Stigma and US Nurses' Intentions to Provide the Standard of Maternal Care to Incarcerated Women, 2017.

Objectives. To examine relationships among actionable drivers and facilitators of stigma and nurses' intentions to provide the standard of maternal care recommended by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) for incarcerated women.Methods. We conducted a Web-based survey of perinatal nurses in the United States (n = 665; participation rate 98.0%; completion rate 95.3%) in July through September 2017. We used multivariable logistic regression to predict higher than median intentions to provide the standard of care.Results. Lower stigmatizing individual attitudes and institutional norms and higher perceived autonomy when caring for an incarcerated woman were significantly associated with higher care intentions. Knowledge of the AWHONN position statement on the standard of care or their own state's shackling laws was not associated with higher care intentions.Conclusions. We documented significant associations among actionable drivers and facilitators of stigma and the intentions of a key health care provider group to deliver the standard of maternal care to incarcerated women. Individual- and institutional-level stigma-reduction interventions may increase the quality of maternal care and improve perinatal outcomes for women who give birth while incarcerated.

Perinatal Nurses' Experiences With and Knowledge of the Care of Incarcerated Women During Pregnancy and the Postpartum Period.

OBJECTIVE: To describe perinatal nurses' experiences of caring for incarcerated women during pregnancy and the postpartum period; to assess their knowledge of the 2011 position statement Shackling Incarcerated Pregnant Women published by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN); and to assess their knowledge of their states' laws regulating nonmedical restraint use, or shackling, of incarcerated women. DESIGN: Cross-sectional survey. SETTING: Online across the United States. PARTICIPANTS: AWHONN members who self-identified as antepartum, intrapartum, postpartum, or mother-baby nurses (N = 923, 8.2% response rate). METHODS: A link to an investigator-developed survey was e-mailed to eligible AWHONN members (N = 11,274) between July and September 2017. RESULTS: A total of 74% (n = 690) of participants reported that they cared for incarcerated women during pregnancy or the postpartum period in hospital perinatal units. Of these, most (82.9%, n = 566) reported that their incarcerated patients were shackled sometimes to all of the time; only 9.7% reported ever feeling unsafe with incarcerated women who were pregnant. "Rule or protocol" was the most commonly endorsed reason for shackling. Only 17.0% (n = 157) of all participants knew about the AWHONN position statement, and 3% (n = 28) correctly identified the conditions under which shackling may ethically take place (risk of flight, harm to self, or harm to others). Only 7.4% (n = 68) of participants correctly identified whether their states had shackling laws. CONCLUSION: Our results suggest critical gaps in nurses' knowledge of professional standards and protective laws regarding the care of incarcerated women during pregnancy. Our findings underscore an urgent need for primary and continuing nursing education in this area.

Salivary Biomarkers of Parenting Stress in Mothers Under Community Criminal Justice Supervision.

BACKGROUND: Community criminal justice supervised mothers are an underserved population who experience high rates of psychological distress and unique parenting challenges, but little is known about physiological stress system function in this population. OBJECTIVE: We tested the salivary biomarkers of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis function as predictors of subjective maternal stress. METHOD: We recruited 23 mothers (age: M = 35.6 years, SD = 9.3 years; 35% Hispanic, 22% Black, 22% White, 22% multiracial) who were court mandated to a residential treatment center. We measured salivary alpha-amylase (AA) and cortisol, which index SNS and HPA activity, respectively, before and after a naturalistic reminder of a stressful parenting experience. We assessed self-reported parenting stress using the Parenting Stress Index-Short Form (PSI-SF) subscales Parental Distress, Parent-Child Dysfunctional Interactions, and Difficult Child. We used regression to test AA and cortisol mean levels and reactivity as predictors of subscale scores. RESULTS: Mean, but not reactive, salivary stress biomarker levels were associated with parenting stress domains. Mean cortisol levels predicted scores on the Parent-Child Dysfunctional Interaction subscale (adj. R = .48), whereas mean AA predicted Difficult Child subscale scores (adj. R = .28). DISCUSSION: Our results demonstrate the potential predictive utility of AA and cortisol as salivary biomarkers of maternal stress in community-supervised mothers. Given that maternal stress is associated with criminal recidivism and child behavioral health in this population, these biomarkers could potentially inform interventions to improve dyadic health and social outcomes.

