Saskatchewan Provincial Correctional Nurses: Roles,Responsibilities,and Learning Needs

Abstract

Nurses represent the largest group of health care professionals working with incarcerated persons. Using a self-administered online questionnaire, this study surveyed a group of provincial correctional nurses to gain insight into their roles, responsibilities, and learning needs in relation to this complex area of practice. Specific aims included describing who they are, what they do, what they need, and what factors influence their practice. A total of 33 responses were received and analyzed, representing a response rate of 34.7%. Many areas of need were identified by the respondents related to their roles and practice. These findings will provide a foundation for continuing education, practice, and future research.

Keywords

correctional nursing learning needs assessment nursing interventions roles and responsibilities

Introduction

Nurses represent the largest group of health care professionals working with incarcerated populations. The health and psychosocial issues experienced by this captive group are extremely complex and contribute to treatment challenges both during incarceration and upon release from custody. Nurses who work in provincial correctional facilities in particular deal with large numbers of incarcerated persons, including those on remand, who tend to present with a multitude of long neglected physical and mental health challenges, often complicated by significant substance abuse problems (Peternelj-Taylor & Woods, 2016). The daily practice of correctional nurses “taps the knowledge and skills base of occupational health, emergency room, acute care, community health, maternity care, psychiatric care, geriatrics, and end-of-life nursing domains” (Shelton, Weiskopf, & Nicholson, 2010, p. 299). Thus, correctional nurses have a significant role to play in meeting the health care needs of incarcerated persons across the life span at the primary, secondary, and tertiary levels of intervention, including health promotion and illness prevention; assessment, screening, and identification of health challenges; crisis intervention; suicide risk assessment and management; and management of acute and chronic illness including medication administration, case management, and relapse prevention and recovery-oriented programming (American Nurses Association [ANA], 2013; Peternelj-Taylor & Woods, 2016). Nursing care within the criminal justice system takes place across a continuum of community-based transitional organizations and institutional settings such as jails, prisons, and correctional centers.

This study addresses nurses practicing in provincial correctional facilities—organizations that are dedicated to confinement and security. The competing and conflicting philosophical and cultural perspectives held between health care and corrections present a paradox of sorts, one known as custody and caring (Peternelj-Taylor & Johnson, 1995). As employees of correctional facilities, nurses must abide by the correctional policies that govern all employees and often find themselves in a “catch 22” position as they face the competing tensions enmeshed in their collective responsibilities (Peternelj-Taylor & Woods, 2016). They are responsible for the incarcerated person who is their patient, but they are also accountable to their profession, their employer (correctional system), and the community at large (ANA, 2013; Peternelj-Taylor & Woods, 2016; Storch & Peternelj-Taylor, 2009).

Literature Review

Nurses have historically “ministered” to vulnerable populations (Drake, 1998); however, before the late 1960s, very few nurses gave much thought to working in correctional environments. Since then, correctional nursing as a specialty has undergone significant transformations in professional development, as nurses have been challenged to embrace a multitude of roles in their quest to provide incarcerated persons with evidence-informed quality nursing care (ANA, 2013; Kearley & Steeves, 2010; Norens, 1971; Norman & Walsh, 2014; Peternelj-Taylor & Johnson, 1995; Peternelj-Taylor & Woods, 2016; Royal College of Nursing, 2017; Schoenly & Knox, 2013; Smale, 1983; Smith, 2005; Walsh, Freshwater, & Fisher, 2013). The extant literature addressing correctional nursing is a blend of anecdotal references and in-depth inquiries focusing on specific populations; very few critical analyses address the realities of correctional nursing practice in general.

More recently, correctional nurse researchers have recognized the importance of studying this specialty group. Studies addressing human resource perspectives, including recruitment and retention initiatives, have emerged in recent years (Almost, Gifford, et al., 2013; Chafin & Biddle, 2013). At the same time, other researchers have focused their attention on the work–life issues nurses face as they attempt to reconcile the ethical issues related to providing care in custodial settings (Almost, Doran, et al., 2013; Flanagan & Flanagan, 2001; Weiskopf, 2005). Shelton (2003, 2009) and White and Larsson (2012) have addressed scope-of-practice issues specific to correctional nursing. These authors concluded that correctional nursing is a unique specialty, one that requires further articulation of the professional role of the nurse.

