Understanding your patient’s life perspective can help you be an effective nurse whatever patient population you care for. Recognizing the mental framework of correctional patients is vital to both effectiveness and safety. One way to better comprehend prisoner patients is by grasping the concept of the criminal lifestyle.

Not All Inmates are Criminals

While not all our patients are criminals, many are. Sometimes this depends on the correctional setting. For example, in a local jail there is a mix of offenses including drunk driving, probation violations, morals offenses or public disorder. These inmates may be incarcerated for the first time and otherwise live typical American lives. Mixed in with these inmates are those held for drug offenses, property violations, and violent offenses. Inmates held for these charges are more likely to be repeat offenders. Some of them are living the criminal lifestyle.

Prison inmates, however, have been convicted of a crime and are serving out their sentence in a state or federal facility. Chances are, the higher security level of your facility, the larger the patient population of actual criminals. For the sake of this discussion, criminals are defined as those who have chosen to live out their lives without regard for laws or social norms. Their thoughts and patterns of activity are very different from how you or I think or act. This affects our relationship with them in delivering nursing care.

Those who have studied the Criminal Lifestyle describe it using these three variables.

Conditions

Having heard many inmate life stories as a care provider, it is easy to see how our patients end up breaking the law. Place any one of us into a difficult environment involving abuse, violence, drugs, and peer influence toward anti-social behavior and we may have followed the same path. Actually, it is suggested that the interaction of personal characteristics such as temperament and intelligence with environment strongly influences whether a criminal lifestyle is embraced.

Which brings us to the second variable – choice

Choice

If we consider conditions alone, we might conclude that our patients are not responsible for their actions and should be given a pass on their illegal activities. Yet, in a civilized society, we are all responsible for the choices we make. Some have harder situations to overcome, but we all have the opportunity to choose to follow the rules or bypass them.  Unlike those living a non-criminal lifestyle, criminals often consider crime as a problem-solving option in many life situations. These same patients will use deception and manipulation in health care interactions, too.

Cognition

Cognition, then, is the thinking patterns that develop in response to the conditions and choices of life over time. Cognition is the belief system our patients develop and then live by. This belief system justifies, supports, and rationalizes the person’s decisions to commit crimes. The criminal lifestyle belief system includes several key elements.

• Entitlement: Feeling personally exempt from the rules others follow
• Power Orientation: A need to control others and use others for their own benefit
• Discontinuity: A failure to follow-through on commitments or remain focused on goals over time
• Greed/Laziness: While many criminals are energetic and motivated in carrying out elaborate cons or schemes, these actions are an attempt to circumvent socially acceptable means of obtaining wealth or status.

Impact on the Nurse-Patient Relationship

Why is understanding the criminal lifestyle important for correctional nursing practice? By being aware that some of your patients live and think like this you can:

• Be especially vigilant for physical and psychological safety. Patients who have embraced a criminal lifestyle may use intimidation, the threat of injury, or blackmail to obtain an object of desire such as medications, treatments, or special living accommodations.
• Understand what motivates a segment of your patient population and use this to encourage health goals.
• See the underlying causes of patient responses and actions
• Objectively evaluate and respond to patient concerns and requests

What about your experience with inmate patients? Share your thoughts about the impact of the criminal lifestyle on your nursing practice in the comments section of this post.