Correctional Nursing CE Course

2.0 ANCC Contact Hours AACN Category B

Syllabus

Objectives

At the completion of this activity, the participants should be able to:

  1. Identify the qualities and characteristics of a successful correctional nurse.
  2. Describe expectations and the typical duties of a correctional nurse.
  3. Explore and discuss what the nurse should consider prior to becoming a correctional nurse.
  4. Identify and understand the legal expectations of a nurse and typical policies at a correctional institution. 
  5. Identify common pathogens related to correctional nursing and an institutionalized population.
  6. Explore and identify special considerations for the institutionalized population.
  7. Identify and describe common injuries within the workplace for correctional nurses. 
  8. Identify strategies and ways the correctional nurse can maintain safety within the workplace.

Background

Correctional nurses encounter a wide variety of illnesses, diseases, and injuries due to the nature of their occupation (Knox & Schoenly, 2013). Responsibilities include caring for inmates with acute or chronic illnesses, and a government or private organization can employ them. Job growth is expected to significantly rise as the demand for correctional nurses increases to approximately 16% by 2026, according to the Bureau of Labor Statistics (2019). Correctional nurses must maintain professionalism at all times, often take specialized training, be mindful of safety considerations, and be able to meet the needs of the population for which they care. Nurses who work in this area must also understand the specific risks and personalize their nursing considerations for this particular population. Correctional nurses must be very patient, open-minded, able to adapt, flexible, vigilant, compassionate, and team player. Nurses in this field must also have excellent assessment and communication skills (Knox & Schoenly, 2013).

Correctional Nurse Special Considerations 

Correctional nursing can be a very demanding and stressful job, but it can also be extraordinarily rewarding. It takes a very disciplined and unique individual to take on a position in correctional nursing, but it is an occupation with a wealth of opportunities and openings. Nurses who work in this occupation must remain objective and open-minded, as the patients they care for are individuals with rights, and it is imperative that the nurse care for them as they would any other person. Dhaliwal and Hirst (2016) state that correctional nurses "must be nonjudgmental override the stigmas related to offenders, and focus on patient care, not the patient's crime, because judgmental attitudes can affect the care nurses provide" (p.10). Nurses also need to ensure culturally appropriate care and respect inmate traditions, beliefs, and practices just as they would with any other patient population. This specialty in nursing is associated with a lot of stigmas and often misunderstood; therefore, job growth in this particular area is expected to increase compared to other nursing specialties such as pediatrics, labor, and delivery, and critical care nursing due to the stigmas and misunderstanding surrounding this profession there will continue to be a demand for nurses seeking this field (Bureau of Labor Statistics, 2019). Nurses need to understand the unique risk factors for inmate populations and be aware of the diseases that are more prevalent in correctional institutions, such as HIV/AIDS, methicillin-resistant Staphylococcus aureus (MRSA), tuberculosis (TB), and sexually transmitted illnesses (STIs). According to the Centers for Disease Control and Prevention (CDC, 2015), “multiple studies have demonstrated that persons entering correctional facilities have high rates of STIs (including HIV) and viral hepatitis” (p. 4). Preventative care and patient education are paramount in these populations, as access to adequate care are difficult due to an increasing population, demand, and overcrowding in prisons (Williams & Heavey, 2014).

Correctional nursing is often misunderstood and underappreciated; many other healthcare professionals do not always understand the aspects and what is involved in being a correctional nurse. According to Clayton (2015), correctional nurses are often looked down upon and referred to as “not real nurses” and many individuals are apprehensive and intimidated by this occupation secondary to a perceived level of danger for the nurse. Nurses and healthcare professionals must work to break that stigma and correct any misconceptions as correctional nurses care for a wide variety of conditions, work very hard, and often find the career to be much more rewarding when compared to other specialties in nursing (Williams & Heavey, 2014). Correctional nursing can be a very challenging career as the population they care for can include very violent criminals and can be dangerous at times. This particular specialty requires patience, discipline, and vigilance. Nurses in this field care for the entire individual, and they may encounter aspects of psychiatric nursing, medical-surgical nursing, labor and delivery, pediatrics (juvenile population), community nursing, hospice, and even critical care nursing all within one career (Knox & Schoenly, 2013). 

