Introduction
This study aims to develop a support strategy for novice nurses working with young self-harming inmates. Working with self-harming young men affects the psychological stability of mental health nurses. No less importantly, self-harm is usually related to dual harm and increased potential of suicides in places of incarceration. The study research question was formulated using the PICO model (demographic, intervention, comparisons, and outcomes). The goal of this project is to analyze the research on novice nurses working in penitentiary settings with young self-harming inmates and suggest a support strategy that will benefit the inmates and services provided.
Identifying The Quality Issue
Self-harm and suicidal attempts are still prevalent among US citizens, and the number of people who self-harm remains growing. According to the latest data from the CDC’s National Center for Health Statistics, there were 45,979 deaths from suicides in 2021, with the cause of death ranking 12 compared to other reasons (“Suicide and self-harm injury, ” 2022). In March 2019-2020, 64,552 self-harm incidents were reported in prison settings in the US, 11% up, compared to the previous 12 months (“Prison self-harm, ” 2020). There were 294 deaths in prison custody, among which 76 were apparent self-inflicted deaths and 179 – deaths from natural causes, including 23 deaths from COVID-19 (“Prison self-harm, ” 2020). Notably, there were 31,568 assault incidents (8% down tendency), among which 9,784 assaults on staff (5% down tendency), including 3,681 serious assaults (7% decrease) and 853 serious assaults on staff (5% decrease) (“Prison self-harm,” 2020). These data concern all penitentiary facilities and suggest that working in prisons and corrections can be dangerous.
There are straightforward downward trends in violence among inmates during the last two years. Importantly, the National Institute of Corrections has not presented research on juvenile suicide trends since 2016, although suicides in adult prisons include the articles published in 2021 (“Suicide in corrections,” n.d.). This suggests that the adult prison systems face more challenges related to violence and self-harm compared to juvenile corrections.
The considerably high reported numbers of staff assaults imply that mental health nurses may feel unsafe when working in jails. Lazzari et al. (2019) suggest that the most important variable that impacts moral distress and intention to leave is the long experience in prisons. At the same time, incompetent colleagues and short staffing increased the levels of moral distress. Therefore, the scholars suggested providing specific training for nurses who work in this high-risk environment.
The prison officers often show insufficient understanding of the causes of self-harm, which can be seen as an additional negative factor. Sousa et al. (2019) notice that while “prison officers did not advocate harsh treatment for self-harming prisoners,” they tend to reveal some difficulties “in understanding the causes of self-harm, reproducing the negative myths referred to in the literature,” and “tend to neglect the fact that these behaviors may, in some cases, culminate in suicide” (p. 3). This is a good observation, as Slade et al. (2020) report that “60% of men who harmed themselves also engaged in custodial violence, while 32% who were violent also had a self-harm event” (p. 182). Scholars say that men who do dual harm use a greater variety of self-harm methods, and increased use of lethal methods. These data suggest that, first, self-harm is closely related to assaulting behavior, and second, that self-harm increases the chances of violence becoming more lethal. Hence, self-harm in prisons is a critical issue that should be addressed immediately.
Understanding the Problem from a Range of Perspectives
The work of a nurse in prisons has its specific characteristics dictated by the environment. Issues of safety are usually referred to when speaking of problems and challenges novice nurses face in these settings. Novice nurses working with young inmates subject to self-harm often report experiencing fear not only for the patient’s life but also for their own (Caputo, 2020). In stressful situations, inmates may act unpredictably, and this creates additional stress for nurses’ work. Safety is an important issue that can determine the nurses’ decision to stay in the profession and carry on with their daily duties.
Noteworthy, feeling safe is the central factor that determines the nurses’ mental well-being. Needham & van de Mortel (2020) report that novice nurses declared that safety was the most crucial aspect that allowed them to cope with stress. Abbott et al. (2020) distinguish three strategies to support nurses: giving instructions on the rules of safety, providing the characteristics of prisoners, and elaborating actions in unforeseen situations. The scholars also noted that interactions between guards and security had a visible impact on the inmates’ behaviors and nurses’ perceived safety. Although working with complex patients who self-harm may cause uncertainty in novice nurses, those who work in pairs with experienced colleagues saw this cooperation as helpful in overcoming anxiety (Solell & Smith, 2019). Hence, experience is seen as the best way for reducing nurses’ anxiety, while being informed of prison rules, and prisoners’ following these rules is important for nurses’ feeling safe.
In some cases, nurses may have biases and discriminatory attitudes toward the inmates. Scholars note that family, friends, communities, and media impact the image of prisoners and violent offenders which can cause nurses’ unfavorable attitudes (Hunt et al., 2020). However, a decent percentage of nurses do not feel anxious but, on the contrary, are interested in gaining new knowledge about the specifics of working with prisoners (Hunt et al., 2020). Importantly, studies show that nurses can work out their prejudices about the danger of criminals’ behavior toward prison staff (Terblanche & Reimer-Kirkham, 2020). This means that well-informed nurses have much fewer fears for their safety.
Current US penitentiary and judicial systems still have laws that lead to the imprisonment of younger offenders for minor offenses, such as drug abuse. But there is a difference between the psychological characteristics of adult violent criminals and people under 18 who are often put in prison for shorter terms, and further undergo probationary terms under social workers’ supervision on the stages of reintegration into society. These youngsters staying in corrections should be perceived as kids, as most often they are essentially kids who made some wrong choices under the pressure of life circumstances.
