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

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

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

Solutions

  • Increasing compliance with psychotropic medications

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


Research questions

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

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

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

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

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

Institutional Characteristics N = 14


Demographic characteristics gender age education n 55

Demographic Characteristics: Gender, Age, Education N = 55


Phyllis m connolly phd aprn bc cns professor san jose state university

Ethnicity N = 55


Nursing experience n 55

Nursing Experience N = 55


Nursing experience as forensic nurse n 55

Nursing Experience as Forensic Nurse N = 55


Experience with inmates with mental illness n 55

Experience With Inmates With Mental Illness N = 55


Medication compliance views n 55 very important to important

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


Assessment of medication compliance

Assessment of Medication Compliance


Medication compliance nurse behaviors n 55

Medication Compliance Nurse Behaviors N = 55


Perceived barriers referrals to outside agencies n 55

Perceived Barriers Referrals to Outside Agencies N = 55


Barriers providing discharge summaries to outside psychiatrist and or medical clinic

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


Barriers when providing medications at discharge

Barriers When Providing Medications at Discharge


Barriers when providing prescription prior to release

Barriers When Providing Prescription Prior to Release


Self care practices n 55

Self Care Practices N = 55


Personal safety n 55

Personal Safety N = 55


Limitations

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

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

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

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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