Gender responsive and trauma-informed care are two terms that arise from a growing understanding that women experience the environment and interact in ways that are unique to their gender. Numerous studies show that the pathways women travel toward incarceration are different as well (Covington & Bloom, 2006). Women who are incarcerated have higher incidence than their male counterparts of chronic medical and mental health diseases co-occurring with substance use disorders and infectious diseases (Guthrie, 2011; Schoenly 2013). The majority of incarcerated women report a history of repeated trauma and victimization that is directly related to their criminal behavior. Consequences of repeated traumatization include anxiety disorders, suicidality, self-injurious behavior and addiction (Harner & Burgess, 2011). It can be very challenging to address the complex symptoms and behaviors that women portray during incarceration. Each of the concepts described below provide rationale and guidance for nurses to effectively address the health care needs of incarcerated women.
1. Relationships: A woman’s identity is formed by patterns of interaction with others and the effects over time are cumulative. Thus, it is within relationships that a woman identifies and defines herself. Nursing actions consistent with this concept include:
- establishing a collaborative relationship with the patient that supports their involvement and self-determination
- explaining the rationale for treatment recommendations
- using conflict management, compromise, flexibility and advocacy in addressing treatment goals
- assisting the patient to develop positive coping skills
- understanding those aspects of the correctional environment experienced by the woman that are counter-therapeutic
- maintaining the boundaries of the nurse patient relationship.
2. Trauma: Repeated abuse and victimization affects a woman’s world view and use of coping mechanisms. The most important nursing actions are to:
- observe for signs and symptoms of reactivation of traumatic memories that may trigger feelings of anxiety, shame or anger
- provide an environment that protects the patient from self-harm or further victimization
- support the patient’s decision to seek counseling or mental health assistance.
3. Holistic Care: The woman is more than their diagnosis, criminal sanction or lifestyle. Nursing actions that demonstrate understanding the whole person are to:
- avoid stereotyping the patient by her diagnosis or criminal behavior
- validate and give voice to the patient’s experience of trauma related symptoms
- recognizing that self-destructive and unsafe behaviors are efforts to cope with trauma
- assist patients to make sense of their behavior and support efforts to change or control coping behaviors
- support the patient’s efforts to make positive change.
4. Self-determination: Return the sense of control and autonomy to the patient by addressing their strengths in addition to their needs. Key nursing actions consistent with this concept are to:
- assess women’s strengths and include strategies to build on identified strengths in the treatment plan
- provide health education and promotion to increase skills in self-care and how to access the health care system in the community
- support women’s contact with their children and the caretakers of their children
- develop re-entry plans and identify resources to continue health care upon return to the community.
To read more about the unique aspects of women’s health care in the correctional setting see Chapter 9 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1209 the price is discounted by $15 off and shipping is free.
How do you describe the unique aspects of providing nursing care to women in the correctional setting? Do you have experience with gender responsive and trauma-informed care that you would like to share? If so please tell us about it by writing in the comments section of this post.
Covington, S.S., & Bloom, B.E. (2006). Gender responsive treatment and services in correctional settings. Women and Therapy. 29 (3/4): 9-33.
Guthrie, B. J. (2011). Toward a gender-responsive restorative correctional health care model. Journal of Obstetric, Gynecologic and Neonatal Nurses. 40: 497-505.
Harner, H., Burgess, A.W. (2011). Using a trauma-informed framework to care for incarcerated women. Journal of Obstetric, Gynecologic and Neonatal Nurses. 40: 469-476.
Schoenly, L. (2013) Women’s Health Care. In Schoenly, L. & Knox, C. Essentials of Correctional Nursing. New York: Springer.
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