Improving Chronic Pain Management in a Correctional Setting
Introduction
People confined in correctional facilities do not have unlimited access to health care facilities like those who are outside confinement. The number of people in correctional facilities is significantly higher than the health care providers assigned to them. However, these people still need medical attention as they are human beings, and they can have medical complications from time to time. When this happens, correctional healthcare workers need to be on standby to deal with the issue to avoid overworking. One of the significant health problems likely to affect these individuals is the presence of chronic pain. Chronic pain may result from various underlying conditions, such as autoimmune disorders, cancer, and gastrointestinal diseases (Nwachuku, 2018). Effective management of chronic pain requires treatment and management of the underlying condition.
Depending on the cause of the pain, various methods can help to manage the pain. The most commonly used intervention is the use of medicine, although other people prefer complementary and alternative medicine (CAM) (Kong et al., 2016). In very severe cases, the patient may require surgery. Several factors affect the choice of intervention, such as cost and accessibility. Therefore, it is vital to provide prompt healthcare services to patients to ensure that their health does not deteriorate further.
Role of Correctional Nurses
In the United States, correctional nurses play a primary role in providing health care services to inmates (Kilgore, 2016). However, these nurses face several challenges that prevent them from carrying out their duties effectively. These challenges include the lack of clearly defined roles, stigmatization for working in correctional facilities, and lack of proper policies to prevent stress in their workplace. Due to these reasons, the correctional nurses may fail to effectively carry out their assigned duties, including the management of chronic pain among the inmates. Many inmates may not have had proper knowledge regarding health issues before they faced arrest. Therefore, correctional nurses have the responsibility of conducting health education among the inmates (Kinghorn & Halcomb, 2017). This process may be tiresome, especially if one nurse has to cover an entire shift alone.
Management of Chronic Pain
In society, one of the significant reasons individuals schedule meetings with doctors is the presence of chronic pain (Handtke et al., 2016). In correctional facilities, the scenario is the same as inmates go to see physicians in correctional settings. Despite chronic pain being a common occurrence in society, it is not easy to manage it. According to statistics, chronic pain is one of the most challenging conditions to manage and treat in the health care setting (Gil et al., 2019). For many health care providers, managing chronic pain becomes stressful for them. Naturally occurring social or behavioral stressors make chronic pain management even more difficult (Gil et al. 2019).
The situation in prison facilities does not make the case any better. On the contrary, it makes matters complex because of the emotional stress associated with being confined in correctional facilities. Inmates no longer have the freedom to move around and associate with friends. Therefore, as a form of recreation, they turn to drug abuse. Consequently, inmates have a high chance of being drug addicts as drug abuse is one of the limited activities they can engage in for pleasure. These factors only make the pain worse for the patient, and treatment becomes tough, thus stressing out the health care provider.
Aside from these risk factors, the treatment of chronic pain becomes more complicated due to the lack of trust between the patient and the health care provider (Handtke et al., 2016). Proper management of chronic pain requires that the patient is completely honest with the physician. This honesty helps determine the primary cause of the problem. Treating the primary cause eventually eliminates the pain effectively. However, managing pain alone will only provide temporary periods of pf well-being before the pain kicks in again.
Ethical considerations recognize that inmates require proper health care services just as much as other members of society. For this cause, the principle of equivalence governs health care provision in correctional facilities (Handtke et al., 2016). This principle requires that the kind and quality of health care given to inmates should be almost equal to that given to members of the community in the same country or territory. However, health care providers in correctional facilities find it challenging to adhere to this principle due to various factors. Perhaps the most common reason is the presence of a conflict of interest in their minds. Correctional facilities serve the primary function of containing security threats within confinement. Health practitioners in this field find it challenging to offer optimal health care services because of security concerns that supersede health care delivery.
The population of prisoners is exceptionally diverse from the outside community. These differences are in terms of age, health conditions, and social stressors of health (Handtke et al., 2016). Most health professionals receive training based on the conditions present in the outside community. Exposure to individuals in correctional facilities is a foreign territory to them. This situation makes it difficult for such practitioners to handle the cases in the manner that they deserve.
