Susan Loeb, Penn State University – End of Life Care in Prisons

FID-250-LoebHealth care needs don’t stop when you’re behind bars.

Susan Loeb, Associate Professor of Nursing at Penn State University, examines end of life care for those in prison.

Dr. Loeb’s program of research focuses on the health needs and issues of older inmates with chronic health conditions including those with advanced chronic illnesses who are approaching the end of life. Her research has been funded by two NIH institutes (National Institute on Aging and National Institute of Nursing Research). Over the past two decades Dr. Loeb has taught a wide array of courses across the nursing curriculum, from undergraduate through doctoral education. Most recently her teaching has been in writing-focused courses where students develop their scholarly papers or dissertations. In addition, she regularly teaches NURS 501: Issues in Nursing and Health Care.

End of Life Care in Prions

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Prisons in the United States are increasingly faced with managing the health needs of a graying prison population, many of whom will also spend their final days behind bars. The convergence of the aging Baby Boom generation and get tough on crime laws which result in longer sentences have in large part caused this demographic shift. Building upon more than a decade of my research focused on aged and dying prisoners, my student Rachel Wion and I embarked on a systematic literature review in order to paint a comprehensive picture of care for prisoners at end of life and suggest nursing practice measures to enhance prison end-of-life care. Two of our research questions were: what facilitates delivery of humane end-of-life care to prisoners; and what contributions do inmates make to the care of their dying peers?

We learned that nurses are ideally suited to promote prisoners’ awareness of end-of-life and hospice services in prison so inmates may seek out needed services or contribute to providing such services. As well, nurses can play a critical role in discussing end-of-life treatment wishes with prisoners in advance of need and revisit and regularly update these preferences alongside currently routine care such as annual physical exams or health screenings.

We also learned that inmate peers were providing many services offered by free world community hospice volunteers and patient families. Other services were unique to the context of prison, including: fundraising; vetting others who wished to be an inmate caregiver, advocating for their fellow inmates who were dying; as well as keeping the dying inmate safe from predators. Looking to the future, since little attention has been afforded to dying prisoners’ family members—this shortcoming is an area ripe for investigation to learn of needs and strategies for filling this gap in supportive care.

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