A correctional nurse should strive to possess qualities such as excellent assessment skills, clinical judgment, patience, and assertiveness (Holwick, 2018). Nurses who choose this occupation must also be open-minded, reliable, and honest. The nurse must research and understand the population which they will be caring for, special considerations for that particular community, what this type of specialty entails, any requirements or stipulations within the employment contract, rules, and regulations of the correctional facility, pay, benefits, and hours/shifts related to the potential employment (Williams & Heavey, 2014).

Special Considerations When Caring for an Institutionalized Population

When caring for patients in a correctional institution, the nurse must maintain safety at all times, establish boundaries, speak assertively, and remain consistent, while at the same time treating patients with compassion. Nurses must also have high standards of moral and ethical conduct to safely and adequately care for institutionalized patients (Dhaliwal & Hirst, 2019). Nurses should care for inmates as a whole, as they deserve the same respect and care as any other patient (Holwick, 2018). 

Correctional nursing can be demanding, very stressful, dangerous, and ever-changing (Williams, & Heavey, 2014). Nursing roles may vary within institutions, but it is essential to remember nurses provide care to inmates in a variety of ways, involving all body systems; therefore, the nurse must be flexible and be able to easily adapt to the demands related to the position in which they are working (Dhaliwal & Hirst, 2019). They are expected to care for anything, including patients with minor cuts or scrapes, infectious diseases, mental health disorders, going through drug withdrawal, and dying from terminal illnesses. The nurse must quickly adapt to changes and be ready for a variety of problems, conditions, and injuries they must treat (Sasso, Delogu, Carrozzino, Aleo, & Bagnasco, 2018).

Cultural Considerations in Correctional Nursing

Culture is vital in correctional nursing just as it is in any other specialty. The nurse must respect the traditions and beliefs of their patients. The nurse should understand the inmate’s cultural background as this can assist in gaining trust and maintaining a therapeutic relationship. According to Steefel (2018), “correctional nursing practice is focused on a unique patient population: inmates who present with their own ethnicities and have an imposed culture from the prison structure. As such, culture must be considered to provide holistic care” (p. 27). Nurses must understand the culture within the correctional institution in which they are working and the patient’s individual beliefs and cultural practices as well. The nurse should do this by not making assumptions but by being open-minded, patient, and understanding. Asking questions and being engaged when communicating is imperative in developing a rapport with patients. Nurses need to respect inmates’ beliefs, values, and practices, just as they would with the general population. 

Inmates are particularly vulnerable as they have only a single option in obtaining or receiving care. Nurses must be able to communicate and provide quality, compassionate care by first understanding the patient’s background, religious beliefs, and cultural practices. Nurses also have a responsibility to research and contribute to nursing practice by advancing further the quality of culturally competent care. Goshin, Colbert, and Carey (2018) state that “nurses are at the center of providing health care to criminal justice (CJ)-involved people around the world, as we are in other healthcare service sites, and should play an active role in the development and dissemination of new knowledge” (p. 53). The nurse must recognize that due to health disparities, this population is particularly at-risk for different illnesses, and often might avoid seeking care due to misunderstanding or fear (Clayton, 2015). Correctional nurses play a critical role as they have the potential to develop a good therapeutic relationship with the inmates, educate them, empower them to be involved in their care, and positively impact patient outcomes.

Correctional Nursing and Workplace Safety

Nurses must be vigilant and aware of their surroundings when working in a correctional institution and take training specific to their area, or inmate population. According to Loeb et al. (2013), being assertive and consistent is essential within this population as safety must be maintained. Although nurses are caring and compassionate, they must keep in mind the people for which they provide care. Often nurses go through different kinds of training and educational activities when hired as a correctional nurse. They may undergo safety and security training to learn how to handle violent, combative, or aggressive patients, techniques to reduce the chances of physical harm or escape methods, and how to protect oneself from harm. Nurses who specialize in institutionalized nursing can also take the Certified Correctional Health Professional exam and become certified. Other training or courses offered may include communication courses or interdepartmental training that involves correctional officers and nurses to promote teamwork, safety, and productivity within the work environment. Workplace safety is paramount within correctional nursing as the population can range from mild convictions to very violent criminals. For example, a correctional nurse must take extra precaution when handling sharps, drugs, or other potentially hazardous materials. While the correctional officer should be escorting the nurse, which does not always guarantee safety within the institution (Sasso et al., 2018). The nurse must be vigilant and aware of their surroundings; they must be able to handle stress and emergencies on a moment’s notice. Correctional nurses must also work closely with correctional officers to communicate effectively to ensure everyone’s safety (Díaz, Panosky, & Shelton, 2014).

