Prison Nurses' Professional Identity

Perceptions and experiences of clinicians and correctional officers facilitating palliative care for people in prison: A systematic review and meta-synthesis

BACKGROUND

As the number of people ageing in prison with complex healthcare needs continues to increase, so does the need for palliative care in the restrictive prison context. Palliative care for people in prison is facilitated by correctional officers, and prison- and hospital-based clinicians. A collective analysis of existing research to identify common experiences of these stakeholders globally has not been completed.

AIM

To explore the perceptions and experiences of correctional officers and prison- and hospital-based clinicians who facilitate palliative care for people in prison.

DESIGN

A systematic review and meta-synthesis.

DATA SOURCES

Keywords and subject headings related to palliative care and prisons were used to search seven databases with no time limitations. Peer-reviewed research in English, containing qualitative data from stakeholders facilitating palliative care for people in prison were included, and appraised using the CASP tool.

RESULTS

Two analytical themes emerged: (i) a prison lens on a palliative approach and (ii) coping complexities. Palliative care is 'translated' into the prison setting according to security and environmental constraints. Stakeholders experienced ethical, personal and professional difficulties, because prison-based palliative care did not align with community norms. Ambiguous policy and expectations regarding prioritising care needs and balancing custodial rules led to role stress.

CONCLUSIONS

Providing palliative care for people in prison is complex and impacts stakeholders and people in prison with palliative care needs. Supporting person-centred care through a multi-service approach, stakeholder education and standards will improve the quality and accessibility of care.

Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review

Background

Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves.

Aim

To improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions.

Methods

Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards' reporting guidelines.

Data sources

First round database searching in Medical Literature Analysis and Retrieval System Online Database ALL (via Ovid), cumulative index to nursing and allied health literature database (via EBSCO) and health management information consortium database (via Ovid), was undertaken between February and March 2021, followed by supplementary searching strategies (e.g. hand searching, expert solicitation of key papers). Reverse chronology screening was applied, aimed at retaining 30 relevant papers in each profession. Round two database searches (December 2021) targeted COVID-19-specific literature and literature reviews. No date limits were applied.

Results

We built on seven key reports and included 75 papers in the first round (26 nursing, 26 midwifery, 23 paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. Through the realist synthesis we surfaced 14 key tensions in the literature and identified five key findings, supported by 26 context mechanism and outcome configurations. The key findings identified the following: (1) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; (2) it is difficult to promote staff psychological wellness where there is a blame culture; (3) the needs of the system often override staff well-being at work ('serve and sacrifice'); (4) there are unintended personal costs of upholding and implementing values at work; and (5) it is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors.

Conclusions

Our realist synthesis strongly suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological well-being. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Healthcare organisations need to (1) rebalance the working environment to enable healthcare professionals to recover and thrive; (2) invest in multi-level system approaches to promote staff psychological well-being; and use an organisational diagnostic framework, such as the NHS England and NHS Improvement Health and Wellbeing framework, to self-assess and implement a systems approach to staff well-being.

Future work

Future research should implement, refine and evaluate systemic interventional strategies. Interventions and evaluations should be co-designed with front-line staff and staff experts by experience, and tailored where possible to local, organisational and workforce needs.

Limitations

The literature was not equivalent in size and quality across the three professions and we did not carry out citation searches using hand searching and stakeholder/expert suggestions to augment our sample.

Study registration

This study is registered as PROSPERO CRD42020172420. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172420.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129528) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.

The emergence of custodial health nursing as a specialty whose time has come: An Australian experience

BACKGROUND

Nurses provide healthcare in prisons worldwide. Working within security restraints, in environments not designed for nursing care, custodial health nurses (CHNs) use specialist nursing skills and knowledge to do essential work. Rapid increases in prisoner age, infirmity and ill-health of prisoners mandate their access to these nurses.

AIM

To raise awareness of the CHNs struggle for specialty status within the nursing profession, public health frameworks and prisons.

SOURCES OF EVIDENCE

Publicly available information is organised and analysed through the author's lens of 20 years working in the Australian prison system as a general nurse and nurse practitioner.

DISCUSSION

CHNs efforts towards becoming a specialty within nursing, public health and prisons are ongoing. Overcoming barriers and maximising facilitators to effective CHN practice would be indicators of successful incorporation of nursing models that assist prisoner patients. Prison healthcare contexts are unique regarding prisoner health and funding that impacts the CHNs resourcing, their scope of practice and acceptance of nursing in prison systems and the broader healthcare sectors.

CONCLUSION

Greater visibility of the CHNs will help promote policy reforms regarding nursing services within a changing prisoner demographic. Changes to educational and professional support for CHNs are needed. Policy restrictions on funding for CHN models in Australia fall short of international standards for prison healthcare; however, political and organisational commitment in this area will be necessary to attain community-equivalent healthcare standards across the custodial setting.

IMPLICATIONS FOR NURSING AND OTHER POLICIES

Professional structures, competencies and specialty policy frameworks are required to promote CHNs as advocates for prisoners needing care and their professional development. CHNs at the forefront of policy development and review will benefit all stakeholders in custodial health.

