The U.S. Department of Justice, Bureau of Justice Statistics (BJS) recently released a report that describes the tremendous burden of disease among inmates in our nation’s correctional systems. See Medical Problems of State and Federal Prisoners and Jail Inmates, 2011-12 released February 2015. Over 100,000 adult inmates participated in a survey about their physical health conducted at 606 correctional facilities of all types between February 2011 and May 2012. The following is a summary of the findings and their implications for correctional nursing practice.
Forty percent of the incarcerated population report having a current chronic medical condition with 25 percent reporting two or more chronic diseases. When standardized for comparison, only a third of adults in the “free” community report having a chronic disease. Inmates are more likely than adults in the “free” community to have hypertension, diabetes, cardiovascular problems, asthma and cirrhosis of the liver. Female inmates are more likely to have a chronic condition than men and the likelihood of having a chronic disease increases with age. The prevalence of diabetes among inmates is twice the rate and hypertension is 1.5 times the rate reported in the 2004 survey by the BJS. Two thirds of inmates reporting a chronic condition took prescription medication for it in the 90 days preceding incarceration.
Infectious disease is also more prevalent among incarcerated persons (14.3%) than the “free” community (4.6%). Inmates are twice as likely to have had tuberculosis infection, six times more likely to have hepatitis and twice as likely to have had a sexually transmitted disease. While the rate of HIV among inmates is higher (1.3%) than the general population in the community (0.3%) the overall prevalence of HIV among prisoners has been slowly and steadily declining since 2001.
Mirroring the nationwide epidemic of obesity, nearly three quarters of prisoners and more than 60 percent of jail inmates were either overweight or obese as reported in the 2001-20012 BJS survey. Obesity contributes to the chronic health problems discussed earlier, specifically hypertension, heart disease, stroke and diabetes. Race and gender differences were consistent with those reported for the community at large.
So what does this all mean for correctional nurses?
- It is a reminder that we practice “population based” care. In other words we are responsible for the health and wellbeing of a population of people who happen to be incarcerated. We are not just an OB-GYN nurse or the ED nurse or the psych nurse but instead see patients whose health problems are not well established and can include a wide variety of concerns. Rather than view a patient’s problem, headache for example, within narrow parameters and judgmental stereotypes we should consider the high rates of disease in our population and thoroughly evaluate the patient. Our patients do not have the same disease profile as the general community.
- Every patient encounter (sick call, med line etc.) is an opportunity to teach and support a healthy lifestyle that encourages the patient’s self-care and quality of life. These conversations should not just be reserved for the visit with the ID nurse or the chronic care visit. The most effective behavior change takes place when patients received the same information and support from multiple sources to make change.
- Many of our patients will require coordination of their care as they transition from the community to incarceration, upon transfer to another correctional facility, during off site specialty care and upon return to the community after release from incarceration. This means obtaining records from previous providers, maintaining an up to date problem list, reconciling medication lists, tracking appointments, communicating information to other providers, developing and carrying out release plans.
- Managing chronic and infectious disease in prisons, jails and detention facilities also requires advocating for conditions that support attaining a healthier lifestyle during incarceration. The provision of a heart healthy diet, access to aerobic exercise, and clean air are topics that nurses should advocate for if not available at a correctional facility. If these provisions are available nurses should actively include and support use of these resources when working with patients.
Our work is a lot easier if we are taking care of a diabetic who is in good control or an HIV patient whose condition has stabilized. Blaming the patient for being sick or having a disease that is preventable only makes for an adversarial relationship resulting in worse patient care outcomes. Taking steps to identify disease early and get treatment initiated as well as coordinate the patient’s care during incarceration and upon release is a more effective way to manage our practice than waiting until problems arise before taking action.
What does the information from the BJS report on medical conditions of prison and jail inmates mean for your practice? How does your facility address obesity? Are inmates counseled about weight control? Please share your thoughts by responding in the comments section of this post.
For more on the nurses’ role in addressing chronic disease see Chapter 7 in the Essentials of Correctional Nursing. You can order a copy from Springer Publishing and get $15 off as well as free shipping by using this code – AF1209.
Photo credit: © jpramirez – Fotolia.com