ContextofCorrectionalNursing LorrySchoenly
Correctionalnursingis“... thepracticeofnursingandthedeliveryofpatientcare withintheuniqueanddistinctiveenvironmentofthecriminaljusticesystem ... ” (ANA,2007,p.1).Thiscriminaljusticesystemincludescountyjails,stateandfederal prisons,juveniledetentioncenters,andsubstance-abusetreatmentcenters.
Correctionalnursespracticeinaspecializedenvironment,onethatdoesnot embracehealthcareasitsprimarymission.Thepatientpopulation,inmatesand detainees,isuniqueaswell.Althoughprofessionalnursingpracticeisbasedonuniversalconcepts,theapplicationofthesecareconceptsinthisspecializedenvironment tothisuniquepatientpopulationprovidestheprimarycomponentsofthenursing specialty.Anunderstandingofthecareenvironment,patientpopulationdemographics,andthecultureofcorrectionalprofessionalshelpstoframethepracticeof acorrectionalnurseandinformsthecareprovided.
Therearebothrewardsandchallengestothepracticeofcorrectionalnursing. Initialinvestigationofthecorrectionalnursingroleindicatesthatnurseresponsibilitiescanvarygreatlydependingonthesizeandtypeoffacility.Therolecan provideincreasedautonomyofpracticeandpotentialforreducedconflictwith otherhealthcareprofessionals(Flanigan&Flanigan,2001; Shelton,2009; Smith, 2005).Themajorityofjailnursesrespondingtoasurveydescribedthereactionof theirpeerswhenthenursesaidthattheyprovidedhealthcaretooffendersasmost oftenconsistingofrespect,interest,andfascination(Hardesty,Champion,&Champion,2007).Theseresearchersalsofoundthatsocializationtotheroleofcorrectional nurses(suchasarotationduringschoolorhavingamemberofthefamilywhoworks inacorrectionalfacility)andpriorworkexperienceinemergencyormentalhealth environmentscontributedtojailnursejobsatisfaction.Thevarietyofdailyactivities
TABLE1.1DailyFunctionsofCorrectional HealthCareNurses
Source:Adaptedfrom FlaniganandFlanigan(2001)
andpotentialfornovelsituationscanalsobeattractive.Table 1.1 describesthetypes ofactivitiesinwhichthenursesrespondingtothissurveywereengagedandhow oftentheyperformedeachactivity.
Correctionalnursingpracticeisachallengingnursingspecialtyforseveral reasons.Healthcareunitsinjailsandprisonsareoftenunderequippedanddonot haveappropriatespacefordeliveryofhealthcare.Thelocationofthehealthcare unitmayhavebeenanafterthoughtinfacilitiesthatwerebuiltbeforetheadvent oforganizedonsitehealthcare.Somecorrectionalfacilitieswerebuiltinisolated, rurallocations,makingitdifficulttorecruithealthcareprofessionals.Professional isolationcanbeaprobleminretainingnursesoncerecruited.Manycorrectionalfacilitiesareovercrowded,leavinglittleroomforprivacyindealingwithhealthcareconcerns.Privacyissuesarealsoincreasedbytheneedforcorrectionalofficeroversight ofthehealthcaredeliveryareasinordertomaintainsafetyofstaffandotherinmates. Someinmatesmustbeisolatedinhighersecurityunitswithrestrictedmovement, makingitnecessarytodeliverhealthcareinthehousingarea.
Theimplicationsofacaringrelationshipbetweenthecorrectionalnurseandthe inmate-patientalsocreateachallengetopractice.Correctionalnursesmustestablish atherapeuticrelationshipwithindividualsconvictedofcrimes,someofaviolent nature.Reconcilingthehumanityofthepatientinneedofhealthcarewiththecriminalbehavioroftheinmateisanimportantaspectofprovidingcare.Correctional patientshavebeendescribedas“difficult,manipulative,aggressive,anddemanding”(Flanigan&Flanigan,2001,p.75).Asignificantnumberofinmate-patients seekhealthcareservicesforsecondarygainsuchasadditionalprivileges,reduced workassignments,orspecialclothing(Paris,2006).Thiscancloudthenurse’sevaluationandtreatmentdecisions.Theincreasedautonomyofthecorrectionalnurseand theneedtosortoutdesireforsecondarygainfromtruemedicalneedrequiressolid assessmentandcriticalthinkingskills.Finally,creativepatienteducationplansare requiredduetolimitedhealthylivingoptionssuchasfreshfruitsandvegetables oradequateexercise.
Negotiatingwithotherentitiesinthecareenvironmentalsobringschallenge. Strictboundariessetbythecorrectionssystemcanprovefrustratingtonurses
desiringtoshowcompassionforpatients(Weiskopf,2005).Inthecustodyenvironment,nursesmayfeelthattheyareforbiddenfromenteringintoacaringrelationshipwithaninmate-patient(Maeve,1997; Maroney,2005).Thenoncaringattitudes ofothersintheworkenvironmentsuchassecurityofficers,otherstaffmembers, andtheinmatepopulationcaninfluencenursingattitudesovertime(Weiskopf, 2005).Somecorrectionalnursesmustbalancetheconflictingrolesofbeing employedbyanorganizationwithamissionofpublicsafetyandsecuritywhile upholdingaprofessionalmissionofhealthandwell-beingfortheinmatepopulation(ANA,2007).
Finally,theneedtobeever-vigilantaboutpersonalsecurityinapotentially unsafeenvironmentcanerodethecaringrelationshipwithpatients.Unlikemany othercareenvironments,nursesmustawaitanevaluationofthesafetyofanenvironmentbeforeenteringtoassistinemergencytreatment.Thecontinualconcernfor personalsafetywhiledeliveringcarecanchallengebasicprinciplesofcaring.Therefore,ithasbeensaidthatcorrectionalnurses“walkatightropebetweenproviding therapeutictreatmentandmaintainingasecureenvironment”(Weiskopf,2005, p.341).
EXHIBIT1.1
PrinciplesofCorrectionalNursing
† Aregisterednurse’sprimarydutyinthecorrectionssettingistorestoreand maintainthehealthofpatientsinaspiritofcompassion,concern,and professionalism.
† Eachpatient,regardlessofcircumstances,possessesintrinsicvalueand shouldbetreatedwithdignityandrespect.Eachencounterwithpatients andfamiliesshouldportrayprofessionalism,compassion,andconcern. Eachpatientshouldreceivequalitycarethatiscosteffectiveandconsistent withthelatesttreatmentparametersandclinicalguidelines.
† Patientconfidentialityandprivacyshouldbepreserved.Nursesshouldcollaboratewithotherhealthcareteammembers,correctionalstaff,andcommunitycolleaguestomeettheholisticneedsofpatients,whichinclude physical,psychosocial,andspiritualaspectsofcare.
† Nursesshouldencourageeachindividualthroughpatientandfamilyeducationtotakeresponsibilityfordiseasepreventionandhealthpromotion. Eachnursemaintainsresponsibilityformonitoringandevaluating nursingpracticenecessaryforcontinuousqualityimprovement.
