Correctional nursing or forensic nursing is nursing as it relates to prisoners. Nurses are required in prisons, jails, and detention centers; their job is to provide physical and mental healthcare for detainees and inmates. [1] In these correctional settings, nurses are the primary healthcare providers. [2] These nurses also work with crime victims and assist in expert witness testimonies, and are involved in a variety of legal cases, including paternity disputes and workplace injuries. [3]
Correctional facilities vary widely in size and population. Correspondingly, there is a wide range of roles which correctional nurses fill. [4] Some facilities are as large as small cities and include an in-house hospital with inpatient and emergency facilities. Most correctional nurses fall into four categories: Reception Screening, Chronic Care Clinicians, Medication Administration, and Ambulatory Care (often called "sick call").
Intake screening (also known as R&R, or Reception and Release Screening) is the process where a nurse evaluates an inmate who is new to an institution before they are moved to their housing unit. Custodial officers use this information in order to decide which part of the facility is appropriate for a particular inmate, and will sometimes call for an inmate to be moved to another facility if the inmate's medical or mental health needs cannot be met at the initial placement. The nurse performing intake screening generally schedules the inmate for an appointment with a healthcare provider for a detailed medical history and physical examination depending on the inmate's needs and presence of chronic diseases.
Inmates with chronic health concerns, such as asthma, diabetes, or high blood pressure, generally have regularly scheduled appointments at chronic care clinics, where nurses provide patient assessments and education about chronic health concerns. Generally, these clinics are overseen by a mid-level provider, such as a physician or nurse practitioner.
Medications, even over-the-counter ones, can be misused in a correctional environment, so medications are usually administered to patients via a medication pass or queue system. Inmates requiring regularly scheduled medication either report to a nurse located centrally in a medical unit, or receive their doses in their housing unit. In higher-security areas, where movement is more restricted and inmates are largely confined to cells, medications are administered at the cell front.
Inmates requiring episodic healthcare generally follow a process called Sick Call. After requesting treatments generally by completing a form (sometimes called a "Sick Call Slip"), a nurse meets with the patient. Most facilities have standardized protocols for conditions like headache, athlete's foot, and constipation, which can be treated with over-the-counter medication without the need for a physician or other advanced medical provider. An assessment of a more serious condition, or one that falls outside the protocols, is referred to a medical provider for further evaluation.
 | The examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject.(February 2024) |
According to the National Alliance of Mental Health reports in 2019 roughly 40% of all people with mental illness will be introduced to the criminal justice system (2 million). Of the inmates incarcerated in the many different types of facilities, 25% have mental illness (550,000 on any day). In 2017 State and Federal Governments paid more than $150 billion to incarcerate these individuals and their stays in the system are usually 4 times longer than other patients. [5]
Treating those patients is quite difficult. Prisons rely on security over healthcare, and expression of care from nurses is restricted due to budget limitations, patient restrictions and ethical unknowns. Making their care even more difficult is the fact that many inmates in correctional justice facilities have lost their rights and are limited in what they are allowed to receive and the measure of their care leading to a dehumanizing of patients. [6] Another main problem of nursing mental illness in correctional facilities is the overwhelming association with these patients and the likelihood they will end up in solitary confinement, which greatly compounds their mental status. [7] Nurses training in the criminal justice system must be prepared for these problems in their daily practices.
When it comes to establishing a career in correctional/forensic nursing, there are many avenues one can undertake which can include sexual assault nurse examiner, nurse coroner, nurse attorney or a forensic nurse examiner. [3]
When one enters into a correctional facility, the presence of health care should not go away. The patients in prison populations are at a greater risk for health complications, especially if there are untreated, underlying chronic health conditions. Some of the most common health concerns for those in prison include communicable diseases, including HIV/AIDS, hepatitis, and tuberculosis. These remain an issue for this population due to the prisoners engaging in high-risk behaviors including unprotected sexual contact. [3] For the older adult prison population (aged 50 years and above), common chronic health conditions reported include diabetes, hypertension, arthritis, cancer, and respiratory disorders such as asthma and emphysema. [8]
For women in prison, there are more components that need to be considered to ensure their overall health. Also, with the common chronic conditions as listed above, there needs to be increased access to reproductive health services including gynecological exams. [3] There also needs to be improved mental health processes for women in prison. For some, there have been increased reports of self-harm and suicide while in prison when compared to the male prisoner demographic. [9] The root causes of this issue are related to being isolated, being detained in locations away from loved ones, and bullying from other prisoners. To further address these needs, improvements must be made to assessment screenings of the women prisoners, which involves addressing the patient's history of trauma, as well as the offering of social support services.
Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Within the published literature, many definitions of palliative care exist. The World Health Organization (WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain, illnesses including other problems whether physical, psychosocial, and spiritual". In the past, palliative care was a disease specific approach, but today the WHO takes a broader patient-centered approach that suggests that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness. This shift was important because if a disease-oriented approach is followed, the needs and preferences of the patient are not fully met and aspects of care, such as pain, quality of life, and social support, as well as spiritual and emotional needs, fail to be addressed. Rather, a patient-centered model prioritizes relief of suffering and tailors care to increase the quality of life for terminally ill patients.
The Veterans Health Administration (VHA) is the component of the United States Department of Veterans Affairs (VA) led by the Under Secretary of Veterans Affairs for Health that implements the healthcare program of the VA through a nationalized healthcare service in the United States, providing healthcare and healthcare-adjacent services to veterans through the administration and operation of 146 VA Medical Centers (VAMC) with integrated outpatient clinics, 772 Community Based Outpatient Clinics (CBOC), and 134 VA Community Living Centers Programs. It is the largest division in the department, and second largest in the entire federal government, employing over 350,000 employees. All VA hospitals, clinics and medical centers are owned by and operated by the Department of Veterans Affairs, and all of the staff employed in VA hospitals are federal employees. Because of this, veterans that qualify for VHA healthcare do not pay premiums or deductibles for their healthcare but may have to make copayments depending on the medical procedure. VHA is not a part of the US Department of Defense Military Health System.
Psychiatric nursing or mental health nursing is the appointed position of a nurse that specialises in mental health, and cares for people of all ages experiencing mental illnesses or distress. These include: neurodevelopmental disorders, schizophrenia, schizoaffective disorder, mood disorders, addiction, anxiety disorders, personality disorders, eating disorders, suicidal thoughts, psychosis, paranoia, and self-harm.
A health professional, healthcare professional, or healthcare worker is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician, physician assistant, registered dietitian, veterinarian, veterinary technician, optometrist, pharmacist, pharmacy technician, medical assistant, physical therapist, occupational therapist, dentist, midwife, psychologist, audiologist, or healthcare scientist, or who perform services in allied health professions. Experts in public health and community health are also health professionals.
Patient advocacy is a process in health care concerned with advocacy for patients, survivors, and caregivers. The patient advocate may be an individual or an organization, concerned with healthcare standards or with one specific group of disorders. The terms patient advocate and patient advocacy can refer both to individual advocates providing services that organizations also provide, and to organizations whose functions extend to individual patients. Some patient advocates are independent and some work for the organizations that are directly responsible for the patient's care.
A registered psychiatric nurse (RPN) specialises in a field of nursing that focuses on the mental health of patients. Psychiatric nurses assist the interdisciplinary team in the assessment and treatment of the patient's psychiatric illness and symptoms. They treat a variety of mental health disorders such as bipolar, depression, schizophrenia, anxiety, substance abuse addiction and eating disorders such as bulimia and anorexia. However, they do not diagnose the patient, this is the responsibility of a qualified psychologist or a psychiatric doctor. Psychiatric nurses are in charge of dispensing medication and the overall care of patients. Registered psychiatric nurses work under the supervision of doctors’ and they practice within the health care industry, mostly in mental health clinics, outpatient facilities, mental health agencies, long-term care centres or hospitals.
Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses can be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialties with differing levels of prescription authority. Nurses comprise the largest component of most healthcare environments; but there is evidence of international shortages of qualified nurses. Nurses collaborate with other healthcare providers such as physicians, nurse practitioners, physical therapists, and psychologists. There is a distinction between nurses and nurse practitioners; in the U.S., the latter are nurses with a graduate degree in advanced practice nursing, and are permitted to prescribe medications unlike the former. They practice independently in a variety of settings in more than half of the United States. Since the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Ambulatory care nursing is the nursing care of patients who receive treatment on an outpatient basis, ie they do not require admission to a hospital for an overnight stay. Ambulatory care includes those clinical, organizational and professional activities engaged in by registered nurses with and for individuals, groups, and populations who seek assistance with improving health and/or seek care for health-related problems. The American Academy of Ambulatory Care Nursing (AAACN) describes ambulatory care nursing as a comprehensive practice which is built on a broad knowledge base of nursing and health sciences, and applies clinical expertise rooted in the nursing process.
Corizon Health, Inc., formed by a 2011 merger of Correctional Medical Services, Inc. (CMS) and Prison Health Services, Inc. (PHS) and currently operating under the names YesCare and Tehum, is a privately held prison healthcare contractor in the United States. The company provides healthcare and pharmacy services (PharmaCorr) to approximately 28 clients in 15 U.S. states, including 139 state prisons, municipal jails, and other facilities. Serving over 115,000 inmates, Corizon Health offers dental, mental health, optometry services, and substance abuse treatment as well as general healthcare. The company is headquartered in Brentwood, Tennessee.