Shelton (2003) conducted a small focus group study with nurses who worked with adolescent populations detained in juvenile or young offender institutions. Questions centered on clinical practice issues, evidence-based nursing, ethical issues, challenges encountered in enacting their professional roles, standards for practice, and the needs of the population being served. Not surprisingly, issues surrounding the competing demands of custody and caring emerged, as did clinical challenges related to caring for suicidal, manipulative, and disruptive patients. Nurses also identified the unique nursing skill mix required when working with juvenile offenders, emphasizing the need for expertise in psychiatric nursing and medical–surgical issues, as well as knowledge of infectious diseases. In a later study, Shelton (2009), using the Staff Questionnaire taken from the Nursing in Secure Environments project (United Kingdom Central Council & University of Central Lancashire [UKCC & UCL], 1999), administered the questionnaire to 180 correctional nurses in the United States. Two significant roles emerged in data related to (1) the promotion and implementation of principles that underpin effective quality care for individual patients and (2) the assessment, development, implementation, and improvement of programs of care for individuals.

Until very recently, no Canadian studies have addressed the professional development of correctional nurses. Almost, Doran, et al. (2013), in a study addressing the work–life issues experienced by provincial correctional nurses in the province of Ontario, identified several factors that they felt impacted on the professional role development of correctional nurses, including inadequate staffing and heavy workloads, limited control over their practice and scope of practice, limited resources, and challenging workplace relationships. In a related study focused on the learning needs of correctional nurses in Ontario, Almost and Gifford (2013) reported that mental health and addictions tied with traumatic wound management as the highest ranked learning needs by nurses in their study. Unfortunately, for many individuals experiencing mental health problems and/or illnesses, correctional facilities have become “defacto psychiatric institutions” with “access to psychiatric care only [occurring] after they have been criminalized” (Chaimowitz, 2012, p. 5). As outlined in the Mental Health Strategy for Canada, individuals with mental illness in correctional systems need to be able to access appropriate services, treatments, and supports that are “consistent with professionally accepted standards” (Mental Health Commission of Canada, 2012, p. 47). A Scottish study by Hurley, Linsley, Elvins, and Jones (2013) also discussed workforce development issues related to professional standards. Issues surrounding collaborative practices, enacting clinical leadership, and the provision of nursing education were identified as mechanisms to generate service provision, while nurturing professional autonomy in nursing. In an editorial addressing a special issue of the Journal of Forensic Nursing dedicated to correctional nursing, Peternelj-Taylor and Panosky (2013) concluded that “Nurses represent the largest group of healthcare professionals practicing in correctional systems, yet little is known about their work environments, what challenges they experience, or how those challenges impact on the care of those in custody” (p. 1).

Research Objectives

The overall goal of the research was to gain insight into the roles, responsibilities, and learning needs of nurses practicing in provincial correctional facilities in the province of Saskatchewan. There were four related research objectives:

Describe the profile of Saskatchewan provincial correctional nurses (i.e., who they are),

Explore their professional roles and responsibilities (i.e., what they do),

Identify their unique learning needs required for continuing competence (i.e., what they need), and

Identify the contextual factors that influence their ability to work to their full scope of practice in providing evidence-informed care (i.e., what factors influence their professional roles).

Method

This was a two-phase mixed methods study examining the roles, responsibilities, and learning needs of Saskatchewan provincial correctional nurses. Saskatchewan is a large province in Western Canada. Two levels of service provision exist in Canada—one at the provincial/territorial level and the other at the federal level—and are delivered through similar yet differing sets of policies and legislation. Provincial and territorial sentences generally are considered 2 years, less a day.

This article reports on the first phase of the study. In Phase 1, eligible study participants (registered nurses [RNs], registered psychiatric nurses [RPNs], and licensed practical nurses) employed by the Ministry of Corrections, Public Safety and Policing, and practicing in Saskatchewan provincial correctional facilities were asked to complete two related self-administered questionnaires: (1) a Demographics and Learning Needs Assessment and (2) a Staff Questionnaire (UKCC & UCL, 1999). Both questionnaires were distributed and completed online through Fluid Survey. Frequent notices were sent to remind people to complete the survey.

The Learning Needs Assessment, originally developed by faculty from the College of Nursing, University of Saskatchewan, was adapted for use in this study. This questionnaire consisted of 22 questions. Questions 1 to 9 covered respondents’ demographic information. Questions 10 to 16 used a 5-point Likert-type scale and asked respondents to rate the level of importance (not very important to very important) for each topic in relation to knowledge and learning needs for nurses in their facility. Questions 17 to 21 asked a number of yes/no choices mainly in relation to ongoing professional development. Question 22 was open-ended and invited participants to make additional comments.