† Nursingleadershipshouldpromotethehighestqualityofpatientcare throughapplicationoffairandequitablepoliciesandproceduresincollaborationwithotherhealthcareservicesteammembersandcorrectionsstaff.
† Nursingservicesshouldbeguidedbynurseadministratorswhofosterprofessionalandpersonaldevelopment.Theseresponsibleleadersaresensitive toemployeeneeds;givesupport,praise,andrecognition;andencourage continuingeducation,participationinprofessionalorganizations,andgenerationofknowledgethroughresearch.
Source: Copyright2007byAmericanNursesAssociation.Reprintedwithpermission.Allrights reserved.
Correctionalnursesmaintaintheprofessionalnatureoftheirpracticethrougha principledapproachtopatientcare.TheseANA-affirmedprinciplesfocuscorrectionalnursingpracticeonthehealthandsafetyneedsofthepatientpopulation whileprovidingacompasstonavigatethecorrectionalsystemforthemselvesas wellastheirpatients.Theessenceofcorrectionalnursingiscaringforandrespecting thehumandignityoftheincarcerated(ANA,2007).Limitedresources,challenging patients,competingsecuritypriorities,andongoingconcernforpersonalsafety canmitigateagainstprinciplednursingpractice.Afrequentreturntothecore valuesandgoalsundergirdingcorrectionalnursingpracticehelpsre-centernurses onthemeaningandimportanceoftheirrole(Exhibit1.1).
HISTORYOFCORRECTIONALNURSING
AlthoughhealthcarehasbeendeliveredintheU.S.correctionalenvironmentasearly as1797withtheopeningofNewgatePrisoninNewYorkCity(ANA,2007),theestablishmentofthecorrectionalnursingspecialtycamemuchlater.Thecorrectional settingfornursingpracticebegantoemergeintheprofessionalliteratureinthe 1970sasnursesbecameinvolvedindevelopingworkingsystemsofhealthcarein thissetting(Murtha,1975).Prisonriots,thecivilrightsmovement,andcivillitigation shedlightontheinvisibleprisonhealthcaresetting.Inaddition,healthcareforthe incarceratedreceivedalegalmandatewiththe1976SupremeCourtdecisionof Estelle vGamble.Thiscaseestablishedtheconstitutionalobligationtoprovidehealthcareto anycitizeninthecustodyofthegovernment.
Whilestillinitsinfancyincomparisontomorematurenursingspecialties,correctionalnursinghasbeenrecognizedbytheAmericanNursesAssociation(ANA) since1985,whentheTaskForceonStandardsofNursingPracticeinCorrectional FacilitiesunderthedirectionoftheExecutiveCommitteeoftheCouncilofCommunityHealthNursespublished StandardsofNursingPracticeinCorrectionalFacilities (C. Bickford,personalcommunication,July1,2011).Professionaldevelopmentofthe specialtyhasincludedcertificationthroughatleasttwomultidisciplinarygroups (AmericanCorrectionsAssociation,NationalCommissiononCorrectionalHealth Care).Mostnurseswhohaveworkedintraditionalsettingssuchasahospitalor clinicbeforeenteringcorrectionsfindthespecialtytobeunique.Othershave describeditassimilartonursingcaredeliveredinapsychiatric,military,orpublic healthclinicsetting(Flanigan&Flanigan,2001).
Nursesarethepredominanthealthcareprovidersinthecorrectionalsetting. Theyareoftenthefirsttoseeapatientinneedofserviceaswellastheonesto assurethatappropriatetreatmentisreceived.Thelimitedandfragmentednature ofhealthservicesincorrectionsrequiressolidcaredeliveryprocessesandreliable follow-through.Nursesareoftenthemanagersofcaredeliveryprocessesinthis setting.Establishingefficientandeffectivecaredeliveryinthemidstoftheconditions citedmakesthisspecialtybothchallengingandrewarding.
CAREDELIVERYENVIRONMENT
Over7.2millionpeopleareundersomeformofcorrectionalsupervisionintheUnited States(Glaze,2010).Thesizeandtypeofcorrectionalfacilityandthelevelofsecurity canaffectthetypesofhealthcareservicesdeliveredandthereforetheprovisionof
nursingcare.Generally,nursingcareisnotdeliveredinparoleandprobationsettings. Individualscompletethesesupervisedexperiencesinthecommunityandhaveaccess tocommunityorpublichealthserviceresources.Correctionalnursingtakesplacein jails,prisons,andjuveniledetentionsettings.
CorrectionalNursinginJails
Localjailsaremanagedbycountiesorcitiesandholdindividualsawaitingcourthearings,trials,orsentencing.Inaddition,individualsmayremaininthejailsettingtoserve outsentencesof12monthsorlessratherthanbeprocessedandclassifiedintoastateor federalprisonsystem(Minton,2011).Thetemporaryandtransientnatureofajailstay lendsanemergentnaturetothehealthcaredelivered;however,chronicconditions muststillbeconsideredandtreated.Drugandalcoholwithdrawalisafrequentissue andpatientswithmentalhealthconditionsmaynotbecurrentlytakingtheirmedications.Stabilizingthehealthconditionofnewlyenteringinmatesisapriority.
Rapidturnovercanresultinincompletetreatments,misseddiagnoses,and uncontainedcommunicablediseases.Itisimportantfornursesworkinginajailsetting tohavestronglinkswithlocalcommunityandpublichealthservicestoextendtreatmentpastthefacilitywalls.
CorrectionalNursinginPrisons
Prisonshouseindividualswhohavebeenconvictedofacrimewithsentencesgenerallylongerthan12months.Theextendednatureofthestayleadstohealthmanagementofamorelong-standingnaturethatcanincludemanagingchronicconditions andsurgicalprocedures.Therearetwosystemsmanagingprisonsbasedonsentencing.TheFederalBureauofPrisons (FBOP) managesaprisonsystemof102facilities housinginmatesservingsentencesrelatedtoafederalcrime(BureauofJustice,2008). ThesefacilitiesarespreadthroughouttheUnitedStatesbuthavecentralizedmanagementandsimilarstandardsofpractice.
Bycontrast,stateprisonsystemsareunderthejurisdictionofthestate’sgovernmentandpracticestandardsareconsistentthroughoutthenetworkofstatefacilities butmaydifferamongthestates.Severalstates(Delaware,RhodeIsland,Massachusetts)havecombinedjailandprisonfacilities,wherebothdetaineesandsentenced inmatesreside.
CorrectionalSecurityLevels
Inmatesarebroughtintoaprisonsystemfromjailcustodyaftersentencing.Stateand federalprisonsystemsdesignateintakefacilitieswhereincominginmatesareevaluatedandclassifiedonanumberoffactorsthatleadtoafacilityassignment.Intake facilitiesarearrangedtorapidlyevaluateanindividual’spsychological,criminological,andmedicalstatusforplacement.Nursesworkinginaprisonintakefacility developexcellentassessmentskills.
Althoughterminologycanvaryfromstatetostate,prisonsarecategorized bythedegreeofsecurityneededtomaintainthesafetyofinmates,staff,andthe public.Securityleveldesignatesthedegreeofexternalandinternalenvironmental controlsinplace,aswellasthesecuritystafftoinmateratio.Higherlevelsofsecurity requirelowerratiosandgreaterenvironmentalcontrols.
