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Culture Exploration Project 

Culture Exploration Project

Nursing 401

Old Dominion University

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  • Prison Culture in America - Prisons, and jails the United States of America

  • U.S. Department of Justice, Bureau of Justice Statistics reports 2,173,800 persons in prison or in local jails at the end of 2015

  • USA County Records reports there are 81 inmates currently in the Culpeper County Jail (2015)

 

Cultural beliefs related to communication (eye contact, space & distance issues, time & punctuality, gender communications)

  • “Prisonization” – incarcerated individuals lose a sense of self, the degree depends on the institution and the offender (Dobbs, & Waid, 2012)

  • Comradeship – “them against us” mentality (Dobbs, 2012)

  • General distrust of prison staff (Dobbs, 2012)

  • Sharing – development of strong bonds with other inmates (Dobbs, 2012)

  • Do not inform or do not tell on others mentally (Dobbs, 2012)

  • Deep sense of loyalty to others (Dobbs, 2012)

 

How is health maintained?

  • Dietary restrictions, health rituals, etc

  • Three full meals are provided daily at a cost of $2.00 to $4.00 per adult (Camplin, 2016, p.27)

  • Food is typically “flash-frozen” at an off-site facility then reheated (Camplin, 2016, p. 30)

  • A “re-rack” system is used - the uneaten food is repurposed by refreezing then reserving the same food up to seven days later (Camplin, 2016, p.30)

  • No set nutritional or caloric standards for correctional facilities in the U.S., each facility can have its own standards (Camplin, 2016, p.42)

  • The Bureau of Prisons food policy manual states that a non-flesh protein option is to be offered at both noon and evening meals to accommodate special diet requirements (Camplin, 2016, p. 53)

  • Most institutions have a commissary where inmates can purchase food (Camplin, 2016)

 

What causes ill health?             

  • The level of incarceration directly effects the level of violence an inmate is exposed to (Allen, Wakeman, Cohen, and Rich, 2010)

  • Abuse and violence is permitted by correctional staff regarding inmates (Allen, 2010)

  • A 1976 U.S. Supreme Court ruling mandated healthcare for all inmates (Allen, 2010)

  • Care provided to the inmates by a physician is often influenced by the correctional facilities regulations (Allen, 2010)

 

Health beliefs/ practices specific to pregnancy, the birthing process, and child rearing; Who attends the birth?                  

  • The American Journal of Public Health reported in the U.S. over 1,400 women gave birth in one year while in prison (Brusie, 2017)

  • Between 6 to 10 percent of incarcerated women are pregnant (Brusie, 2017)

  • Any time a pregnant inmate is required to leave and return for healthcare outside the facility they are subjected to a strip search (Brusie, 2017)

  • During transportation and OBGYN visits pregnant inmates are required to be in hand cuffs and belly chains (Brusie, 2017)

  • Special pregnancy units where they receive childbirth education, parenting classes, substance abuse education, domestic violence education, as well as prenatal and postpartum care information (Brusie, 2017)

  • Laboring inmates can be hand cuffed (Brusie, 2017)

  • A prison guard is monitoring the labor but does not offer any support, family and close friends are not allowed (Brusie, 2017)

 

Is circumcision done?  If so, what rituals are associated with it?                   

  • Circumcision decisions are left up to the foster family or adoptive family (Brusie, 2017)

  • The incarcerated mother rarely has input (Brusie, 2017)

 

Is birth control practiced and if it is what are the birth control practices?               

  • White County Tennessee jail has offered men and woman the opportunity to cut thirty days off their sentences by receiving either a vasectomy or Nexplanon implant for woman, which would reduce the chance of pregnancy for up to three years (Jackson, 2017)

  • There are some trial programs which help released prisoners to receive birth control once they are back in the community (Rice, 2017)

 

Are there customs associated with the postpartum period for the mother or the infant?                   

  • Woman are chained and handcuffed within the first half hour to an hour after giving birth (Brusie, 2017)

  • The website, Woman in Prison, states that 46 states have no regulations regarding shackling pregnant or postpartum woman (Brusie, 2017)

  • If an incarcerated woman has a vaginal deliver they are to return to the prison within twenty-four hours after the birth in most states (Brusie, 2017)

  • Most incarcerated women lose their parental rights if their sentence exceeds two years and/or are influenced to put their babies up for adoption (Brusie, 2017)

  • Incarcerated women are at higher risk of postpartum depression and postpartum psychosis (Brusie, 2017)

 

Is breast-feeding supported in the culture?                    