The Staff Questionnaire was taken from the Nursing in Secure Environments project (UKCC & UCL, 1999) and consisted of 45 questions targeting five skill sets relevant to clinical practice: (1) promote and implement principles that underpin effectiveness, quality, and practice; (2) assess, develop, implement, and improve programs of care for individuals; (3) create and maintain environments and relationships with individuals that value them as people and support their therapeutic roles; (4) provide and improve resources and services that facilitate organizational functioning; and (5) develop the knowledge, competency, and practice of self and other. In completing the questionnaire, respondents were first asked to identify the level of involvement within their work role for each of the 45 nursing interventions and then they were asked to rate using a Likert-type scale how important each intervention was to their role as correctional nurses working in secure environments.

Data Analysis

Quantitative data were entered into IBM SPSS Statistics Version 23 and analyzed through the use of descriptive statistics. Specifically explored, as appropriate to data, were frequencies, percentages, ranges, means, and standard deviations.

Ethical Considerations

This study was reviewed by, and received approval through, the Research Ethics Office, University of Saskatchewan, and the Ministry of Justice for Corrections and Policing, Research and Evidence-Based Excellence Branch. Before participating in the study, participants were informed of the purpose of the study and given the opportunity to ask questions. Participants completing and submitting the online Fluid Survey gave their free and implied informed consent.

Sample

Invitations to participate in the study were sent to all 95 nurses who were employed in provincial corrections at the time of the study. A total of 33 responses were received and analyzed (response rate = 34.7%); 28 responses had a complete data set and 5 had some missing data. The missing data were mainly from the Staff Questionnaire; missing responses were excluded from any analysis.

There was a relatively even split in responses from RNs (N = 15, 45.5%) and RPNs (N = 14, 42.4%). The remaining responses were from dually registered RPN/RN (N = 3, 9.1%) and other (N = 1, 3.0%). A higher number of respondents were female (N = 26, 78.8%) than male (N = 7, 21.2%). The mean age was 39.18 years (SD = 11.99, min = 24, max = 60). There was a relatively even split between respondents who worked full-time (N = 15, 45.5%) and part-time (N = 17, 51.5%). The highest level of education was a degree completed (N = 18, 54.5%), diploma (N = 15, 45.5%), and graduate degree in progress (N = 2, 6.1%). Overall, the respondents had a lengthy amount of experience in nursing (mean = 12.75 years, SD = 12.04, min = 0.5, max = 40) and in correctional nursing (mean = 8.65 years, SD = 9.70, min = 0.42, max = 33). Most respondents reported that they currently worked with an adult correctional population (N = 29, 87.9%) as opposed to a youth correctional population (N = 4, 12.1%). A larger proportion of respondents had previous experience working with adult correctional populations (adult male: N = 26, 78.8%; adult female: N = 21, 63.6%) than youth correctional populations (youth male: N = 8, 24.2%; adult female: N = 4, 12.1%). Table 1 summarizes the populations that respondents have worked with.

Table 1.

Summary of Populations Worked With.

Correctional Population	N	%
Adult male	9	27.3
Adult female	4	12.1
Youth male	1	3.0
Adult male and female	12	36.4
Adult male and female, youth male	3	9.1
Adult male and female, youth male and female	2	6.1
Youth male and female	2	6.1
Total	33	100.0

Results

Learning Needs Assessment

Seven questions on the survey asked respondents to rate the level of importance of various areas in relation to the knowledge/learning needs of nurses working in their facility to meet the needs of the clients in their care.

The first area was correctional assessment (see Table 2). While most respondents placed some level of importance for all six assessment areas, those rated by the larger proportion as “very important” were suicide assessment, mental health assessment, and self-harm assessment. No assessment areas were considered “not at all important” by any of the respondents. Additional areas of assessment identified by the respondents were gang affiliation activity (important, N = 1; very important, N = 4), past medical or psychiatric history (important, N = 1), and prenatal care and status, diabetes status, and parental custodial concerns (very important, N = 1).

Table 2.

The Importance of Correctional Assessment for the Knowledge/Learning Needs of Nurses to Meet Client Needs.

Correctional Assessment	Not at All Important	Somewhat Important	Neutral	Important	Very Important
Correctional Assessment	N (%)	N (%)	N (%)	N (%)	N (%)
Risk		1 (3.0)	2 (6.1)	6 (18.2)	24 (72.7)
Mental status		1 (3.0)		3 (9.1)	29 (87.9)
Addictions		1 (3.0)	1 (3.0)	9 (27.3)	22 (66.7)
Suicide		1 (3.0)		1 (3.0)	31 (93.9)
Self-harm		1 (3.0)		3 (9.1)	29 (87.9)
Violence		2 (6.1)		7 (21.2)	24 (72.7)
Physical		1 (3.0)	1 (3.0)	6 (18.2)	25 (75.8)
Harm reduction		2 (6.1)	3 (9.1)	10 (30.3)	18 (54.5)

The second area was therapeutic interventions (see Table 3). A large percentage of respondents placed some level of importance for all three types of therapeutic intervention. Individual therapeutic intervention was rated as “very important” by a higher number of respondents. Group and psychoeducation therapeutic intervention were rated “not at all important” by a small number of the respondents.