Thesecuritylevelofaprisonwilldeterminethedegreeofrestriction,particularlyonthemovementofinmatestoandfromthemedicalareaandthelevelof
custodyinvolvementinthemedicalunit.Somelargeprisoncomplexesmayhavea mixofsecuritylevelsamongbuildingswithinacommonexternalperimeter.Itis importanttoknowthesecuritylevelofafacility,asthisindicatescharacteristicsof thepatientandthenursingcareenvironment.
MinimumSecurity
Minimumorlowsecurityfacilitieshouseinmatesdesignatedaslowriskforviolence orelopement(FBOP,n.d).Minimumsecurityfacilitiesfocusonpersonalresponsibilityandinmatesmaybeinvolvedincommunityworkassignments.Minimumsecurityfacilitiesmayalsoincludeworkingfarms,machineshops,andmilitary-styleboot camps(NorthCarolinaDepartmentofCorrections,n.d.).
Healthcaremayonlybeavailablepartofthetime.Nursesworkinginthese facilitiesareinvolvedinmedicalclearanceforworkprograms.Inaddition,care activitiescanincludeevaluationandtreatmentofwork-relatedinjuries.
MediumSecurity
Inmatesdesignatedforamediumsecuritysettinghavebeendeterminedtobean escaperiskandposeathreattoothers(ExecutiveOfficeofPublicSafetyandSecurity, n.d.).Inmatesinthesefacilitieshavemoredirectsupervisionandmorerestricted movement.Mediumsecuritysettingshavemoreworkandself-improvementprojects withintheexternalsecurityperimeterandfewerpatienttransportsorcontactwith thepublic.
HealthUnitsinmediumsecurityprisonsareusuallystaffed24hoursadayand involveafullarrayofambulatoryservices.Theyaremorelikelytoincludeinfirmary careandinitiatetreatmentssuchasIVtherapyandtubefeedingsasneeded.Health careisdeliveredprimarilyinthehealthcareunit,althoughnursingstaffmustbeable todealwithemergencies(man-down)inthehousingandexerciseareas.Permanent securitystaffsareoftenassignedtothehealthcareunitsinmediumsecuritysettings andinmate-patientsareobservedatalltimes.
HighSecurity(Maximum)
Inmatesdesignatedforhighsecuritysettingshavebeendeterminedtobeaserious escapeorviolencerisk.Highsecurityprisonshaveavarietyofdescriptorsincluding penitentiary,maximum,supermax,andclosesecurity.Deathrowinmatesandthose convictedofparticularlyviolentorheinouscrimeswillbeassignedtohighsecurity prisons.Theinternalenvironmentofhighsecuritysettingsincludesagreaterdegree ofphysicalbarriersandcheckpoints.
Nursesworkinginmaximumsecurityprisonsmustdeliveragreaterpercentage ofcarecell-sideduetothesecuritynatureofthesetting.Inmatemovementislimited andsecuritystaffescortsarerequiredformovementtothehealthcareunit.Sentences aretypicallylonginmaximumsecurityprisonsandsothehealthcaretrajectorycan alsobelongerthaninothersettings.Afullarrayofhealthcareservicesisprovided includingambulatorycare,infirmarycare,andchronicdiseasemanagement.
SpecialHousing
Correctionalfacilitiesalsohavespecialhousingareasforincreasedsecuritypurposes orforvulnerableinmatepopulations.Correctionalnursesmayhaveresponsibilities forprovidingnursingcareinthesespecializedenvironments.Terminologymay
differacrosssystemsandwithinvariousregionsofthecountry.Itisimportant,therefore,tounderstandthemeaningofthevariousspecialhousingsituationswithinthe systemorfacilityofemployment.
Segregation
Thisspecializedunit,alsocalledSeg,AdministrativeSeg,ProtectiveHousing,or SecureHousingUnit(SHU),isarestrictedsecurityareawithinajailorprisonfor inmateswhocontinuetoviolatesecurityrules,threaten,orotherwiseplaceother inmatesandstaffmembersindanger.Inmatesplacedinsegregationhavetheirmovementseverelyrestricted.Healthcaremustbeprovidedinthehousingareawithan escortbycorrectionofficers.Deliveryofmedicationandtreatmentscanbechallengingandifappropriatefacilitiesandequipmentarenotavailable,nursesmaybe expectedtodeliversuchcarecell-side.Nursesmustbepreparedforthepossibility ofverbalabuseorattemptsatphysicaldisruptionsuchasspittingorthrowingof bodilyexcrement.Patientprivacyduringexaminationandhistory-takingcanbedifficult.Specialarrangementsandadditionalsecurityarerequiredwhensegregated inmatesaretransportedtothemedicalunitforevaluationortreatment.
Medical,Sheltered,orProtectiveHousing
Medical,sheltered,andprotectivehousingunitsarecreatedinlargecorrectional institutionsorsystemstoprovideaddedsafetyforinmateswithphysicalormentalimpairmentthatcouldleadtovictimizationinthegeneralinmatepopulation. Theolderinmate,adolescentssentencedasadults,andthosewithsignificantdisabilityrequireextraprotection,asdothosewithseverementalhealthissuessuchas schizophreniaorpsychoses.Medical,sheltered,andprotectivehousingunitsare oftenlocatednearthehealthcareunit.
Prerelease
Prereleasefacilitiesandhalf-wayhousesareusedtoprepareinmatesnearingtheend ofincarcerationbydevelopingindependentskillsforcommunityliving.Prerelease facilitiesgenerallyhaveminimalhealthcarestaffandfrequentlyreferinmateswith chronicorseriousacuteconditionstoanearbyhigher-levelprisonmedicalunit fortreatment.
CORRECTIONALMANAGEMENTSTRUCTUREANDHEALTHCAREDELIVERY
Correctionalhealthcareunitscanbemanagedinseveralways.Unlikehospitalsor clinicsinthecommunity,thehealthcarestaffinacorrectionalsettingmaynotreport directlytothesameleadershipasotherstaffinthefacility(Table 1.2).Havingan understandingoflinesofauthoritywithinthefacilitycanimproveeffectiveness anddecreasemessageconfusion.
GovernmentalAgencies(Self-Operated)
Themajorityofnursesworkingincorrectionsareemployedbythesamegoverning bodyastheircustodypeers.Alsocalledself-operatedorself-op,healthcaremanagers inthismanagementstructureareapartoftheorganizationalhierarchyandreporting framework.Thisorganizationalframeworkhasadvantagesinallowingforparity
TABLE1.2ManagementSystemsforCorrectionalHealthCare Units
MANAGEMENTTYPE
Source:Adaptedfrom Corizon(2011)
amongtheservicesandcanfostersupportforinmatemedicalneeds.Althoughthe wellbeingoftheinmatepopulationisacommongoalforbothcustodyand nursingstaff,professionalframeworksandguidingprinciplescandiffer.Nursesin theseorganizationsmustbevigilanttomaintainprofessionalnursingjudgmentin allmattersofcaredelivery.
