Unlocking Prevalence Data: Describing the Job Stress and Well-being of U.S. Correctional Nurses

BACKGROUND

Little is known about the health and well-being of U.S. correctional nurses. To protect correctional nurses, a better understanding of organizational characteristics, job stress, and well-being must be undertaken.

METHOD

A cross-sectional design was used in the form of an online survey. Correctional nurses were conveniently recruited using national listservs and snowball sampling. Variables were measured with the Health & Safety Executive Management Standards Indicator Tool, Nurse Wellbeing Index, and the Perceived Stress Scale. Data were analyzed using descriptive statistics and analyses of variance.

FINDINGS

Two hundred seventy participants (142 registered nurses, 83 licensed practical nurses/licensed vocational nurses, and 42 advanced practice nurses) completed the survey. Job stress scored moderate (M = 16.26, SD = 7.14), and well-being levels were just below the risk for adverse events (M = 1.8, SD = 3.06). Lower scores were noted for managerial support (M = 3.13, SD = 0.35) and job demands (M = 3.56, SD = 0.92), but slightly better for job control (M = 3.57, SD = 0.77), peer support (M = 3.85, SD = 0.64), and workplace relationships (M = 3.73, SD = 0.95).

CONCLUSIONS

Significant differences between organizational characteristics, job stress, and well-being were found across nursing licensure, workplace environments, biological sex, and employment through state or private agencies. Registered nurses working in U.S. prisons experienced the highest job stress and worse well-being.

APPLICATION TO PRACTICE

This work is an essential next step in promoting healthy workspaces, urging the need for further research establishing the impact of organizational characteristics and job stress on nurse well-being.

Exploring cognitive dissonance in the correctional nursing experience

OBJECTIVE

Correctional nurses navigate conflict between custody and caring. Balance is needed between healthcare and security priorities. This study explores the unique nature of nursing practice within correctional settings to inform interventions reducing stress, enhancing coping and mitigating cognitive dissonance among these nurses.

DESIGN

Qualitative, semi-structured interviews.

SAMPLE

Purposive sampling of nurses practicing in a correctional facility in the Southwestern United States.

RESULTS

Thematic analyses identified six themes describing the experiences of nurses in the correctional facility. The themes, "We have a sense of purpose," "We don't trust each other," "We want respect," "We experience unique stress," "It changes who you are," and "We try to leave it all there," describe the need for interventions providing debriefing opportunities, strengthening of relationships with corrections personnel, reflection and stress reduction to ameliorate the potential for cognitive dissonance.

CONCLUSIONS

Correctional nurses in this study perceived a strong sense of purpose and a desire for respect. They are challenged by relationships with both correctional staff and inmates and perceived a change in who they are due to practice in this challenging environment. Measurable, evidence-based stress relief interventions such as mindfulness practices, reflection interventions, physical activity, prayer and meditation are indicated to address these challenges.

Correctional Nurses on the Front Lines of the COVID-19 Pandemic: Omaha System Guidelines Documentation Case Study

During a pandemic, basic public health precautions must be taken across settings and populations. However, confinement conditions change what can be done in correctional settings. Correctional nursing (CN) care, like all nursing care, needs to be named and encoded to be recognized and used to generate data that will advance the discipline and maintain standards of care. The Omaha System is a standardized interprofessional terminology that has been used since 1992 to guide and document care. In 2019, a collaboration between the newly formed American Correctional Nurses Association and the Omaha System Community of Practice began a joint effort with other stakeholders aimed at encoding evidence-based pandemic response interventions used in CN. The resulting guidelines are included and illustrated with examples from CN practice.

The implementation of correctional nursing practice-Caring behind bars: A grounded theory study

AIM

To understand how registered nurses implement their nursing practice in correctional institutions with healthcare governance by a health authority (e.g. Ministry of Health).

DESIGN

Straussian grounded theory.

METHODS

Simultaneous data collection and analysis were undertaken using theoretical sampling, constant comparison and memo writing. Thirteen registered nurses engaged in semi-structured telephone interviews about implementing their correctional nursing practice including, providing direct care to adult offenders. Data were collected (December 2018 to October 2019) until saturation occurred. Analytic coding (open, axial and final theoretical integration) was performed to identify the core category and subcategories around which the substantive theory was developed.

RESULTS

The theory of Caring Behind Bars refers to the process of how registered nurses implemented their correctional nursing practice to care for offenders. The core category of Caring Behind Bars is comprised of five subcategories: tension between custody and caring, adaptability and advocacy, offender population, provision of care, and challenging and positive elements.

CONCLUSION

Caring Behind Bars required registered nurses to address tension between custody and caring by adapting and advocating to access offenders. The provision of care required registered nurses to use assessment skills and numerous resources to provide a variety of patient focused care to offenders. The consequences of Caring Behind Bars had challenging and positive elements.

IMPACT

The tension provides purposeful space to continue improving teamwork among correctional officers and registered nurses. More research is required about the impact of correctional healthcare governance models on professional practice and health outcomes. Frontline registered nurses can use the theory to make informed choices when providing care. Registered nurses practising in other domains of correctional nursing (i.e. administration, education and research) can also use this theory to advance and inform practice with the goal of promoting offender health.

