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Nursing Practice and the Criminal Justice System

The current issue of ANS features two articles focused on Crime, Justice and Health.  The first of these two articles is titled “In a Spirit of Restoration: A Phenomenology of NursingPractice and the Criminal Justice System” by Geraldine Gorman, PhD; Rebecca M. Singer, ND; Erin Christmas, MS; Catherine Herbstritt, MS; Layne Miller, MS; Mary Murphy, MS; Cailan Shannon, MS; and Katrina Wyss, MS.  We invite ANS readers to download this article while it is featured (no cost), and share your reflections in the comments section below.  Dr. Gorman shared this summary of her work, and how she became dedicated to addressing this timely and important social justice issue, followed by a message from co-author and faculty colleague Rebecca Singer:

From Geraldine Gorman:

Tragedy and crisis divert our attention from other tragedy and crisis. I became interested in prison reform back in the 90’s when I attended a forum focused on the impact of Buddhism on healthcare.  A Religious Studies professor from DePaul University in Chicago talked about  the

Geraldine Gorman

sangha he initiated for the men imprisoned in the maximum security facility in Michigan City, IN. I was intrigued and Ron invited me to attend one of their Zen Buddhist sittings. For the next 15 years I went into the prison as a volunteer with the Buddhist group, sitting and chanting in Korean– not a word of which I understood– and getting to know the men, some of whom had spent time on death row. During those years  3 executions took place, one which took the life of one of the members of the sangha. A peaceful protest accompanied each state-sanctioned murder with black robed Buddhists  sitting silently in the parking lot, from dusk till dawn. The reverberations from each death ran deeply.

But then 9/11 shook the world and my nursing conscience turned from the injustices of the prison industrial complex to the horrors of war. I continued going into the prison but war dominated my thoughts and words and  outrage.  This is what happens when the dike starts springing too many leaks. We have only so many hands, so much time.  It goes without saying that our current political dike has become a sieve.

Ten years ago as part of our public health nursing class, I began bringing students to the Indiana prison. They were able to walk through the cell blocks, observe what passes for healthcare, listen to men describe their journey to and through incarceration. Chicago’s own Cook County Jail had remained an impenetrable fortress until very recently when our reform-minded Sheriff reached out to the College of Nursing and we began providing health education to the men and women detained in the cavernous jail. Our article describes the initiation of this project, along with the gratifications and challenges faculty and students encountered.

We appreciate the opportunity to share this with the ANS audience. While we must pay close attention to the ever present rumors of war and more war, we cannot allow our attention to be diverted from the injustices in our own communities.  And we need to expose our students to what is done in our names without paralyzing them. Such is the challenge for nursing practice, education and scholarship: to witness and confront insurmountable suffering and to move forward.

From Rebecca Singer:

My primary area of practice is within humanitarian response work which takes me to conflict or post-conflict zones where I try to provide services with few resources to displaced peoples who have lost nearly everything but their lives. In my work with students, they express interest in this work and often ask what they should do to prepare for a job in humanitarian response. After

Rebecca Singer

several weeks in the jail, I realized that Cook County Jail was the closest I had ever come to a refugee camp in Tanzania or a displaced persons’ settlement in South Sudan while never traveling beyond my own city’s limits. The students and I needed to travel no further than 26th and California, just over 2.5 miles from our own College of Nursing, to be surrounded by displaced peoples who have lost nearly everything but their lives and to provide health education with few resources but our wits, several pieces of paper and a poster board.

As the weeks passed and we struggled to understand the rules, to navigate the bleak halls, and to be heard over the din, I came to see how much like a foreign country the jail was. Each time we enter the jail, we repeatedly are asked to show our ID and permission letter, which serve as our passport to this foreign land. We pass through metal detectors and check-points which remind me of the international borders and military check-points I cross to get to my other work. They check our bags and confiscate anything that might pass as contraband; this week a permanent marker and next week a roll of tape. We must pack our bags with care.

The people who get caught up in our criminal justice system live in the same city that we do, yet their lived reality is essentially foreign to me and to most of the students.  They often speak a different language, using slang that I have never heard.  Coming from parts of the city with higher rates of unemployment and lower rates levels of education, they function in an economy far removed from the Loop that I can see from our campus. The exchange of illegal items, including illicit drugs and the firearms that drive up the rates of violence in their communities, render the currency they use different from ours. And while our city is diverse, the range of brown and black people I meet in the jail do not look like the faculty I call my colleagues at our university.

Yet, it is only like a foreign country, because, in fact, this jail is in our city. It houses fellow citizens of our Midwestern city–polite, friendly sports’ fans who love to complain about the weather. They are fellow citizens whose current conditions serve as a stark and vivid reminder that the social determinants of health are at play right here. Now when students ask me about my humanitarian response work and express interest in doing it, I can encourage them to come with us to do that very work without traveling more than 2.5 miles—no passport necessary—just pack with care.

Enacting Social Justice Practice

Nancy Murphy, NP, PhD is the author of our current featured article titled “Advancing the Interdisciplinary Collaborative Health Team Model: Applying Democratic Professionalism, Implementation Science, and Therapeutic Alliance to Enact Social Justice Practice.” In the article she examines three foundational pillars of social justice practice: democratic professionalism, implementation science, and therapeutic alliance to advance this practice. Dr. Murphy has provided this description of her work:

I can’t recall when I have not been thinking about interdisciplinary collaborative team work, its value, its challenges, and the ongoing effort to keep the patient in the center of care!  As my early career coincided with the emergence of the HIV/AIDS epidemic, I was fortunate to be part of dynamic and

Dr. Nancy Murphy

Dr. Nancy Murphy

creative interdisciplinary work, both in the hospital and the community setting.   The early HIV models of care were immediately collaborative, as it was clear that one discipline alone could never provide all of what was needed.  The “team” went beyond clinicians to include not only patients and families, but friends, communities, legal advocates, spiritual providers, and many other ‘partners in care.’ 

Decades later I am still at it, now hoping the application of democratic professionalism, implementation science and therapeutic alliance may advance and improve the Interdisciplinary Collaborative Health Team model. The ideas of task sharing, thoughtful and strategic implementation, and therapeutic alliance among and between colleagues, patients, families, communities, and systems are extremely timely, especially as the US ventures into reorganization of health care financing: Affordable Care Act, Accountable Care Organizations, Bundled Payments, etc. Burwell, the Secretary of HHS, has set forth a range of upcoming changes in reimbursement that are claimed to reward value over volume.  The question is open as to whether these strategies are able to fulfill the social justice goal of both improving individual health outcomes and health disparities while simultaneously addressing larger health inequities (social, political, economic) that drive the negative social determinants of health.  

I continue to rely on Audre Lorde’s advice and offer it here for others to consider, “Only within the interdependency of different strengths, acknowledged and equal, can the power to seek new ways of being in the world generate, as well as the courage and sustenance to act where there are no charters” (Sister Outsider, 1986, p. 111).

Visit the ANS web site now to download your copy of this thought-provoking article while it is featured!  We welcome your comments and ideas!

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