Correctional Health & Prevention

Week 11 Project Notes

• Part 4 of the project must be done independently, whereas Parts 1, 2, and 3 could be completed within groups.

General Notes

• Web of Causation, Upstream, and Downstream

Correctional Health

• Incarcerated individuals are entitled to healthcare that aligns with professional and community standards, as stipulated by the Corrections and Conditional Release Act.
• Nurses are responsible for assessing and triaging clients with acute healthcare concerns, transferring them to a local hospital if emergency care is needed.
• Timely healthcare identification, treatment, and management benefits the client, other offenders, facility staff, and the broader community.
• Nurses use clinical assessment and triage skills to provide primary, secondary, and tertiary interventions for incarcerated persons.

Levels of Prevention

• The 5 levels commonly associated with nursing and community health include: Primordial, Primary, Secondary, Tertiary, and Quaternary Prevention.

Primordial Prevention

• Primordial prevention, the most recent addition to preventive strategies, was described in 1978.
• Primordial prevention involves risk factor reduction targeting an entire population, with a focus on social and environmental conditions, often promoted through laws and national policy.
• As the earliest prevention modality, primordial prevention is often aimed at children to minimize risk exposure.
• It focuses on the underlying stage of natural disease by addressing the social conditions that promote disease onset.
• Improving access to safe sidewalks in urban areas to promote physical activity is an example, which in turn, decreases risks for obesity, cardiovascular disease, and type 2 diabetes.

Primary Prevention

• Primary prevention involves measures targeted at a susceptible population or individual.
• It aims to prevent a disease from ever occurring, targeting healthy individuals through activities that limit risk exposure or increase immunity, preventing progression in a susceptible individual to subclinical disease.
• Immunizations are a form of primary prevention.

Secondary Prevention

• Secondary prevention emphasizes early disease detection, targeting healthy-appearing individuals with subclinical forms of the disease.
• Subclinical diseases involve pathologic changes without overt symptoms diagnosable in a doctor's visit.
• Screenings are a common form of secondary prevention.
• A Papanicolaou (Pap) smear is an example, designed to diagnose cervical cancer in its subclinical state before progression.

Tertiary Prevention

• Tertiary prevention targets both the clinical and outcome stages of a disease.
• It is implemented in symptomatic patients to reduce the severity of the disease and any associated sequelae.
• Tertiary prevention aims to reduce the effects of the disease once established, while secondary prevention seeks to prevent its onset.
• Rehabilitation efforts are common forms of tertiary prevention.

Quaternary Prevention

• Quaternary prevention identifies patients at risk of overmedicalization.
• It protects them from new medical invasion and suggests ethically acceptable interventions.
• Marc Jamoulle initially proposed this concept targeting patients with illness but without the disease.
• Quaternary prevention involves action taken to protect individuals from medical interventions that are likely to cause more harm than good.

Population of Incarcerated Persons in Canada

• Incarcerated persons may experience similar age- and gender-specific healthcare concerns as the general population.
• Morbidity and mortality data indicate higher rates of disease and disability among incarcerated populations compared to non-incarcerated populations.
• 13% of male and 29% of female offenders in Canada present with mental health issues upon prison admission.
• Women and individuals older than 50 are the fastest-growing subgroups within correctional environments.
• 20% of offenders are 50 or older.
• 26% of inmates are Indigenous, while Indigenous people represent less than 5% of Canada's adult population.
• 15% of inmates are Black, while they only represent 5% of the overall population.
• Nearly one out of every 15 young Black men in Ontario has experienced jail time, compared to approximately one-in-70 young white men.
• A study published in the journal Race and Justice states these findings.
• Young Black men between 18 and 34 have the highest rates of being in the prison system, with 7 per 100 compared to 1.4 per 100 for white males in the same age range.

Health Challenges in Correctional Settings

• The majority of Canadian inmates meet the criteria for substance or alcohol abuse disorders.
• Blood-borne infection prevalence, such as HIV, HBV, and HCV, are higher in incarcerated populations.
• Harm reduction is the most widely accepted approach for addressing substance abuse and STIs in correctional institutions.
• Infectious diseases in crowded correctional settings represent a public health challenge, necessitating policies related to infection prevention and control measures.

Professional Challenges and Ethical Responsibilities

• The correctional environment can be severe for both offenders and staff due to the interpersonal climate, organizational culture, and social context.
• Challenges working with incarcerated clients include: limited client access, maintaining confidentiality with a corrections officer present, and large caseloads.
• Professional autonomy often means working alone, which can be a concern for correctional nurses as professional isolation.
• Security takes precedence over nursing care.

