In Spain, the current prison healthcare scenario differs greatly from that of past decades. Several factors such as the significant increase of the imprisoned population, substantial variations in its composition greater presence of female, foreign and elderly inmates , as well as the emergence of new communicable diseases: AIDS, HIV and thus, the resurgence of conditions which had been long gone such as tuberculosis brought to light that prison healthcare was unable to meet inmates' new needs and ensure efficiently their right to life, health and integrity.
Moreover, the Secretary General executes cooperation agreements regarding hospital and specialized care in several autonomous communities. The idea to create specific hospitals is therefore abandoned and public hospitals are expected to set up specialized spaces for the hospitalization and outpatient care of inmates owing to security reasons articles and of Reglamento Penitenciario In in our country, forty-three HCU were operational.
Furthermore, to this purpose, the HCU is provided with the necessary human, material and financial resources. Appropriate relations are therefore established between individuals, institutions, the media and the procedures used for healthcare organization to improve planning and coordination. Moreover, the achievement of both HUFA and HCU objectives and values is enhanced and the latter takes active part in incorporating the hospital's quality plan.
The result of this paper is highly relevant for professionals in general and more specifically for both extra and intra-penitentiary healthcare professionals since it provides a practical and descriptive approach of the design, planning and organization of a HCU and therefore provides information to the scientific community for studying, sharing, teaching and discussing in terms of extra-penitentiary healthcare. The knowledge on the changes that the discipline has undergone, has allowed positioning this paper's subject of study and purpose. We aim to raise awareness among healthcare professionals on the advisability of HCU in enhancing equal and safe healthcare for patients under custody.
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It also enables continuous specialized and nursing care within the circuit of care between primary care and hospitals in the extra-penitentiary scope. We expect that readers will integrate the knowledge acquired by means of this paper, in order to improve the quality of their professional activities. Last, we would like to say that the development of this Project provides, from a narrative point of view, joint reflection by means of the touch with reali and sharing knowledge and experiences between those involved, who have observed the pros and cons of nursing practice in its many aspects provision of healthcare, teaching, organization and management roles for its continuing improvement.
The issue is widely covered under Reglamento Penitenciario Prison Regulations , title IX and other references are also found in the corresponding healthcare regulations, both nationally and internationally 3,5,7, However, the result of this paper is the creation and organization of a HCU regarding all its stages of development see Table 1.
All of it highlights the need for more research, reports, studies, conferences or technical meetings on the influence and impact of these extra-penitentiary care units in hospitals, professionals, users, society and the development of healthcare quality as a whole. It is necessary to approach this issue from a more updated and contextualized point of view, both technically and practically: by ensuring evolutionary longitudinal cross sectional and transcultural studies, with a series of specific methods and research designs, adapted to the nature of their study object and to their degree of development to move forward in the administration, management, functioning and assessment of these units.
In February there were people imprisoned in Spain. Moreover we should also consider those under alternative sentences 13 , which makes Spain the fourth European country with a higher imprisoned population The vast majority were between 41 and 60 years old In fact, the imprisoned population of the Penitentiary of Madrid IV-Navalcarnero consisted of men and that of Madrid VI-Aranjuez consisted of 57 women and men The HCU is a hospital unit for the admittance of inmates derived from prisons under police custody, with any type of medical or surgical conditions, whose care cannot be provided in the infirmary of the prison itself or by means of outpatient care.
Furthermore, it is intended to ensure the active safety of the rest of admitted patients, users in general and healthcare professionals Currently, HCUs are architectonically designed with perimeter security to ensure the creation of spaces that facilitate everyday activities in hospital and meet the double need of providing a space of custody and a space to promote the rehabilitation of health. It is a protected unit whose access is restricted and whose equipment and surveillance protocols have been approved by the Directorate General of Penal Institutions.
The Unit has five double-bed rooms, one of which has been fully adapted for disabled patients and a maximum security single-bed room for those requiring isolation.
It also has an electronically centralized police control area and a visiting room. The Unit counts upon modern security systems such as several close-circuit television networks, armored doors and security barrier doors, anti-vandal materials, bars on windows, alarm sensors, etc. The Unit also counts upon healthcare resources and protocols, administrative procedures and clinical control systems for the provision of healthcare to inmates see Table 1.
For its appropriate functioning it is essential that all the hospital's personnel be involved. The main roles of those working within the HCU are the same as those developing their activities in hospitalization units. They only assume the responsibility entailed by the provision of healthcare yet with the particularity that patients admitted to this Unit are deprived of liberty and have been convicted, due to which they need the surveillance and custody of the judiciary and law enforcement bodies, who assume this competence 5, Nursery Management creates the position of HCU nursing supervisor as a critical link between Management and the personnel in the Unit, to ensure the proper functioning of all human, material and technical resources to meet the health needs of inmates by ensuring quality nursing care through protocols and evidence-based procedures.
The budgetary provision for the creation of the HCU is established by the corresponding allocation of the General State Budget at the expense of the Penitentiary Administration of the Ministry of the Interior 5, This project is launched at the end of , after the appropriate development stages and begins its activity in May If the planning and organization of any hospitalization unit for its implementation and management is already a tough challenge, that of a HCU is even more due to the special features of both the service and patients themselves.
Moreover it implies the coordination between different institutions, professionals from the penitentiary context, the police, healthcare providers, hospital staff and the interaction between different professional disciplines and technical, logistical, economical, job-related, judicial, ethical, moral, deontological, psychosocial and psychopathological factors.
Likewise, the search for information in this context and the study of a widely unknown scenario and somewhat stigmatized , both regarding intra and extra-penitentiary healthcare allows for a different approach of this healthcare reality and thus of the provision of care, both from a professional and a personal point of view.
The UCH can be a most effective mechanism to increase the levels of coexistence, respect and harmony within the hospital organization, both for patients and healthcare providers and the society as a whole.
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These units are considered supplementary to the rest of elements of the healthcare network of the Public Administration and a support element for Penal Institutions. They are included in a mixed model of comprehensive nature oriented towards the provision of healthcare, prevention, healing and rehabilitation.
Their main objective should be envisaged as that of an instrument with the intention to rehabilitate both psychophysically and psychosocially inmates by taking into account themselves as individuals and their environment 9. Therefore the health and welfare of inmates has always been an issue of special concern for the Penitentiary Administration 2, The Directorate General of Penal Institutions is in charge of ensuring the life, integrity and health of inmates according to Ley y Reglamento Penitenciarios Prison Regulations and Law Thus, the principles and criteria which allow to exercise the right to health are included in the corresponding General Health Law Ley General de Sanidad 21 and related regulations.
When inmates need to be admitted to hospital, the Penitentiary Administration counts upon HCUs within public hospitals, which ensure appropriate care with full diagnostic and therapeutic resources for patients under custody.
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The design and organization of HCUs has evolved throughout recent years due to improved concepts and the implementation of functionality principles which allows to adapt them to the objectives of specialized extra-penitentiary care of sick inmates and the custody of these patients, while ensuring the safety of providers and the rest of users HCUs ensure the intimacy of patients under custody, the confidentiality of their healthcare procedure and the surveillance and custody needs by judicial and law enforcement bodies.
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