Factors influencing nursing professional identity development: A qualitative study

This research focuses on approaches that best support nursing professional identity formation, particularly by providing the insights of nursing students in their own words. This report reflects qualitative phenomenological research on nursing professional development from the perspective of both associate degree and baccalaureate degree student nurses in their final semester of study and describes factors that support or detract from the experience of nursing professional identity development. Participants were guided through individual interviews using semi-structured interview questions and later invited to facilitated focus groups with other students to clarify and elaborate on previous comments. The approach participants most often described as helping them develop into a professional nurse was clinical experience and the ability to practice independently. It was mentioned far more than the next most common response: role models and mentors. Other methods include reflection, critical thinking, and confidence. This research adds to a limited body of literature on the factors that influence nursing professional identity.

Unsafe and Unsettling: An Integrative Review on Correctional Nursing Work Environments and Stressors

BACKGROUND

Stress remains a major occupational hazard among nurses. As the United States maintains the largest correctional system in the world, little is understood regarding the occupational stress of correctional nurses and how that stress impacts their overall health and well-being.

QUESTION ADDRESSED

What are the occupational/environmental stressors and professional burnout factors experienced by correctional nurses?

REVIEW METHODS

Guided by Whittemore and Knafl's methodology, an integrative review was conducted using online databases of Scopus, CINAHL, NIOSH-tic, and PubMed in July of 2021 for peer-reviewed articles ever published internationally. Key concepts of "correctional health nursing" and "occupational stress" were used in our search.

REVIEW RESULTS

One hundred fifty-two articles were identified. Eleven articles met eligibility criteria and were included in this review. Three key themes emerged: conflict , fear , and demands .

DISCUSSION

Conflict arose from ethical and relational issues among coworkers, management, and incarcerated patients. Fear stemmed from physical safety concerns and workplace violence, whereas demands involved high workloads paired with a lack of organizational support. Findings revealed evidence on the unique occupational environment of correctional nursing professionals that impacted levels of stress and burnout across all types of correctional settings (e.g., jails and prisons).

IMPLICATIONS

Better assessment and consistent evaluation of the health and well-being of correctional nurses and their correctional nursing environments are needed. Additional resources to reduce stress, along with ensuring policies that mitigate ethical challenges, workplace violence, and bullying, may promote professional and safe workspaces.

Historical Context of Custodial Health Nursing in New South Wales, Australia

Australia's prison healthcare originated during the establishment of the colony of New South Wales by Britain in 1788. Initially managed by the Colonial Medical Service, the history and healthcare of the penal settlement has been well documented in government records, academic works, museum displays, and fictional dramatizations. This article explores the origins and historical development of the nursing care of prisoners in Australia, starting with the original Australian prisoners, the convicts of colonial New South Wales. Largely overlooked in historical and academic studies, custodial health nurses are rarely mentioned or acknowledged for their contribution to the health of the colony. However, their expertise as healthcare professionals has continued to grow and is explored within the context of today's health landscape.

Current occupational well-being status and protective and risk factors of male nurses in Chengdu, China: A cross-sectional study

Aims

This study explores the current occupational well‐being status of male nurses in Chengdu, China, and identifies the concomitant protective and risk factors.

Design

This study has a cross‐sectional survey design.

Methods

From 13 July to 21 July 2019, a cross‐sectional survey involving 209 male nurses in 7 tertiary hospitals in Chengdu, China, was conducted using a general information questionnaire, the Mindfulness Attention Awareness Scale, the Acceptance and Action Questionnaire‐II, the Professional Identity Scale and the Nurses' Occupational Well‐being Scale.

Results

The score of male nurses' occupational well‐being was 78.7 ± 14.2. The higher the mindfulness and professional identity (p = .002, p < .001, respectively), the higher the occupational well‐being of male nurses. The lower the experiential avoidance, the higher the occupational well‐being (p = .001). The highest occupational well‐being was found among male nurses who had less than 5‐years' working experience.

Conclusions

The results suggest that male nurses' occupational well‐being was at a moderate level. Mindfulness and professional identity were the protective factors of male nurses' occupational well‐being, and experiential avoidance was the risk factor. Nursing managers should ascertain male nurses' current occupational well‐being and the influencing factors and formulate effective improvement strategies. Male nurse courses on enhancing mindfulness and professional identity and reducing experiential avoidance should be explored, with a focus on helping nurses improve their professional well‐being and, in turn, prospectively reducing the turnover rate.

Correctional nursing in Canada's Prairie provinces: Roles, responsibilities, and learning needs

Background

Nurses represent the largest group of health care professionals working with incarcerated persons, yet there is limited understanding of their learning needs, or their roles and responsibilities; and what is known is poorly disseminated.

Purpose

The goal of this research was to describe the roles, responsibilities, and learning needs of correctional nurses practicing in provincial correctional facilities in Alberta and Manitoba, and to add these data to the existing data set from Saskatchewan.