Existing Evidence
Nurses who receive support in prison settings have better attitudes toward their responsibilities. According to study results, some 87% of intern nurses claimed that prison institutions have a well-thought-out system of employee protection (Sutherland et al., 2021). When performing their work duties, the interns constantly interacted with supervisors and guards who provided direct assistance. However, as discussed above, when working with younger inmates, increased protection may be less required.
Studies also demonstrate the importance of the entry of novice nurses into direct interaction with inmates. Working with more experienced colleagues can be highly beneficial, especially in situations of self-harm (van de Mortel et al., 2017). Most research proves the opportunity of overcoming one’s prejudices and misconceptions about working in prison institutions. By gaining confidence in their safety, nurses gain confidence when working with inmates.
As a rule, bias and discrimination attitudes are caused by misconceptions about prisoners’ behavior and the danger of working in juvenile corrections. Therefore, scholars propose to allow novice nurses to start with open interactions with prisoners to feel their motivations and psychological states (Brooker et al., 2018). Importantly, nurses will briefly observe the mental states that provoke self-harm, dual harm, or violence against staff or other inmates (Brooker et al., 2018). By becoming a part of the team working with juvenile prisoners from the very beginning of entering their jobs, nurses can have an increased sense of awareness about the important features of working with correctional service receivers.
After becoming part of the service team and getting instructions on the rules of correction, the nurses will feel calmer and better aware of the individual problems of young inmates. They will observe and learn to predict potential emergencies, such as suicide attempts or self-harming behavior through the constant daily interaction with prisoners. The scholars also report that the prison’s medical staff must possess professional skills that meet the qualifying medical requirements to provide high-quality help (Terblanche & Reimer-Kirkham, 2020). Therefore, professionalism and participation in inmates’ lives are seen as beneficial elements of young prisoners’ mental well-being. Primary and specialized medical care for convicts in a penitentiary institution is crucial (Terblanche & Reimer-Kirkham, 2020). Prescribing medications such as anti-depressants and making questionnaire-based mental health assessments are a part of the correction nurses’ daily routines.
Effective and Less Effective Practices to Solve the Problem
Although the nurses’ comfort is an important constituent of eliminating unwanted behavior, inmate-directed initiatives will bring better results. Changing the conditions of detention and the attitude of staff towards inmates is an important component of their mental health. However, there is an opinion that trauma-informed practice (TIP) across the workforce in penitentiary facilities is currently barely appropriate. This is due to a large “gap between vision and practice,” although the prisons can and should become more “trauma-aware” (Vaswani & Paul, 2019, p. 513). The scholars emphasize that true TIP is hardly possible “within current custodial contexts” (Vaswani & Paul, 2019, p. 513). Such a frank denial of the effectiveness of the soft-skills-based methods relates to an insight into the situation in the US juvenile penitentiary system as regards violence and self-harm based on the views of 200 prison staff. Probably, a deeper reform of the system is necessary along with more superficial strategies like staff training.
For instance, there is still widespread practice of solitary confinement in juvenile and adult corrections. Silverman et al. (2022) presented the study results saying that “the hazard of self-harm associated with solitary confinement exposure was 1.51 times that of incarcerations with no solitary exposure” (p. 396). Importantly, although the ban on solitary incarceration was introduced in the NYC jail system in February 2015, the practice is still prevalent in juvenile corrections in NYC (Silverman et al., 2022; “Behind bars: USA – Locking up children, ” 2022). Therefore, the ban on solitary confinement was one of the effective solutions to prevent and reduce self-harm and dual harm. The ban should be thoroughly implemented in NY state and spread to other states.
The architectural-based approaches can also become a good solution to improve the mental health of inmates. Morgan et al. (2020) provide evidence that prisons with a higher proportion of the area given over to natural vegetation show lower levels of self-harm and violence against each other and staff. The green areas can also be complemented by the green sports yards, as a physical activity also proves to improve the inmates’ well-being (“Behind bars: USA – Locking up children,” 2022). Experts say that in juvenile detention, there are a lot of teenagers who were imprisoned for minor offenses, or through participation in gangs, which they could not avoid.
Many of them were subjected to physical abuse, so, to some extent, getting into well-designed and organized correctional facilities improves their lives. This happens through a safe environment, and development opportunities, including having school classes, visiting the gym, and playing sports games (“Behind bars: USA – Locking up children,” 2022). Consequently, the mental health nurses’ advice and attention, combined with the adequate imprisonment conditions, give the young inmates faith in a better future and improve their psychological states.
Conclusion
Thus, the analysis of research on mental health novice nurses working in penitentiary settings was presented. The support strategies that address the issue of self-harm and benefit the inmates were presented. Given the above, the recommended innovation is developing a team-based approach to service provision in jails. This innovation can go along with the architectural redesigning or repurposing of the correctional facilities to provide more space for development and relaxation such as green areas, libraries, and sports areas. Nurses should demonstrate professional skills when working with inmates and be well-informed of the prison rules and safety issues. No less importantly, the guards should ensure that the prisoners follow the safety rules, as nurses will fail to perform their duties appropriately in dangerous environments. The implementation of the proposed innovations will attract more nurses to work in the prison settings, will benefit the inmates’ well-being, and help establish trust and support-based communication in the prisons.
References
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