The Challenge of Caring for a Graying Prison Population

Photo by Ackerman + Gruber An elderly prisoner in hospice care. Photo by Ackerman + Gruber

Inmates 54 or older are the fastest growing age demographic in U.S. prisons. According to the U.S. Bureau of Justice Statistics, the percentage of inmates who are 54 or older jumped from 3% to 8% in two decades (1991–2011). Criminal justice experts say the increase is probably an effect of the longer sentences of 1980s antidrug laws.

A 2014 report by the Vera Institute of Justice asserts that “prisons and jails are generally ill-equipped to meet the needs of elderly patients who may require intensive services” for their medical conditions. Correctional staff often lack training for treating age-related illnesses and prisons typically don’t have the ability to monitor chronic health issues or employ preventative measures. Inmates are often sent off-site for medical treatment beyond what prisons can provide.

Older adults with physical disabilities or cognitive impairments are also more vulnerable to injury, abuse, and psychological decompensation in the prison setting. “ [T]he prison environment is, by design, an extremely poor place to house and care for people as they age or become increasingly ill or disabled,” said a 2013 American Civil Liberties Union report. Even reliance on devices like wheelchairs, walkers, or breathing aids can present logistical hardships for inmates in facilities that were designed to accommodate a younger population.

This month’s CE feature, “

March 15th, 2016|Nursing, nursing perspective|0 Comments

The Balancing Act: A Dying Patient and a Spouse Who Can’t Let Go

Illustration by McClain Moore Illustration by McClain Moore

The Reflections essay in the March issue of AJN is called “The Balancing Act.” The author describes a situation she faced as an ICU nurse in which her efforts to keep a dying patient comfortable were complicated by a spouse’s reluctance to accept the inevitable. It’s often hard to advocate for a patient while honoring the emotional struggle of a close family member. Here’s the start of the essay.

I have just arrived to work in the ICU and am assigned a patient in respiratory distress. Her name is Darlene and her husband Tom is pacing the room. Within 10 minutes, he drinks three cups of coffee, ignoring the cot provided by the previous nurse so he could sleep next to Darlene. His wife has more than one cancer and both are growing. She left the hospital a week ago for hospice care, but has been readmitted after a decision by her husband to reattempt curative treatment.

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March 9th, 2016|Nursing, nursing perspective, Patients|2 Comments

Unexplained Deathbed Phenomena: Honoring Patient and Family Experience

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

by luke andrew scowen/flickr creative commons luke andrew scowen/flickr creative commons

When my dad died, a special little travel clock that he’d given me years before stopped working. It restarted a week after his death, and continued running for years. I have no explanation for this sudden lapse in timekeeping, but it made me feel closer to my dad.

I’ve heard many other stories of unusual events surrounding the death of a loved one. I was therefore delighted to read this month’s Viewpoint column, “Letting Patients and Families Interpret Deathbed Phenomena for Themselves.” In this short essay, Scott Janssen presents some intriguing research findings and a compassionate argument for speaking openly about these occurrences. He writes:

“It’s an open secret among those of us working with the dying – there’s a lot of strange stuff going on for patients, as well as for the clinicians and family members who care for them, that rarely if ever gets talked about: near-death experiences, synchronistic coincidences (stopped clocks at time of death, for example), out-of-body experiences, and visitations from deceased loved ones.”

Janssen, a former hospice social worker and now a psychotherapist, sees such phenomena as part of “the normal continuum of experiences at the end of life.” He calls upon clinicians to create safe contexts in which patients and families can share these experiences without fear that they will be judged, ridiculed, or dismissed by caregivers.

It’s food for […]

‘An Immutably Personal Process’: A Hospice Nurse Contemplates Uncontrol

Megen Duffy, RN, BSN, CEN, currently works in hospice case management. She writes AJN’s iNurse column, which focuses on technology and nursing.

by mark ahsmann/ wikimedia commons by mark ahsmann/ wikimedia commons

I started my day the way I often do: watching sunlight begin to filter in and softly illuminate the sunken face of a person who would die, not later, but sooner. I sat curled in the chair I’d been in since 3:00 AM, wrapped in my sweater against the institutional chill, and waited.

This is, perhaps unbelievably, my favorite part of being a nurse. In hospice, there is no deadline. No one needs the room right now. The patient does not have to go to the floor in the next 30 minutes to avoid throughput delays. I do not have five other patients claiming my time. No, I have the gift of being able to sit quietly with only one objective: to do everything I can to make sure this person leaves this life without pain or fear.

I am not bored. It may appear as if I am doing nothing, but that is far from true. I am watching and listening for every breath, every movement, every toe that turns a deep bruised purple, every expression that may say “I am hurting.”

I am merely cooperating with death, and death’s agenda is never known to me. My job is to wait for death to make a move and see how my […]

August 27th, 2015|Ethics, narratives, Nursing, nursing perspective|9 Comments

Strong Nurse and Patient Voices On the Blogs This Week

By Jacob Molyneux, senior editor/blog editor

Photo by mezone, via Flickr. Photo by mezone, via Flickr.

Here’s a short Friday list of recent smart, honest, informative blog posts by nurses, as well as a couple of interesting patient perspectives on prominent types of chronic illness and the ways they are talked about by the rest of us.

At Head Nurse, in “Yes…No. I’m Having Some Thoughts About BSNs,” an ADN-prepared nurse makes some familiar and some more surprising observations about the effects of the new policy of hiring mostly BSN-prepared nurses at her facility as it tries for Magnet status. For example, one of the effects she notes is “a massive drop-off in terms of the diversity of our nursing staff.” The move toward BSNs is obviously the trend in nursing, and is supported by research, but this doesn’t mean that there aren’t still two sides to the issue, or real unintended consequences to address as this change is gradually implemented.

At Hospice Diary, the blog of hospice nurse Amy Getter, there’s a post called “Hearts, Flowers, and Bucket Lists.” Reflecting on the imminent death of a patient, the author puts the popular notion […]