High-quality community nursing implies caring for people from highly diverse backgrounds who live in many different settings, including prisons, jails, and similar facilities. Healthcare excellence is particularly important in the latter environments because incarcerated individuals often face an extensive list of health risks and have multiple complex health problems. The Miami Dade Juvenile Detention Center (JDC) operated by the Florida Department of Juvenile Justice (FDJJ) is one such setting. The facility accommodates youth under the age of 18 throughout the time of their detention screening (FDJJ, n.d.a; FDJJ, n.d.b). Working with incarcerated adolescents and children, nurses should consider health issues all populations inhabiting correctional settings tend to have: substance abuse, adverse mental conditions, chronic and communicable diseases (Nies & McEven, 2018). Besides, they must address the developmental needs of children as a vulnerable population. Considering this, the purpose of the present paper is to review the risks to which detained youths are exposed, discuss possible nursing interventions, and analyze the roles of nurses working in the selected juvenile detention center.
Community Setting
The JDC is one of 21 juvenile detention centers located across Florida (FDJJ, n.d.a). The facility accommodates youth detained by various local courts for up to one month before their release or placement in a long-term correctional setting (FDJJ, n.d.b). The JDC acknowledges the significance of a safe and ethical environment for detainees where all their needs and interests are satisfied. Thus, it provides mental health, substance abuse, physical health, and education services (FDJJ, n.d.b). Noteworthily, the setting provides education in partnership with the Department of Education (FDJJ, n.d.b). However, nurses play an essential role in rendering three other types of services in the facility.
Physical and mental health services include timely detection of any problems in detainees, as well as prevention of morbidity and promotion of well-being and positive behaviors in them. Substance abuse services comprise nursing activities aimed to identify at-risk individuals and factors that contribute to substance use in them (Marotta, 2017). This type of service also seeks to engage incarcerated youth in counseling, on-site cognitive-behavioral therapies, and other interventions (Marotta, 2017). Overall, the described services address all major risks that prevail in the incarcerated youth population. Besides such medical conditions as nutritional deficiencies, respiratory and dental problems, this demographic group frequently demonstrates high-risk behaviors, including early onset of sexual activity, drug use, violence, and gang participation (Kumwenda, Nzala, & Zulu, 2017). Moreover, incarcerated children are frequently exposed to traumatic experiences (namely, sexual abuse and domestic violence) that only aggravate their psychological conditions and adverse behaviors (Marotta, 2017). It is valid to say that services available at the JDC aim to provide an immediate response to existing issues in detained children. Moreover, they target long-term health outcomes and have a purpose to foster detainees’ successful integration into society after release.
Health Promotion Nursing Intervention
As was mentioned above, children and adolescents often become involved in illegal activities and develop at-risk behaviors as a result of prior traumas. Thus, it may be suggested for the JDC to employ interventions that would address previous traumatic experiences in detainees. As stated by Marotta (2017), “trauma-informed interventions acknowledge the impact of unresolved trauma on inhibiting the delivery of effective substance misuse treatment” (p. 11). Besides helping to resolve the problem of substance abuse, trauma-informed practices also allow preventing sexual risk behaviors in individuals, which is frequently used as a coping mechanism (Myers, Carney, Browne, & Wechsberg, 2018). Activities that can be utilized as a part of such interventions are group discussions of links between traumas and depression/violence/abuse, HIV prevention, utilization of relevant healthcare services (Myers et al., 2018). Moreover, interventions may include individual treatment sessions for traumas and post-traumatic stress disorder (Myers et al., 2018).
It is clear that to be effective, this type of intervention must address a broader range of social/environmental factors as well. Moreover, it must connect youth to essential community and support resources to help them maintain positive and healthy behaviors after incarceration. Thus, nurses alone will not be able to perform comprehensive trauma-informed interventions successfully and need the assistance of interprofessional team members. Besides professional psychologists and social workers, nurses may collaborate with such local organizations as the Children Foundation and Miami Children’s Initiative. These organizations specialize in community analysis and networking aimed to meet children’s needs and help them fulfill their potentials. In the role of advocates, nurses may develop partnerships with those organizations and engage them in the design of targeted community programs aimed to support incarcerated youth and help them integrate into society better.