  • Highly unlikely, but it is possible for a prisoner to breastfeed if the prison is nearby the child's place of residence and the fostering or adopting family is willing to picking up frozen breast milk for the infant (Brusie, 2017)

 

What are the practices regarding immunizations?                    

  • Vaccinations are not offered free of change in the prison system at this time (Andrews, 2015)

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Health beliefs/ practices specific to end of life & death rituals.                   

  • What are the practices for caring for the dying and the dead?

  • If any, what are the funeral practices of the culture?

  • 1 in 10 prisoners are lifers which means 100,000 prisoners will die in prison (Ridgeway, 2012)

  • There are assisted living and hospice units in some penitentiaries for the aging population (Ridgeway, 2012)

  • 75 hospice programs in U.S. prisons in 2012, more than half rely on inmate volunteers to provide care to the dying (Neumann, 2016)

  • Aging inmates are targeted by the younger incarcerated population (Ridgeway, 2012)

  • Prisoners are influenced to make a will and complete advanced directives upon receiving long-term sentencing (Johnson, 2013)

  • Family members can assume responsibility for a loved one’s funeral, they become responsible for all cost associated with the burial (Johnson, 2013)

  • If there is no family or they cannot afford the cost the body will be treated per county regulations which may include burial, cremation or donation to science (Johnson, 2013)

 

What are the mourning practices of the culture?                                

  • Some hospice unit staff do provide a type of minor service and/or grave side service (Neumann, 2016)

  • Few penitentiaries allow participation in the mourning and burial process – at Angola state penitentiary inmates build coffins and have a funeral procession to the grave side for the deceased (Fields, 2005)

  • Eleven penitentiaries have their own graveyards on the property for inmate burials in the U.S. (Ridgeway, 2012)  

 

Physiological variations within the culture which affects treatment or response to treatment  

  • Are there variations within the culture based upon geography? (3)

  • Five different levels of security within the U.S. prison system– minimum, low, medium, high or administrative (BOJ, 2017)

  • The top three states with the largest incarcerated populations are Louisiana, Oklahoma, and Alabama (BOJ, 2017)

  • 1 out of every 5 prisoners has reported being a victim of physical or sexual assault by either another inmate or a correctional staff member (Gilson, 2016) 

  • Mandatory minimum sentences have created a larger population who are spending longer in the prison system (Ridgeway, 2012)

  • Minorities represent 75% of inmates incarcerated for drug offenses (Allen, 2010)

 

Are there genetic predispositions to any diseases?  

  • The incarcerated population in the U.S. has an extremely high number of infectious diseases including viral hepatitis, HIV/AIDS, other sexually transmitted diseases and tuberculosis (Allen, 2010)

  • Deinstitutionalization left a large majority of the mentally ill population untreated and unstable, many became homeless or in prisoned (Allen, 2010)

  • Incarceration has become “the asylum of last resort” for the mentally ill (Allen, 2010)

  • More than half of the inmates meet the Diagnostic and Statistical Manual, 4th Ed. (DSM-IV) diagnoses for drug addiction (Allen, 2010)

 

Are there environmental factors resulting in physiological variations?                                                   

  • Prisons and jails are not designed to handle individuals with psychiatric illness, placement in isolation can often push them into acute psychosis (Allen, 2010)

  • Long-term incarceration is said to add 10 years to a person’s physical age reducing life expectancy (Ridgeway, 2012) 

 

Role of nursing within the culture; How are nurses valued, viewed / utilized? 

  • Correctional forensic nurses provide healthcare to incarcerated individuals in jails, prisons, and juvenile detention centers (Schoenly, 2017)

  • Forensic nurses are trained regarding legal issues (Schoenly, 2017)

  • Primary responsibilities of nurses in correctional facilities are to perform assessment intake screenings, manage chronic illnesses, administer medications, and schedule sick call for inmates with acute issues to be seen by a physician (Schoenly, 2017)

 

Are there restrictions related to the practice of nursing?                                                               

  • Physicians and nurses are constantly reminded that custody and security is the priority (Vaughn, 1999)

  • A general suspicion that all prisoners seeking medical services are attempting to manipulate the system becomes a barrier for healthcare (Vaughn, 1999)

  • When correctional medical staff adopt custodial officials’ punitive beliefs and implement the mandates of penal harm, the wellbeing of the prisoners is brought into question (Vaughn, 1999)

  • Documented cases of healthcare being withheld from inmates by security staff (Vaughn, 1999)

 

Based on the information provided in this table, how would you provide culturally sensitive nursing care to a patient from this culture?              