IndependentHealthCareServiceCompanies
Anotherwaycorrectionalhealthcareisprovidedthroughcontractswithindependenthealthcareservicecompanies.Thesecompaniescontractwithcountyorstate governmentstodeliverneededhealthcareserviceswithincorrectionalfacilities. Nursesaremostoftenemployeesofthehealthcareservicecompanyandreportto managerswithinthecompany.Whenworkingforacompanyindependentofthecorrectionalauthority,nursesmustunderstandthecontractualrelationshipwiththe DepartmentofCorrectionsandthecommunicationandreportingstructure.Health carestaffinthissituationareguestsinthefacilityandmuststrivetodevelopcollaborativeworkingrelationshipswithcustodystaff.
StateUniversityMedicalSystems
Severalstateprisonsystemsprovidehealthcaretoinmatesthroughthestateuniversitysystem.Forexample,inConnecticut,inmatesreceivecarethroughtheUniversity ofConnecticutmedicalsystem,andinNewJersey,healthcareservicesareprovided throughthestate’sUniversityofMedicineandDentistry.Nursesworkinginthese systemshavetheadvantageofaccesstoacademicresourceswhilenursing,medical, anddentistrystudentshaveanopportunitytoexperiencethecorrectionalenvironment.Thecorollaryinjailsisforthecountyhealthdepartmenttoprovidethe healthcareatthejail.Inthiscircumstance,nurseshavetheadvantageofaccessto resourcesofthecountyhealthdepartment.Althoughhealthcarestaffarenotemployeesofthesameentityascorrectionsstaff,acommonrelationshipexistsamongthe governmentbodies.
CORRECTIONALOFFICERDEMOGRAPHICS
Theenvironmentinwhichcorrectionalnursesprovidepatientcareisshapedbythe professionalsmanagingtheprimaryserviceofsecuritywithinthefacility.Correctional officers,alsocalledCO’s,custodyofficers,orsecurityofficers,areprofessionalswith theirownperspectiveandworldviewgainedduringtrainingfortheirroleand
assimilationintotheirworkenvironment.Primaryconcernsofcorrectionalofficersare order,control,anddiscipline(Maroney,2005).Thesethemesprovideaframeworkfor thesystemsandprocessesthathelpmanagethecorrectionsenvironment.
Theworkenvironmentshapestheactionsandreactionsofcorrectionalofficers. Highlevelsofworkstress,ongoingpotentialforworkplaceviolence,andaperceived lackofpublicsupportcancreatebondsofsolidarityamongthecustodystaff(Garcia, 2008).Correctionalnursesmustsomehowbridgethissolidaritywithoutcompromisingnursingprofessionalprincipleswhencollaboratingwithcustodystafftoaccomplishcaregoals.
FromtheExperts ...
“Mutualrespectwillgoalongwaytofacilitatecollaborationwithsecuritystaff. Correctionalofficersandadministratorshaveahardjob.Correctionalnurses needtorecognizethisandrefrainfrombeingoverlycriticalorjudgmental aboutsecurityperspectivesaboutprisoners—withoutsacrificingtheirnursing perspective.Simplyput—thewords“please”and“thankyou,”professional courtesy,andconsiderationwillhelpnursescollaboratewiththeirsecurity colleagues.”
SueSmith,MSN,RN,CCHP-RN Columbus,OH
PATIENTPOPULATIONDEMOGRAPHICS
Individualsdetainedorinthecustodyofthecorrectionssystemhaveseveralterms usedasidentifiers.Individualsheldinpretrialsettingssuchascountyjailscanbe calleddetaineesorarrestees.Oncesentenced,themostcommonterminologyisoffenderorinmate.Forthepurposesofthisdiscussion,thetermsinmateorpatientwillbe usedtodesignatethepatientpopulationreceivingcorrectionalnursingcare.
TheU.S.inmatepopulationhasgrownconsiderablyoverthelastthreedecades foravarietyofreasons.Infact,theUnitedStateshasthelargestincarceratedpopulationintheworld,at2.3millioninmates.Thesecondlargestinmatepopulation, China,isfarbehindwith1.5million.Russiaisadistantthirdwithlessthanamillion behindbars.Reasonsgivenforthehigherincarcerationrateincludetoughersentencing rules,three-strikesmeasures,andreductionofmentalhealthhospitalizationoptions (The PEWCenterontheStates,2008; Torrey,Kennard,Eslinger,Lamb,&Pavle,2010).
Slightlymorethanoneinevery100Americansisbehindbars (Pew,2008).The incarceratedpopulationdoesnotmirrorgeneralpopulationstatisticsastogender, race,education,orage.Thecontrasthelpstoframethetypeofnecessaryhealth careservicesprovidedbycorrectionalnurses.
Gender
ThemajorityofincarceratedAmericansaremaleadults.TheBureauofJusticeStatisticsfor2009indicatesmaleindividualsareimprisonedatarate14timestherate forfemaleindividuals.Localjaildetaineepopulationsare,onaverage,almost88%
male(Glaze,2010).Maleinmatesaremorelikelythanfemaletobealcoholdependent (Binswangeretal.,2010).Althoughwomenmakeuponly10%ofthoseincarcerated, theirnumbersareincreasingnearlytwiceasfastasmen (Pew,2008).Strictersentencinglawsbringinagreaternumberoffemaleindividualswhowerepartofadomesticviolencedisturbanceoranaccomplicetoamale-directedcriminalactivitysuch asdrivingaboyfriendorspousetoatheftordrugdeal(Kelly,Parlaz-Dieckmann, Chang,&Collins,2010).
Femaleinmatesaremorelikelythantheirmalecounterpartstohavecustodyof theirchildrenandtohavebeenavictimofsexualabuseordomesticviolence (Belknap,2006; Kellyetal.,2010).Thehealthissuesofincarceratedwomenexpand toalsoincludereproductivehealthissues.Inaddition,womenhaveadisproportionatelyhigherrateoftreatedmentalillness(Binswangeretal.,2010)withincreasedprescriptionofpsychotropicsandtranquilizers(Belknap,2006).Thoseprovidinghealth careinfemaleinstitutionsfindahigheruseofmedicalandpsychiatricservicesthan similarlysizedmaleinstitutions(Binswangeretal.,2010; Drapalski,Youman, Stuewig,&Tangney,2009).
Race
AfricanAmericansandHispanicsaredisproportionatelyrepresentedintheU.S. inmatepopulation.AlthoughBlackAmericansmakeup12.6%ofthegeneralpopulation,theymakeup39.3%oftheincarceratedpopulation(West,Sabol,&Greenman, 2010).Whileonein106Whitemenoverage18areimprisonedinAmerica,onein15 Blackmeninthisagegrouparebehindbars (Pew,2008).Likewise,onein36Hispanic menaged18orolderareincarcerated.Hispanic/Latinosmakeup15.8%ofthejail population(Minton,2011)and21%oftheprisonpopulation(Westetal.,2010).
Disproportionatelyhighernumbersofminorityinmateswillimpactthefrequencyofcertainmedicalconditionstreatedincorrectionalsettings.Notonlyare BlackAmericansthreetimesmorelikelytohavediabetesandstroke,buttheyare 11timesmorelikelytodieofHIVdisease.Blackmenhavehigherratesofprostate, lung,stomach,andcolorectalcancers.Blackwomenaremorepronetoprenataldiseasesandcancersofthecolon,pancreas,andstomach(CDC,2005).
