Nursing Components of Chronic Care Management

Although many consider the inmate population to be young and healthy, this is often not the case. Years of unhealthy lifestyles and poor personal choices such as smoking, alcohol overuse and drug dependence coupled with infrequent healthcare visits result in a variety of poorly treated chronic conditions requiring management during incarceration. Chronic care is sometimes seen as a physician appointment system where inmates arrive every 90 days to have their medications managed, lab work drawn and other diagnostic tests ordered. In reality, chronic care management has many opportunities for nurse-driven care. Here are a few areas of chronic disease management that can benefit from nurse involvement.

Patient Education
Patient education is the single most important nurse intervention in chronic care. Inmate patients are often ill-informed of basic self-health practices such as nutrition, personal hygiene and activity. Besides basic information, patients can be uninformed or misinformed about the nature of their condition, medication regimens and treatment side effects. Many patients lack basic reading skills. Patient information tailored to the individual and free of confusing words and medical jargon can remedy this situation.

Collaborative Care
Correctional nurses also have a major role in initiation and delivery of chronic care treatments. For example, systems must be in place to verify chronic care medications that patients are already taking when detained or sentenced. Treatment changes require revised regimens involving procuring, administering and documenting care delivery. Treatment side effects may be noted during sick call visits or medication passes may reveal compliance issues. Nurses are most often the first care providers to see a patient for a chronic condition related problem.

Security Interface
Because health care is delivered in a secure setting, correctional officers become part of the healthcare team. Housing officers must be aware of situations that require health care consultation. This means developing a positive relationship among the professionals including negotiating the boundaries of each member’s position. Correctional nurses can improve patient care through enlisting the contributions of custody officers in detecting medical or mental health issues requiring attention.

How have you been involved in chronic care management at your facility? Share your stories and tips in the comments section of this post.

Read more about chronic care management in correctional nursing practice in Chapter 6: Chronic Conditions from Essentials of Correctional Nursing. Order your copy directly from the publisher. http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4

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