When Prison is an End-of-Life Sentence: Hospice in Corrections

Correctional nurses provide end-of-life care in this video documentary by Edgar Barens filmed in Iowa State Penitentiary

Terminal illness is an increasing possibility as inmate’s age and remains in custody. This can be a time of great sorrow, loneliness, suspicion, pain, and suffering for prisoners. They may have great fear of dying alone, in pain and without support. Every correctional facility will inevitably have an inmate who is diagnosed with a terminal condition. Are you prepared to provide the care needed for a good death in your facility?

There are several reasons why an inmate may live out their final days behind bars. It may be unsafe to release the inmate, even in their physically weakened state. Depending on community resources, it may be more appropriate to provide care in the correctional facility. In addition, the inmate may actually desire to remain at the facility because they have a support system or family close by.

People with life-limiting or terminal illnesses suffer not only from the illness itself but from loss of function, diminished control of their body, and loneliness as others around them go on with life. A prisoner suffers these losses but also experiences the loss of family, the freedom to determine their surroundings and schedule, as well as their individuality. The losses associated with incarceration magnify the suffering of an inmate patient with life-limiting illness.

According to the National Hospice and Palliative Care Organization, 75 prisons and jails in 41 states have a form of hospice program available to dying inmates. When the first programs started in prisons there were no standards for delivery of hospice services in correctional settings. Many programs now involve fellow inmates in peer-support roles that benefit both the dying inmate and the care provider.  Correctional nurses have an opportunity to profoundly affect the outcome of terminal illness and assist inmates to have a ‘good death’ even while incarcerated.

Do you have a hospice program at your facility? How do you manage dying inmates?


Even Minimal Exercise is Important


Even Minimal Exercise is ImportantEven small amounts of regular physical activity can have big benefits for your patients, according to research recently published in the Lancet.  That means correctional nurses should be encouraging physical activity for all inmate-patients, and especially those with chronic conditions such as cardiovascular disease. The astounding news is that even 15 minutes a day of low-level activity 6 days a week can ‘reduce all-cause mortality by 14%, cancer mortality by 10%, and mortality from cardiovascular disease by 20%.” (pg 1202). Holy smoke, that is good news for our patients in confinement or with exercise-limiting disability!

A big factor in starting and increasing physical activity among patients is simple and repeated advice to do so. Correctional nurses are the health care professionals most likely to be in contact with inmates. Be sure you have a game plan that includes regular reminders to exercise. Scope out possible exercise venues in your facility and encourage patients to use them. If permitted, consider creating a simple exercise plan sheet to provide to interested patients. Even those in Ad Seg, Special Housing, or other restricted locations can find a way to do low-level physical activity daily for 15 minutes.

If your facility encourages group activities, you may want to try organizing a group exercise program. If you get something like this going, be sure to videotape it and get it posted on YouTube! Here is a video done by inmates at Cebu Provincial Detention and Rehabilitation Center (CPDRC), a maximum security prison in the Philippines.


Photo Credit: © Anton Vakhlachev – Fotolia.com

FEATURED VIDEO: Maracopa County Jail Correctional Nursing

This is a great video describing jail health services. Maracopa is a large jail that serves the Phoenix, AZ community. You may remember that Sheriff Joe Arpario is in charge here. Information on their medical services from their website indicate the depth of health services provided. The Medical Services Section is located at the Lower Buckeye Jail, and is licensed by the State of Arizona. It is comprised of a 60 bed inmate infirmary, a fully staffed Medical Clinic, and a 268 bed Psychiatric Unit. Detention and Medical personnel work closely to provide optimum care for all of the inmates housed within the Infirmary and Psychiatric unit. The main objective of these units is to provide progressive treatment to both the mentally and physically handicapped inmates within the Maricopa County Jail system. Continual efforts are made to treat and stabilize these inmates so that they may again be housed in the jail’s general population, when feasible, and eventually be reintegrated into the community upon release.

Featured Video: Jail Tattoos

I’m not sure why someone would want to know how to make a jail tattoo….except maybe some of our inmate patients, I guess. However, correctional nurses need to know that these procedures go on in jail and prison cells all over the country. The process is crude and the instruments are often unclean. That means plenty of potential for infection and the passing of blood born pathogens like Hepatitis C. Read my blog post on what nurses need to know about prison tattoos and watch this short video for more particulars (sorry about the short advertisement at the beginning).

Sexual Abuse Behind Bars: Serving Incarcerated Victims

SAFEta Victim Centered Care Series

View Archive Webinar until October 29, 2011

Webinar Details:

Since the 2003 passage of the Prison Rape Elimination Act, the issue of sexual abuse behind bars has gained attention among many corrections and government officials, and some community-based victim advocates and medical professionals.  However, too often victims of sexual abuse in detention still face extreme barriers in receiving proper medical, crisis intervention, and mental health services.  This webinar will address the unique dynamics of sexual abuse in detention and how medical professionals, victim advocates and community-based Sexual Assault Response Teams can address the unique needs of incarcerated victims.  The webinar will include information about the prevalence of sexual abuse in both adult and juvenile facilities, barriers to victims’ recovery, best practices for providing crisis intervention and counseling to victims, and the importance of prison-based SARTs.

This webinar was originally presented at 2:00 p.m., Eastern, Thursday, July 28, 2011.  If you are viewing the archive of this webinar, and would like a certificate of completion once you have viewed the event, please go to the on line Evaluation at THIS LINK and complete the survey.   You can then send an email to:  info@safeta.org for a copy of your certificate to be emailed to you.

Presenter Information:

Linda McFarlane is the Deputy Executive Director at Just Dentention International (JDI)

Handouts for the Webinar: Power point handout

PowerPoint Slides

DOJ Standards for Community Providers.

Hope for Survivors Who are Incarcerated.

*NOTE: there are no nursing CEU’s offered for the SAFEta webinars. However,after completing an evaluation of the webinar, you are able to receive a certificate of attendance for attending the event. Contact kimday@iafn.org for help with this option.

Featured Video: Mental Health Jail Diversion Program

Michigan has implemented a mental health jail diversion program geared toward getting those individuals with nonviolent misdemeanor charges diverted to treatment programs rather than incarceration. They have teamed up with an unlikely partner, Easter Seals, to create the program. Not only is treatment enhanced for the mentally ill but nuisance calls to the police are reduced and resources can be shifted to crime prevention. Jails now have more mentally ill than hospitals according to a 2010 study by the National Sheriff’s Association. This program is a promising option if there are enough treatment beds available.

Featured Video: Correctional Nursing in Washington State

This is a short video with some examples of correctional nursing practice in a prison setting. The speaker, Dana Outtersetter, RN, is a nurse manager at this facility. She says nurses are apprehensive about working in corrections because of what is shown on TV. This is so true. The sensationalization of the prison experience by shows like Lock-up, Oz and Prison Break distort the actual situation and cause undue fear.

Videos like this and others posted by various corrections entities help to demystify the correctional nursing experience. What ideas do you have to get the word out about the important work done by correctional nurses?

Featured Video: Hospice Nursing at Iowa State Penitentiary

This video clip is from a documentary being filmed by my friend Edgar Barens. Hospice nursing in correctional facilities is a compassionate field of nursing made visible and given voice by this work. Consider supporting this fine work.


Prison Terminal: They’re Warriors from Edgar Barens on Vimeo.

Do you work in a hospice setting or know someone who does? Tell us your story.