HealthdisparitiesintheLatinocommunityalsoimpacttheinmatepopulation. Hispanicshaveadisproportionatelyhigherdiseaseprofilewithincreaseddeathfrom stroke,chronicliverdisease,diabetes,andHIVdisease.Also,thispopulationsegment hasamuchhigherrateofcancersofthestomachandcervixthanthegeneralpopulation(CDC,2004).
Education
EducationlevelsoftheU.S.inmatepopulationarelowerthanthegeneralpopulation. Harlow(2003) reportslessthan50%ofthetotalincarceratedpopulationhaveahigh schooldiploma.Thisfigureisunder20%forthegeneralU.S.population.Inmatesare morethantwiceaslikelyasothercitizenstohavelearningdisabilities(Greenberg, Dunleavy,&Kutner,2007a).
Literacy,acomponentofeducationlevel,thatisofparticularimportancefor healtheducation,isalsobelownormallevelsintheinmatepopulation.Usingathreefactorscaleofliteracyevaluation(prose,document,quantitative),researchersfound inmates,onaverage,weremorelikelytohaveonlybasiclevelsofliteracyandbelow comparedtothegeneralpopulation.Inaddition,veryfewprisonerswereabletoread andcomprehendatthehighestlevel(Greenberg,Dunleavy,Kutner,&White,2007b).
Basicliteracyallowsinterpretationofsimpleinstructionandgraphicmaterial. Specialconsiderationshouldbegiventothereadinglevelofprintedhealthinformationprovidedtotheinmatepopulation.Inaddition,correctionalnursesneedto evaluatethepatient’sunderstandingofhealthinformationprovided. CaseExample 1.1 providesanopportunitytoapplythisinformation.
CASEEXAMPLE1.1
Nursesatalargemaximumsecurityprisonareteachingpatientsaboutsexually transmitteddiseases.Whiletheinmatesawaittheirchroniccareappointmentin theclinicholdingarea,theyaregivenwrittenmaterialfromtheCentersfor DiseaseControlwebsite.Duringthenurseportionofthechroniccarevisit,each inmateisaskediftheyreceivedthematerialandiftheyhaveanyquestions.Ifthey havenoquestions,thenursedocumentssuccessfulpatientteachingonthetopicin themedicalrecord.Describeflawsinthisprocessandsuggestimprovementsin theteachingmethod.
Age
Generallyspeaking,themajorityofinmatesinadultfacilitiesareyoungmaleindividuals.Forexample,theaverageinmateageinthefederalprisonsystemis39years (BureauofPrisons,2011).Inmatesaged20to39makeup64%ofthe1.45millionsentencedprisonersattheendof2009(BureauofJustice,2011a).Thegrowingedgesof theagecontinuum,youthandelderly,havespecifichealthneedstoconsider.
Elderly
Byallaccounts,theU.S.inmatepopulationisagingalongwiththegeneralpopulation asbabyboomersmoveintoretirementandgeriatriccare.However,duetomany factors,inmatesageearlierinlifeandelderinmatesaregrowinginnumberbehind barsduetomaximumsentencingformulasdevelopedinpriordecades(Aday,2003). Althoughthedefinitionofelderlydiffersacrosssystems,thereisgeneralagreement thatinmatesintheir50sareconsideredtobeinthiscategory(Anno,Graham,Lawrence,&Shansky,2004; Loeb&AbuDagga,2006).Elderlyinmatesusemoremedical andmentalhealthresources.Theyrequireadditionalprotectionfromabuseandpredation.Theyoftenneedprotectivehousingandassistivedevices.Bothcorrectional officersandnursesmustbevigilanttoidentifydecreasingfunctionalityandincreasingdiseaseburdeninthissegmentoftheinmatepopulation(Annoetal.,2004).
Youth
Theyouthorjuveniledesignationisgenerallygiventothoseunder18yearsofagein theU.S.prisonsystem.Themajorityofyoutharedetainedandservesentencesin residential-styledfacilitieswithanenvironmentcreatedtomeettheneedsofadolescents.Correctionalnursesworkinginjuvenilefacilitiesdealwithgrowthanddevelopmentissues,psychosocialconcerns,andparentalcustodymatters.
Agrowingnumberofyoutharegivenadultsentencesandsenttoadultfacilities toserveouttheirtime.Upwardsof25%ofjuvenileoffendersareinadultprisons. Younginmatesinadultprisonshaveincreasedratesofsuicideandprisonrape(CampaignforYouthJustice,2007).Youngoffendersareavulnerablepopulationthat
shouldhaveadditionalprotectionsfromthegeneralprisonpopulation.Itisimportantforcorrectionalnursesinadultfacilitiestoknowaboutandmonitortheyouth segmentoftheinmatepopulation.Youthnutritionalneedsandmedicalconditions areuniquetotheirseasonoflifeandshouldbeconsideredateveryhealth careencounter.
PHYSICALHEALTH
ChronicIllness
WhenageisstandardizedwiththeU.S.generalpopulation,inmatesinjailsand prisonswerefoundtohavehigherratesofdiabetes,hypertension,priormyocardial infarction,andpersistentasthma(Wilperetal.,2009).Detailsofthisdifferenceare foundinTable 1.3.Correctionalnurseshaveanopportunitytoimproveinmate healthandtherebypublichealththroughtheevaluationandtreatmentofthese chronicconditionsduringincarceration.
InfectiousDiseases
Poornutrition,substanceabuse,homelessness,lackofmedicalcare,andriskysexual behaviorsleadtoadisproportionatelyhigherratesofHIV,HepatitisC(HCV),sexuallytransmittedinfections(STIs),andtuberculosis(TB; Hammett,2006).RatesofHIV infederalandstateprisonsarenearlyfourtimesthegeneralpopulation,whileupto 35%ofinmateshavechronicHCVinfection(Goughetal.,2010).Tuberculosisinthe correctionspopulationisagrowingconcern,withreportedratesatleast3timesthat ofthegeneralpopulation(MacNeil,Lobato,&Moore,2005).STIsarealsocommonin thispatientgroup.Syphilis,chlamydia,andgonorrhearatesamongjailandprison inmatesaresurprisinglyhighcomparedtothegeneralpopulation(Table 1.4).
Awarenessoftheincreasedlikelihoodofanyparticularpatienttohaveoneor moreoftheseconditionscanleadtoearlyidentificationandtreatment.Correctional nursescanhelplimitthespreadofthesediseasesthroughpatienteducationand encouragementofrisk-reductionpractices.
MENTALHEALTH
Mentalillnessamongtheinmatepopulationisalsomorefrequentthaninthegeneral population(Table 1.5).While11%ofAmericansmeetcriteriaforamentalhealthdisorder,morethanhalfofthejailandprisonpopulationhaverecenthistoryor
TABLE1.3Age-StandardizedPrevalenceofSelectedChronicConditionsAmong AdultFederalandStatePrisoners,JailInmates,andtheNoninstitutionalizedU.S. Population
Source:Adaptedfrom Wilperetal.(2009)
symptomsofamentalhealthproblem( James&Glaze,2006).Thisalmostfivefold differenceincludessymptomsofmania,majordepression,andpsychoticdisorders.
