NPs caring for people who are incarcerated and negatively impacted by social determinants of health.

ABSTRACT: This article explores roles filled and care provided by NPs in diverse carceral settings along with the impact of health disparities experienced as a result of social determinants of health on the chronic disease burden of people who are incarcerated. Opportunities abound for NPs to positively influence this patient population's health, but specialized education is needed.

Developing educational modules to enhance care of aged and dying inmates: Set-up phase.

The purpose of this article is to explain the strategies used in the "Set-up" phase of developing computer-based education on the care and management of incarcerated people who are older and/or dying. Public health nurses have an opportunity to support efforts in educating corrections staff to enhance health care for older and dying inmates. Such endeavors can promote social justice through inmates receiving evidence-based care that parallels that received by the community at large. "Set-up" is the first of four phases in the Institute for Healthcare Improvement's Framework for Going to Full Scale. Our design approach was threefold and included an environmental scan, a modified Delphi survey, and a usability study. An expert advisory board was consulted throughout the Set-up Phase. Participants for the Delphi Survey had expertise in geriatrics and corrections health care. Usability testing was conducted at two State Correctional Institutions. The Delphi Survey consisted of three Qualtrics surveys. Usability testing examined navigability; detected problems; observed time spent solving problems; identified problem severity; and developed recovery strategies. The Set-up established proof of concept, three prototype modules, and a specifications document to guide future programming. In addition, a Technology Niche Analyses® provided a preliminary commercialization plan (NIH, 2017). The Set-up phase has been instrumental in exposing the available infrastructure for dissemination of an educational product within corrections and may be a first step in addressing public health concerns on issues in aging. Commercial feasibility of the program and the need for continued research for Developing the Scalable Unit were established.

Empowering Change Agents in Hierarchical Organizations: Participatory Action Research in Prisons.

Participatory action research (PAR) approaches harness collaborative partnerships to stimulate change in defined communities. The purpose of this article is to illustrate key methodological strategies used in the application of PAR methods in the particularly challenging environment of a hierarchical organization. A study designed to promote sustainable, insider-generated system-level changes in the provision of end-of-life (EOL) care in the restrictive setting of six state prisons is used as an exemplar of the application of three cardinal principles of PAR. First, development of a collaborative network with active partnership between outsider academic researchers and insider co-researchers began with careful attention to understanding the culture and processes of prisons and gaining the support of organizational leadership, using qualitative data gathering and trust-building. During the implementation phase, promoting co-ownership of change in EOL care through the co-construction of knowledge and systems to enhance sustainable change required carefully-orchestrated strategies to maximize the collaborative spirit of the project. Co-researchers were empowered to examine their worlds and capture opportunities for change using new leadership skills role-modeled by the research team. Third, their local knowledge of the barriers inherent in the contextual reality of prisons was translated into achievable system change by production of a toolkit of formalized and well-rehearsed change strategies that collaborative teams were empowered to enact within their hierarchical prison environment. © 2016 Wiley Periodicals, Inc.

Administrators' perspectives on changing practice in end-of-life care in a state prison system.

OBJECTIVE: Sentencing trends have created a demographic shift in prison populations. Greater numbers of inmates are aging and dying in prison, creating a demand for enhanced end-of-life (EOL) care. Changing practice to meet escalating care demands in correction settings is complicated by economic constraints, attitudinal barriers, and organizational features. This study explored perspectives of EOL care held by administrators in a state prison system to reveal challenges to changing practice to meet the needs of inmates suffering advanced illness and dying in prison. DESIGN AND SAMPLE: Qualitative interviews were conducted with 12 administrators from the central office of a state department of corrections. MEASURES: Semi-structured discussion guide. RESULTS: Key influences impacting EOL care services included: local prison culture, treatment versus security focus, case-by-case consideration, public sentiment, budget neutral approaches, and conflicting views of service targets. CONCLUSIONS: These findings revealed the organizational structures, attitudes, and beliefs held by the administrative echelon of a state prison system and were used to guide the derivation of discrete approaches to changing practice in this complex system. Contextual evaluation permitted a much deeper understanding of the influences on changing practice in this hierarchical bureaucracy. This type of preliminary evaluation is crucial to infusing new practice initiatives in complex organizations caring for stigmatized, at-risk populations.

Health issues faced by adolescents incarcerated in the juvenile justice system.

Incarcerated adolescents have a high level of health problems when compared to those not incarcerated. These higher rates are in part due to inadequate coping skills. The purpose of this paper is to conduct a literature review of articles that focus on the health issues of incarcerated adolescents. This review provides an overview of the issue, strategies that nurses working in juvenile facilities can employ to increase their impact on the health of adolescent offenders, and research needs for the future. Thirty articles published around the world between the years 1995 and 2007 are reviewed and described.

