End-of-Life Care and Correctional Nursing

baby handWhat do you think are the most common causes of death among inmates? I remember the first time I looked at the information collected annually at my correctional facility and being surprised to find that cancer and heart disease were the most common causes of death.

Since 2000-2001 correctional facilities have been required to report information to the Bureau of Justice Statistics (BJS) about each inmate or detainee who dies while in custody.  Reporting includes demographic information, the inmate’s criminal background and details about the death. This information is analyzed and trends concerning inmate deaths are reported by BJS every year. According to a recent report from BJS over half of all deaths in jails and nearly 90% of all deaths in prisons were the result of illnesses like cancer, heart and liver disease (Noonan, M.E. 2012).

All of this information is to make the case that correctional nurses take care of inmates with illnesses that are life-limiting or terminal.  Therefore correctional nurses need to be competent in the delivery of end-of life care.  Here is a description from an inmate who witnessed a fellow inmate’s death from cancer

“We sat with him in his cell when we could and helped him to move and the nurse kept popping in to see him-she was upset that he had to stay there. He wasn’t allowed any morphine to kill his pain and died a few days later in agony in his cell and alone (Prison Reform Trust, 2008, p. 4)”. 

Can you imagine what the nurse was feeling while providing care to this inmate during his last days? To watch a patient die and to know you could do better is a powerful incentive to improve. As Susan Loeb and her colleagues point out it is time to harness nurse’s expertise and apply their power of compassion to allow prisoners “to die with a modicum of dignity, respect, and humane care” (2011, p. 483).

Nursing care of inmates with terminal illness includes:

  • Assisting patients to make decisions about treatment, palliative care and life sustaining measures
  • Effectively addressing patient concerns, especially symptom management
  • Coordinating care among multiple providers
  • Communication with the patient’s family and other members of the health care team.

Resources for nurses to gain knowledge and skill in end-of-life care can be accessed through local hospice in the community or at a nearby university. A national education initiative, the End-of Life Nursing Consortium (ELNEC) has made training available to nurses in all 50 states and 77 other countries since 2000 and has many resources on the website at http://www.aacn.nche.edu/elnec. The ELNEC also has established competencies for end-of-life nursing care. The GRACE Project (Guiding Responsive Action in Corrections at End of Life) sponsored by the Volunteers of America has been responsible for supporting the establishment of hospice and end-of-life care in more than 75 prisons and jails in America.  The Central Plains Geriatric Education Center at the University of Kansas Medical Center is continuing to emphasize the development of capacity to provide end-of-life care and the education of health care providers to deliver this care in prisons and jails (McAdoo & Price 2012). To access this resource go to http://www.kumc.edu/landon-center-on-aging/central-plains-geriatric-education-center.html or call 913 588 1464.

“Assessment and then intervention to relieve distressful symptoms is a major role of nurses in end-of-life care” (Knox 2012, p. 145). Use of a standardized assessment tool is recommended.  One assessment tool that is available on-line is the Edmonton Symptom Assessment System-Revised. It assesses nine of the most common symptoms experienced by patients at the end of life.  What do you think these symptoms are and how would you address each of them?

For more on nursing and end-of-life care in the correctional setting see Chapters 8 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.

References and Resources:

Howe, J.B., Scott, G. (2012) Educating prison staff in the principles of end-of-life care. International Journal of Palliative Nursing.  18(8): 391-395

Knox, C. (2012). End-of- life care. In Schoenly, L. & Knox, C. Essentials of Correctional Nursing. Springer. NY.

Loeb, S.J., Penrod, J. Hollenbeak, C.S., Smaith, C.A. (2011) End of life care and barriers for female inmate.  Journal of Obstetric, Gynecological and Neonatal Nurses. 40: 477-485

McAdoo, C., Price, C. (2012) Models of Care: End-of-Life Care in Prisons. Presented at Updates in Correctional Health Care. National Commission on Correctional Health Care. May 2012. San Antonio TX. Accessed 8/12/13 at http://ncchc.sclivelearningcenter.com/index.aspx?PID=4622&SID=128752

Noonan, M. E. (2012) Mortality in Local Jails and State Prisons, 2000-2010- Statistical Tables. Bureau of Justice Statistics. Retrieved August 8, 2013 from http://www.bjs.gov/content/pub/pdf/mljsp0010st.pdf.

Prison Reform Trust. (2008) Doing time: the experiences and needs of older people in prison. Prison Reform Trust: London.

Stone, K., Papadopoulos, I., Kelly, D. (2011) Establishing hospice care for prison populations: An integrative review assessing the UK and USA perspective.  Palliative Medicine.  26(8):969-978

Photo Credit: © Thierry Dagnelie – Fotolia.com

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