Evidenced based practice ctd
The Prisons and Probation Ombudsman investigate prison deaths, provide information to family, and identifies areas for improvement.
- In 2008 it identified the need for a highly skilled workforce
- In 2009 the Royal College of Nursing (RCN) Prison Nurses Forum stated that low levels of staffing and inadequate equipment can make it difficult for nurses to appropriately deal with inmates’ health needs.
- It has been suggested that greater investment is required in offender health care, staff and equipment (RCN 2009).
- The Complex health care needs of the prison society require nurses to have many public health skills, understand psychological therapies to help reduce reoffecdning, and learn about the custodial/security issues that can affect care
- Many nurses who provide such care do not receive enough recognition. This can be demoralizing, lead to high turnover rate, and affect staff retention and recruitment.
- Improved practice can be encouraged through conferences, publications, and sharing new knowledge.
Correctional Nurse working in Jail
General challenges of prison nursing
- Difficulty in knowing whether prisoner is manipulating nurse or whether they have a true health concern because prisoners will try to obtain medications on a false pretext.
- Contradictory feelings about being a caregiver and a correctional officer
- Many times correctional nurses provide healthcare that is beyond their professional competence. For example, a general RN will deal with acute mental illnesses and a mental health RN will provide physical assessments and treatment
Evidenced Based Practice ctd.
Risk Factors
- Alcohol and drug withdrawal
- High numbers of inmates with poor health and social exclusion
- Prisoners tend to have poorer physical, mental and social health than the general population.
- Many prisoners have had little or no regular contact with health services before entering prison
- Prison takes away autonomy and may inhibit or damage self-esteem
- High risk lifestyles
- Depression
- Vulnerable people
- Size of the prison population
Healthcare needs of the inmate population: Substance Abuse
- Substance abuse has been linked in inmate with mental health problems and those with communicable diseases
- 90% of all prisoners have a diagnosable mental health problem, substance misuse problem or both
- A study of 7563 patients and found a prevalence of alcohol abuse/dependence of 18-30% among male prisoners and of 10-24% among female prisoners and of substance abuse/ dependence of 10-48% among male prisoners and of 30-60% among female prisoners
- 56%of state inmates and 50 % of federal inmates reported drug use in the month prior to incarceration
Healthcare needs of the inmate population: Other Factors
Healthcare needs of the inmate population: Mental Health
- Prison population will disregard their health because they are in the prison setting and are constrained by the prison regime.
- New prisoners may have limited access to information about prison routines,
- Overcrowding and lack of basic commodities such as ‘fresh air’ when they can only go out for limited periods of time.
- Prisoners identified the following factors as affecting their health: threatening behaviors by other prisoners, poor cell conditions, physical violence and racism.
- Outside factors: concerns about their home and families, financial difficulties or not being able to seeing family members or properly grieve for the death of family member.
- As can be noted, the inmate population is at risk for and endure a wide range of issues that can impair health
What do forensic nurses need to know?
- Estimated that at midyear 2005, more than half of all prison and jail inmates had a mental health problem.
- 50 % of prison and jail inmates reported symptoms that met the criteria for mania, 25 % reported symptoms of major depression, and 20 % reported symptoms that met the criteria of a psychotic disorder
- Only 1 in 3 state prisoners and 1 in 6 jail inmates with a mental health problem received treatment since admission
- 3/4 of prison and local jail inmates who had a mental health problem also met the criteria for substance dependence.
Socioeconomic Factors
- Overcrowding
- Ethnic diversity, language, and religion
- Disability (intellectual or developmental)
- Poverty
- Poor hygiene or nutrition
- Chaotic, unstructured lifestyle
- Poor educational attainments
- Few assets or social capital
- History of past abuse
- Poor family capacity, parenting and supportive relationships
Cultural Implications of problems faced in relation to inmates in forensic nursing
- Inmates often come from a cultural background that does not emphasize reading, writing, or education. It is estimated that around one in ten of the prison population has a learning disability, while the reading skills of up to half of all offenders are equivalent to those of a child aged 11 years or younger (Perry et al., 2010, p. 38).
- Patient information must be available in different languages and nurses need adequate training in learning disabilities and cultural awareness
- Professionals may experience problems communicating about health care with black and minority ethnic people, particularly if the information given to patients is not supplied in different languages (HMCIP 2009). Using other offenders to assist with translation raises concerns about patient confidentiality and accuracy (Perry et al., 2010, p. 38).
