Nurses play valuable role in assessing people held in police custody

Oct 4 2007

Nurses are now playing a valuable role in assessing people held in police custody, complementing the traditional role of the police doctor and improving response times, according to research published in the latest Journal of Advanced Nursing.

Researchers from the University of Wolverhampton, UK, analysed just under 9,000 calls for medical assistance from five police stations and interviewed 31 custody nurses, custody officers and Forensic Medical Examiners (FMEs).

“FMEs - specially trained family doctors - have traditionally provided on-call forensic and custodial medical services to UK police stations, in addition to their main primary care role” explains lead author Dr Patricia Bond from the Research Institute for Healthcare Sciences at the University of Wolverhampton.

“Many UK police authorities are also starting to use dedicated custody nurses as well as FMEs to ease pressure on the healthcare system.

“Our research showed that the nurses – who were specifically employed to provide on-call custody support - demonstrated faster response times and similar consultation times to the doctors. Police custody staff also found them extremely approachable when it came to providing information.

“Using nurses as part of a multi-disciplinary team is a practical response to the challenges faced by an overburdened health service and our research suggests that it has been very successful.”

The custody nursing service surveyed was designed to complement and extend the provision of on-call healthcare services to five police stations in the north of England. Six nurses were contracted to deliver care and assess patients between 6pm and 2am, working in parallel with a network of experienced FMEs, who provided round-the-clock cover.

8911 calls for medical assistance were analysed over the course of a year.

4,771 calls (54 per cent) were received in the first six months of the study period - before the dedicated custody nursing service was launched – and these were all handled by the FMEs.

These were then compared with the 4,140 calls received in the second six-month period - after the service had been launched. The nurses responded to 35 per cent of these calls, with the FMEs handling the remainder.

The researchers found that:

• Average response times were all within the contracted timescales agreed with the health professionals. Before the new service was introduced, FMEs responded to calls for medical assistance in an average of 51.3 minutes. After the new service was launched, FMEs responded in 42.7 minutes, with the nurses recording an average response time of 29.5 minutes.
• The time that professionals spent with patients was roughly the same. FMEs spent 32 minutes before the service launch and 30 minutes after the launch, while nurses spent 34 minutes.
• 91 per cent of the cases handled by the nurses were to determine if the person was fit to be detained or interviewed. Other issues included medication requests, illegal drug use assessments, Mental Health Act assessments, injuries, suicide risks and alcohol related issues.
• Nurses referred just over a third of calls to the FME. 56 per cent were because the person in custody needed medication they were not authorised to prescribe, 17 per cent were Mental Health Act assessments and five per cent were to determine if the person was fit to be interviewed.

Police officers working in the custody suites liked the fact that nurses turned up promptly, used less medical jargon and appeared more insightful, sensitive and relaxed. They also found them extremely approachable.

The FMEs had mixed views about custody nurses. They agreed they were more approachable and helpful in determining detainees' clinical needs, but they felt they were slower when it came to examinations and had less experience of custody situations.

The nurses themselves felt that they provided a holistic assessment of the detainees' needs. They realised they had to overcome a great deal of scepticism about their role, but were keen to promote inter-professional working, particularly with the police custody officers.

“Our research shows that nurses can have a very positive impact in custody situations and can, by supplementing the work of the FME, increase operational efficiency, which is very important for both the health and police services” says Dr Bond.

“Previous research by the UK Audit Commission found that most of the FMEs' workload related to non-forensic tasks. Employing nurses as part of a multi-disciplinary team seems a logical way of matching clinical need to resources more effectively so that FMEs don't need to attend routine cases.”

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