for explaining and understanding programmes: 'mechanism', 'context', 'outcome pattern' and 'context-mechanisms-outcomes (CMO) pattern configuration'. A CMO configuration is a proposition stating what it is about an initiative that works, for whom and in what circumstances. In this way, the effectiveness of the programme is understood, with an explanation of why the outcomes developed as they did and how the programme was able to react to underlying mechanisms and in what contexts. Therefore, a realistic evaluation researcher is not just inspecting outcomes to see if an initiative (implementation) works, but is analysing the outcomes to discover if the conjectured mechanism or context theories are confirmed. This analysis provides not only evidence of effectiveness, but also an explanation that helps to develop and improve the content and the targeting of future programmes. CONCLUSION: The development of CMOs requires a great deal of skill on the part of the researcher and requires a flexibility of approach when collecting and analysing the data and in understanding the topic being investigated. IMPLICATIONS FOR RESEARCH/PRACTICE: Applications of realistic evaluation have focused largely on evaluating initiatives in the field of social policy and, more recently, social work practice. To date, however, there have been few published realistic evaluation studies within nursing; therefore this study is novel in its use of the methodology.

Managed care: a structured approach.

The authors developed a model of clinical nurse management based on the concept of managed care. This article, which describes the model, is intended to encourage nurses to consider their role as manager and engage in activities that support good management of clinical practice. The model presents several components that need to be monitored and controlled if best care is to be achieved. Specifying these components in the form of a model allows a visual representation of practice and supports contemporary thinking about healthcare management from the perspective of the nurse in clinical practice.

Utilizing the mental health nursing workforce: A scoping review of mental health nursing clinical roles and identities.

Despite rising international needs for mental health practitioners, the mental health nursing workforce is underutilized. This is in part due to limited understandings of their roles, identities, and capabilities. This paper aimed to collate and synthesize published research on the clinical roles of mental health nurses in order to systematically clarify their professional identity and potential. We searched for eligible studies, published between 2001 and 2021, in five electronic databases. Abstracts of retrieved studies were independently screened against exclusion and inclusion criteria (primarily that studies reported on the outcomes associated with mental health nursing roles). Decisions of whether to include studies were through researcher consensus guided by the criteria. The search yielded 324 records, of which 47 were included. Retained papers primarily focused on three themes related to mental health nursing clinical roles and capabilities. Technical roles included those associated with psychotherapy, consumer safety, and diagnosis. Non-technical roles and capabilities were also described. These included emotional intelligence, advanced communication, and reduction of power differentials. Thirdly, the retained papers reported the generative contexts that influenced clinical roles. These included prolonged proximity with consumers with tensions between therapeutic and custodial roles. The results of this scoping review suggest the mental health nurses (MHNs) have a wide scope of technical skills which they employ in clinical practice. These roles are informed by a distinctive cluster of non-technical capabilities to promote the well-being of service users. They are an adaptable and underutilized component of the mental health workforce in a context of escalating unmet needs for expert mental health care.

It is time for us all to embrace person-centred language for people in prison and people who were formerly in prison.

The use of person-centred language is well accepted regarding substance use and infectious disease healthcare and research, and appropriate acronyms have become commonplace, e.g., "people who inject drugs (PWID)" has mostly replaced phrases like "injecting drugs users". However, the use of the term's 'prisoner' or 'prisoners' remains common. Although less common, terms such as 'offenders' and 'inmates' are also still used on occasion. This persists despite calls from people with lived experience of incarceration, and fellow academics, to stop using these terms. Given the considerable overlap between substance use, infectious diseases, and incarceration, in this commentary we discuss how they interact, including the stigma that is common to each. We propose that using person-centred language (i.e., people in prison or people formerly in prison) needs to become the default language used when presenting research related to people in prison or people formerly in prison. This is a much-needed step in efforts to overcome the continued stigma that people in prison face while incarcerated from prison officers and other employees, including healthcare providers. Likewise, overcoming stigma, including legalised discrimination, that follows people who were formerly in prison upon gaining their freedom is critical, as this impacts their health and related social determinants, including employment and housing.

Constructing a middle-range theory to explain the uptake of hepatitis C tests in prison.