Table 3.

The Importance of Therapeutic Interventions for the Knowledge/Learning Needs of Nurses to Meet Client Needs.

Therapeutic Intervention	Not at all Important	Somewhat Important	Neutral	Important	Very Important
Therapeutic Intervention	N (%)	N (%)	N (%)	N (%)	N (%)
Group	5 (15.2)	3 (9.1)	9 (27.3)	11 (33.3)	5 (15.2)
Individual		1 (3.0)	1 (3.0)	8 (24.2)	23 (69.7)
Psychoeducation	1 (3.0)	1 (3.0)	3 (9.1)	11 (33.3)	17 (51.5)

The third area was special populations (see Table 4). Similar to other topic areas, most respondents placed some level of importance for all 16 special populations. Mentally ill inmates were rated as “very important” by the largest number of respondents. Inmates with addiction issues, fetal alcohol spectrum disorder (FASD), and bloodborne infectious diseases were also rated as “very important” by more than 70% of respondents. Surprisingly, women, youth, the elderly, and chronically physically ill inmates were rated “not at all important” by a small number of respondents. Other special populations identified were post-traumatic stress disorder (PTSD) and spousal abuse (important, N = 1; very important, N = 3).

Table 4.

The Importance of Special Populations for the Knowledge/Learning Needs of Nurses to Meet Client Needs.

Special Populations	Not at all Important	Somewhat Important	Neutral	Important	Very Important
	N (%)	N (%)	N (%)	N (%)	N (%)
Aboriginal		1 (3.0)	2 (6.1)	10 (30.3)	20 (60.6)
Women^a	2 (6.1)	1 (3.0)	3 (9.1)	7 (21.2)	17 (51.5)
Youth^a	4 (12.1)		6 (18.2)	11 (33.3)	10 (30.3)
Elderly^a	2 (6.1)	1 (3.0)	3 (9.1)	13 (39.4)	13 (39.4)
Palliative care^a		3 (9.1)	6 (18.2)	11 (33.3)	12 (36.4)
Mentally ill		1 (3.0)		3 (9.1)	29 (87.9)
Addictions		1 (3.0)	2 (6.1)	6 (18.2)	24 (72.7)
Sex offense		3 (9.1)	8 (24.2)	8 (24.2)	14 (42.4)
Personality disordered		1 (3.0)	1 (3.0)	8 (24.2)	23 (69.7)
Disabled/intellectually impaired		1 (3.0)	1 (3.0)	8 (24.2)	23 (69.7)
Acquired brain injury		1 (3.0)	1 (3.0)	10 (30.3)	21 (63.6)
Fetal alcohol spectrum disorder		1 (3.0)	1 (3.0)	7 (21.2)	24 (72.7)
Bloodborne infectious diseases		1 (3.0)	1 (3.0)	7 (21.2)	24 (72.7)
Other infectious diseases		1 (3.0)	1 (3.0)	9 (27.3)	22 (66.7)
Chronically physically ill	1 (3.0)	1 (3.0)	4 (12.1)	7 (21.2)	20 (60.6)
Concurrent disorders		1 (3.0)	1 (3.0)	10 (30.3)	21 (63.6)

^aSome missing data (percent and not valid percent used).

The fourth area included roles and specialties (see Table 5). Again, most respondents placed some level of importance for all three topics. A large percentage of respondents identified professional development and roles of the interdisciplinary team as “very important.” One respondent thought all three roles were “not at all important.” Other roles and specialties identified were continued education and community awareness, know issues outside of facility, and be current on issues and treatments that affect inmates (important, N = 1) and role of nursing manager (very important, N = 1).

Table 5.

The Importance of Roles and Specialties for the Knowledge/Learning Needs of Nurses to Meet Client Needs.

Topic Area	Not at all Important	Somewhat Important	Neutral	Important	Very Important
	N (%)	N (%)	N (%)	N (%)	N (%)
Roles and specialties
Professional role development	1 (3.0)		1 (3.0)	9 (27.3)	22 (66.7)
Career opportunities	1 (3.0)	2 (6.1)	4 (12.1)	10 (30.3)	16 (48.5)
Roles of the interdisciplinary team	1 (3.0)	2 (6.1)		9 (27.3)	21 (63.6)
Research and development^a	2 (6.1)	1 (3.0)	2 (6.1)	16 (48.5)	11 (33.3)
Correctional/other relevant education available^a	1 (3.0)	3 (9.1)	1 (3.0)	6 (18.2)	21 (63.6)

^aSome missing data (percent and not valid percent used).

