Title: Correctional Nursing
1Correctional Nursing
- Chia-Chen Lee, MSN, RN, FNP Nurse Manager
- Santa Clara County Custody Health Services
2Historical 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 -
3Correctional 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
4Constitutional 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
5Correctional 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
6Correctional School of Nursing
- Medication administration
- Emergency response
- Infirmary care
- Differences in nursing approach to men and women
7Correctional School of Nursing
- Vanderbilt University School of Nursing partnered
with Federal Bureau of Prisons (BOP)-graduate
course for nurse practitioners in correctional
health care
8Correctional 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
9The 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)
10Santa Clara County
11Solutions
- Increasing compliance with psychotropic
medications - Improving compliance ?relapse, ? hospital
readmission and ? criminal transgression (Dubyna
Quinn,1996)
12The 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
13Nursing 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
14Santa 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
15Research 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?
16Methodology
- 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
17Final 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
18Procedure
- 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
19Response 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
20Institutional Characteristics N 14
21Demographic Characteristics Gender, Age,
Education
22Ethnicity
23Nursing Experience N 55
24Nursing Experience as Correctional Nurse N 55
25Experience With Inmates With Mental Illness N 55
26Medication Compliance Views (N 55)Very
Important to Important
27Assessment of Medication Compliance
28Medication Compliance Nurse Behaviors N 55
29Perceived Barriers Referrals to Outside Agencies
N 55
30Barriers Providing Discharge Summaries to Outside
Psychiatrist and/or Medical Clinic
31Barriers When Providing Medications at Discharge
32Barriers When Providing Prescription Prior to
Release
33Self Care Practices N 55
34Personal Safety N 55
35Limitations
- 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
36Conclusions
- 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
37Recommendations
- 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
38A 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