BorderlinePersonalityDisorder(BPD)isalsooverrepresentedintheinmate population.Thismentalhealthconditionischaracterizedbypoorimpulsecontrol, self-injury,andsubstanceabusewithincreasedratesofdiagnosisinthefemalepopulation(NationalInstitutesofMentalHealth,n.d.).Studiesvarywidely;however,BPD ratesinthegeneralU.S.populationarewellbelow5%,whileestimatesinthejailand prisonpopulationvaryfrom25%to50%(Sansome&Sansome,2009).
Correctionalnursesneedtounderstandmentalillnessestoidentify,refer,and supportthepatient’streatment.Nursesmustalsounderstandtheimplicationsof mentalillnessco-morbidityinmanagingothermedicalconditions.Vigilantmonitoringfordrug–druginteractions,preventingadversereactions,andhelping patientstotolerateandmanagesideeffectsarekeyaspectsinnursingcareof thispopulation.
TraumaticBrainInjury
Traumaticbraininjury(TBI)anditseffectsarecommonintheinmatepopulation. Althoughanestimated2%ofthegeneralpopulationhassustainedaTBIwithcontinuingdisability(Langlois,Rutland-Brown,&Wald,2006)ametaanalysisof studiesintheinmatepopulationindicatesaprevalenceofover60%(Shiroma,Ferguson,&Pickelsimer,2010).Thisconditioncanbecausedbyavarietyofbrain traumassuchasassault,falls,motorvehiclecrashes,andmilitarydutyblasts (CentersforDiseaseControl,n.d.).TBIcanleadtodepression,anxiety,failedanger TABLE1.5DiagnosedMentalConditionsAmongInmatesofStateandFederal
Source:Adaptedfrom Wilperetal.(2009) TABLE1.4ComparisonofSexuallyTransmittedInfectionsAmongU.S.
managementcontrol,andsubstanceabuse.Itcanalsopredisposetoseizuredisorders,Alzheimer’s,andParkinson’sdiseases(CentersforDiseaseControl,n.d.). CorrectionalnursesmustconsidertheimpactofTBIaftermathonthefunctioning ofthepatientpopulation. CaseExample1.2 providesopportunitytoapplythis information.
CASEEXAMPLE1.2
A23-year-oldmaleisbeingmedicallyevaluatedinalargeurbanjail,detainedfordisorderlyconductatalocalbar.Theinmateisbelligerentandargumentativeduringthe assessment.Heisalargeman,wasalinebackerforhishighschoolfootballteam,and hasamilitaryhistorywithdeploymentinAfghanistan.Basedonhishistory,what primaryandsecondaryconditionsmightthenurseassessforinthispatient?
PosttraumaticStressDisorder
Anotherconditioncommonintheinmate-patientpopulationisposttraumaticstress disorder(PTSD).PTSDisananxietydisorderthatdevelopsfollowingaterrifying eventorwhenanindividualisfrequentlyplacedindangerousordeadlysituations (NIMH,2011).Inmatesenterthesystemwithavarietyofbackgroundsleadingto thiscondition,suchashighlevelsofphysicalorsexualabuseandinvolvementin violentcrime(Haugebrook,Zgoba,Maschi,Morgen,&Brown,2010).Addedto thisisthetraumaofincarcerationwithconcernsovervictimization,coercion,and assault.Militaryveteransmakeup13%ofstateand15%offederalprisonpopulations andhavehighratesofPTSDfromcombatduty(BureauofJustice,2000).Thisconditionisalsocommonamongfemaleinmatesdue,inpart,tothehighlevelofchild, domestic,andsexualabuseintheirhistory(Binswangeretal.,2010).PTSDsymptoms canaffectthenurse–patientrelationship.Triggerssuchasconfinement,perceived coercion,andloudaggressivevoicetonescancausePTSDvictimstoexperienceflashbacksandrespondtoperceivedthreatinnontypicalfashion.Anunderstandingof thisconditionanditsprevalenceinthepatientpopulationcanaidthedeliveryof nursingcareinthecorrectionssetting.
DrugandAlcoholInvolvement
Astaggering84.8%ofallU.S.inmatesaresubstanceinvolved,whetheralcoholor illegaldruguse(NationalCenteronAddictionandSubstanceAbuse,2010).Even thoseservingtimefornonsubstance-relatedoffenseshaveextremelyhighratesof dependence.Morethanhalfofthoseconvictedofviolentorpropertycrimewere alcoholinvolvedatthetimeofthecrime.Inaddition,substanceinvolvementisfrequentlyfoundtoco-occurwithmentalhealthproblems.Nearlyoneinfourinmates havebothasubstanceusedisorderandadiagnosisofmentalillness (NationalCenter onAddictionandSubstanceAbuse,2010)
Alcoholanddrugwithdrawal,therefore,isamajorconcernforcorrectional nursesworkingincorrections,particularlyjails.Regardlessofthesettingforincarceration,inmatesshouldbesupportedinthedevelopmentofalternativecoping
mechanismsbecausetheevidenceisclearthattreatingsubstanceabusereducescriminalrecidivism.
FromtheExperts
“Inthejailenvironment,nursesarechallengedtotreatindividualswhoare comingstraightfromthestreetandinmanycaseshavehadnohealthcare priortoincarceration.Theymayhavedrugoralcoholaddictionsinaddition tootherchronicillnesses.Intheprisonpopulation,thepatientshavehad theirchroniccareneedsidentifiedandatreatmentplanhasalreadybeenestablishedbythetransferringjail.Jailswouldthereforebecomparedtoanacute caresettingandprisonswouldbeconsideredmoreofalong-termcarefacility inregardstohealthcare.”
DyniBrookshire,RN,MSN,CCHP-RN Lumberton,TX
TobaccoUse
Thoseenteringthecorrectionsystemaremorelikelytosmoketobacco.Atleast one-thirdoftheprisonpopulationwassmokingatthetimeofarrest,comparedwith one-quarterofthegeneralpopulation(TheNationalCenteronAddictionandSubstanceAbuse,2010).Ofparticularnoteisthehighrateofsmokingamonginmates withothersubstanceissues.Withthecurrenttrendforcorrectionalfacilitiesto becomesmoke-free,correctionalnursesmustlookforwaystoassistinmate-patients tocopewithnicotinewithdrawal.
Suicidality
Theinmatepopulation,especiallyinjails,hasgreaterpotentialforattemptedand completedsuicidethananyotherpopulation(Hayes,2010).Althoughtheratehas droppedsignificantlysincefirsttrackedin1980(seeTable 1.6),itisstillamajor concernthatshouldbeattendedtobyallcorrectionalstaff.Correctionalnursesmust considersuicidepotentialinallinmatecontacts,butespeciallyonintake,aftersentencingorwhenat-riskforinthreatswhileincustodysuchasrape,gangactivity,orpersonalviolence(Hanson,2010).