Table 5 also shows responses related to research and development as well as correctional and other relevant education available. In keeping with other areas, a large number of the respondents placed some level of importance for these. Clearly though, research and development was not considered as “very important” compared to education available. A few respondents considered both areas as “not at all important.”

The final area was practice issues (see Table 6). Again, a large percentage of the respondents placed some level of importance on the 10 practice issues. Infectious disease management, medication management, ethical/moral issues in correctional care, trauma/emergency response, and information sharing were all practice issues considered “very important” by a large percentage of respondents. Only one respondent rated the therapeutic relationship as “not at all important.”

Table 6.

The Importance of Practice Issues for the Knowledge/Learning Needs of Nurses to Meet Client Needs.

Practice Issues	Not at all Important	Somewhat Important	Neutral	Important	Very Important
	N (%)	N (%)	N (%)	N (%)	N (%)
The therapeutic relationship	1 (3.0)	1 (3.0)	1 (3.0)	7 (21.2)	23 (69.7)
Ethical/moral issues in correctional care		1 (3.0)	1 (3.0)	5 (15.2)	26 (78.8)
Care and custody		1 (3.0)	1 (3.0)	8 (24.2)	23 (69.7)
Restraint and segregation		3 (9.1)	3 (9.1)	12 (36.4)	15 (45.5)
Trauma/emergency response				7 (21.2)	26 (78.8)
Medication management			1 (3.0)	5 (15.2)	27 (81.8)
Human rights/inmate rights/victim rights			2 (6.1)	11 (33.3)	20 (60.6)
Infectious disease management		1 (3.0)	1 (3.0)	3 (9.1)	28 (84.8)
Documentation				3 (9.1)	30 (90.9)
Information sharing		1 (3.0)	3 (9.1)	3 (9.1)	26 (78.8)

Respondents were asked to identify any other practice areas they considered relevant, and eight were named: prenatal management (important, N = 1); team development, critical incident support and debriefing, PTSD (very important, N = 1); training to maintain competency and stay current (very important, N = 1); training on the use of the computer management system which is very limited for casual staff (important, N = 1); diabetes management (very important, N = 1); effects of shift work (very important, N = 1); understanding different diets, kitchen is very reluctant to alter inmate’s dietary needs despite requests, diabetic trays do not look like diabetic trays, and so on (very important, N = 1); and wellness, balance of work life and home life (very important, N = 1).

Similar numbers of respondents reported that their facility offered, as opposed to did not offer, in-service education related to their role (yes: N = 14, 42.4%; no: N = 15, 45.5%; unsure: N = 4, 12.1%). A range of resources were reported as being available at participant workplaces for professional development, including personal self-development, telehealth, webinars, and personal work plans/mandatory nonnursing-related training. Limited resources was also cited; one participant stated, “NONE! It’s the responsibility of staff to seek out educational opportunities and then go through the ‘red tape’ of trying to get funding and the time off.”

A large number of participants were aware of correctional nursing conferences that are offered (N = 19, 57.6%). The remaining N = 14 (42.4%) were not aware. Only a small proportion (N = 11, 33.3%) had ever attended a conference on correctional nursing. When asked if they would like to attend a conference on correctional nursing, N = 33 (100%) replied yes.

Participants were asked if they would like to make any other comments, and three comments stood out: (1) “Continued education for the nurses in corrections needs to be mandatory. Fiscal restraints often do not allow for educational opportunities. Out of province or out of country education would not be considered.” (2) “Like most workplaces, nursing in corrections seems to have little or no funds to foster opportunities for staff development, even staff meetings seem difficult to arrange. It’s the old adage of doing more with less.” (3) “Often there is no funding for casual employees despite how long [they] have worked there or for how many hours overall are put in.”

Staff Questionnaire

For 45 nursing interventions, respondents were asked to rate the level of involvement they had within their work role. Possible responses were (1) part of role and ensure others undertake this, (2) ensure others undertake this, (3) part of role, and (4) not part of role. Secondly, respondents were asked to rate how important these interventions were for nursing in secure environments. Possible responses were very unimportant, unimportant, undecided, important, and very important. These nursing interventions are grouped into five skills sets within the questionnaire.

Reported here is a subset of results from respondents who said the intervention was “part of role and ensure others undertake this” or “part of role” (referred to as part of role from now on). Each results table includes the percentage this represents of the total respondents for each item and the mean score and related statistics on how important this subset of respondents rated each item. Higher mean scores relate to higher importance (range = 1 to 5).

