Learning Objective #1: Describe pros and cons of jails as clinical settings for undergraduates, based on evaluation data from a USA university

Learning Objective #2: Compare and contrast health care provision inside a jail with other populations

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Educational goals for community health include students working within a population's needs and emphasizing health promotion and disease prevention. Typically, sites include health departments, visiting nurse associations, and community-based clinics. Rarely, however, do such placements include jails. The walls designed to keep the detainees ‘in' also serve to keep students ‘out.' The incarcerated population presents complex health challenges: high rates of communicable diseases, high-risk pregnancy, and severe chronic illnesses. As a population, detainees are a microcosm of community groups whose health needs are prioritized within a broader dimension, in this case the justice system.

Four years ago, Saint Xavier University faculty began placing undergraduate nursing students in the Cook County Jail. The jail is one of the nation's largest, with 1100 detainees who typically stay 90 days. 128 undergraduate nursing students completed 8 week rotations at the jail. Organizationally, students work with a master's prepared nurse to provide care, including sick call, pre-natal care, medication administration, and wound care. Correctional officers are present continuously and students never enter a patient's cell alone. Students utilize critical thinking skills to provide care with limited resources and focus on the detainee as a person, in a setting where security overrides all else.

Pros and cons are described using data from students, nurse preceptors, and faculty. Pros include health care units with advanced practice nurses and patient-centered care, experienced mentors who adapt students' activities to avoid aggressive inmates, connections with community based providers who follow-up after prisoner release, and unprecedented opportunities to manage wounds and advanced TB. Cons include fears of students and faculty, difficulty in observing students acting independently, and limited time for student-detainee interactions. A major reason for continuing is the positive views of students who advanced in critical thinking, application of assessment skills, and gained in-depth understanding of population-based strategies.