An Integrative Review of Nurse-Authored Research to Improve Health Equity and Human Rights for Criminal-Justice-Involved People.

BACKGROUND: An estimated 10 million people are incarcerated internationally, including 2.1 million people in the United States. Criminal justice involvement is a social determinant of individual and family health disparities. Health care in correctional and forensic psychiatric facilities is nurse driven. The unique contributions of nurse authors to the research literature on health equity and humane conditions for this population have not been aggregated, nor have the nursing research gaps in this area been systematically identified. This article determines the volume and country location of nurse-authored research in this area and analyzes the research by population (prisons, jails, community supervision, forensic psychiatry), clinical foci, and research methods. METHODS: We conducted an integrative review of research literature published in English between 1990 and 2017. RESULTS: Our search revealed 283 data-based articles written by 349 nurse authors, representing Asia, Australia, Europe, and North and South Americas. Most research occurred in prisons (53.3%) and focused on mental health/substance use (32.5%), infectious disease (21.6%), or correctional health services (15.6%). Almost one third of articles across clinical foci sampled nurses, not patients. IMPLICATIONS: Although there is clearly a cadre of nurse researchers working in this area, it remains a relatively small group focused most closely on mental health, infectious disease, and the correctional nursing experience. Gaps and opportunities for important nursing contributions remain, especially in reproductive health, meeting the needs of community-supervised people, and explicitly connecting this work with its human rights implications.

Intention and Initiation of Breastfeeding Among Women Who Are Incarcerated.

The Baby-Friendly Hospital Initiative recommends that all mothers be shown how to breastfeed, even when mothers and newborns are separated. Most incarcerated women are separated from their infants after the postpartum hospital stay, creating barriers to breastfeeding. We examined breastfeeding among a sample of women participating in a prison-based pregnancy program. Quantitative data indicated that women who discussed breastfeeding with their doulas were more likely to initiate breastfeeding. Three qualitative themes were identified: Benefits of Breastfeeding, Barriers to Breastfeeding, and Role of the Doula. We identified incongruence between the expected standard of breastfeeding support and the care incarcerated women received. Findings suggest that prison-based doula care might be an effective intervention for supporting breastfeeding among incarcerated women and highlight the importance of education for perinatal nurses about breastfeeding support of incarcerated women.

Women in Transition: Experiences of Health and Health Care for Recently Incarcerated Women Living in Community Corrections Facilities.

Health priorities of women after incarceration remain poorly understood, constraining development of interventions targeted at their health during that time. We explored the experience of health and health care after incarceration in a focused ethnography of 28 women who had been released from prison or jail within the past year and were living in community corrections facilities. The women's outlook on health was rooted in a newfound core optimism, but this was constrained by their pressing health-related issues; stress and uncertainty; and the pressures of the criminal justice system. These external forces threatened to cause collapse of women's core optimism. Findings support interventions that capitalize on women's optimism and address barriers specific to criminal justice contexts. © 2016 Wiley Periodicals, Inc.

Ethnographic assessment of an alternative to incarceration for women with minor children.

Allowing criminal justice-involved women to remain with their children in the community may decrease some of the negative intergenerational effects of incarceration. Little is known about potential program models to safely support community coresidence in this population. Ethnographic methods were used to explore the historical development of and life within a supportive housing alternative to incarceration (ATI) program for women with minor children and the health and social needs of resident families. Participants included 8 current and former adult tenants, 12 of their resident children, 3 program staff, the program administrator, and 5 prosecutors who originally conceptualized it. Women also reported information about their 8 nonresident children. Analysis revealed 3 major themes: "The Cycle," "This is My Home," and "This Doesn't Go With That." While the program built on a core value of family preservation, results illustrate that keeping families together is only the beginning. Clinical and research implications for coresidence ATI programs are discussed in relation to the uniqueness of this context and population.

Recidivism after release from a prison nursery program.