Methods

Three hundred and forty nurses working in provincial correctional facilities in western Canada were invited to complete a self-administered online survey consisting of a Learning Needs Assessment questionnaire (demographic information, knowledge and learning needs, and professional development); and the Staff Questionnaire (which targeted specific skill sets relevant to clinical practice in secure environments). Eighty-two nurses completed the online survey (overall response rate 24%).

Results

Overall, those who participated were experienced in nursing and correctional nursing. The learning needs they identified aligned with their correctional nursing roles and unique practice settings. In particular, issues related to the care of incarcerated persons with mental health disorders and related care were paramount (self-harming behaviours, suicide, mental health assessments in general). In response to the five comprehensive skill sets assessed in the Staff Questionnaire, respondents rated their involvement and importance of the individual skills as important to varying degrees.

Conclusions

The results of this survey shed light on contemporary developments in correctional nursing within provincial correctional facilities in western Canada and provide a foundation for continuing professional education and development, practice, and future research initiatives.

Professional Identity in Graduating Nursing Students

BACKGROUND

This research examines the meaning of nursing professional identity development from the perspectives of both associate degree nursing students and baccalaureate degree nursing students in their final semester. It provides insight into the student's understanding of nursing professional identity and the factors students identified as supporting or detracting from it.

METHOD

Participants were guided through individual interviews using semistructured interview questions and later invited to focus groups with other students to clarify and elaborate on previous comments.

RESULTS

Results demonstrated both groups shared many descriptions of what it means to be a nursing professional, including knowledge, caring, team-work, and integrity. Good communication, confidence, competence, critical thinking, advocacy, and leadership were concepts the participants frequently used to describe the professional nurse.

CONCLUSION

This research helps to further the understanding of this significant topic in nursing education and to serve as a basis for student activities that help foster nursing professional identity formation. [J Nurs Educ. 2021;60(2):74-80.].

Towards abandoning the master's tools: The politics of a universal nursing identity

Healthcare environments continue to prove discriminatory and marginalizing towards patients and healthcare workers themselves, which contributes to inequitable health outcomes across lines of socially constructed difference. This content and discourse analysis of nursing identity scholarship asks whether there is a connection between nursing identity and oppressive behaviour by examining the construction of nursing identity and the foundational discourses, sometimes in absentia, that support such a construction. Bourdieu's concepts of social fields and Audre Lorde's concept of the master's house are applied as a framework towards understanding the constructs of power and status in healthcare. The analysis identifies a gap in nursing identity literature where social constructs of difference are not considered. In the reviewed literature, nursing identity has been co-opted by the professionalization project in effort to stabilize a conceptualization of nursing's contribution to healthcare towards gaining professional and societal status. This leads to a monolithic, apolitical representation of nursing identity that erases difference, denies historical influence, universalizes nursing work and further marginalizes marginalized identities. The oppressive and hegemonic nature of a universal nursing identity may contribute to a lack of disciplinary reflexivity about the ongoing influences of foundational discursive constructs of gender, epistemology, power and professional status.

Coronavirus disease 2019 pandemic promotes the sense of professional identity among nurses

Background

Under the COVID-19 pandemic, nurses are the mainstay in the fight against the pandemic.

Purpose

To evaluate potential impact of the pandemic on nurses’ professional identity.

Method

Self-report questionnaires were distributed online. Data collected were compared with available norms. Multivariate logistic regression analyses were employed to calculate the OR of frontline vs. nonfrontline nurses.

Findings

The mean of the total score of the scale was 121.12 out of 150. Both the total score and scores on the five dimensions were significantly higher than norms. Frontline nurses had a significantly higher professional identity than non-frontline nurses (total score: odds ratio [OR], 1.19; professional identity evaluation: OR, 1.27; professional social support: OR, 1.18; professional social proficiency: OR, 1.33; and dealing with professional frustration: OR, 1.19). The most frequently mentioned tags were Hope, Frontline, Protection, Outbreak, Work, Situation.

Discussion

COVID-19 outbreak was associated with an enhancement in the professional identity of nurses.

Professional identity: A concept analysis

The purpose of this study is to give clarity to the concept of professional identity, drawing from health-related fields to help provide a common language and understanding for research and practice. Professional identity, professionalism, professional socialization, and other related terms are often used without a clear definition or with conflicting definitions. This can lead to misunderstandings and assumptions that complicate research and confuse educators and professionals in guiding novice members. Concept analysis. Initially, 737 articles were identified by searching CINAHL, PubMed Central, Google Scholar, Academic Search Complete, PsyINFO, and SocINDEX for the period 2000 to 2019. Finally, 68 studies met the inclusion criteria, 60 of which are discussed in this concept analysis. This concept analysis uses the method described by Walker and Avant. This concept analysis clarifies the definition of professional identity, using literature from health and related professions, as containing the attributes: skills and functions; knowledge values and ethics; personal identity; group identity; and the influence of the context of care. A more clear definition of professional identity will help researchers to have more precision in their analyses and provide mentors and educators with a clear goal.