Health Promotion and Maintenance

One of the primary roles of a correctional nurse is providing patient education that emphasizes health promotion, wellness, and recovery.  As articulated in NCCHC Standard J/P-B-01: Healthy Lifestyle Promotion (2018), correctional nurses should include individualized health education and instruction in self-care in patient encounters. Correctional nurses often oversee preventive health and safety measures that benefit the incarcerated individuals and correctional staff and their families (e.g., vaccinations, standard precautions, environmental safety rounds, and postexposure prophylaxis and counseling). In addition, correctional nurses should include information about exercise and healthy lifestyles, smoking cessation, nutrition, and personal hygiene. Providing information in writing is helpful to patients and should be at a basic level of vocabulary.

The assessment of patient educational needs begins at Receiving Screening. Questions asked should include those pertaining to the patient’s health history, current health conditions, and risk factors for future health needs (J-E-12 NCCHC, 2018).  It also should identify urgent health needs; known or easily identifiable health needs that require medical/mental health attention; and identify and isolate new admissions who appear potentially contagious.

Other encounters where the correctional nurse assesses the patient’s educational needs include the health assessment, nurse sick call, medication administration, urgent care, treatments, and chronic care. From this experience, the correctional nurse summarizes information for the patient and explains the recommendations for ongoing care. For many incarcerated individuals, this may be the first time they have received information about their health risks, needs and preventive care.  Knowing what is recommended, when it should occur, and its relative importance will assist the individual to plan follow up, even if they are transferred or discharged. 

Health promotion and education is more effective when it is targeted to specific health risks, appropriate to the situation, and responsive to the patient’s interest. There is evidence to support that brief interventions to promote healthier lifestyles given during routine health care encounters are effective in changing risk behaviors. Thus, correctional nurses have the opportunity at every patient encounter to provide health information, education, and counseling that improves health and well-being.  The Correctional Nursing: Scope and Standards of Practice, third edition (ANA, 2020) includes patient education as a critical responsibility for correctional nurses.  Teaching methods should be appropriate to the situation and should consider the patient’s developmental level, learning needs, readiness to learn, ability to learn, language preference, and cultural practices and beliefs. 

PROVIDING PATIENT EDUCATION

Simplicity and reinforcement are the two most important principles to remember when  providing patient education.

  • Present the simplest topic first, followed by progressively more complex material. Avoid using medical terminology; instead, use words persons in the greater community would readily understand.
  • Provide the material in the native language of the patient whenever possible.
  • Be concrete and explicit when informing the patient what you want them to learn or do.
  • To reinforce the information, teach the most important concept first and repeat it at the end of the encounter. Use a technique like the Teach-Back Method that requires the patient to “teach” you what they just learned, so that you can assess understanding, then use their description to emphasize key points, correct misunderstanding, and answer questions.
  • Provide information in auditory, visual, and tactile ways to increase learning, understanding, and skill acquisition.

Counseling for behavior change builds on the assessment of health status and previous advice or information given to the patient. The focus of counseling is the development of  behaviors and skills that improve health. Effective behavioral counseling requires patient involvement; the health care team provides professional support for changes the patient choses to make. Readiness to change is assessed by asking patients to describe how important the change is to them, and how much confidence they have in mastering the skills necessary to make the change.

Correctional nurses must also identify barriers to their patient’s change/goal so they can be addressed.  Sometimes having the patient describe a typical day will identify barriers to change. Listening to the patient’s perspective about the change may reveal barriers that are not apparent; it also helps build the rapport needed for a collaborative change relationship. The nurse should also work with the patient to identify environmental and interpersonal factors that support behavior change. Have the patient select a realistic therapeutic goal and assist them to resolve or avoid barriers. It also is important for the patient to identify reinforcements and support needed to initiate and maintain the change.

Follow up is most effective when it takes place relatively soon after counseling, with additional follow up at longer intervals. Follow up provides support by acknowledging effort and success, modifying goals and interventions based on the patient’s experience, and addressing relapse and its prevention.

RESOURCES

Many health education and promotion resources are available to correctional nurses, including the Centers for Disease Control and Prevention; local and state health departments; national organizations, like the American Diabetes Association, the American Heart Association, the American Red Cross, the American Academy of Neurology, and the World Health Organization; and reputable online resources like the American Academy of Family Practitioners, UpToDate, Medscape, and VisualDx. 

Providing patient education is one of the most important and lasting correctional nursing roles we perform (Correctional Nursing: Scope and Standards, 3rd edition, ANA, 2020).  Correctional nurses truly have the potential to impact their patients’ health and well-being, both during incarceration and in their future. 

Author Lori Roscoe, DNP, PhD, APRN, CCHP-RN, is the Accredited Provider Program Director for NCCHC, co-chair of the NCCHC Nursing Education Subcommittee, and a member of NCCHC’s  Multi-Disciplinary Education Committee.  Through her companies, The Correctional Nurse LLC and Correctional HealthCare Consultants LLC, Dr. Roscoe provides accredited continuing education specialized for correctional nurses and maintains CorrectionalNurse.Net, a blog about correctional nursing practice, and offers professional consulting services in correctional healthcare operations, staff training and legal matters.