Dissertations, Theses, and Capstone Projects

Date of Degree

2-2023

Document Type

Dissertation

Degree Name

Ph.D.

Program

Nursing

Advisor

Lorie Goshin

Committee Members

Elizabeth Capezuti

William Samuels

Subject Categories

Geriatric Nursing | Nursing

Keywords

Long-Term Care Nurses, Justice-involved, Incarceration-related stigma, experimental design, LTC healthcare stigma

Abstract

Background: A silver tsunami is occurring in U.S. prisons because of an unprecedented increase in the older population. Prisons are structurally ill-suited to care for this population and financially burdened with providing the necessary medical and nursing care. States have enacted legislation to afford justice-involved persons parole to manage chronic conditions in community-based long-term care (LTC) facilities. Changes in Medicaid regulations provide a seamless transition from prison to community long-term care for this population. However, it is not known if the stigma of justice involvement impacts the perception of long-term nurses concerning this population.

Aims/Purpose: This study examined the effects of a stigmatizing stimulus on the caring efficacy of LTC nurses by testing the following hypotheses: a) knowledge of the older patient’s justice involvement will be associated with lower caring self-efficacy when compared to the control vignette; b) knowledge of a history of sexual offenses will be associated with the lowest caring self-efficacy, when compared to all other vignettes, followed by non-sexual violence and non-violent offenses vignettes; c) justice-involved friend or family member and identifying with a Christian religion will be associated with higher caring self-efficacy for older justice-involved persons when compared to those without; and d) friends or family members working in law enforcement will be associated with a lower caring self-efficacy for older justice-involved persons when compared to those without.

Methods: Using a vignette-based experimental design, participants completed the Caring Efficacy Scale after they were randomly assigned to one of four vignettes that mirrored the LTC resident population in age, chronic condition, and behavior, but differed by justice involvement. Data was examined with ANOVA analysis. Additional analyses investigated the effects of demographic variables obtained from participants using the researcher-developed demographic questionnaire.

Results: This study suggested that LTC nurses exhibited a higher caring self-efficacy to the resident without justice-involvement as opposed to those residents with justice-involvement. Furthermore, among those residents with justice-involvement, LTC nurses exhibited a lower self-caring efficacy towards the resident with a sex offense history as opposed to the vignette residents with a violent and non-violent history of justice-involvement. The nurse’s identification with a Christian religion, having a friend or relative imprisoned, or having a friend or relative in law enforcement did not significantly affect the nurse’s caring self-efficacy. Furthermore, the nurse’s experience of being victimized or having knowledge of a friend or relative’s victimization did not significantly affect the nurse’s caring self-efficacy.

Conclusion: Incarceration-related stigma affects the caring self-efficacy of LTC nurses. The effect may be driven by the nurse’s fear of justice-involved people, the nurse struggles with forgiveness towards those imprisoned for specific offenses, or the nurse may feel that justice-involved people are not deserving of high-quality nursing care. Qualitative research is needed to understand the feelings that LTC nurses experience when working with justice-involved people so that training can be developed.

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