Nurses must be mindful of the population that they are caring for, as inmates can be difficult and a bit manipulative at times. According to Sasso et al. (2018), “in prisons, the role of the nurse is also that of an outside professional who can provide support and reassurance. Nevertheless, some respondents expressed their awareness that the friendliness exhibited by some prisoners was often actually aimed at obtaining favors” (p. 402). Nurses must be aware of how to communicate therapeutically with patients while maintaining boundaries and being consistent. Inmates deserve to receive compassionate care, just like any other patient. The nurses must be assertive, consistent, and aware of manipulation tactics a patient might utilize. Being vigilant and maintaining boundaries is imperative for the nurse’s safety and the safety of other staff, as these can prevent injuries, and potentially save lives.  Inmates can gain access to weapons or objects that could be used as weapons in mere minutes or seconds. Dhaliwal and Hirst stress that correctional facilities have specific rules in place, and it is crucial that the nurse understands the rules and policies within the organization and understands the reason behind those guidelines (2016).

Working closely with correctional officers is a substantial part of the job and can significantly impact nurse safety. Nurses must be open-minded and communicate effectively with correctional officers as they are professionals, and it is vital to understand each other’s perspectives to maintain a cohesive team. Correctional officers are trained that safety is the most critical aspect of their job, along with security and enforcing rules. However, the nurse is there to treat the patient’s illnesses and provide compassionate care. Lazzari et al. (2019) said the following:

Nurses are challenged to straddle the chasm between custody and care. The requirement of adhering to the restrictive, oppressive policies of the correctional system while staying true to nursing ethical principles of treating patients/clients with respect, dignity, and compassion and protecting human rights can create moral distress (p. 80). 

Nurses must communicate with officers and strategize to care for their patients properly; the nurse must recognize the role of the officer, but at the same time, provide compassionate care to the patient. Williams and Heavey (2014) state that “the primary focus of a nurse is advocacy and the well-being of an inmate, whereas correctional staff is concerned primarily with safety" (p. 51). Nurses must maintain an open-mind and healthy line of communication with officers while still advocating for patients. Any additional training offered by the facility should be utilized and taken whenever possible by the nurse.

Common Pathogens in Correctional Nursing

    It is imperative correctional nurses treat all patients, including inmates, as potentially infectious by utilizing standard precautions, unless otherwise indicated. According to Bouchoucha and Moore (2019), care delivery can be complicated for the correctional nurse as many supplies and equipment must remain in locked cabinets or drawers for safety reasons. The nurse must problem solve, keep track of all equipment, remain aware of his/her surroundings, and have access to the necessary supplies to prevent the spread of infection. Being careless and leaving equipment out could be dangerous to both staff and other patients within the facility. The nurse must lock up supplies, properly dispose of potentially hazardous instruments such as needles, and understand how these actions can directly impact their safety. Correctional nurses must simultaneously make every effort to prevent the spread of infection, as prisons are often over-crowded and confined. Nurses must also be mindful of patients placed in special precautions and adhere to facility policy. 

    According to the CDC (2019), common infectious diseases within institutionalized populations include hepatitis, HIV/AIDS, TB, MRSA, and STIs. Nurses need to be aware of the conditions specific to the population they are caring for to provide competent, comprehensive, and quality care. This awareness enables the nurse to provide preventative care, focus on patient education, and screen efficiently. The nurses can anticipate what labs may be ordered, inquire about expected signs and symptoms, and effectively prevent the spread of infection. With adequate preparation, the nurse will be capable of handling potential outbreaks, identifying possible causes, and adequately treating the patients.

