The impact of systemic over regulation on nurse mental health well being in a prison hospital

Nursing Care delivered to patients in a prison hospital is delivered in the context of shared responsibility for the patient with custodial officers. The custodians carry responsibility for the day-to-day movement and activity of the patients. Nurses collaborate with the custodians to organise access to their patients. This access is largely determined by the prison routines, which are maintained as a priority, to facilitate the ends of security maintenance through predictability and resource allocation. Purpose: The purpose of this study is to examine whether nursing behaviour takes on the over regulated nature of the prison system, and whether this manifests as a form of impaired well being reflected in elevated scores for nurses on the Maslach Burnout scale, a scale commonly used to measure occupational stress in the nursing literature. Method: As part of an ethnographic study in the prison hospital, nursing culture was sampled through participant observation in which extensive field notes were made, audio-recorded interviews focussed on episodes of care, and the collection of cultural artefacts. The material was analysed in the light of the question of whether over regulation of practice is an issue in this unique context of care. Participants also completed the Maslach Burnout scale. Results: A discussion of the impact of prison routine on nursing practice is presented with examples from the observations of care, sampled artefacts, and the predominant nursing discourse manifested in the interviews. Maslach Burnout scores for the sample are discussed in terms of reflected nurse mental health well being, and compared to scores published from other contexts of practice. Conclusions: The results are discussed through the lens of Chaos Theory. Implications for the model of nursing practice in a prison hospital are discussed