Source:Condensedfrom BureauofJusticeStatistics(2011b), CentersforDisease Control,NationalCenterforHealthStatistics,NationalVitalStatisticsSystem(2002)
SUMMARY
Correctionalnursesworkinthechallengingenvironmentofjails,prisons,andjuveniledetentionfacilities,sometimeswithlittleresources,respect,orrecognition.The correctionalenvironmentincludingtheleveloffacilitysecurity,correctionalofficer, andadministrativestaff,andtheinmate-patients,createaframeworkfortheprovisionofnursingcare.Anunderstandingoftheuniqueneedsofthepatientpopulationandthespecificrestraintsofthecorrectionsenvironmentallownursestobe effectiveinmaximizinghealth,decreasingillness,andreducinginfection.Correctionalnurseschoosetousetheirknowledgeandskillstocareforamarginalizedcommunityofvulnerablepatientswhoareoftendifficulttocareforandcareabout.Many nursesfindthisarichandfulfillingcareerchoice.
DISCUSSIONQUESTIONS
1.Whataresomedifferencesinjailandprisonnursingbasedoninformationinthis chapter?
2.Basedonthecontextofcorrectionalnursing,whatwouldbekeyskillsand characteristicsfornursesinthisenvironment?
3.Whatchallengestocaredeliveryarefoundintheinformationinthischapter?
4.Whatarethesimilaritiesanddifferencesbetweenthepopulationatyourfacility andthestatisticsdescribingtheinmatepopulationinthischapter?
REFERENCES
Aday,R.H.(2003). Agingprisoners:CrisisinAmericancorrections.Westport,CT:Praeger. AmericanNursesAssociation(ANA).(2007). Correctionsnursing:Scope&standardsofpractice.Silver Spring,MD:Author.
Anno,B.J.,Graham,C.,Lawrence,J.E.,&Shansky,R.(2004). Addressingtheneedsofelderly,chronicallyill,andterminallyillinmates.Retrievedfromnicic.gov/Library/Files/018735.pdf
Belknap,J.(2006). Theinvisiblewoman:Gender,crime,andjustice.Belmont,CA:Wadsworth/ThompsonLearning.
Binswanger,I.A.,Merrill,J.O.,Krueger,P.M.,White,M.C.,Booth,R.E.,&Elmore,J.G.(2010). Genderdifferencesinchronicmedical,psychiatric,andsubstance-dependencedisorders amongjailinmates. AmericanJournalofPublicHealth, 100(3),476–482. BureauofJustice.(2000). Specialreport:Veteransinprisonorjail. NCJ178888.Retrievedfrom http:// bjs.ojp.usdoj.gov/content/pub/pdf/vpj.pdf
BureauofJustice.(2008). Censusofstateandfederalcorrectionalfacilities,2005.Retrievedfrom http:// bjs.ojp.usdoj.gov/content/pub/pdf/csfcf05.pdf
BureauofJustice.(2011a). Bureauofjusticestatistics:Keyfactsataglance.Retrievedfrom http://bjs. ojp.usdoj.gov/content/glance/corr2.cfm
BureauofJustice.(2011b). Deathsincustodystatisticaltables.Retrievedfrom http://bjs.ojp.usdoj. gov/content/dcrp/dcst.pdf
BureauofPrisons.(2011). Quickfactsaboutthebureauofprisons.Retrievedfrom http://www.bop. gov/news/quick.jsp CampaignforYouthJustice.(2007). Jailingjuveniles:Thedangersofincarceratingyouthinadultjailsin America.Retrievedfrom http://www.campaignforyouthjustice.org/Downloads/NationalReportsArticles/CFYJ-Jailing_Juveniles_Report_2007-11-15.pdf
CentersforDiseaseControl.(n.d.). Traumaticbraininjury:Aguideforcriminaljusticeprofessionals. Retrievedfrom http://www.tbiwashington.org/professionals/documents/Prisoner_Crim_ Justice_Prof.pdf
CentersforDiseaseControl.(2004). Morbidity&mortalityweeklyreport:Healthdisparitiesexperienced byHispanics—UnitedStates.Retrievedfrom http://www.cdc.gov/mmwr/preview/mmwrhtml/ mm5340a1.htm
CentersforDiseaseControl.(2005). Morbidity&mortalityweeklyreport:Healthdisparitiesexperienced byBlackorAfricanAmericans—UnitedStates.Retrievedfrom http://www.cdc.gov/mmwr/ preview/mmwrhtml/mm5401a1.htm
CentersforDiseaseControl.(2009). TrendsinsexuallytransmitteddiseasesintheUnitedStates:2009 Nationaldataforgonorrhea,chlamydiaandsyphilis.Retrievedfrom http://www.cdc.gov/std/ stats09/tables/trends-table.htm
CentersforDiseaseControl,NationalCenterforHealthStatistics,NationalVitalStatisticsSystem. (2002). Age-adjusteddeathratesfor72selectedcausesbyraceandsexusingyear2000standardpopulation:UnitedStates,1979–1998.UnpublishedtableNEWSTAN79-98S.RetrievedJune30, 2011,from http://www.cdc.gov/nchs/data/mortab/aadr7998s.pdf
Corizon.(2011). U.S.correctionalhealthcarespending:Marketshareanalysis.Unpublishedinternal documentusedwithpermission.
Drapalski,A.L.,Youman,K.,Stuewig,J.,&Tangney,J.(2009).Genderdifferencesinjailinmates’ symptomsofmentalillness,treatmenthistoryandtreatmentseeking. CriminalBehaviorand MentalHealth, 19,193–206.doi:10.1002/cbn.733
ExecutiveOfficeofPublicSafetyandSecurity.(n.d.). Securitylevels.RetrievedJune20,from http:// www.doc.state.nc.us/dop/custody.htm
FBOP.(n.d.). Federalbureauofprisons:Prisontypesandgeneralinformation.RetrievedJune20,2011, from http://www.bop.gov/locations/institutions/index.jsp
Flanagan,N.A.,&Flanagan,T.J.(2001).Correctionalnurses’perceptionsoftheirrole,training requirements,andprisonerhealthcareneeds. JournalofCorrectionalHealthCare, 8(1), 67–85. Garcia,R.M.(2008). Individualandinstitutionaldemographicandorganizationalclimatecorrelatesofperceiveddangeramongfederalcorrectionalofficers.Unpublisheddissertation.Retrievedfrom http:// www.ncjrs.gov/pdffiles1/nij/grants/222678.pdf
Glaze,L.(2010). Bureauofjusticestatisticsbulletin:CorrectionalpopulationsintheUnitedStates,2009. Retrievedfrom http://bjs.ojp.usdoj.gov/content/pub/pdf/cpus09.pdf
Gough,E.,Kempf,M.,Graham,L.,Manzanero,M.,Hook,E.,Bartolucci,A.etal.(2010).HIVand hepatitisBandCincidenceratesinUScorrectionalpopulationsandhighriskgroups:Asystematicreviewandmeta-analysis. BMCPublicHealth, http://www.biomedcentral.com/14712458/10/777
Greenberg,E.,Dunleavy,E.,&Kutner,M.(2007a). Literacybehindbars:Resultsfromthe2003National AssessmentofAdultLiteracyPrisonSurvey(NCES2007-473).U.S.DepartmentofEducation. Washington,DC:NationalCenterforEducationStatistics.