BACKGROUND: Realist evaluation is increasingly used in healthcare research, and theories can provide plausible explanations of why interventions work or do not work in certain circumstances such as the effect of the opt-out hepatitis C virus (HCV) testing policy in English prisons. AIM: To present the process of constructing the middle-range theories (MRTs) developed as part of an evaluation of hepatitis C test uptake in an English prison as a resource for researchers using realist evaluation. DISCUSSION: MRTs are propositions that can explain a particular behaviour or outcome. In this evaluation, the MRTs emerged from a realist evaluation, a theory-driven approach for understanding what interventions work, in what circumstances and how. The mixed-methods data collected during the realist evaluation and the sociological theory of prisonisation were used to create the MRTs. Combining prisonisation with the qualitative data illustrates how healthcare interventions may be viewed by people in prison who may have adopted either the 'deprivation' or 'importation' processes of adaptation to cope with their incarceration. Their views may affect the acceptance of HCV tests. CONCLUSION: The development of MRTs is a creative and iterative process, requiring an in-depth understanding of the data collected and the subject area. MRTs permit us to see relationships among phenomena that might otherwise seem disconnected, thereby aiding the development of more efficacious interventions. IMPLICATIONS FOR PRACTICE: The MRT developed presents an evidence base for selecting interventions to increase the uptake of HCV tests in prisons. This paper explains how a MRT was developed and how HCV test uptake in prisons can be explained using a sociological theory.

Preparing for the future: nurse education and workforce development.

Nurse education needs to be responsive to changes not only within health policy but also those relating to workforce development. Viewed within this context this discussion paper highlights areas of consideration when planning for and responding to such demands.

Men's Preconception Health: A Primary Health-Care Viewpoint.

The purpose of this article is to theoretically explore men's preconception health as a mechanism to enhance fertility, as well as the health and well-being of the subject and his descendants. Premorbid risk factors and behaviors associated with stress, environmental toxins, excessive alcohol consumption, smoking, lack of exercise/obesity, and the use of illicit drugs are all known to affect fecundity. While there are many health clinics available to women, where advice in areas such as postnatal care of the newborn, family planning, and couples fertility is provided, there are few, if any, equivalent health clinics available to men. Additionally, getting men to attend primary health-care services has also been continuously problematic, even in the context of there being a clearly discernible need for treatment. It is argued in this article that an impetus is required to encourage men to focus on and improve their preconception health and to utilize primary health-care services to take action. An assertive men's preconception health outlook can positively influence the conjugal relationship, fathering, male self-esteem, and continued good health. Using the sometimes complex concept of preconception health as a motivating factor for healthy lifestyle adaptation has the potential to improve male fertility outcomes and general health and well-being, as well as the health of future generations.

Improving health care through payment by results.

Nursing faces new opportunities and challenges as part of the government's initiative to introduce Payment by Results. These opportunities arise from increasing demands to work effectively in an environment of intensive customer demand and expectation. The challenge for all nurses is to continue to deliver quality health care while keeping pace with changes to services and organisational responsiveness. It is important that nurses and other health professionals ensure that the needs of patients are not compromised in the pursuit of financial reward and that systems of work are improved as part of this initiative.

Empathy at a distance: a qualitative study on the impact of publically-displayed art on observers.

While there is some evidence in the literature on the impact of art therapy for consumers, there is comparatively little written on how art that has been created by consumers impacts on those observing the art. This paper reports on a qualitative research study that sought to determine if publically-displayed art created by young consumers impacted on stigma reduction and self-help-seeking behaviours of the observers. The findings derived from the thematic analysis of qualitative interviews suggested that publically-displayed art is a safe medium, through which empathy and understanding towards young people with mental illness can be enhanced, and that the art generates discussion and self-help behaviours for mental illness. These findings highlight how mental health nurses can promote social inclusion and reduce stigma through public mental health initiatives that are an important inclusion in the scope of mental health nursing practice.

Nurses leading care in custody suite environments: a qualitative study from Scotland.

This paper outlines the qualitative findings of a recent multimethod study exploring the impact of nurses assuming leadership roles in delivering primary health care to detainees within police custody suites in Scotland. The full multimethod study was conducted within a framework of realistic evaluation with key findings indicating that the nurse-led model of service delivery offers positive outcomes for all key stakeholders. Findings from the qualitative component of the study showed that the quality of clinical care for detainees improved, policing concerns for detainee safety were mitigated, and forensic medical examiners were able to expand their specialist roles. Key supporting mechanisms in achieving these outcomes included generating collaborative practices, enacting clinical leadership, and providing a forensic nursing educational program to empower nurses to generate service provision and grow professional autonomy.

Leadership challenges to move nurses toward collaborative individualism within a neo-corporate bureaucratic environment.

AIM: The purpose of this article was to highlight the increasing corporate style pressures being exerted upon the NHS in England and Wales and how the nursing profession needs to fundamentally change in response to this emerging environment. Through examining a range of nursing leadership responses this paper offers a way forward to meet these challenges. BACKGROUND: Given the accelerating pace of fundamental change within health service delivery the nursing profession is particularly challenged to enact not just new structures but a new, eclectic model of nursing leadership that engages nurses at the clinical interface. Without this, both individual nurses and the wider professions risks being inert within an era of profound change. CONCLUSION: The palpable incongruence between health organizations and leadership models create ineffectiveness and a paucity of self-determinism within nursing. Apparent is the wide range of leadership styles required to respond to these challenges that overtly exceed a single leadership model alone.