CA Forensic Nurses Practices

1
CA Forensic Nurses Practices Views With
Inmates with Serious Mental Illness Medication
Compliance

• Phyllis M. Connolly, PhD, APRN, BC, CNS
• Professor, San Jose State University
• Chia-Chen Lee, MS, RN, FNP
• Santa Clara County Custody Facilities
• NP Crestwood

2
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)

3
Solutions

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

4
Research Questions

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

5
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

6
Final Instrument

• Survey design expert formatted the final 60
  questions in a 4 page questionnaire
• Piloted by 10 forensic nurses not part of the
  final study

7
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
• Forensic nurses RNs, NPs, CNSs
• Each nurse was supplied pre-stamped,
  pre-addressed envelope
• A follow up phone call was made 1 week after
  mailing

8
Response Data Analysis

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

9
Institutional Characteristics N 14
10
Demographic Characteristics Gender, Age,
Education N 55
11
Ethnicity N 55
12
Nursing Experience N 55
13
Nursing Experience as Forensic Nurse N 55
14
Experience With Inmates With Mental Illness N 55
15
Medication Compliance Views (N 55)Very
important to Important
16
Assessment of Medication Compliance
17
Medication Compliance Nurse Behaviors N 55
18
Perceived Barriers Referrals to Outside Agencies
N 55
19
Barriers Providing Discharge Summaries to Outside
Psychiatrist and/or Medical Clinic
20
Barriers When Providing Medications at Discharge
21
Barriers When Providing Prescription Prior to
Release
22
Self Care Practices N 55
23
Personal Safety N 55
24
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 forensic nurses
• Self-report and may not match actual practice or
  behaviors

25
Conclusions

• 55 well educated, experienced, caucasian forensic
  nurses in 14 jails prisons in CA believe that
  medication compliance is very important in
  reducing recidivism crime
• Believed that forensic 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

26
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 15 California Code of
  Regulations to include discharge plans, follow up
  care, medications or prescriptions upon release,
  visits by forensic nurses after release

27
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