Skill Set 1, “promote and implement principles that underpin effective quality and practice,” contains 3 items. Over 80% of respondents reported that this was part of their role. Mean scores indicate that all 3 items were considered important for nursing in secure environments (see Table 7).

Table 7.

Combined Responses “Part of Role and Ensure Others Undertake This” and “Part of Role”—Items Skill Set 1.

Skill Set 1: Promote and Implement Principles That Underpin Effective Quality and Practice
	N	% Total Item Response	Min	Max	$\bar{x}$	SD
1. Promote people’s equality, diversity, and rights	29	90.63	1	5	4.41	0.82
2. Promote effective communication and relationships	31	96.88	1	5	4.10	1.35
3. Promote communication with individuals where there are communication differences	26	81.25	1	5	4.27	0.92

Skill Set 2, “assess, develop, implement, and improve programs of care for individuals,” consists of 19 items. Over 70% of respondents reported that 11 of the items were part of their role. For Items 6, 8, 14, 20, and 21, between 60% and 70% of respondents said they were part of their role. For 1 item (11—enable individuals to develop and maintain skills of independent living), 58% reported it was part of their role, and for the remaining 2 items (12—enable individuals to develop meaningful relationships with others and 22—contribute to the evaluation and improvement of programs of care for individuals), 50% or less reported it was part of their role. All items in which a lower percentage of respondents, indicated that the specific skills were part of their role, is perhaps a reflection on just how the role of correctional nursing is articulated in the clinical environment. All items were rated as important for nursing in secure environments, although 1 item (21—negotiate, agree, and support placements for individuals) had a mean score below 4, indicating it is moving in the direction of undecided (see Table 8).

Table 8.

Combined Responses “Part of Role and Ensure Others Undertake This” and “Part of Role”—Items Skill Set 2.

Skill Set 2: Assess, Develop, Implement, and Improve Programs of Care for Individuals
	N	% Total Item Response	Min	Max	$\bar{x}$	SD
4. Assess individuals to determine their overall needs and risk	29	90.63	1	5	4.28	1.16
5. Provide specialist assessment services on individuals’ needs so that others can take action	26	81.25	1	5	4.19	0.98
6. Assist in the assessment of and the planning of programs of care for individuals	21	65.63	4	5	4.67	0.48
7. Plan specific therapeutic interventions to enable individuals to recognize and address any socially unacceptable behavior	25	78.13	1	5	4.32	1.07
8. Contribute to the joint implementation and monitoring of programs of care for individuals	19	61.29	1	5	4.26	1.10
9. Implement specific therapeutic interventions to enable individuals to manage their behavior	23	74.19	1	5	4.30	0.88
10. Assist in the implementation and monitoring of specific therapeutic interventions	25	80.65	1	5	4.24	1.09
11. Enable individuals to develop and maintain skills of independent living	18	58.06	1	5	4.33	1.03
12. Enable individuals to develop meaningful relationships with others	13	41.94	1	5	4.38	1.12
13. Enable individuals who are at risk to themselves and others to identify behavioral boundaries and develop control	29	93.55	1	5	4.24	1.12
14. Contribute to the evaluation and improvement of programs of care for individuals	22	68.75	1	5	4.05	0.92
15. Assess individuals’ needs for primary health care services	30	93.75	1	5	4.43	1.04
16. Develop, monitor, and review programs of primary health care for individuals	24	75.00	1	5	4.35	0.93
17. Contribute to raising awareness of health issues	31	96.88	1	5	4.26	1.21
18. Enable individuals to address issues which affect their health and well-being	25	89.29	1	5	4.16	1.28
19. Raise awareness of the needs of individuals discharged from your services	23	82.14	1	5	4.30	0.88
20. Promote the needs of individuals in the community	19	67.86	1	5	4.21	1.03
21. Negotiate, agree, and support placements for individuals	18	64.29	1	5	3 83	1.38
22. Develop, monitor, and review discharge packages to manage individuals	14	50.00	1	5	4.21	1.19

Skill Set 3, “create and maintain environments and relationships with individuals that value them as people and support their therapeutic goals,” contains 14 items. For only 6 items did over 70% of respondents report they were part of their role (see Table 9). For 3 of the items (25—physically intervene in situations where there is a breakdown in environments and relationships to limit risks to those involved, 27—enable individuals to maintain contacts in isolating situations, and 33—create and maintain boundaries between the community and individuals detained in secure conditions), between 50% and 60% of respondents said it was part of their role. For 2 items, between 30% and 40% said it was part of their role (23—contribute to the provision of effective physical, social, and emotional environments for group care and 31—contribute to establishing and running mutual support networks). The remaining 3 items had just over 20% report they were part of their role (29—enable individuals’ partners, relatives, and friends to adjust to and manage the individual’s loss; 30—enable individuals, their partners, relatives, and friends to explore and manage change; and 36—escort patients within and beyond secure settings). Like the previous skill set, these smaller numbers likely reflect the clinical role of nurses in provincial corrections in the province. Generally, the mean scores show that the respondents consider the items important for nursing in secure environments, with four of the items tending toward respondents being undecided.