Health care workers often administer opioid to help in the management of pain. An opioid is a commonly abused drug, and many individuals end up becoming addicts. One-third of these individuals usually end up in correctional facilities as the government tries to curb opioid abuse (Fiscella et al., 2018). However, many correctional nurses give opioids to the patients to help them with the pain. Instead of using the drug for medicinal purposes, some individuals may end up abusing it. This activity offers a challenge in the nurses’ efforts to curb chronic pain. Also, correctional facilities act as rehabilitation centers aimed at helping opioid addicts recover from their addiction. Giving opioids to a recovering individual may result in a relapse, thereby rendering the whole procedure ineffective.
Members of the outside community can visit health centers at will for check-ups and screening procedures. As already state, chronic pain may result from various conditions, including cancer. Therefore, screening for such conditions is essential in combating chronic pain. For example, screening procedures can detect cancer in its early stages. Early detection of such chronic illnesses allows for medical interventions to begin promptly, increasing the chances of recovery. Once the treatment manages to eliminate cancer, the patient would not experience chronic pain as a result of cancerous cells. However, in correctional facilities, regular screening procedures are not a regular occurrence. Therefore, even if an inmate is suffering from a chronic illness, they cannot receive treatment early on. Instead, the person will only receive medical attention when they start to experience the different signs and symptoms associated with the disease. At this point, the condition is in the advanced stages, and chances of recovery are not as high. Therefore, the inmate continues to suffer from chronic pain caused by disease up to the time of death.
Measures for Improvement
Correctional facilities face different problems when it comes to managing chronic pain, as discussed in the previous section. Therefore, these facilities should come up with measures that help improve the management of chronic pain in correctional facilities. Correctional nurses and associated health professionals should undergo additional training that would equip them with the necessary skill-set to handle prisoners appropriately. This intervention arises from the fact that prisoners exhibit massive differences when compared to the outside population. Therefore, these differences play a significant role in influencing how doctors and nurses handle such patients. Thus, additional training would help such practitioners understand their patients better. This knowledge would enhance their productivity when dealing with chronic pain among such patients.
Prison infirmaries need to have opioid agonists in place to help in the management of opioid disorders (Fiscella et al., 2018). An opioid is very useful in the management of chronic pain. However, patients can develop opioid-related disorders. This realization may make nurses reluctant about using opioid therapy to manage chronic pain. However, the presence of opioid agonists gives correctional nurses the required confidence to use opioid treatment where necessary. This confidence arises from the fact that the agonists provide an alternative that would effectively reverse the adverse effects of the opioid on the patient.
Correctional facilities should make a point of employing an adequate number of correctional nurses to deal with the large population of prisoners. Chronic pain is a disorder that requires constant monitoring for any danger signs that may warrant referral to more specialized care. Understaffing correctional nurses would leave them overwhelmed by the amount of work they have to do in monitoring the health of the inmates. In such cases, it becomes impossible to focus on individual patients because the other prisoners also require medical attention from time to time. However, with proper staffing, some nurses can dedicate their time to monitoring chronic pain patients while the rest of the nurses attend to the other inmates.
Positive relationships between inmates and their health care providers are essential in the management of chronic pain. When individuals develop a deep connection with the health care providers, they are more likely to open up to them and give them all the necessary information relating to their problems. As such, correctional health workers can develop a comprehensive diagnosis of the causative agent of chronic pain. Once the practitioner has all this information, it becomes relatively easier to manage chronic pain by eliminating the primary cause of the problem.
Correctional facilities need to improve the working conditions of correctional nurses. These measures may include creating a conducive environment for the workers to work in, an environment free from stigmatization. As a result, the nurses would be more committed to their work because of the presence of suitable working conditions. Once a person commits themselves to perform a particular duty, they are more likely to achieve positive results as compared to those that feel compelled to perform similar tasks. Management of chronic pain is not an easy task. Therefore, it requires high levels of commitment to increasing the chances of success. An up worked nurse is very likely to make many medical errors when handling patients, resulting in mismanagement of chronic pain.
Correctional facilities need to offer regular screening services to inmates. After all, they are still citizens, and above all, human beings. As such, they deserve access to quality health care, which involves regular screening that helps in detecting dangerous diseases in their early stages. Once the facility implements this system, the prisoners will be able to know whether they have any conditions that may cause them health problems in the future. Once the health care officials identify these problems early enough, they can begin administering treatment to the affected individuals. Early-onset of treatment effectively eliminates the underlying condition or keeps it under control. This measure helps limit the occurrence of chronic pain among inmates. By treating the primary cause early enough, the patient may not get to the stage where they start experiencing pain o=regularly.
