We need more research in correctional nursing so I am always delighted to come across articles about our specialty in peer-reviewed journals. That’s why I was over-the-moon to find Caring in Correctional Nursing: A Systematic Search and Narrative Synthesis by Dhaliwal and Hirst in the 12(1) issue of the Journal of Forensic Nursing. This article provides a synthesis of published literature on the issue of caring in correctional nursing. If you are a regular reader of this blog, you know that caring is a concept of concern that I have written about before (I list prior post at the bottom of this one). The results of this published research review confirm the themes that run through our prior discussions of the challenges of caring and compassion in our specialty.

A Narrative Synthesis

A narrative synthesis is a way to explain findings by identifying recurrent themes among various published works. In this case, 42 articles were included in the synthesis; most (31) were not research but a few (11) were. This emphasizes the continued need for research in our specialty. The articles were international in nature with representation from the United States (12), United Kingdom (8), Canada (6) and New Zealand (2). The remaining document was a position statement from the International Council of Nurses in Switzerland.

Theme 1: The Struggle of Custody and Caring

The strongest theme found in the synthesis was that of our struggle to balance custody and caring in our work in the criminal justice system. Correctional nurses feel the strong pull of the dual obligation to both security and patient care. The authors refer to this as a “dual mandate of therapy and social control”. In a deeper discussion of this conflict, three further concepts are represented in the literature:

• Ethical and Philosophical Conflict: The ideology of the custody environment is often antithetical to the values of nursing.
• Correctional Priorities Overriding Nursing Priorities: Nurses feel pressure to conform to the correctional priorities of compliance and discipline rather than patient-centered priorities.
• Safety and Security: Therapeutic relationship is difficult to maintain in a rigid security setting.

Theme 2: Need to be Nonjudgmental

While the struggles with the external environment are very real for correctional nurses, we also have an internal struggle to remain nonjudgmental while working with patients who can be manipulative, deceitful, and even cruel. There were two subthemes in this section of the review.

• The Impact of Judgmental Attitudes: Working with a patient population characterized by mental illness, substance abuse, and criminal behavior can lead to judgmental attitudes that affect care quality and outcomes.
• Focus on Health Rather than the Crime: Many of the documents reviewed by the authors called for correctional nurses to look beyond past criminal behavior and see the human being in need of care.

Theme 3: Importance of Boundaries

The final theme found in this synthesis was the importance of boundaries in patient relationships. These boundaries can ensure that patient relationships remain therapeutic in nature but can also feel restrictive for many nurses. Finding the needed balance in the nurse-patient relationship avoids exploitation of nurses by those patients who choose to be manipulative and intimidating.

Recommendations

The authors conclude with several recommendations including, of course, the need for more research! Besides more research, correctional nurse leaders need to work with custody colleagues to address the custody/caring struggle. Nurse educators are encouraged to provide multidisciplinary education among officers and nurses to increase communication and understanding. Finally, there is a call for more new nurse mentoring, including peer support groups.

What do you think? Have you experienced any of these themes in your correctional nursing practice? Share your thoughts in the comments section of this post.

Check out these links for more about caring and compassion in correctional nursing practice:

• Caring for Criminals: Should We be Glad Ariel Castro is Dead?
• Caring within the Culture of Incarceration (podcast with Dr. Stacy Christensen)
• Correctional Nurse Dilemma: Compassion or Cynicism
• Should Correctional Nurses be Compassionate?
• Struggling to Define Caring in Correctional Nursing