- Forensic nurses need to understand evidence collection, like forensic photography, for legal and civil proceedings
- They are the "bridge between the criminal justice system and the health care system."
- Skills of the forensic nurse include:
- Documentation
- Observation
- Preservation and collection of evidence
- Educate and counsel victims of violent or sexual assault
These skills are all critical in determining the legal outcome of violent crimes.
- In order to improve health care in the prisons, nurses and forensic nurses need to be supported, to feel appreciated, and have access to the resources they require.
- This entails appropriating funding for medical equipment, medication, and medical supplies.
- This also entails proper nutrition, which is necessary for immune function, wound healing, and decrease the risk of delayed recovery, ulcers, disease, and mortality.
- (Leach & Goodwin, 2013, p. 51)
Nursing Problems Encountered with Inmates in Forensic Nursing
Evidence Based Practice
The study: Nursing in prisons: developing the specialty of offender health care, examines evidence based practice, professional standards, and policies in prisons to evaluate and improve offender health care. They found several pertinent points:
- Patient care in the prisons needs to be individualized. Due to growing rates of prisoners and overcrowding, this adds a burden to the nurse who is already working in a stressful environment.
- Patients entering the prison system are generally at a poorer health status than the general public. This means their healthcare needs, both primary and secondary, are very extensive.
Preventative Nursing Interventions
Cultural Implications of problems faced in relation to inmates in forensic nursing
Never see a patient by yourself: a nurse usually works in conjunction with another nurse, which is helpful for both safety and support. Prison officers are present when a nurse sees a patient. This can lower the risk of injuries, clear up altercations, and prevent and “he said she said” scenarios.
- Eye contact
- Eye contact can mean various things in different cultures. For example, in the US, eye contact is important; it conveys respect and that one is paying attention. Lack of eye contact could indicate fear or that someone is lying.
- In other cultures, eye contact is perceived differently. For example, in Mexican and some Middle Eastern cultures, direct eye contact is considered rude, immodest, or even dangerous.
- These cultural implications are important to take into consideration as the forensic nurse, because finding out the truth of what occurred and getting an accurate history is crucial in functioning as a successful forensic nurse.
What is Forensic Nursing?
Always show respect to your patients.
Respect establishes a good rapport with patients and helps build trust. Forensic nurses in the prisons are often faced with problems such as assessing a rape victim or a an assault victim. Inmates are more likely to truthfully disclose if they feel that their health care provider believes them and will follow through.
- Forensic nursing is one of the newest specialty areas recognized by the ANA (gained specialty recognition in 1995).
- The largest subspecialty of forensic nursing is sexual assault, closely followed by death investigation, forensic psychiatric nursing and medical-legal consulting.
- It is the application of nursing science to public or legal proceedings.
- Responsibilities include:
collecting evidence from perpetrators and survivors of violent crime
testifying in court as a fact witness (someone who saw a situation firsthand)
Testifying in court as an expert witness (someone who offers an opinion on a particular situation).
What is the role of correctional nurses?
Collaboration with other HCPs:
- Respiratory therapists
- Asthma educators
- Diabetes educators
- Dentists
- Physical and occupational therapy
- HIV/AIDS, STI education to prevent, help cope and reduce the risk of transmission.
- Nutritionists
- Correctional nurses have a great deal of autonomy: they usually work under standing orders. They provide acute and chronic assessments, dispense medications, manage acute illness and injuries, manage chronic illnesses, perform health screenings, and educate inmates on many different health related topics.
- The prison population is unique as nurses see a huge age range. Depending on the type of prison, they can also see the same patients for many years.
- Correctional facilities are a reflection of our society: the health problems of inmates mirror the health problems in the community. Much of the incarcerated population is aging and has a wide range of health issues that need to be addressed while serving their sentence.
Levels of prevention
Collaboration with other healthcare providers: with the physician
Tertiary:
- chronic care clinic and chronic disease management
- medication administration
- nursing sick call
- Treatment of mentally disordered patients who are deemed to be dangerous or violent, or to have criminal propensities
- Post-trauma counseling
- First aid
- Post-op care
- Pain management
- Referals
- Correctional nurses work under standing orders from a doctor. Many have advanced degrees as well. Working under standing orders enables them to:
- Administer antibiotics to treat infections and abscesses
- Use medications to help pt’s who are withdrawing or detoxing
- Wound care
“Often by the time the doctor gets to see a patient, he is well on the way to recovery”
(Manchester, 2009, p. 20)
Adriana Sabella, Eteciana O’Rourke, Pedro Carrasco
References
Why is forensic nursing important in the correctional setting?