    Hepatitis C (HCV) is a bloodborne viral infection and damages the liver, but there is a cure. Due to the high prevalence of HCV in correctional facilities, the nurse should work with inmates to reduce the spread of the disease and promote awareness. According to Han, Zhou, François, and Toumi (2019), “patients may be unaware they have Hepatitis C, as it is often asymptomatic; in fact, less than 15% of infected patients are aware of their infection” (p. 19). Nurses can emphasize to patients the importance of regular check-ups and screening tests even if there aren’t symptoms. If present, symptoms may include fatigue, nausea/vomiting, jaundice, dark urine, and discolored stools, or diarrhea (Ayoub, Chemaitelly, Omori, & Abu-Raddad, 2018). To prevent transmission of HCV, the nurse should educate patients about not sharing needles, razors, tattoo needles/equipment, or toothbrushes; not sharing or handling any potentially infectious material; using protection when having intercourse; and the risks of receiving a blood transfusion prior to 1992 (Botheju et al., 2019). While most patients can be cured with newer medications on the market, the best treatment for HCV is prevention. Han et al. (2019) found that: “Treating Hepatitis C involves antiviral medications and can take anywhere from 12 to 24 weeks to eradicate the virus completely” (p. 15).

     TB is an extremely contagious condition that affects the lungs, caused by bacteria called mycobacterium tuberculosis, and symptoms include hemoptysis, night sweats, fever, chills, weight loss, and chest discomfort. The nurse must remember to utilize airborne precautions and educate patients about preventing the spread of this disease. Nurses need to make every effort to isolate patients who may have TB to prevent the spread of infection. There are two phases, the latent phase, and the active phase. In the latent phase, the person may show no signs or symptoms and is not contagious; while in the active phase, the patient is contagious and shows signs and symptoms (Basu, 2019). If left untreated, it can be deadly, but there are effective treatments available. Typically, several medications are utilized; a patient may be prescribed rifampin (Rifadin), isoniazid (INH, Rifamate), ethambutol (Myambutol), or pyrazinamide (Rifater) (Walsh et al., 2019). Inmates must be checked regularly for TB due to the high occurrence rate in institutions. Prevention and patient education are essential in this population as it can spread rapidly and is hard to treat. Doing regular TB screening tests is important, especially when transferring inmates, admitting, or bringing in new inmates. Anytime a new inmate is brought to a facility, transferred to another unit, or sent to another facility; testing should be completed. Prisons and correctional institutions can often be overcrowded, and treatment is often inadequate (Basu, 2019). 

    HIV/AIDS is also very prevalent among inmate populations; estimates show that institutionalized patients have five times the infection rate of the regular population (Valera, Chang, & Lian, 2017). HIV is a viral infection that destroys CD4 T-cells, which weakens the immune system. Symptoms may include unexplained rashes, frequent infections, swollen lymph nodes, night sweats, fatigue, and mouth ulcers, or patients can be HIV positive and asymptomatic (Morrison, Laeyendecker, & Brookmeyer, 2019). AIDS is caused by HIV infection, which weakens the immune system, allowing opportunistic infections to occur. Again, one of the best ways for correctional nursing staff to combat this disease is to educate the inmates and staff regarding the risk factors, disease process, signs and symptoms, significance of regular testing, and the use of protection. Possible methods for contracting HIV are unprotected sex, sharing needles, and mother-to-child, although there is medication to help prevent this. Antivirals may be given to those with potential or known exposure to the virus. At-risk populations can utilize pre-exposure prophylaxis (PrEP) to ower their risk of transmission significantly. It is important to educate patients who are HIV positive to adhere to their medication regime and abstain from unsafe sex. Teaching inmates about risk factors associated with HIV, how to prevent the spread, and getting routine tests is paramount in treating this disease (Spaulding, 2017).

    MRSA is another infection prevalent in correctional institutions within the United States. MRSA is drug-resistant, meaning it requires potent antibiotic therapy to treat it. MRSA is very contagious, and contact precautions should be utilized when caring for patients who are positive for MRSA or are suspected of having MRSA (Richards & Tremblay, 2019). Blood cultures must be drawn to identify the bacteria, and sensitivity testing to determine the most effective drug(s) to treat the infection. The most common drug of choice is vancomycin (Vancocin). Patients taking vancomycin (Vancocin) should be monitored for effectiveness and toxic levels. Vancomycin (Vancocin) is contraindicated in patients with renal problems, and elderly patients should be monitored carefully while on the medication (Honore et al., 2019).  

    STIs are prevalent in inmate populations as well. Javanbakht et al. (2014) state that: 

Populations passing through correctional facilities represent a group that is at increased risk for sexually transmitted infections (STIs), including HIV, as the prevalence of risk factors such as substance use, transactional sex, previous history of an STI, and inconsistent condom use with multiple partners is high (p. 103). 

