Correctional Nursing

1
Correctional Nursing

• Chia-Chen Lee, MSN, RN, FNP Nurse Manager
• Santa Clara County Custody Health Services

2
Historical Overview

• American Nurses Association recognized
  correctional nursing as a specialty profession in
  1975
• ANA published Scope of Nursing Practice in
  correctional Facilities in 1985
• ANA states that nurses practicing in correctional
  facilities have a minimum of BS degree

3
Correctional Medicine
Moving from Isolation toward professional
identity (1975-2005) Pioneering survey of medical
care in U.S. jails published by American Medical
Association 1972 National Commission on
Correctional Health Care (NCCHC) 1981 Society of
Correctional Physicians (SCP) founded 1993
4
Constitutional Rights of Inmates

• Federal courts to improve conditions
• A) Lack of inmate access to medical services
• B) Poor follow-up care of recognized health
  needs
• C) Insufficient staff and funding to provide
  adequate care
• D) Preventable negative outcomes of care,
  including death or permanent injury

5
Correctional School of Nursing

• Idaho nine-weeks correctional nursing certificate
  program
• Understanding inmate behavior
• Managing narcotics
• Self-defense
• Responding to riot/hostage situations
• Conducting sick call

6
Correctional School of Nursing

• Medication administration
• Emergency response
• Infirmary care
• Differences in nursing approach to men and women

7
Correctional School of Nursing

• Vanderbilt University School of Nursing partnered
  with Federal Bureau of Prisons (BOP)-graduate
  course for nurse practitioners in correctional
  health care

8
Correctional Staff and Health Care

• Collaboration between health care and security
  staff
• Balancing institutional movement rules and inmate
  access to services
• Working with security to send inmate/patient
  off-site
• Inmate turnover and the episodic approach to
  health services

9
The Problem

• Estimated 283,800 mentally ill inmates is US
  (Sniffen, 1999)
• 547,800 mentally ill offenders on probation every
  year (Sniffen, 1999)
• Non compliance with psychiatric medications most
  significant predictor of arrest (McFarland, 1989)
• 1/3 discharged from psychiatric hospitals lose
  contact with services within a year (Barr, 2000)
• Costs California, 40,000,000 annually (MIOCRG,
  2002)

10
Santa Clara County
11
Solutions

• Increasing compliance with psychotropic
  medications
• Improving compliance ?relapse, ? hospital
  readmission and ? criminal transgression (Dubyna
  Quinn,1996)

12
The Role of Nurses

• Health screening and physical examinations
• Assessment and treatment of health complaints
  (sick call)
• Triage and treatment of urgent complaints
• Medication administration
• Health education and counseling

13
Nursing Role and Correctional Facilities

• A) Lone provider versus health care team
  member
• B) Clinical assessment and use of nursing
  protocols
• C) Professional autonomy
• D) Risk and rewards of correctional nursing

14
Santa Clara County Custody Health Services

• Valley Medical Center
• Elmwood-daily average population/20052981
• Main Jail-daily average
• population/2005 1503
• Mental Health (8A) daily average population
• 30 approx 800-900 OPD-ELM and MJ
• Juvenile Facilities-average daily population
• 350-400 minors

15
Research Questions

• What do correctional nurses believe about
  medication compliance?
• What information do correctional nurses collect
  during their assessment of inmates medication
  compliance?
• What barriers do correctional nurses identify
  related to medication compliance after inmates
  are released?
• What are the self care behaviors?
• Do they have concerns for their safety?

16
Methodology

• Exploratory mail survey
• Questionnaire developed based on literature
  review and Scope and Standards of Forensic
  Nursing Practice (IAFN ANA, 1997)
• Experts utilized to develop and pilot tool
• Human Subjects Protected by meeting IRB
  requirements, SJSU
• 31 jails or prisons with population over 500 in
  CA were targeted

17
Final Instrument

• Survey design expert formatted the final 60
  questions in a four page questionnaire
• Piloted by 10 correctional nurses not part of the
  final study

18
Procedure

• Phone call made to medical directors/or directors
  of nursing stratified nonrandom sample of 31 CA
  jails or prisons with populations over 500
• 3 facilities could not obtain administrative
  approval
• Surveys were mailed to 28 sites in CA
• nurses RNs, NPs, CNSs
• Each nurse was supplied pre-stamped,
  pre-addressed envelope
• A follow up phone call was made 1 week after
  mailing

19
Response Data Analysis

• 14 facilities participated (50)
• 55 nurses returned questionnaires
• Question 50 asked for the exact number of nurses
  based on self-report there were 86 potential
  participants
• 64 response (55/86)
• SPSS was used to compute frequencies and
  percentages

20
Institutional Characteristics N 14
21
Demographic Characteristics Gender, Age,
Education
22
Ethnicity
23
Nursing Experience N 55
24
Nursing Experience as Correctional Nurse N 55
25
Experience With Inmates With Mental Illness N 55
26
Medication Compliance Views (N 55)Very
Important to Important
27
Assessment of Medication Compliance
28
Medication Compliance Nurse Behaviors N 55
29
Perceived Barriers Referrals to Outside Agencies
N 55
30
Barriers Providing Discharge Summaries to Outside
Psychiatrist and/or Medical Clinic
31
Barriers When Providing Medications at Discharge
32
Barriers When Providing Prescription Prior to
Release
33
Self Care Practices N 55
34
Personal Safety N 55
35
Limitations

• Nonrandom sample
• Survey tool lacked established reliability
  validity
• Study population in California only
• Participants well educated experienced and may
  not be representative of all correctional nurses
• Self-report and may not match actual practice or
  behaviors

36
Conclusions

• 55 well educated, experienced, caucasian nurses
  in 14 jails prisons in CA believe that
  medication compliance is very important in
  reducing recidivism crime
• Believed that correctional nurses had the most
  influence over inmates medication compliance
• Believed that the therapeutic relationship was
  very important to medication compliance
• Identified many barriers to medication compliance
  after release
• 58 were concerned about their personal safety
• Self care behaviors are not engaged in frequently
• 94 believed that debriefing services were
  important

37
Recommendations

• Repeat study with larger random sample in
  multiple states
• Maintain high percentage of baccalaureate and
  advanced practice nurses employed in jails and
  prisons
• Increase self care practices
• Increase ethnic diversity of nurses
• CA specific recommendations
• Add regulation to Title 17 California Code of
  Regulations to include discharge plans, follow up
  care, medications or prescriptions upon release,
  visits by correctional nurses after release

38
A Vision

• Mandating discharge medications and ensuring
  follow up treatment, along with well-educated,
  experienced, compassionate, and dedicated
  forensic nurses practicing in CA jails and
  prisons may lower rates of crime, recidivism and
  reduce costs. Furthermore, ex-inmates with
  serious mental illness may have an opportunity
  for improved quality of life and increased tenure
  in the community