Barbara Curtis, MSN, RN, Director of Nursing Service, Washington State Department of Corrections talks about the high prevalence of traumatic brain injury in the correctional patient population and responses to the condition. Barbara has been an RN for over 30 years with 20 of those in emergency services both as administrator and clinician. She has been with correctional nursing for 11 years.
Although an estimated 2% of the general population has sustained a TBI with continuing disability, a meta analysis of studies in the inmate population indicates a prevalence of over 60% . It is suggested that this condition may be under-reported for a variety of reasons. A study performed in the Washington State Correctional System found as much as 89% prevalence. That equates to 9 out of 10 of our inmate patients having some form of brain injury.
The long-term effects of TBI are memory problems, inability to focus, and poor impulse control. Inmates with this condition may respond in anger, aggression or verbal disrespect to cover for their deficits. This means that our patients with TBI often show these behaviors:
- Act out in anger or irritation
- Forget rules of prohibited conduct
- Not remembering where they should be or by when
- Forgetting that they cannot go into certain areas
- Increased behavioral infractions
TBI treatment focuses on symptom management and compensation for cognitive deficits. A careful intake history is an important first step to diagnosing TBI and managing symptoms. The CDC recommends that special attention be given to impulsive behaviors, violence potential, sexual behavior and suicide risk if the inmate is depressed.
Barbara suggests nurse interventions that focus on assisting patient to remember and follow direction.
- Speak slowly and clearly
- Give the patient time to register the information and respond
- Provide memory tools like writing down health instructions
- Give only a few directions at a time and keep it simple
She also emphasizes the importance of awareness of the condition for both custody and health care staff.