Nurses need to educate patients about the importance of safe sex, condom use, and not sharing needles. Programs that are designed to educate inmates and encourage regular screenings will increase awareness and help prevent the spread of infection. According to the CDC (2015), “treatment completion rates of greater than 95% can be achieved by offering screening at or shortly after intake, facilitating earlier receipt of test results; follow-up of untreated persons can be conducted through public health outreach” (p. 1). Regular screenings are integral in reducing the spread of STIs, as many patients will not experience signs or symptoms initially, despite being contagious. The nurse should educate patients regarding the prevalence of STIs within the correctional institution and what they can do to help prevent the spread of infection (CDC, 2015).

 Nurses need to provide resources and information to inmates and educate them regarding the risk for different conditions while incarcerated. Simply making patients aware of risk factors can help reduce the spread of infection and allow inmates to identify ways in which they can help prevent potential outbreaks within correctional facilities. Correctional facilities are often overcrowded, and many have poor ventilation, which can undermine infection control efforts (Lazzari et al., 2019). Nurses must be able to quickly identify possible cases of infectious disease and do their best to isolate, identify, and treat the causative microorganism. Supplies must be stored safely, away from the inmate population, so nurses must also be creative in how they provide care for inmates. Nurses must also provide adequate education to inmates, especially regarding infectious diseases, to prevent their spread and empower their patients to be more involved in their care (Bouchoucha & Moore, 2019). 

    There are different initiatives the nurse can take to help address and combat both infectious diseases, and assist in preventing the spread of STIs. Nurses should provide educational sessions to inmates regarding activities like proper handwashing, how different diseases are spread, the importance of personal hygiene, vaccines, and safe sex (Fleming, 2019). Teaching inmates about proper handwashing techniques and methods can quickly assist the nurse in combating infectious diseases, and breakouts within the facility. Proper education regarding safe sex and the prevention of spreading sexually transmitted infections is imperative in preventing the spread of diseases such as HIV (Saeed, Tribble, Biever, Crouch, & Kavanaugh, 2018). Teaching patients about the importance of hand hygiene and proper technique is imperative to assist in preventing the spread and helping them identify ways in which they can keep themselves healthy is empowering. Educating clients on safe sex practices, condom use, and ways to prevent contracting an STI is an excellent method and often an inexpensive tactic in promoting health within the correctional environment.  Nurses must utilize the resources they have and understand the environment in which they are working to adequately educate clients and make a direct impact. Simply providing educational sessions and speaking with different clients can make all the difference when it comes to the spread of infection within the correctional environment (Williams & Heavey, 2014). It is also imperative for the nurse to provide similar information and have educational sessions with other staff members within the facility such as correctional officers to combat the spread of infection within the correctional facility (Dhaliwal & Hirst, 2019).

Conclusion

    Employment in correctional nursing is expected to grow significantly as this is a very challenging specialty, despite the stigmas associated with this particular field. Correctional nurses must take an active role when working with inmates and understand the special considerations when caring for this specific population. Patients within correctional facilities are particularly vulnerable due to their inability to access care in other facilities or with other providers. According to Almost et al. (2013), nurses are essential to patient care within correctional facilities as they are the primary caregivers and the inmates must be able to trust them and feel comfortable speaking with them. Often because they are the primary caregivers, correctional nurses are not limited to one specialty and may work with pregnant patients, pediatric patients, terminally ill patients, chronic or acute illnesses, and even patients suffering from a variety of mental illnesses. The nurse needs to develop a therapeutic relationship by understanding the inmate’s cultural background, religious practices, and personal values. It is also imperative to understand and respect the culture within the institution since it can directly impact the care that patients are receiving. Correctional nurses must also understand the conditions and risk factors related to the population to which they are providing care. Inmates are particularly at-risk for HIV/AIDS, MRSA, TB, and various STIs. The nurse must be creative in caring for these patients as supplies may be limited or difficult to access due to safety concerns. Workplace safety is paramount in caring for this population as correctional facilities have the potential to become a violent work environment. Every effort should be made to maintain safety and consistent compliance with facility policies. While the nurse’s primary responsibility is to provide competent, compassionate care, the nurse will also be working with correctional officers who are focused primarily on safety. The nurse must maintain a team approach and work effectively with officers to provide safe, quality care. 

References

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