Working at the Interface of Health and the Criminal Justice System. The Lived Experiences of Liaison and Diversion Nurses. An Interpretative Phenomenological Study

Abstract

This study investigates the lived experiences of mental health and learning disability nurses who are employed to work in custodial settings as Liaison and Diversion Nurses (L&DNs). L&DNs facilitate access to health and social care services for offenders and provide timely health information to criminal justice partners aimed at improving the care of offenders along the offender pathway. Utilising an interpretative phenomenological approach (IPA), this study aims to contribute to a body of evidence by adopting an idiographic approach to exploring how L&DN experience their role. The thesis analyses the complexities related to how L&DNs operate at the interface of health and the criminal justice system. The rich descriptions give an insight into how L&DNs experience and interpret their social world. By critically analysing a range of subjective experiences, this study offers valuable evidence base informing future policy, training and service development.
National Health Service (NHS) Trust X (Pseudonym), with a Liaison and Diversion service, was targeted, and n=9 Nursing and Midwifery Council (NMC) registered nurses – n=5 (mental health) and n=4 (learning disability) – were recruited using purposive sampling techniques. Two modes of data collection were utilised, including semi-structured interviews and the submission of images outlining what it is like being a L&DN. Interview scripts were analysed using the six stages of the IPA framework, including the reading and rereading of interview scripts, creation of experiential statements, creation of personal experiential themes, repeating the process (stages 1–3) with all nine transcripts to find connections amongst participants, creation of group experiential themes, and rewriting and renaming themes. A 7th stage was created to aid the analysis of how participants used imagery to reflect each theme that emerged in the interviews. Submitted images were analysed using the framework for analysing abstract drawings, consisting of five stages: an overall analysis of each image, how the participant is presented in the image, relationships, interconnectedness, and overall tone.
Five superordinate themes emerged: ‘identity devolution’, ‘custody care paradox’, ‘restricted jurisdiction’, ‘moral distress and injury’ and ‘skills transition and support system.’ Study results indicated that the custody environment and PACE implications were foundational in perpetuating the medico-legal conflict. L&DNs suggested they had limited decision-making powers and perceived the environment prioritised legal matters over health. There was an indication that L&DNs experienced a perpetual novice status, and many suggested the role was deskilling and was not a nursing role. The L&DNs discussed how the proximity to offending behaviour triggered moral distress, leading to notable changes in worldview influencing personal lives where L&DNs disclosed they experienced hypervigilance; but wellbeing supervision was said to be limited. Analysing the experiences of L&DNs unearthed significant implications for education, policy and practice that are essential for the development of the L&DN workforce, especially in relation to skills transference and development, interprofessional working challenges and wellbeing support. A better understanding of the lived experiences of the nursing workforce has a direct coloration with improved quality of care for patients and contributes to improvements in retention rates, staff wellbeing, leading to overall job satisfaction.

Date of Award	26 Jun 2025
Original language	English
Awarding Institution	Northumbria University
Supervisor	Annessa Rebair (Supervisor) & Michelle Glascott (Supervisor)