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Correctional Nursing

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American Nurses Association recognized correctional nursing as a specialty profession in 1975 ... in U.S. jails published by American Medical Association 1972 ... – PowerPoint PPT presentation

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Title: 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
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