by Magnus Nødland Skogedal

"Prison is meant to be a punishment and a deterrent. But nurses are supposed to promote health within this system, and that creates a tension. I wanted to find out what nurses themselves think about this," says Professor Terje Emil Fredwall.

There are currently around 120 nurses working in Norwegian prisons. They are employed by the municipality in which a prison is located, and their everyday working life takes place inside the prison.

Fredwall works at the University of Agder’s Centre for Care Research and has recently published the book Sykepleie på bortebane – about nurses working on unfamiliar ground in Norwegian prisons. This is an area that has long been overlooked by researchers.

Fredwall has interviewed 16 nurses who work in nine different high-security prisons in Norway. They speak about good moments at work, challenging days, and their relationships with the inmates, who are their patients. Suicide, self-harm, medication use and sleep problems are some of the issues addressed in the book. Central to their work is hope.

"Hope was not something I had really planned to write much about. But hope appeared in every interview, and most often it was the nurses themselves who brought it up. They spoke about hope as an important driving force in their work, and as something they felt had crucial significance in prison, says Fredwall.

“And that’s not surprising. In an institution like a prison, which has such a potential to create hopelessness and fuel despair, it becomes especially important to have people who can reduce hopelessness and support hope. Hope is something we humans can create together. And I found that the nurses were very reflective about this," he adds.

One of the chapters in the book is about hope and what it means within the prison walls. It is co-authored with Associate Professor Åsne Knutson de Presno at the University of Agder’s Department of Health and Nursing Science. Professor Inger Beate Larsen at the Department of Psychosocial Health has also contributed to two of the chapters in the book

"Gaining insight into how these nurses practise and reflect on their profession and their role has been incredibly exciting. These nurses are not just anyone, and they are truly worthy of a book," says Knutson de Presno.

Being employed by the municipality while working in the prison means that nursing resources are tied to municipal budgets. Municipalities receive earmarked funding for prison nurses from the Norwegian Directorate of Health, but they are also expected to contribute on their own. This means that prisoners’ healthcare is affected when a municipality’s finances are poor.

Also, cuts to the correctional services over many years have resulted in fewer prison officers on duty, more time spent alone in cells, reduced services and activities, and a rise in violence and threats in prisons.

"These circumstances affect the nurses’ everyday working lives. Many of them enjoy their jobs and remain in post for a long time, but the cuts are noticeable. In some prisons, the nurses say it is impossible to provide anything other than strictly necessary healthcare with the resources they have," says Fredwall.

He hopes the book will draw more attention to the importance of nurses’ work in prisons.

"One of the nurses I interviewed didn’t understand why there wasn’t more focus on the work they do. I hope the book can shed light on and increase knowledge about the job they do, and what it means in everyday life in Norwegian prisons," says Fredwall.