OBJECTIVE: To analyze 3-year recidivism after release from a prison nursery, a secure unit that allows imprisoned women to care for their infants. DESIGN AND SAMPLE: Descriptive study of 139 women who co-resided with their infants between 2001 and 2007 in a New York State prison nursery. MEASURES: Administrative criminal justice data were analyzed along with prospective study data on demographic, mental health, and prison nursery policy-related factors. RESULTS: Results reflect a sample of young women of color with histories of clinically significant depressive symptoms and substance dependence, who were convicted of nonviolent crimes and had multiple prior arrests. Three years after release 86.3% remained in the community. Only 4% of women returned to prison for new crimes. Survival modeling indicated that women who had previously violated parole had a significantly shorter mean return to prison time than those who were in the nursery for a new crime. CONCLUSION: Women released from a prison nursery have a low likelihood of recidivism. Innovative interventions are needed to address incarceration's public health effects. Nurses can partner with criminal justice organizations to develop, implement, and evaluate programs to ensure the health needs of criminal justice involved people and their families are met.

Preschool Outcomes of Children Who Lived as Infants in a Prison Nursery.

This study examined long-term outcomes of children who spent their first one to eighteen months in a US prison nursery. Behavioral development in 47 preschool children who lived in a prison nursery was compared with 64 children from a large national dataset who were separated from their mothers because of incarceration. Separation was associated with significantly worse anxious/depressed scores, even after controlling for risks in the caregiving environment. Findings suggest that prison nursery co-residence with developmental support confers some resilience in children who experience early maternal incarceration. Co-residence programs should be promoted as a best practice for incarcerated childbearing women.

Predictors of post-release research retention and subsequent reenrollment for women recruited while incarcerated.

Correctional facilities are prime targets for nursing interventions to decrease health disparities, but challenges to post-release follow-up limit use of the longitudinal research designs needed to fully examine intervention effects. Using an adapted version of the Behavioral Model for Vulnerable Populations, we determined predictors of 1-year post-release study retention and subsequent reenrollment an average of 3 years later in 88 mother and child dyads recruited from a state prison nursery. Predisposing characteristics and enabling factors emerged as strong predictors of loss to follow-up. Female research participants can be successfully retained years after release from a correctional facility. Understanding the barriers and facilitators to post-release follow-up supports the creation of theoretically informed strategies to retain formerly incarcerated populations.

Parent self-efficacy for managing pain in seriously ill children and adolescents nearing end of life.

OBJECTIVE: Using data from a multi-site study of parent-child symptom reporting concordance, this secondary analysis explored the role of parent self-efficacy related to pain management for seriously ill school-age children and adolescents. METHOD: In the initial study, 50 children and adolescents who were expected to survive 3 years or less were recruited along with their parent/primary caregiver. Parent self-report data were used in this secondary analysis to describe parent self-efficacy for managing their child's pain, caregiver strain, mood states, and perception of the child's pain; to explore relationships among these variables; and to determine predictors of greater self-efficacy. RESULTS: Parents expressed a wide range of self-efficacy levels (Chronic Pain Self-Efficacy Scale; possible range 10-100, mean 76.2, SD 14.7) and higher levels on average than reported previously by family caregivers of adult patients. Caregiver Strain Index scores were markedly high (possible range 0-13, mean 8.1, SD 3.8) and inversely correlated with self-efficacy (r = -0.44, p = 0.001). On the Profile of Mood States parents reported more negative moods (t = 4.0, p < 0.001) and less vigor (t = -5.0, p < 0.001) than adults in a normative sample, yet vigor rather than mood disturbance predicted self-efficacy. With the exception of child age, self-efficacy was not associated with demographics (child gender, ethnicity, household income, parent age, education, family size) or with the diagnostic groups (primarily cardiac and oncologic) comprising the sample. Younger child age, less caregiver strain, more parent vigor, and parent perception that child is without pain predicted more than half of the variance in parent self-efficacy (R2 = 0.51). SIGNIFICANCE OF RESULTS: Findings advance knowledge of parent self-efficacy in managing the pain of a child with life-threatening illness. Results can be used to design supportive interventions enhancing parents' caregiving roles during their child's last stages of life.