The Relationship Among Secondary Trauma, Self-Efficacy, and Correctional Nurses

Many of the nurses working in corrections suffer from secondary trauma as a result of taking care of a population that has had a high percentage of traumas in their lives. There is limited research in correctional nursing, and perhaps by identifying the relationship among secondary trauma, self-efficacy, and correctional nursing, there will be growth as a profession. A literature review was completed using PubMed, CIHAHL, and Google Scholar. If nurses apply self-efficacy and secondary traumatic growth into their profession, they will be removing negative emotions from secondary trauma and emergency medical crisis situations. With the correctional populations, it is important for correctional nurses to recognize the barriers in themselves to better take care of their patients. This might then lead to better care and have an impact on the violence in society upon release.

Correctional nursing and transformational leadership

Transformational leadership (TL) is a highly discussed approach in the literature for many professions. Likewise, the TL approach continues to be explored in a myriad of nursing contexts to demonstrate its advantages for practice and client health. The tension between custody and care is particular to correctional nursing practice, such as the correctional priorities of safety and security that often override caring-focused nursing practice. Presented herein, is information relating to correctional nursing leadership as found in the minimal, available literature; and hypothetical examples of how correctional nursing leaders can use TL are provided. Measuring the influence of TL on practice and offender health can assist in determining if this approach is an appropriate "fit" for the correctional nursing context. The dearth of literature regarding correctional nursing leadership must be addressed to advance this subspecialty of nursing and promote offender health. The intent is not to argue that TL is the only applicable leadership approach for this subspecialty of nursing. Rather, introductory insight is offered regarding the suitability of TL in correctional nursing practice.

Integrating Correctional and Community Health Care: An Innovative Approach for Clinical Learning in a Baccalaureate Nursing Program

PROBLEM

With an evolving focus on primary, community-based, and patient-centered care rather than acute, hospital-centric, disease-focused care, and recognition of the importance of coordinating care and managing transitions across providers and settings of care, registered nurses need to be prepared from a different and broader knowledge base and skills set. A culture change among nurse educators and administrators and in nursing education is needed to prepare competent registered nurses capable of practicing from a health promotion, disease prevention, community- and population-focused construct in caring for a population of patients who are presenting health problems and conditions that persist across decades and/or lifetimes. While healthcare delivery is moving from the hospital to ambulatory and community settings, community-based educational opportunities for nursing students are shrinking due to a variety of reasons, including but not limited to increased regulatory requirements, the presence of competing numbers of nursing schools and their increased enrollment of students, and decreasing availability of community resources capable and willing to precept students in an all-day interactive learning environment.

METHODS

A detailed discussion of one college of nursings' journey to find an innovative solution and approach to the dilemma of limited and decreasing available community clinical sites to prepare senior level prelicensure baccalaureate nursing students for healthcare practice in the twenty-first century.

FINDINGS

This article demonstrated how medium/maximum prisons can provide an ideal learning experience for not only technical nursing skills but more importantly for reinforcing key learning goals for community-based care, raising population-based awareness, and promoting cultural awareness and sensitivity. In addition, this college of nursing overcame the challenges of initiating and maintaining clinical placement in a prison facility, collaboratively developed strategies to insure student and faculty safety satisfying legal and administrative concerns for both the college of nursing and the prison, and developed educational postclinical assignments that solidified clinical course and nursing program objectives. Lastly, this college of nursing quickly learned that not only did nursing students agree to clinical placement in an all-male medium- to maximum-security prison despite its accompanying restrictive regulations especially as it relates to their access to personal technology devices, but there was an unknown desire for a unique clinical experience.

CONCLUSION

The initial pilot program of placing eight senior level prelicensure baccalaureate nursing students in a 4,000-person all male medium- to maximum-security prison for their community clinical rotation has expanded to include three state-run maximum all male prisons in two states, a 3,000-person male/female federal prison, and several juvenile detention centers. Clinical placement of students in these sites is by request only, resulting in lengthy student waiting lists. This innovative approach to clinical learning has piqued the interest of graduate nurse practitioner (NP) students as well. One MSN, NP student has been placed in the federal prison every semester for over a year. Due to increasing interest from graduate students to learn correctional health nursing, the college of nursing is now expanding NP placement to the other contracted maximum-security prisons. This entire experience has changed clinical policies within a well-established academic culture and promoted creative thinking regarding how and where to clinically educate and prepare registered baccalaureate nurses for the new culture of health and wellness.

Research Priorities in Correctional Nursing Practice: Results of a Three-Round Delphi Study

Correctional nursing has been recognized as a specialty since 1985, but research to describe and support nursing practice in the criminal justice system has been sparse. The development of a research agenda can stimulate the research necessary to provide an evidence base for specialty practice development. A three-round Delphi study was undertaken to elicit a prioritized list of research topics to guide future research efforts for meaningful results. Six predominant themes emerged from an analysis of top research questions generated by a panel of 18 correctional nursing experts. Research priorities include critical thinking and clinical judgment, competency and educational level, assessment, nursing protocols, effect on patient outcomes, and the environment of care.

Simulation: Introduction to Correctional Nursing in a Prison Setting

Simulation can be used to introduce students to critical nursing skills that reduce errors, enhance nurse-patient communication, and improve safety and security when caring for patients in the correctional setting. The interactive environment creates scenarios in a realistic fashion that include experiences that nursing students may encounter in a correctional facility setting, such as aggressive clients, gang-related activities, and noncompliant personalities. Orientation prior to entering the facilities is the key to safety, reducing student anxiety, and enhancing the student's ability to learn. The simulation scenario designed for the correctional setting provides an environment for the teaching and learning of correctional nursing skills and multidisciplinary collaboration. Scenarios are embedded with communication, safety, delegation, and critical thinking education goals. Student evaluations are assessed and reported.