Ca forensic nurses practices views with inmates with serious mental illness medication compliance
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CA Forensic Nurses’ Practices & Views With Inmates with Serious Mental Illness: Medication Compliance. Phyllis M. Connolly, PhD, APRN, BC, CNS Professor, San Jose State University Chia-Chen Lee, MS, RN, FNP Santa Clara County Custody Facilities & NP Crestwood. The Problem.

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Phyllis M. Connolly, PhD, APRN, BC, CNS Professor, San Jose State University

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CA Forensic Nurses’ Practices & Views With Inmates with Serious Mental Illness: Medication Compliance

Phyllis M. Connolly, PhD, APRN, BC, CNS

Professor, San Jose State University

Chia-Chen Lee, MS, RN, FNP

Santa Clara County Custody Facilities &

NP Crestwood


The Problem

  • Estimated 283, 800 mentally ill inmates is US (Sniffen, 1999)

  • 547,800 mentally ill offenders on probation every year (Sniffen, 1999)

  • Non compliance with psychiatric medications most significant predictor of arrest (McFarland, 1989)

  • 1/3 discharged from psychiatric hospitals lose contact with services within a year (Barr, 2000)

  • Costs California, $40,000,000 annually (MIOCRG, 2002)


Solutions

  • Increasing compliance with psychotropic medications

  • Improving compliance ↓relapse, ↓ hospital readmission and ↓ criminal transgression (Dubyna & Quinn,1996)


Research Questions

  • What do forensic nurses believe about medication compliance?

  • What information do forensic nurses collect during their assessment of inmates’ medication compliance?

  • What barriers do forensic nurses identify related to medication compliance after inmates are released?

  • What are the self care behaviors?

  • Do they have concerns for their safety?


Methodology

  • Exploratory mail survey

  • Questionnaire developed based on literature review and Scope and Standards of Forensic Nursing Practice (IAFN & ANA, 1997)

  • Experts utilized to develop and pilot tool

  • Human Subjects Protected by meeting IRB requirements, SJSU

  • 31 jails or prisons with population over 500 in CA were targeted


Final Instrument

  • Survey design expert formatted the final 60 questions in a 4 page questionnaire

  • Piloted by 10 forensic nurses not part of the final study


Procedure

  • Phone call made to medical directors/or directors of nursing stratified nonrandom sample of 31 CA jails or prisons with populations over 500

  • 3 facilities could not obtain administrative approval

  • Surveys were mailed to 28 sites in CA

  • Forensic nurses: RNs, NPs, & CNSs

  • Each nurse was supplied pre-stamped, pre-addressed envelope

  • A follow up phone call was made 1 week after mailing


Response & Data Analysis

  • 14 facilities participated (50%)

  • 55 Forensic nurses returned questionnaires

  • Question #50 asked for the exact number of forensic nurses & based on self-report there were 86 potential participants

  • 64% response (55/86)

  • SPSS was used to compute frequencies and percentages


Institutional Characteristics N = 14


Demographic Characteristics: Gender, Age, Education N = 55


Ethnicity N = 55


Nursing Experience N = 55


Nursing Experience as Forensic Nurse N = 55


Experience With Inmates With Mental Illness N = 55


Medication Compliance Views (N = 55)Very important to Important


Assessment of Medication Compliance


Medication Compliance Nurse Behaviors N = 55


Perceived Barriers Referrals to Outside Agencies N = 55


Barriers Providing Discharge Summaries to Outside Psychiatrist and/or Medical Clinic


Barriers When Providing Medications at Discharge


Barriers When Providing Prescription Prior to Release


Self Care Practices N = 55


Personal Safety N = 55


Limitations

  • Nonrandom sample

  • Survey tool lacked established reliability & validity

  • Study population in California only

  • Participants well educated & experienced and may not be representative of all forensic nurses

  • Self-report and may not match actual practice or behaviors


Conclusions

  • 55 well educated, experienced, caucasian forensic nurses in 14 jails & prisons in CA believe that medication compliance is very important in reducing recidivism & crime

  • Believed that forensic nurses had the most influence over inmate’s medication compliance

  • Believed that the therapeutic relationship was very important to medication compliance

  • Identified many barriers to medication compliance after release

  • 58% were concerned about their personal safety

  • Self care behaviors are not engaged in frequently

  • 94% believed that debriefing services were important


Recommendations

  • Repeat study with larger random sample in multiple states

  • Maintain high percentage of baccalaureate and advanced practice nurses employed in jails and prisons

  • Increase self care practices

  • Increase ethnic diversity of nurses

  • CA specific recommendations:

    • Add regulation to Title 15 California Code of Regulations to include discharge plans, follow up care, medications or prescriptions upon release, visits by forensic nurses after release


A Vision

Mandating discharge medications and ensuring follow up treatment, along with well-educated, experienced, compassionate, and dedicated forensic nurses practicing in CA jails and prisons may lower rates of crime, recidivism and reduce costs. Furthermore, ex-inmates with serious mental illness may have an opportunity for improved quality of life and increased tenure in the community


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