Myocardial infarction in women: promoting symptom recognition, early diagnosis, and risk assessment.

Even with national campaigns to help increase awareness, most people do not realize that heart disease is now the leading cause of death for women. Women experiencing an acute cardiac event often do not recognize the symptoms or are misdiagnosed by healthcare providers because of atypical symptom presentation. This can lead to a significant delay in treatment and a less desirable recovery outcome. To help promote early identification of cardiac risk and cardiac events, this article highlights the range of symptom presentation in women with myocardial infarction and focuses on how advanced clinical nurses can increase nurses' and the public's understanding of this disease in women.

In their own words: older male prisoners' health beliefs and concerns for the future.

U.S. prisons are experiencing an exponential growth in inmates aged 50 years and older, a group with disproportionately high disease burden. The purpose of this study was to examine, in largely exploratory terms, the health beliefs and concerns of older male inmates and the health challenges they anticipate facing upon their return to the community. Results indicate that there is much to be gained from the assessments and insights of older prisoners with regard to health changes that occur during incarceration, health programs that they desire, the reasons for their confidence (or lack thereof) in health self-management, and fears about their health upon release. Geriatric nurses are well positioned to heed these important insights of inmates and translate them into steps for 1) preventing many of the health deteriorations experienced by older prisoners and 2) advocating for more seamless health care when incarcerated offenders transition back into the community.

Reframing person-centered nursing care for persons with dementia.

Alzheimer's dementia manifests in a complex clinical presentation that has been addressed from both biomedical and phenomenological perspectives. Although each of these paradigmatic perspectives has contributed to advancement of the science, neither is adequate for theoretically framing a person-centered approach to nursing care. The need-driven dementia-compromised behavior (NDB) model is discussed as an exemplar of midrange nursing theory that promotes the integration of these paradigmatic views to promote a new level of excellence in person-centered dementia care. Clinical application of the NDB promotes a new level of praxis, or thoughtful action, in the care of persons with dementia.

Health-related research on older inmates: an integrative review.

The literature on older inmates' health is fragmented and insufficiently developed. In this integrative review, 21 research articles on health and older inmates were identified, critiqued, and synthesized to determine: the minimum age criterion most commonly used; health-related variables explored; health status; the health impact of incarceration; and aging-specific policies, programs, and facilities. Age 50 and older was used most often. The top three health variables were psychiatric conditions, physical illnesses, and substance abuse. Self-reports of health status varied across studies; however, inmates consistently reported health declines since incarceration. Older inmates' health needs appear often to be left unmet. Nursing investigations are needed leading to practice innovations to enhance prisoners' self-management to reduce disease burden and fiscal and societal costs.

Healthcare providers' perspectives: estimating the impact of chronicity.

PURPOSE: To compare elders' self-ratings of the impact of their chronic conditions with healthcare providers' estimates of the impact of the same conditions on older adults. The effect of length of time in clinical practice and rural or urban clientele on healthcare providers' impact ratings was also explored. DATA SOURCES: A pen-and-paper survey was administered to 122 community-dwelling adults aged 55 years and older, attending health education or exercise programs held by a hospital in a city of approximately 60,000 people. Elders were asked to identify which of 11 common chronic conditions they had and then to rate the impact each condition had on their daily lives. A sample of 290 healthcare providers who are members of the Gerontological Society of America completed a mailed survey asking them to estimate the impact that each of the 11 conditions had on older adults. CONCLUSIONS: Healthcare providers consistently overestimated the impact that chronic health conditions had on older adults when compared with the elders' self-ratings of impact. Greater levels of experience were not significantly related to providers' impact ratings of chronic conditions. IMPLICATIONS FOR PRACTICE: Nurse practitioners, as primary care providers, must understand the impact of chronic conditions on older adults' daily lives in order to provide effective, efficient, and evidence-based health care. This study points to the need for more research to discover why older adults and healthcare providers have such different perspectives on the impact of chronic health conditions.

Older men's health: motivation, self-ratings, and behaviors.

BACKGROUND: There is a documented need to examine the complex motivational systems that lead individuals to adopt health-promoting behaviors and to evaluate the psychosocial aspects of male health. A study focused on health motivation as a determinant of self-rated health and health behaviors among older men was therefore undertaken. OBJECTIVES: This study aimed to explore the relations among health motivation, self-rated health, and health behaviors in community-dwelling older men. METHODS: A descriptive, correlational survey design was used for this study of 135 community-dwelling men ages 55 years and older. The questionnaire packet included a demographic tool, the Older Men's Health Program and Screening Inventory, the Health-Promotion Activities of Older Adults Measure, and the Health Self-Determinism Index. RESULTS: Older men with more intrinsic motivation rated their health as better (p