Table 9.

Combined Responses “Part of Role and Ensure Others Undertake This” and “Part of Role”—Items Skill Set 3.

Skill Set 3: Create and Maintain Environments and Relationships With Individuals Which Value Them as People and Support Their Therapeutic Goals
	N	% Total Item Response	Min	Max	$\bar{x}$	SD
23. Contribute to the provision of effective physical, social, and emotional environments for group care	13	46.43	1	5	3.69	1.38
24. Build and sustain relationships with individuals to reinforce their therapeutic goals	21	75.00	1	5	4.29	1.01
25. Physically intervene in situations where there is a breakdown in environments and relationships to limit risks to those involved	14	50.00	1	5	4.29	1.14
26. Support individuals with difficult or potentially difficult relationships	23	82.14	1	5	4.13	0.97
27. Enable individuals to maintain contacts in isolating situations	16	57.14	1	5	3.75	1.48
28. Enable individuals to adjust to and manage their loss	24	85.71	1	5	4.17	1.09
29. Enable individuals’ partners, relatives, and friends to adjust to and manage the individuals loss	6	21.43	1	5	3 83	1.47
30. Enable individuals, their partners, relatives, and friends to explore and manage change	7	25.00	1	5	4.00	1.41
31. Contribute to establishing and running mutual support networks	9	32.14	1	5	3.50	1.69
32. Support individuals when they are distressed	26	92.86	1	5	4.24	1.30
33. Create and maintain boundaries between the community and individuals detained in secure conditions	16	57.14	1	5	4.19	1.38
34. Protect patients from themselves and each other	25	89.29	1	5	4.28	1.31
35. Contribute to the protection of individuals from abuse	22	78.57	1	5	4.27	1.20
36. Escort patients within and beyond secure settings	7	25.00	1	5	4.00	1.41

Skill Set 4, “provide and improve resources and services that facilitate organizational functioning,” contains 6 items (see Table 10). For 2 items, over 90% of respondents reported they were part of their role. The percentages were between 50% and 60% for the other 4 items: 37—manage one’s caseload against the prioritized needs of individuals, 38—support and lead teams to enable work objectives to be met, 39—support staff in maintaining their identity and safe personal boundaries, and 40—counsel and support staff in times of stress. These are once again a reflection of the role of correctional nurses in the province. All 6 items were considered important for nursing in secure environments.

Table 10.

Combined Responses “Part of Role and Ensure Others Undertake This” and “Part of Role”—Items Skill Set 4.

Skill Set 4: Provide and Improve Resources and Services Which Facilitate Organizational Functioning
	N	% Total Item Response	Min	Max	$\bar{x}$	SD
37. Manage one’s caseload against the prioritized needs of individuals	16	57.14	1	5	4.38	1.03
38. Support and lead teams to enable work objectives to be met	14	50.00	1	5	4.07	1.14
39. Support staff in maintaining their identity and safe personal boundaries	18	64.29	1	5	4.22	1.26
40. Counsel and support staff in times of stress	17	60.71	1	5	4.00	1.28
41. Promote, monitor, and maintain health, safety, and security in the workplace	26	92.86	1	5	4.40	1.12
42. Receive, transmit, store, and retrieve information	26	92.86	1	5	4.23	1.28

Skill Set 5, “develop the knowledge, competence, and practice of self and others,” consists of 3 items. Over 70% of respondents reported these were part of their role. Mean scores indicate that all 3 items were considered important for nursing in secure environments (see Table 11).

Table 11.

Combined Responses “Part of Role and Ensure Others Undertake This” and “Part of Role”— Items Skill Set 5.

Skill Set 5: Develop the Knowledge, Competence, and Practice of Self and Others
	N	% Total Item Response	Min	Max	$\bar{x}$	SD
43. Contribute to the development of knowledge and practice	25	89.29	1	5	4.17	1.31
44. Nursing intervention: Develop oneself within the role	27	96.43	1	5	4.41	1.08
45. Contribute to the development of others	21	75.00	1	5	4.00	1.10

Discussion

The essential role of nurses in the provision of health care to persons incarcerated within the provincial Saskatchewan correctional system underscores the importance of understanding their professional roles, responsibilities, and learning needs. To date, very few researchers have explored correctional nursing as a specialty area of practice. Little is known about correctional nursing in Canada and even less about correctional nursing in the context of provincial corrections in Saskatchewan. This study was particularly important from an occupational, educational, and professional practice perspective, one that is particularly important to nurses and their ability to competently provide inmates with evidence-informed care.

