Understanding incarcerated populations

AORN Journal,  March, 2002  by Cheryl L. Cooke

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The concept of perceived dangerousness can be described using the body as an example. The body of a person who has been incarcerated often reflects the challenges of living in a difficult environment. Many inmates' bodies have a series of tattoos that may be perceived by others as violent or offensive, and insignias may be present on any number of body parts that may reflect gang involvement, artistic ability, or other significant meaning. To the inmate, tattoos often are a symbol of acceptance or a source of pride. These tattoos, however, may be offensive to health care providers, at times evoking feelings of fear or disgust.

Awareness of the inclination to label incarcerated people as dangerous based on looks, perception, and media accounts may be important for health care workers to understand the challenges in providing patient care services to this population. It remains important for nurses to remember that their first responsibility is to provide essential and supportive patient care.

CARING FOR PEOPLE WHO ARE INCARCERATED

In most prisons, health care services usually are provided by various practitioners (eg, advanced RN practitioners, licensed practical nurses, licensed vocational nurses, physicians, physician assistants, RNs). Care usually consists of the prisoner sending a note to the nurse and being triaged into an appointment, sometimes several days later. Prisoners often are transferred to a larger, more complex health care facility to receive treatment for major injuries or illnesses and for childbirth. Both emergency and some elective procedures are performed at off-site health care facilities. Corrections personnel accompany prisoners during transfer to such facilities.

When caring for an incarcerated patient, it is important that the patient and nurse thoroughly understand the nursing role. One aspect of the nursing role is patient confidentiality. For example, nurses may be curious about or ask for information regarding an inmate's crime or sentence. Inmates often are not willing to share this information with people not connected to the corrections system. This information is private and having it may interfere with the nurse's ability to provide quality patient care.

At times, evidence in the form of secretions, hair, or other body fluids or materials will need to be collected to support a criminal proceeding. The nurse must remember that his or her role is that of health care provider. In that capacity, he or she is not an agent of the criminal justice system. In most settings, nurses do not collect evidence; however, a patient who is incarcerated may fear that this is part of the nurse's role. It is important to clarify the nursing role to incarcerated patients and assure them that nurses are not part of the legal team and will not collect physical evidence. Knowing this may help the patient feel more comfortable receiving care.

As previously discussed, the perception that an incarcerated person is dangerous may be common among providers who are not familiar with this population. Corrections personnel will accompany the patient to the health care facility, and their presence may contribute to this perception. Corrections personnel may be corrections officers from federal or state prisons, local police officers, or county sheriff personnel, depending on the custody setting in which the inmate resides. These officers must adhere to specific policies when accompanying an inmate outside of the corrections facility. Custody policies vary according to setting and may be at odds with the mission and policies of the health care facility providing services. There often are tensions between those individuals who provide health care services and those who provide custody services.