Collaborating with Community Partners

• The health of the incarcerated population reflects the overall health of the community from a public health perspective.
• Addressing the comprehensive needs of this population requires interdisciplinary and intersectoral collaboration among health care, criminal justice, education, social services, non-governmental organizations, and the voluntary sector.
• Correctional nurses are key in collaborating with community residential facility staff to ensure the safe release and transition of incarcerated persons.

The John Howard Society

• The John Howard Society of Ontario works to create effective, just, and humane responses to crime and its causes.
• Through community offices across the province, they offer programs and services to help people affected by the justice system develop key life skills, navigate criminal justice issues, and build productive futures after incarceration.

Education, Research, Advocacy and Practice Developments

• Nurses can influence, develop, and change correctional healthcare policies.
• Recognition of correctional nursing as a specialized area is critical for its ongoing growth and development.
• Canadian correctional environments have few nurse researchers.
• Nursing has a vital role in translating and interpreting research relevant to incarcerated populations and identifying emergent research questions.
• Correctional nursing is collaborative and requires a dedication to caring for incarcerated individuals, recognizing it as morally and professionally right.

Root Causes of Violence

• Violence is a complex social and health problem closely linked to the distribution of social and structural determinants of health.
• Violence connects to historical and current patterns of thought, perspectives, attitudes, and behaviors influenced by various factors.
• Diverse violence patterns are rooted in cultural, political, and economic contexts and trends, also influenced by mass media and mass communication.
• Understanding violence requires linking individual actions and reactions to the larger, systemic power structures.
• A structural perspective on violence considers the systemic processes' role in creating and perpetuating violence.
• The ways violence is framed and organized by the healthcare system, the legal system, and other societal institutions are considered.
• Structural violence is also called systemic violence.

Privilege

• Privilege happens in tandem with power.
• Systemic oppressions, like heterosexism, racism, and sexism, are examples of societal structures.

People, Poverty, Power (3P) Model

• People, poverty, and power intersect and overlap regarding violence.
• The 3P Model demonstrates that violence involves more than individual behavior.
• It highlights the link between many forms of violence and privilege and power differentials.
• Trauma is central to the 3P Model, indicating that it is also central to violence.
• Poverty is now understood as central to experiences of community violence.
• Violence in the 3P Model is an output/outcome and an input.
• The 3P Model highlights the importance of empathy in addressing and preventing violence.
• Systemic and self-empathy are vital foundations for preventing violence.
• Systemic empathy is inherent in societal systems, recognizing the importance of striving for structural changes and community liberation.
• Self-empathy, key to building resilience, is defined as actualized self-forgiveness by people experiencing poverty and oppression.

Forms of Violence

• Sexualized violence disproportionately impacts women and is rooted in gender inequity.
• Family violence is abuse, unhealthy conflict, or neglect by a family member toward another, including intimate partners, and leads to ill health.
• Physical impacts of IPV and family violence are compounded by chronic stress and coping responses.
• Universal screening for IPV is recommended as the best practice for all girls and women above 12.
• Innovations in information technology, like using the internet for violence or abuse, are increasingly damaging the health of Canadians.
• Stalking, cyberbullying, and human trafficking often involve various forms of violence, including sexualized violence and IPV.
• Almost half of stalking victims are between 15 and 34 (48%), most of whom are women (62%).
• Bullying is the exertion of power and control over another through vulnerabilities.
• 59% of trans youth from the Atlantic provinces reported being bullied once or more in the past year in an online study.
• Human trafficking is a pervasive and extremely lucrative transnational business.
• The average age for exploitation in human trafficking is 13–15 years.
• Most threatened youths of human trafficking include: Indigenous (30–50%), LGTBQ2S, previously exploited and abused (25%), homeless, migrants, and protective care.
• CHNs have a critical role and responsibility in early identification of those who have been or are being trafficked.
• Research shows half of the people who are trafficked sought healthcare, yet were not asked about their safety.

Power and Control

• The Power and Control Wheel is a key tool for CHNs to assess and intervene in violence.
• The wheel describes how interpersonal power can operate, particularly in IPV and family violence.
• Structural power and control come into play when police administrations and officers use many power and control forms together.
• The missing and murdered First Nation, Inuit, and Métis women and girls serve as an important example of systemic operation.
• The Canadian government's power to act or refrain from acting on the Commission's recommendations is another example.

Trauma and Violence-Informed Practice

• Violence leaves deep physical, spiritual, and psychological wounds from those processes.
• Trauma is embedded in the soul, psyche, and cognitive schema of traumatized individuals.
• Intergenerational trauma transmission and historic trauma are often key in community-based traumas.
• Trauma and violence-informed care integrates the importance and implication of trauma with the traumatic outcomes of violence.
• EQUIP Health Care outlines four ways to practice trauma and violence-informed care: build awareness among staff and clients, emphasize safety and trust, adapt your language, and consider trauma a risk factor(s).