“You know my name, not my story. You’ve heard what I’ve done, but not what I’ve been through.”
― Jonathan Anthony Burkett
Prisoners have got to be the most misunderstood people-group in the country. Yes, many of them have done terrible, even evil, things; leaving a trail of hurting victims and families. Yet, a large portion of our patients are incarcerated due, in part, to the family they were born into, the environment they grew up in, and the poor decisions they made along the way. This is not to say that justice is not served by doing time for criminal activities. This is, instead, to say that, as nurses, we need to have some understanding of our patient’s stories and what they have been through in order to be effective in our practice in the criminal justice system. Indeed, we also need to know the harsh reality of their living conditions behind bars.
A Bleak Background
Incarcerated patients are more likely to come from disadvantaged backgrounds with less education and employable skills. They have high rates of learning disabilities that affect understanding of prison rules and health information.
Those from low socioeconomic backgrounds are likely to have grown up and currently live in neighborhoods with high unemployment and high crime rates. Gangs can be prevalent with great pressure to participate in gang activity.
They are more likely to have been abused in the past by parents or spouses. This means higher rates of traumatic brain injury and post-traumatic stress disorder.
Our patients are less likely to have regular health care and more likely to be drug, alcohol, and tobacco involved. The consequences of years of health neglect and abuse result in most inmates having a biological age older than their chronological ages. In fact, many experts consider the incarcerated patient to be 10 years older than their chronologic age when it comes to the ravages of age and illness.
Poor living conditions and lack of attention to or understanding of personal health habits leads to higher rates of infection. More infectious disease, especially HIV, Hepatitis C, sexually transmitted disease, and tuberculosis are found in this patient population.
Many have undiagnosed or untreated mental illness such as depression, mania, and psychotic disorders. Mental illness can contribute to criminality. Borderline personality disorders that lead to poor impulse control, self-injury, and aggression are often present.
What this means for nursing care: Our patients come into the criminal justice system in great need of health care. The symptoms of their health conditions may not emerge until drugs and alcohol are cleared from their system. Mental illness is exacerbated by security practices such as control and isolation. Our patients may not understand what we generally consider simple health information. The stress of incarceration may overload mental circuits and lead to aggressive or self-harming activities.
Harsh Living Conditions
The criminal justice system was built on a foundation of punishment for crimes against individuals and society. While rehabilitation is also a criminal justice concept, it falls far behind punishment as a part of most correctional cultures. Power and control are evident in many of the facilities in which nurses work. Although there is great variability among systems, here are some common ways a punishment culture works out in the lives of our patients.
- Prisoners are stripped of most of their personal property and much of their identity; often becoming an ID number.
- Individuality is suppressed. Special privileges are discouraged.
- Time is controlled. Prisoners cannot decide when they will eat, sleep, exercise, or shower.
- Housing units are stark and institutional. Cells are small and uncomfortable. Beds have thin or non-existent mattresses. Toilets may have no seat. Air quality may be poor with foul odors.
- Many older facilities lack adequate heating in winter and cooling in summer.
- Prisoners are stripped of privacy, even when showering and using the toilet. Officers may be of either gender.
What this means for nursing care: With nursing care focused on the good of the patient, nurses provide a rare opportunity for a caring interaction for prisoners. This can be turned into an opportunity to obtain as much comfort as possible. Many incarcerated patients will seek out medically-acquired perks that set them out as different or special. Correctional nurses need to be alert to this motivation and objectively determine need based on health and well-being.
Trusting and Being Trusted
A trusting prisoner does not last long in the correctional system. High rates of antisocial behavior among the incarcerated means there are predators always seeking out victims among other prisoners and among the staff. Likewise, this prevailing inmate personality leads to a lack of trust toward any prisoner. Thus, health concerns such as chest pain or seizure activity can be disregarded as ‘faking’ by both officer and health care staff.
What this means for nursing care: Lack of trust is bad for any relationship. The nurse-patient relationship is hindered when patients don’t trust that a nurse will focus on their best interest rather than the interests of the correctional system. Likewise, nurses can easily become cynical and disbelieving if they don’t trust that a patient is being honest when reporting symptoms or past history. Correctional nurses must work to gain the trust of their patient population while seeking to be objective in evaluating patient symptoms and complaints. An awareness of manipulation tactics and methods for avoiding manipulation is also important.
Respecting and Being Respected
The power structure in a correctional institution can easily lead to a culture of disrespect. Once this attitude takes root, it can spread and escalate. Disrespect most often is directed at the prisoner population but deep seated disrespect in a facility shows itself in staff and management interactions, as well.
What this means for nursing care: Basic human respect is foundational to ethical nursing practice. Correctional nurses must strive to be respectful in all relationships; with the patient, fellow health care staff, and officers. Disrespect is shown through voice tone, body language, and actions. It can be a struggle to provide nursing care without judgment of a patient’s lifestyle choices, gender expression, or value system. However, we can disagree with their choices without being disagreeable. Where these factors are self-destructive or risky, we have an obligation to offer opportunities to modify that behavior toward improved health.
What do you think? Does understanding the world of your patient help you provide correctional nursing care? Share your thoughts in the comments section of this post.