Greenberg,E.,Dunleavey,E.,Kutner,M.,&White,S.(2007b). Literacyprisonsurvey(NCES 2007-473). U.S.DepartmentofEducation.Washington,DC:NationalCenterforEducation Statistics.Retrievedfrom http://nces.ed.gov/pubs2007/2007473.pdf
Hammett,T.M.(2006).EpidemiologyofHIV/AIDSandotherinfectiousdiseasesincorrectional facilities.InM.Puesis(Ed.), Clinicalpracticeincorrectionalmedicine (2nded.).Chicago: Mosby/Elsivier. Hanson,A.(2010).Correctionalsuicide:Hasprogressended? JournaloftheAmericanAcademyofPsychiatryLaw, 38,6–10.
Hardesty,K.N.,Champion,D.R.,&Champion,J.E.(2007).Jailnurses:Perceptions,stigmatization, andworkingstylesincorrectionalhealthcare. JournalofCorrectionalHealthCare, 13,196–205. Harlow,C.W.(2003). Educationandcorrectionalpopulations.BureauofJusticeStatisticsSpecial ReportNCJ195670.Retrievedfrom http://www.policyalmanac.org/crime/archive/ education_prisons.pdf
Haugebrook,S.,Zgoba,K.M.,Maschi,T.,Morgen,K.,&Brown,D.(2010).Trauma,stress,health, andmentalhealthissuesamongethnicallydiverseolderadultprisoners. JournalofCorrectional HealthCare, 16(3), 220–229. Hayes,L.(2010). Nationalstudyofjailsuicide:20yearslater.Retrievedfrom http://www.ncianet.org/ suicideprevention/documents/SuicideStudy-20YearsLater.pdf James,D.J.,&Glaze,L.E.(2006). Bureauofjusticestatisticsspecialreport:Mentalhealthproblemsof prisonandjailinmates.Retrievedfrom http://www.nami.org/Content/ContentGroups/Press_ Room1/2006/Press_September_2006/DOJ_reportmental_illness_in_prison.pdf
Kelly,P.J.,Parlaz-Dieckmann,E.,Chang,A.L.,&Collins,C.(2010).Profileofwomeninacounty jail. JournalofPsychosocialNursing, 48(4),38–45.
Langlois,J.A.,Rutland-Brown,W.,&Wald,M.M.(2006).Theepidemiologyandimpactoftraumaticbraininjury:Abriefoverview. JournalofHeadTraumaRehabilitation, 21,375–378.
Loeb,S.J.,&AbuDagga,A.(2006).Health-relatedresearchonolderinmates:Anintegrativeliteraturereview. ResearchinNursingandHealth, 29,556–565.
MacNeil,J.,Lobato,M.,&Moore,M.(2005).Anunansweredhealthdisparity:Tuberculosis amongcorrectionalinmates,1993through2003. AmericanJournalofPublicHealth, 95(10), 1800–1805.
Maeve,M.K.(1997).Nursingpracticewithincarceratedwomen;Caringwithinmandatedalienation. IssuesinMentalHealthNursing, 18,495–510.
Maroney,M.K.(2005).Caringandcustody:Twofacesofthesamereality. JournalofCorrectional HealthCare, 11(1),157–169.
Minton,T.D.(2011). Jailinmatesatmid-year2010—Statisticaltables.Retrievedfrom http://bjs.ojp. usdoj.gov/content/pub/pdf/cpus09.pdf
Murtha,R.(1975).ChangeinOneCity’sSystem:Itstartedwithadirectorofnursing. American JournalofNursing, 75(3),421–422.
NationalCommissiononCorrectionalHealthCare.(2002). Thehealthstatusofsoon-to-be-released inmates:AreporttoCongress.Retrievedfrom http://www.ncchc.org/stbr/Volume1/Preface. pdf
NationalInstitutesofMentalHealth.(n.d.) Borderlinepersonalitydisorder:Symptoms.Retrievedfrom http://www.nimh.nih.gov/health/publications/borderline-personality-disorder-fact-sheet/ index.shtml
NIMH.(2011). NationalInstituteofMentalHealth:Posttraumaticstressdisorder(PTSD).Retrieved from http:// www.nimh.nih.gov /health/ topics/post-traumatic-stress-disorder-ptsd/ index. shtml
North CarolinaDepartmentofCorrections.(n.d.). Assigninginmatestoprison.Retrievedfrom http://www.doc.state.nc.us/dop/custody.htm
Paris,J.E.(2006).Interactionbetweencorrectionalstaffandhealthcareprovidersinthedeliveryof medicalcare.InM.Puisis(Ed.), Clinicalpracticeincorrectionalmedicine (2nded.).Philadelphia: MosbyElsevier.
PewCenterontheStates.(2008). Onein100:BehindbarsinAmerica2008.Retrievedfrom http:// www.pewcenteronthestates.org/uploadedFiles/One%20in%20100.pdf
Sansome,R.A.,&Sansome,L.A.(2009).Borderlinepersonalityandcriminality. Psychiatry, 6(10), 16–20.
Shelton,D.(2009).Forensicnursinginsecureenvironments. JournalofForensicNursing, 5,131–142. Shiroma,E.J.,Ferguson,P.L.,&Pickelsimer,E.E.(2010).Prevalenceoftraumaticbraininjuryinan offenderpopulation:Ameta-analysis. JournalofCorrectionalHealthCare, 16(2),147–159. Smith,S.(2005).Steppingthroughthelookingglass:Professionalautonomyincorrectionalnursing. CorrectionsToday, 67,54–70.
TheNationalCenteronAddictionandSubstanceAbuseatColumbiaUniversity.(2010). Behind barsII:SubstanceabuseandAmerica’sprisonpopulation.NewYork,NY:TheNationalCenter onAddictionandSubstanceAbuseatColumbiaUniversity.Retrievedfrom http://www. casacolumbia.org/articlefiles/575-report2010behindbars2.pdf
Torrey,E.F.,Kennard,A.D.,Eslinger,D.,Lamb,R.,&Pavle,J.(2010). Morementallyillpersonsarein jailsandprisonsthanhospitals:Asurveyofthestates.TreatmentAdvocacyCenter:National Sheriffs’Association.Retrievedfrom http://www.treatmentadvocacycenter.org/storage/ documents/final_jails_v_hospitals_study.pdf
Weiskopf,C.S.(2005).Nursesexperienceofcaringforinmate-patients. JournalofAdvancedNursing, 49,336–343.
West,H.C.,Sabol,W.J.,&Greenman,S.J.(2010). Bureauofjusticestatistics:Prisonersin2009
Retrievedfrom http://bjs.ojp.usdoj.gov/content/pub/pdf/p09.pdf
Wilper,A.P.O.,Woolhandler,S.,Boyd,J.W.,Lasser,K.E,McCormick,D.,Bor,D.H.,etal.(2009). ThehealthandhealthcareofUSprisoners:Resultsofanationwidesurvey. AmericanJournalof PublicHealth99(4),666–672.
