In the spring of 2011, the International Association of Forensic Nurses (IAFN) Corrections Task Force was formed to advance forensic correctional nursing within the IAFN by articulating a cohesive voice, which clearly distinguishes the forensic correctional nursing role, and promotes the growth and development of this role. In this special issue of the Journal of Forensic Nursing(R), we are pleased to feature articles that were solicited in response to a special call for papers. We were at the same time encouraged and overwhelmed by the diversity of the papers we received. We believe that the featured articles highlight the breadth and scope of contemporary forensic correctional nursing within our global community. Through their writing, the authors have positioned themselves (whether consciously or unconsciously) within the emergent dialogue surrounding the ongoing evolution of forensic correctional nursing.
The multifaceted and diverse nature of forensic nursing has long been recognized by the IAFN. However, given the distinct and divergent populations that forensic nurses care for (i.e., victims vs. perpetrators), there exists the potential for professional tensions and a specialty divided. Many nurses who align their practice with offender populations or with custodial settings such as prisons and correctional facilities experience a disconnection of sorts and find themselves questioning their identities within the IAFN as forensic nurses. So what is it that makes one's practice a forensic practice? This is a question of fundamental importance to all forensic nurses and not simply to those who identify as forensic correctional nurses. Is forensic nursing simply about creating a world without violence? Is one assumed to be a forensic correctional nurse simply by virtue of one's place of employment? Is it the clientele with which one works that makes one a forensic correctional nurse? Perhaps, it is about the roles and responsibilities that one assumes in the provision of health care? Or is it about one's knowledge of the criminal justice system or how one navigates the interface of health and legal systems? We hope these questions have captured your attention and stirred you to think deeply about their importance to forensic correctional nursing's place within the larger forensic nursing community, the nursing profession, and the healthcare delivery system.
Contemporary Issues
Nurses represent the largest group of healthcare professionals practicing in correctional systems, yet little is known about their work environments, what challenges they experience, or how these challenges impact on the care of those in custody. In this special issue, Almost and her colleagues introduce readers to the work-life issues experienced by provincial correctional nurses in one jurisdiction in Canada. Participants identified several primary concerns specific to their practice environments that they felt directly impacted on their professional role development including inadequate staffing and heavy workloads, limited control over their practice and scope of practice, limited resources, and challenging workplace relationships. Not surprisingly, these same nurses valued work environments that provided support for education, facilitated positive work relationships, encouraged autonomy, supported control over nursing practice, and provided adequate staffing.
Hurley, Linsley, Elvins, and Jones also discuss workforce development issues in their paper that addresses nurses assuming leadership roles in the delivery of primary health care to detainees within police custody in Scotland. Interestingly, issues surrounding collaborative practices, enacting clinical leadership, and the provision of forensic nursing education were identified as mechanisms to generate service provision, while nurturing professional autonomy within nursing.
Issues of collaboration, service provision, and clinical leadership are also prevalent in the article "Care and Companionship in an Isolating Environment." In this contribution, Loeb, Hollenbeak, Penrod, Smith, Kitt-Lewis, and Crouse show the central role that nurses play in the provision of end-of-life (EOL) care within correctional environments. In this study, the authors explored an EOL model of care that effectively utilized inmate caregivers caring for their dying peers. Providing care to terminally ill patients within the prison milieu is a time-consuming, resource-intensive, exhausting endeavor, one fraught with practical and moral dilemmas typically not encountered in traditional healthcare settings. Through this research, the authors demonstrate how forensic correctional nurses are navigating these practical and ethical quagmires to show effective leadership in EOL care in prisons.
Caring for offenders who engage in self-harming behaviors is another resource-intensive and exhausting endeavor, one that can readily split custodial and healthcare staff. Ramluggun explores the views of prison staff (including prison officers and healthcare personnel) regarding self-harm in a male custodial setting in England and Wales, where self-harm was reported to be twice the national average. The challenges and frustrations experienced by both prison officers and healthcare staff are discussed. Of note, how self-harm was interpreted by prison staff clearly impacted on their discipline-specific responses. Prison officers and healthcare staff alike felt like they were inadequately trained to appropriately care for prisoners who engaged in self-harming behavior. In addition, interdisciplinary conflict regarding the management of self-harming behavior was evident in the study. At times, prison officers attempted to manage self-harm via a mental health lens, whereas some of the healthcare staff were more inclined to support a custodial response. Clearly, the implications for forensic correctional nursing education, research, and practice are immense.
The scope of forensic correctional nursing is perhaps most evident in Salem, Nyamathi, Idemunida, Slaughter, and Ames' research that explored the experiences of homeless female ex-offenders after prison release. Indeed, the practice of forensic correctional nursing is not restricted to institutional settings but must also entail community-based work. Assisting ex-offenders regarding successful transition to the community, facilitating relapse prevention plans, and assisting with their healthcare challenges are important roles for forensic correctional nurses. Women whose lives are enmeshed with the criminal justice system typically present with a myriad of long-neglected healthcare challenges, including histories of victimization and traumatic life experiences, communicable diseases often complicated by significant substance abuse problems, and challenges with housing and employment. Forensic correctional nurses are ideally situated to assume leadership roles in caring for this underserved population.
Finally, Arries and Maposa, in an integrative review of cardiovascular risk factors among prisoners, show how those who are incarcerated are disproportionately affected by cardiovascular risk factors (particularly women, young offenders, and elderly inmates). As noted by the authors, unlike other at-risk vulnerable populations, prisoners represent a captive audience, thereby creating unique opportunities for primary, secondary, and tertiary intervention strategies. Knowledge gained through this review has direct implications for clinicians, administrators, and researchers, who together need to consider these findings within the context of their clinical expertise, available resources, and specific correctional environments.
Closing Thoughts
In many ways, this special issue represents the cumulative contributions of the IAFN Corrections Task Force as a whole, as the idea of a special issue from the outset was central to our raison d'etre. We are indebted to our task force colleagues, whom we have had the privilege of working with over the past 2 years, for sharing not only their intellectual insights but their practical wisdom. The articles illustrated within the pages of this special issue discuss crosscutting issues in forensic correctional nursing within a global context; we are grateful to the authors for furthering the discourse. Forensic correctional nursing is not a solitary, discipline-specific venture. Indeed, all authors, either directly or indirectly, have stressed the importance of collaborative practices. To be successful, practitioners, administrators, and academics need to embrace interdisciplinary collaboration with both healthcare and criminal justice professionals (including custodial staff) across the full spectrum of criminal justice and healthcare systems. How forensic correctional nurses traverse these intersecting systems is indeed noteworthy.
We recognize that nurses who have chosen careers in forensic correctional nursing have often done so at the expense of professional esteem. We hope that the support, mentoring, and infrastructure provided by the IAFN Corrections Task Force will bolster the ongoing evolution of this emergent specialty and move forensic correctional nurses toward a self-actualized professional identity within forensic nursing. Our journeys as forensic nurses take us down many different paths; in the end, perhaps we really only have one goal-creating a world without violence.
Acknowledgments
A special thank you to to our fellow members of the IAFN Corrections Task Force: Dr. Alison Colbert, Kim Day (IAFN staff), Jacquelynne Duguay, Shelia Early (IAFN Board Liaison), Dr. Anita Hufft, Tanya Munger-Montavon, Ginger Riebe, Dr. Deborah Shelton, Dr. Lorry Schoenly, Dr. Elizabeth Walsh, and Dr. Connie Weiskopf.