Population Characteristics and Common Conditions
Correctional nurses deliver care to a diverse inmate population with some distinctive characteristics. Approximately 2.3 million individuals are now incarcerated in the United States, with a disproportionate percentage being male and black. The majority of inmates come from lower socioeconomic groups and have lower literacy rates in comparison to the general population. Many have not established good health habits or received regular medical care prior to incarceration. Levels of drug and alcohol use are relatively high. All of these factors contribute to common illness patterns and affect the application of nursing principles to delivery of care.

Nurses specializing in corrections need a solid understanding of key conditions with higher incidence in this patient population. These include infectious and sexually transmitted diseases, a number of chronic conditions and alcohol-related problems such as withdrawal and cirrhosis. Prevalence of mental illness is high. Concern for self-injury and suicide is also ever-present.

Special Needs of Women and Adolescents
Incarcerated women and adolescents have special needs that require skilled attention during care delivery. Women enter correctional facilities with greater rates of sexually transmitted diseases, substance abuse and mental illness compared to their male counterparts. They are more likely to have been sexually or physically abused, which increases their vulnerability. An estimated two-thirds of women inmates have children younger than age 18 and an increasing number are pregnant at the time of commitment, both of which create additional stresses.

Adolescents often have developmental immaturity, cognitive disorders and behavioral issues to be considered in the delivery of health care. Their special health challenges include attention to maturational stages and immunization needs.

Inmate Goals Not Related to Health Problems
Correctional nurses are aware that patients in this setting can have a variety of motivations for seeking health care other than an actual or potential health problem. Inmates may access assistance for secondary gain such as environmental comforts or work reduction. Although every health concern should be appropriately assessed and treated based on objective data, correctional nurses must guard against making assumptions or basing treatment on only subjective data.

Coping With Major Life Change and Transition
Finally, nursing care and treatment must be delivered with an understanding of the major life changes and transitions experienced by the inmate-patient upon entering the correctional system. Family and community connections have been altered. The corrections environment has a new structure and hierarchy to be adapted to. Stressors such as child custody, spouse abandonment and financial distress may be present and combined with inmate-to-inmate hostility. Correctional nurses have an understanding of the potential life changes of the patient population and how this might impact care.

Our Impact
Correctional nurses have an opportunity to improve clinical outcomes by practicing their profession with a specialized understanding of the corrections environment and the patient population.

— Margaret Collatt, BSN, RN, CCHP-A/RN, is training and development specialist for the Oregon Department of Corrections.