Many abused women, particularly those who have experienced child sexual abuse, end up in the prison system. This is particularly true for aboriginal women in Canadian prisons. The early trauma experienced and lack of sufficient family and cultural supports often sends these women into a downward spiral. Alcohol, drugs, prostitution and domestic abuse mark their lives, and all too often prison becomes a revolving door from which they cannot escape. Health care providers within the correctional system are therefore working with some of the most vulnerable and disadvantaged women in our society.

The following case study is typical of this type of inmate:

Lizzie is a friendly, outgoing 30-year old Canadian aboriginal woman, who was sexually abused by a family member when very young. She started using alcohol and drugs while in grade school, and was selling herself on the streets by age 12. She was soon in and out of prison for prostitution, shoplifting and drug-related offences. While on probation, she was severely beaten by her boyfriend during a heavy drinking session. Lizzie defended herself with a stick. She was arrested and charged with attempted murder.

As a primary health care provider, correctional nurses are often the initial medical contact and have the first opportunity to address the abuse background in a meaningful way to initiate healing. The health care team may include psychiatrists, psychologists, and counselors, but it is a correctional nurse who often manages the treatment plan. There are several specific areas to consider when working with abused women in the prison system.

Physical Trauma: Look beyond the bruises and broken bones and assess symptoms rather than injuries. An abused woman can have internal bleeding. Choking may leave no visible marks, yet underlying brain trauma can be present.

Sexual Abuse Consequences: Child sexual abuse leaves profound wounds that manifest as adult symptoms. Sexual promiscuity, prostitution, self-harm, cutting, substance abuse, and eating disorders are just a few. These women are also particularly vulnerable to further sexual abuse within the prison system and can develop unhealthy and abusive interpersonal relationships.

Mental Health and Trauma: Victims of domestic violence learn to equate abuse with love. These women believe they deserve the abuse and take responsibility for instigating it.

Detox: The vast majority have been self-medicating for much of their lives. Prison detox must be closely monitored, as it is a frightening process for these women, with serious health risks.

Family Relationships and Children: Many have minor children, left in the care of others or in foster homes. This adds to stress and worry that their children will also be abused.

As an important member of the care team, correctional nurses have an opportunity to make a very real difference in the lives of these women, here are some key interventions nurses can take to address specific health concerns and motivate and encourage these women to follow through with counseling and group sessions.

• Encourage development of parenting skills and help set goals for the future.
• Promote long-term physical and emotional healing.
• Provide emotional support and practical suggestions to help manage self-harming behaviours.
• Help to regain a sense of trust in interpersonal relationships.
• Encourage development of empathy skills that are essential in reducing the risk of reoffending.

A compassionate focus on promoting health and healing will maximize chances of success and help these women finally break the cycle of abuse. Have you had experiences with abused patients? Share your story in the comment section of this post.

This guest post was written by Deborah Johnson, a regular contributor to Nursing Career Tips. Deborah is a Canadian counsellor with a graduate degree in Applied Psychology. She works primarily with women who have experienced abuse, focusing in particular on arts-based therapies. As a freelance writer over the past 20 years, she has explored topics in many different genres. Deborah relaxes by spending time with her grandchildren, who inspire and rejuvenate her.

Photo Credit: © Chepko Danil – Fotolia.com