  • Provide them with their own personal space

  • Treat them with compassion and caring

  • Treat them with dignity and respect

  • Listen to their needs without rushing them or doubting them

  • Respect what they are communicating to me regarding their own condition by validation

  • Address their medical concerns in a timely manner

  • Administer medications in a timely manner to address acute or chronic illness

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References

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Allen, S. A., Wakeman, S. E., Cohen, R. L., & Rich, J. D. (2010). Physicians in US prisons in the era of mass incarceration. International Journal of Prisoner Health, 6(3), 100–106. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204660/

 

Andrews, M. (2015). Even in prison, health care often comes with a copay. NPR Health News. Retrieved from https://www.npr.org/sections/health-shots/2015/09/30/444451967/even-in-prison-health-care-often-comes-with-a-copay

 

Brusie, C. (2017). 10 Things you didn’t know about pregnancy in prison. Everyday Family, Inc. Retrieved from https://www.everydayfamily.com/blog/10-things-you-didnt-know-about-pregnancy-in-prison/

 

Bureau of Justice Statistic (BOJ). (2015). National Criminal History Improvement Program (NCHIP). Washington, D.C… Retrieved from  https://www.bjs.gov/

 

Camplin, E. (2016). Prison food in America. [ProQuest Ebook Central]. Retrieved from https://ebookcentral.proquest.com/lib/odu/detail.action?docID=4733917

 

Dobbs, R. R., & Waid, C. A. (2012). Prison culture. Encyclopedia of Prisons & Correctional Facilities, Ed... 720-24. SAGE Reference Online. Retrieved from https://mafiadoc.com/prison-culture-encyclopedia-of-prisons-amp-correctional-facilities_598d59be1723ddd069fb17dd.html

 

Federal Bureau of Prisons (BOP). (2017). About our facilities. Retrieved from https://www.bop.gov/about/facilities/federal_prisons.jsp

 

Fields, G. (2005). As inmates age, a prison carpenter builds more coffins. The Wall Street Journal. Retrieved from https://www.prisonpolicy.org/scans/disturbing/2005/coffins.shtml

 

Gilson, D. (2016) What we know about violence in America’s prisons. Mother Jones. Retrieved from http://www.motherjones.com/politics/2016/06/attacks-and-assaults-behind-bars-cca-private-prisons/ 

 

Jackson, A. (2017). Tennessee county inmates get reduced jail time for getting a vasectomy. Cable News Network (CNN). Retrieved from http://www.cnn.com/2017/07/20/us/white-county-inmate-vasectomy-trnd/index.html

 

Johnson, A. (2013). What happens when a loved one dies in prison? iMortuary Blog. Retrieved from https://www.imortuary.com/blog/what-happens-when-a-loved-one-dies-in-prison/

 

Neumann, A. (2016). What dying looks like in America's prisons. The Atlantic Daily. Retrieved from https://www.theatlantic.com/health/archive/2016/02/hospice-care-in-prison/462660/

 

Rice, A. MD. (2017). The contraceptive needs of incarcerated women: A case report. The American Congress of Obstetricians and Gynecologists (ACOG). Retrieved from https://www.acog.org/About-ACOG/ACOG-Departments/Long-Acting-Reversible-Contraception/Projects-to-Assess-Bedsider-in-Ob-Gyn-Practice/The-Contraceptive-Needs-of-Incarcerated-Women

 

Ridgeway, J. (2012). The other death sentences. Mother Jones and the Foundation for National Progress. Retrieved from http://www.motherjones.com/politics/2012/09/massachusetts-elderly-prisoners-cost-compassionate-release/

 

Schoenly, L. (2017). International Association of Forensic Nurses. Retrieved from http://www.forensicnurses.org/?page=correctionalnursing

 

Vaughn, M. S. (1999). Penal harm medicine: State tort remedies for delaying and denying health care to prisoners. Department of Criminal Justice, Georgia State University Crime, Law & Social Change 31: 273–302. Kluwer Academic Publishers.

 

USA County Records (2017). Culpeper County Jail in Virginia, Culpeper, Va. Retrieved from http://culpepersheriffsoffice.com/divisions/jail.html

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