Prison healthcare is the medical specialty in which healthcare providers care for people in prisons and jails. Prison healthcare is a relatively new specialty that developed alongside the adaption of prisons into modern disciplinary institutions. Enclosed prison populations are particularly vulnerable to infectious diseases, including arthritis, asthma, hypertension, cervical cancer, hepatitis, tuberculosis, AIDS, and HIV, and mental health issues, such as Depression, mania, anxiety, and post-traumatic stress disorder. These conditions link prison healthcare to issues of public health, preventive healthcare, and hygiene. Prisoner dependency on provided healthcare raises unique problems in medical ethics.
Unlicensed assistive personnel (UAP) are paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs). UAPs also provide bedside care—including basic nursing procedures—all under the supervision of a registered nurse, licensed practical nurse or other health care professional. UAPs must demonstrate their ability and competence before gaining any expanded responsibilities in a clinical setting. While providing this care, UAPs offer compassion and patience and are part of the patient's healthcare support system. Communication between UAPs and registered nurses (RNs) is key as they are working together in their patients' best interests. The scope of care UAPs are responsible for is delegated by RNs or other clinical licensed professionals.
Infectious diseases within American correctional settings are a concern within the public health sector. The corrections population is susceptible to infectious diseases through exposure to blood and other bodily fluids, drug injection, poor health care, prison overcrowding, demographics, security issues, lack of community support for rehabilitation programs, and high-risk behaviors. The spread of infectious diseases, such as HIV and other sexually transmitted infections, hepatitis C (HCV), hepatitis B (HBV), and tuberculosis, result largely from needle-sharing, drug use, and consensual and non-consensual sex among prisoners. HIV and hepatitis C need specific attention because of the specific public health concerns and issues they raise.
The incarceration of women in the United States refers to the imprisonment of women in both prisons and jails in the United States. There are approximately 219,000 incarcerated women in the US according to a November 2018 report by the Prison Policy Initiative, and the rate of incarceration of women in the United States is at a historic and global high, with 133 women in correctional facilities per every 100,000 female citizens. The United States is home to just 4% of the world's female population, yet the US is responsible for 33% of the entire world's incarcerated female population. The steep rise in the population of incarcerated women in the US is linked to the complex history of the war on drugs and the US's prison–industrial complex, which lead to mass incarceration among many demographics, but had particularly dramatic impacts on women and especially women of color. However, women made up only 10.4% of the US prison and jail population, as of 2015.
A pediatric nurse practitioner (PNP) is a nurse practitioner who specializes in care for newborns, infants, toddlers, pre-schoolers, school-aged children, adolescents, and young adults. Nurse practitioners have an in-depth knowledge and experience in pediatric healthcare including well childcare, and prevention/management of common pediatric acute illnesses and chronic conditions. This care is provided to support optimal health of children within the context of their family, community, and environmental setting. In order to be a pediatric nurse practitioner one must be compassionate, resourceful, good at communicating and have good attention to detail.
An adult-gerontology nurse practitioner (AGNP) is a nurse practitioner that specializes in continuing and comprehensive healthcare for adults across the lifespan from adolescence to old age.
A Mental Health Nurse (MHN) refers to a psychiatric nurse in the UK, who specializes in the care of patients with mental health issues.
People with mental illnesses are over-represented in jail and prison populations in the United States relative to the general population.
Wellpath, formerly known as Correct Care Solutions is a healthcare company based in Nashville, Tennessee, U.S. and "one of the nation’s largest for-profit healthcare providers for prisoners." The company was founded in 2003 by Jerry Boyle. Currently, Wellpath is owned by private equity firm H.I.G. Capital and was formerly co-owned by Audax Group and Frazier Healthcare Partners. Wellpath's facilities exist in both the United States and Australia. Currently, there are 550 centers in 36 states. Their facilities treat around 300,000 patients per day. It operates the Florida Civil Commitment Center in Arcadia, Florida. Wellpath and CCS have been sued more than 1300 times for inadequate care according to a story in the Augusta Chronicle on January 12, 2019.
In the United States, prisons are obligated to provide health care to prisoners. Such health care is sometimes called correctional medicine. In women's prisons, correctional medicine includes attention to reproductive health.
Travel health nursing is a nursing specialty which promotes the health and safety of national and international travelers. Similar to travel medicine, it is an interdisciplinary practice which draws from the knowledge bases of vaccines, epidemiology, tropical medicine, public health, and health education. Travel nursing has experienced an increase in global demand due to the evolution of travel medicine. Travel health nursing was recognized during the 1980s as an emerging occupation to meet the needs of the traveling public, and additional education and training was established. Travel health nurses typically work in "private practice, hospital outpatient units, universities, the government, and the military", and have more opportunities and leadership roles as travel has become more common. However, they also experience organizational and support-related conflicts with general practitioners and patients in healthcare settings.