Measurement of Outcomes
Once individuals or an institution put together measures to try and improve a particular situation, there are outcomes that they consider to help them monitor the effectiveness of their interventions. Different parameters can show whether there are improvements in the management of chronic pain or not. These parameters give an actual representation of the changes resulting from the implementation of the new measures in an attempt to improve the management of chronic pain in correctional facilities.
Survival Rate
Deaths of prisoners are not uncommon in the present world. Many factors contribute to the death of inmates, including illnesses. Chronic pain may not necessarily kill an individual because it is only a manifestation of the actual problem. The condition causing the pain will result in death if not treated properly. Therefore, comparing the mortality of inmates before and after the introduction of these new measures is essential in evaluating their effectiveness. If the current mortality rate due to conditions related to chronic pain is lower, it indicates that the measures have had a positive impact on the management of chronic pain. However, cases, whereby the mortality rate remains the same or higher, show that the actions were ineffective and more changes are necessary.
Satisfaction with Pain Treatment
Another assessment tool is obtaining information directly from the inmates concerning their contentment with the treatment measures in place. The researcher may seek to find out whether the inmates feel that the treatment they receive for chronic pain is helpful or not. Inquiry on whether the intervention made the situation better would be essential in getting a clearer picture.
Feedback from Correctional Nurses
Nurses require a conducive environment to be able to perform their duties accurately. The provision of a conducive environment is the responsibility of the correctional facility. Feedbacks from the nurses regarding their levels of satisfaction with the work environment could be vital in monitoring the effectiveness of the interventions. Happy nurses are more likely to perform well compared to unhappy ones.
Pain Scales
Several inmates suffering from chronic pain may give their responses to the effectiveness of the treatment they received. The individuals would state the pain levels they experienced before and after medical intervention. If the degree of pain is lower after the response, it shows that the remedy was helpful. The reverse is also true. However, this method of assessment is not reliable because it is almost impossible to tell whether the patient is lying or not. Therefore, the health care professional may need to perform additional tests to check whether the information provided by the patient is correct.
Conclusion
The correctional setting is significantly different from other centers where practitioners offer health care services. Also, prisoners exhibit complex health care needs that need proper monitoring and management. However, researchers have done very little in terms of investigating the appropriate methods and techniques to be used in pain management among prisoners. The little research available does not give comprehensive information on the matter, leaving correctional health staff in a dilemma concerning the appropriate ways to care for prisoners with chronic pain. Therefore, it is necessary to come up with better ways of managing chronic pain among prisoners to ensure that they serve their sentences with minimum discomfort. Correctional facilities aim at reforming individuals to become better citizens. Dying in prison does not do this cause any justice.
References
Fiscella, K., Wakeman, S. E., & Beletsky, L. (2018). Implementing opioid agonist treatment in correctional facilities. JAMA internal medicine, 178(9), 1153-1154. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2687993
Gil, T., Metts, J., & Ugwueze, G. (2019). The Evaluation and Management of Chronic Pain in the Correctional Setting. Journal of Correctional Health Care, 25(4), 382-393. https://journals.sagepub.com/doi/abs/10.1177/1078345819882337
Handtke, V., Wolff, H., & Williams, B. A. (2016). The pains of imprisonment: challenging aspects of pain management in correctional settings. https://www.futuremedicine.com/doi/full/10.2217/pmt.15.62
Kilgore, B. (2016). Challenges in correctional nursing from role ambiguity. The University of Colorado at Denver.
Kinghorn, G., & Halcomb, E. (2017). Correctional nursing. An Introduction to Community and Primary Health Care, 335. https://books.google.com/books?hl=en&lr=&id=35okDwAAQBAJ&oi=fnd&pg=PA335&dq=Correctional+nursing&ots=J0-cUm0IPo&sig=Gkw8w0Gd8DUrpvHL4kMDmNDGiYk
Kong, L. J., Lauche, R., Klose, P., Bu, J. H., Yang, X. C., Guo, C. Q., … & Cheng, Y. W. (2016). Tai chi for chronic pain conditions: a systematic review and meta-analysis of randomized controlled trials. Scientific reports, 6, 25325. https://www.nature.com/articles/srep25325
Nwachuku, A. (2018). Common Conditions That Cause Chronic Pain. Pain-health. Retrieved 13 April 2020, from https://www.pain-health.com/conditions/chronic-pain/common-conditions-cause-chronic-pain.