Arthritis is one of the top five chronic conditions found among our patient population, yet managing this debilitating condition is difficult in a secure setting. Our patients have limited access to therapeutic modalities and limited control over their daily activities. They are usually expected to walk on concrete floors and sleep on thin mattresses. Housing units stack bunk beds and have stairs-only access to upper tiers. Mobility aids such as canes or wheelchairs may be banned as potential weapons.

However, with creativity, correctional nurses can develop a plan of care that can maximize patient functionality and minimize arthritis discomfort, even in this challenging environment. Here are some ideas for how to help your patients manage their arthritis while they are ‘inside’.

Patient education

Healthcare literacy in our patient population is low. There is always time for patient teaching at every patient encounter. Start with the basics of what arthritis is and common principles for reducing pain, protecting current functionality, and increasing mobility. Obesity is an issue for all patient groups, so understanding how to maintain a healthy weight on a prison diet is an important teaching plan component. If possible, encourage intake of the following nutrients to maximize joint health: Calcium, Vitamin D, Phosphorus, Protein, and Zinc.

Relaxation and stress reduction also contribute to patient comfort and functionality. Are programs available at your facility that can be recommended to arthritic patients? Make yourself knowledgeable about the programs available at your facility. Some systems have yoga classes or art therapy programs. Others must rely on printed sheets of deep breathing exercises. You may be surprised at what is available at your facility. Once you create a list of stress reduction options, work out a specific plan for your patient. Encourage and support ongoing use of the plan at each healthcare visit. Look for ways to overcome barriers to participation.

Pain Control

Pain control is a primary factor in arthritis management. Besides increasing comfort and well-being, manageable pain levels improve mobility and functionality.

• Work with providers to develop a pain control plan that includes both prescriptive and OTC remedies.
• Explore commissary options and consider expanding the commissary list, if needed, to include low-dose acetaminophen and ibuprofen. Be sure to monitor the combined effects of prescription and non-prescription medications to reduce the chances for liver and/or kidney damage.
• Non-prescription topical treatments such as capsaicin cream, BenGay ©, or Tiger Balm© can provide local relief to a painful joint.

There are also non-pharmacologic pain management options that nurses can initiate. Collaboration with custody may allow incorporation of these activities into the security environment:

• Weight and nutritional management, discussed above, can have a significant effect on joint pain.
• Hot and cold therapy should not be overlooked. Hot water or ice can be difficult items to obtain, but seek out the options. A disposable heat pack can serve as a heating pad….and don’t underestimate the effect of a hot (or even warm) shower.
• Creating a mild morning stretching routine can also help reduce the effect of morning stiffness. There are many simple stretch routines available on the internet such as this one.

Maximize Function

Having arthritis pain at manageable levels helps encourage the activities needed to maximize functionality. Collaborate with correctional colleagues to initiate these ideas at your facility.

• Besides stretching, non-weight bearing exercise such as a stationary bike or mild weight-bearing exercise such as walking should be encouraged.
• Create a specific exercise plan with the patient based on their security and housing status.
• Even in-cell exercises such as in-place walking and stretching can be helpful if the patient is in a segregated status.
• Determine what assistive devices are allowable in your facility. Restrictions vary widely. A physical therapy consult can result in cane, walker, or splinting devices to assist with functionality.

Managing arthritis in a secure setting requires a creative and resourceful nursing practice. It may, at first, seem impossible to initiate therapies that are commonplace in traditional practice settings. However, you probably have unknown resources at your disposal and you may be able to advocate for environmental modifications that will improve therapeutic options.

Be sure to check out our next two posts – Osteoarthritis for the Correctional Nurse and Rheumatoid Arthritis for the Correctional Nurse that discuss each condition in more depth. .

How are you managing arthritis in your correctional setting? Share your experiences in the comments section of this post.