Barriers to Humane End-of-Life Care for Dying Prison Inmates

Tuesday, July 12, 2011: 3:45 PM

Susan J. Loeb, PhD, RN1
Janice Penrod, PhD, RN1
Carol A. Smith, DSN, RN, MSN, CRNP, FNAP2
Christopher Hollenbeak, PhD3
Pamela C. Spigelmyer, APRN, BC, CNS, CSN1
(1)School of Nursing, The Pennsylvania State University, University Park, PA
(2)School of Nursing, Pennsylvania State University, University Park, PA
(3)A210 Surgery, The Pennsylvania State University College of Medicine, Hershey, PA

Learning Objective 1: The learner will be able to describe barriers to providing humane end-of-life care for dying prison inmates.

Learning Objective 2: The learner will be able to describe contextual differences among six state correctional institutions providing end-of-life care to distinct inmate populations.

Purpose: To highlight the contextual challenges to providing quality end-of-life care to inmate populations in six distinct state correctional institutions in a Northeastern US state.

Methods: In order to build understanding of the inside world of prison health care, qualitative methods were used to explore the perceived barriers to quality end-of-life care reported by 176 employees at six state correctional institutions. Semi-structured interviews were conducted with personnel who were involved in some aspect of end-of-life care, including:  health care; chaplaincy; security; and counseling and coordination staff. Content and thematic analytic techniques were applied by the research team.

Results: Concerns over maintaining a balance between care and security were common. Caring staff members expressed a need to withhold from offering supportive touch or extra time beyond mandated tasks to dying inmates for fear of being perceived by peers or superiors as fraternizing with the dying inmates. While nurses held images of a “good death, many referenced the constraints of prison life as impediments to humane death in prison. The availability of special foods and pain management practices varied across the six prisons. The isolating environment of the prison infirmary was cited as a hindrance to a peaceful death. Special dispensation from the chain of command was required for family visits of the dying, whether in prison or hospital. Visits from inmate buddies to those dying in the prison infirmary also required administrative approvals. While some institutions facilitated death vigils by inmate volunteers, others prohibited the practice due to perceived security threats.  Similarly, opportunities for memorializing the recently deceased varied widely across the six correctional institutions.

Conclusion: Despite variation in the EOL services offered at the six prisons; the everyday dilemmas were commonly experienced. Nurses serve in instrumental roles that could change the course of EOL care for dying inmates.