Professional Nursing Organization
One of the professional nursing organizations related to the JDC’s work, in particular, and correctional settings, in general, is the American Correctional Health Services Association (ACHSA). It was established in 1976 to support the professional development of practitioners working in prisons and jails and improving their work conditions (ACHSA, n.d.a). Moreover, since the very first days, it had a goal of advocating for the rights and needs of incarcerated individuals (ACHSA, n.d.b). Based on this, the organization promotes ethical conduct among medical practitioners working in correctional settings and strives to increase public awareness of various matters about inmates’ health and the medical services they receive.
One of the professional issues that the ACHSA addresses are the quality of medical/nursing care in correctional facilities. Each of such settings is legally required to attend to the needs of people in custody, especially when the latter have issues requiring immediate medical attention. Nevertheless, due to the nature of punitive institutions and multiple restrictions inherent in them, it may be extremely difficult to provide high-quality, comprehensive interventions for detained individuals (Barnert, Perry, & Morris, 2016). Acknowledging these issues, the ACHSA (n.d.c) encourages practitioners to engage in professional development, education, and research. By becoming a member of this organization, a nurse may tap into a wealth of important professional resources. Practitioners can use the ACHSA-provided information to advocate for the interests and rights of detained youths either in the JDC or in any other setting. Research evidence obtained using organizational membership can also be used to design effective interventions and prevention programs for the vulnerable population. Of course, nurses may always engage in independent secondary and primary research of correctional nursing issues, yet with the help of the professional organization, the process may be substantially facilitated.
Summary
As the conducted literature review revealed, the role of nurses working in correctional settings is not limited to the provision of care to inmates but extends to advocacy for the rights and needs of the latter. Besides that, correctional nursing involves the development of networks and partnerships aimed to deliver high-quality, comprehensive interventions and prevention programs targeted at certain vulnerable populations, such as incarcerated youth. Those interventions should necessarily address specific needs and factors defining the health of detained individuals. In the case of children and adolescents accommodated by the JDC, these factors include previous traumatic experiences, leading to psychological and behavioral complications. Nevertheless, it may be hard for nurses to realize comprehensive, trauma-informed interventions in detention facilities, which are restrictive. Thus, one of a few professional organizations dedicated to the field of correctional healthcare, ACHSA, recommends practitioners enhance their knowledge and skills needed to provide high-quality care for detainees. Ethical conduct, advocacy, collaboration with other professionals, and continual professional development are the best ways to attain this goal.
References
American Correctional Health Services Association. (n.d.a). Our history. Web.
American Correctional Health Services Association. (n.d.b). Mission & ethics statement. Web.
American Correctional Health Services Association. (n.d.c). Membership. Web.
Florida Department of the Juvenile Justice. (n.d.a). Detention services. Web.
Florida Department of the Juvenile Justice. (n.d.b). Detention centers. Web.
Kumwenda, M., Nzala, S., & Zulu, J. M. (2017). Health care needs assessment among adolescents in correctional institutions in Zambia: An ethical analysis. BMC Health Services Research, 17(581), 1-9.
Marotta P. L. (2017). Childhood adversities and substance misuse among the incarcerated: Implications for treatment and practice in correctional settings. Substance Use & Misuse, 52(6), 717-733.
Myers, B., Carney, T., Browne, F. A., & Wechsberg, W. M. (2018). Development of a trauma-informed substance use and sexual risk reduction intervention for young South African women. Patient Preference and Adherence, 12, 1997-2006.
Nies, M. A., & McEwen, M. (2018). Community/public health nursing: Promoting the health of populations (7th ed.). St. Louis, MO: Elsevier.