Nursing in the Era of Mass Incarceration

Nursing in the Era of Mass Incarceration

Nursing in the Era of Mass Incarceration

Lorie S. Goshin

As nurses working with those affected by the criminal justice system, including current and former prisoners and their families, we often find ourselves explaining why we choose to focus on this group. Because this population is marginalized, our colleagues may not realize the ubiquity of this system’s effects outside of correctional facilities. Correctional nurses provide the majority of health care in prisons, but nurses in all settings care for patients affected by the criminal justice system. It’s time for all nurses to address the public health consequences of mass incarceration. Nursing in the Era of Mass Incarceration

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Alison M. Colbert

While other industrialized nations average 100 prisoners per 100,000 people, we exceed 500 per 100,000. The system’s reach extends beyond correctional facilities, with about one in 35 adults under some form of correctional supervision. Despite plateauing incarceration rates and a decline in youth incarceration, criminal justice involvement remains drastically elevated by historical and international standards.

Kristin G. Cloyes

Associated health inequities are interconnected and intergenerational. Compared with the general population, incarcerated persons have a higher burden of chronic illness, infectious disease, mental illness, substance dependence, poverty, and trauma. Inmates over 65 are the fastest-growing segment of the prison population, creating critical needs for palliative care. Parental incarceration is associated with pediatric health inequities across domains. Recent research suggests that disproportionate incarceration among African Americans contributes to persistent racial gaps in life expectancy and infant mortality.

Institutional constraints, quality inconsistencies, and limited access to care leave health needs unaddressed in prison populations. A 2011 Supreme Court decision against the state of California highlighted overcrowding and poor quality of care so extreme as to violate the Eighth Amendment prohibition of cruel and unusual punishment. For people on probation or parole, access to and continuity of care may be inhibited by supervision conditions and the separation of correctional and community health systems.

Nurses may wonder what they can do to address a problem of such broad reach. We have developed a short list of practical recommendations for nurses working outside of the criminal justice system.

  • Nurses can practice with an awareness of mass incarceration and associated health inequities, approaching the involvement of patients or family members with sensitivity and incorporating into assessment and treatment any risk factors posed by current involvement.
  • Nurses can research the health causes and consequences of incarceration and how to mitigate their effects.
  • Health care organizations can partner with criminal justice institutions to ensure quality referral sources and minimize barriers to care at community reentry. Nurses can help bridge boundaries, providing cross-institutional coordination.
  • Clinical nursing and interprofessional curricula can include culturally sensitive and competent care of this population, emphasizing the possible presence of criminal justice–affected patients in any area of practice.
  • Nursing faculty can present correctional nursing as a career path for students and provide appropriate clinical placements for them.
  • Nurses can advocate for policies that increase the health and well-being of criminal justice–affected individuals, families, and communities; help plan treatment and rehabilitation alternatives to traditional punishments; and advocate for nurse-led interventions, such as home visiting, that decrease the lifetime risk of incarceration.

By understanding the connections between the myriad factors related to the criminal justice system and health, nurses will be better prepared to provide compassionate care to the people they serve.

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