For instance, from the learning needs assessment, it was clear from respondents that the care of inmates experiencing mental health issues and disorders was very important to their continuing professional development. Related to correctional assessment, 94% identified suicide assessment and 88% identified mental health assessment and self-harm assessment as very important to their professional practice. As to special populations, 88% identified mentally ill inmates and 73% identified addictions issues and FASD as very important. This is not surprising considering that authors around the globe have reported on the complexity of mental health issues experienced by incarcerated populations and the parallel challenges to nursing care provision (Durcan & Zwemstra, 2014; Ellis & Alexander, 2017; Norman & Walsh, 2014; Reingle Gonzalez & Connell, 2014; Williams & Heavey, 2014). And while some researchers have reported on the strides that correctional nursing is making in the care of incarcerated persons, and in particular those with mental illness (Ellis & Alexander, 2017; Maruca & Shelton, 2016; Mollard & Hudson, 2016; Shelton, Bailey, & Banfi, 2017), evidence-based interventions remain limited and ongoing research in this niche area of practice is needed.

Varying numbers of respondents reported that the 45 nursing interventions listed in the Staff Questionnaire were either part of their role, or part of their role and they ensured others undertook this. Overall, 90% of respondents responded affirmatively for 10 of the interventions, 80% for 9 interventions, 70% for 6 interventions, 60% and 50% for 7 interventions, 40% for 2 interventions, 30% for 1 intervention, and 20% for 3 interventions. No matter how small or large the percentage of respondents who reported they had a role to play in the intervention, the importance of the 45 nursing interventions for nursing in secure environments was always high. Similar findings have been reported by Shelton (2009) and Shelton, Weiskopf, and Nicholson (2010).

This research was the first of its kind in Saskatchewan and as such was important in unveiling findings regarding nursing practice in provincial correctional facilities. The exploration of correctional nurses’ learning needs and professional role development within the context of their unique work environments has helped to provide foundational information that will direct future research and innovations in workforce development and continuing education and contribute to evidence-informed quality care for inmates in Saskatchewan. Such research and innovation are well aligned with results from a study by Schoenly (2015), who through a Delphi study identified six research priorities for correctional nursing: critical thinking and clinical judgment, competency and educational level, assessment, nursing protocols, effect on patient outcomes, and environment of care. Indeed, Schoenly highlights that “These topics provide a platform for future research efforts to improve clinical practice and care of patients in the criminal justice system” and “Focusing research efforts in priority areas will maximize advancement of the specialty practice of correctional nursing” (p. 406).

Studies of this nature come with inherent limitations. The response rate, while considered acceptable for surveys such as this, actually represented a small number of nurses. Although not generalizable to other correctional jurisdictions, the results of this study will serve to inform future research with other provincial and federal correctional jurisdictions. A second limitation was the length of the Staff Questionnaire (UKCC & UCL, 1999). This is a complex questionnaire, and feedback from participants suggested this was difficult to complete in a timely way online.

Conclusion

The past decade has seen substantial development in correctional nursing as a specialized area of practice within nursing. Although correctional nurses were once considered second-class nurses, unable to secure employment elsewhere (Peternelj-Taylor & Johnson, 1995), contemporary developments in correctional nursing education, research, and practice have illustrated the important role that correctional nurses play in the care of incarcerated persons, their families, and their communities. This study addressed an underserved area of nursing practice and therefore is foundational to the ongoing professional development of correctional nursing in Saskatchewan and beyond, which will provide a foundation for continuing education, practice, and future research. A replication study in the neighboring provinces of Alberta and Manitoba is currently underway.

Footnotes

Acknowledgments

We would like to thank the nurses who took the time to participate in this study. We would like to thank Amie Rusk, BSN, RN, who at the time of the study was an undergraduate research assistant for the project. We would also like to thank Dr. Arlene Kent-Wilkinson, College of Nursing, University of Saskatchewan, who contributed to the development of the Learning Needs Assessment Questionnaire.

Declaration of Conflicting Interests

The authors disclosed no conflicts of interest with respect to the research, authorship, or publication of this article. For information about JCHC’s disclosure policy, please see the Self-Study Program.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The Centre for Forensic Behavioural Sciences and Justice Studies, University of Saskatchewan, funded the project through a Faculty Research Grant.

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