Collaborate with psychiatrists and mental health counselors
Levels of prevention
American Forensic Nurses, AMRN (2010). FAQ. Retrieved from: http://amrn.com/faq.html
Jackson, J. (2011, November). The evolving role of the forensic nurse. American Nurse Today. 6(11), 42-43.
Leach B, Goodwin S (2014) Preventing malnutrition in prison. Nursing Standard. 28, 20, 50-56.
Manchester, A. (2009, November). Prison Nursing Extends Skills in a Primary Health Setting. Kai Tiaki Nursing New Zealand. 15(8), 20-22.
Norman, A., & Parrish, A. (1999). Professional practice. Prison nursing: improving the quality and range of service. British Journal Of Community Nursing, 4(7), 328-331.
Perry J et al (2010) Nursing in prisons: developing the specialty of offender health care. Nursing Standard. 24 (39), 35-40.
Peternelj-Taylor, C., & Panosky, D. (2013). Advancing Forensic Correctional Nursing. Journal Of Forensic Nursing, 9(1), 1-2. doi:10.1097/JFN.0b013e3182867083
- Many inmates suffer from psychological or psychiatric problems, such as anxiety or depression, bipolar disorder, conduct disorder, and PTSD.
- A large number also suffer from drug and alcohol dependency.
- Dual diagnosis is defined as drug abuse along with other psychiatric conditions.
- Secondary:
- intake screening
- Health screening
- Provide sexual assault examinations
- Infectious disease testing
- Infection control
What is the importance of forensic nursing?
- Forensic nurses investigate patient and staff injuries—obviously, there is an increased likelihood of violent incidents in prisons.
- Forensic nurses protect the wellbeing of both staff and inmates. Questions that are asked after a violent incident could be:
- Was the correctional officer or prison guard within their rights to restrain the inmate?
- Was there an abuse of power and unnecessary or unwarranted force used?
- How extensive are the injuries of the inmate or guard who was injured?
- Are there signs of sexual trauma?
Healthcare needs of the inmate population: HIV/AIDS
- All nurses are trained to observe patient’s physical and mental status and document these observations appropriately.
- The forensic nurse has the unique position of being a qualified medical professional trained to observe, recognize, collect and appropriately document evidence.
- This information ultimately becomes the foundation to establishing the legal causation and responsibility for traumatic injury.
- Up to 31 % of people living with HIV/AIDS in the United States pass through the U.S. correctional system each year
- Up to half of these persons are not aware of their HIV status
- At end of 2005 it was reported that a total of 20,888 state inmates (1.8 %) and 1,592 federal inmates (1.0 %) were diagnosed with HIV infection or had confirmed AIDS.
- African Americans accounted for 53% of known prison HIV/AIDS cases and Hispanic/Latinos accounted for 25 %of known prison HIV/AIDS cases in 2004
Healthcare needs of the inmate population
Levels of prevention
General challenges of prison nursing
- Prisoners have diverse and complex health needs.
- Prison populations have poorer physical, mental and social health than the general population
- Three principal health issues: mental health, communicable diseases and substance abuse
- Primary:
- Supervision
- Inmate education and prevention programs
- Risk assessments (prevention of prison rapes)
- Prevention of pregnancy for female inmates
- Reduction of violent events
- Prevention of harm
- Prevention of suicide
- Counseling
- Physical exams
- Staff education
- immunizations
- Providing care to terminally ill patients in prisons is a time-consuming, resource intensive, and exhaustive task as is caring for offenders who engage in self-harming behavior. These offer challenges and frustrations not usually encountered in traditional healthcare settings because usually the staff members are not adequately trained to deal with these situations.
- Personal safety in which the stigma that prisoners will harm the nurse is high
- Deficiency in skills and knowledge to care for pregnant women in prisons
- Deficiency in skills in mental health and learning disabilities in prisoners
- Deficiency in providing culturally competent care for ethnic minority prisoners