Correctional nurses face challenges when treating inmates with HIV

Nurses working in correctional facilities often face many obstacles when delivering nursing care to inmates: inadequate nursing staff, an overcrowded inmate population, tension between facility guards and nursing staff as to which inmates need care, and a lack of resources for nursing staff to name a few. Even so, correctional health nurses are obligated to provide nursing care consistent with their respective state nurse practice acts and rules and the American Nurses Association's Code of Nurses With Interpretive Statements (2015). These obligations have become increasingly difficult for correctional nurses to meet when caring for HIV inmates. Beth Schwartzapel of the Marshall Project, reports that about "1.5% of prisoners nationwide -- some 30,000 people -- are infected with HIV. When the unique factors of going to jail and becoming infected with HIV overlap, the rate of HIV in prison is nationally some three times higher than in the general population" (Kaiser Health News, "Why Some Prisoners With HIV Get Better Treatment Than Others"). Usually, she continues, inmates in state prisons receive "routine HIV testing and a well-respected funded program to link inmates to medical care on release [from prison]," but care in jails is "limited, haphazard and in many cases, non-existent." Schwartzapel focuses on the fact that this distressing situation is not only a correctional facility issue, but also a public health issue. Treatment protocols that are consistently adhered to can result in an individual's HIV being well-controlled and result in a reduction in infecting others. This report has distinct ethical and legal implications for correctional health nurses. The ANA's Code of Ethics for Nurses provides ethical guidelines that are clearly applicable to this practice setting. Some of the mandates include: 1. Provide care based on need, without regard for bias or prejudice (Provision 1) 2. Take "appropriate action" when unethical situations place patient rights in jeopardy (Provision 3) 3. Be accountable for one's own nursing practice and take actions consistent with the obligation to protect health and provide optimal care (Provision 4) 4. Be responsible for establishing, maintaining and improving the ethical environment of one's work setting (Provision 6) 5. Protect human rights, promote health diplomacy and reduce health disparities (Provision 8) 6. Integrate principles of social justice into nursing and health policy (Provision 9) Legally, state nurse practice acts and rules require similar guidelines. Although they vary from state to state, some examples of similarities include: 1. Report unsafe or unethical healthcare practices or conditions to appropriate authorities 2. Advocate for patients 3. Practice in an ethical and professional manner 4. Be accountable for one's own nursing actions 5. Maintain safe and effective nursing care If you are practicing in correctional care, how is your facility managing inmates with HIV? How could you effect any changes needed? For those of you who do not practice in a jail or prison setting, what suggestions would you identify to provide better care for HIV inmates? NOTE: Nancy Brent's posts are designed for educational purposes and are not to be taken as specific legal or other advice.