Elsevier

Journal of Professional Nursing

Volume 21, Issue 4, July–August 2005, Pages 223-230
Journal of Professional Nursing

Special Feature: Health Disparities Research
Conducting Research as a Visiting Scientist in a Women's Prison

https://doi.org/10.1016/j.profnurs.2005.05.001Get rights and content

Incarcerated populations have disparities in health risks and illness conditions meriting study, but the history of prison research is marred by unethical conduct. Ethical participation strategies are discussed in the context of studies implemented by the author in a state prison system. This study used ethnographic approaches, observed adherence to federal and institutional review board regulations and corrections department directives, and maintained continuous communication with vested interests to provide entry and long-term access for studies on female prisoners and their civilian infants. A culture clash between the punitive restrictive environment that serves the custody–control–care mission of corrections systems and the open inquiry environment needed for conduct of health research exists. Federal regulations protect prisoners as human subjects but additional vigilance and communication by researchers are required. Gaining and maintaining access to prison inmates for nursing research are leadership challenges that can be met within the caring and collaborative paradigm of nursing.

Section snippets

Violence, Addiction, Infectious Disease, and Mental Illness

Incarcerated women as a group experience violence victimization, drug involvement and addiction, sexually transmitted diseases, and HIV infection at disproportionately greater rates than the general population. In a sample of 66 Philadelphia jail inmates, one half had a history of sexual abuse and three quarters had been physically beaten by a boyfriend or spouse (Bond & Semaan, 1996). In North Carolina, pregnant prisoners were compared with pregnant patients seen in the health department and

Troubled History of Prison Research

Minimal public attention was given to prison research during most of its first century in the United States. During this time, diseases were induced for study purposes (Leopold, 1958, Reich, 1995) and up to 85% of all drug toxicity clinical trials were conducted with prisoners (Hoffman, 2000, Kalmbach & Lyons, 2003). As the public became aware of similar research with vulnerable civilian populations, the government finally responded by forming the National Commission for the Protection of Human

Studies in a Prison Nursery

The studies that provide the context for this article have been conducted since 2000 in two correctional facilities for women in a northeastern state prison system. The focus is unique in that the subjects include female inmates convicted of felony crimes and their civilian infants who arrived in the prison because their mothers were pregnant when incarcerated. A statute in this state provides infants with protection against arbitrary separation from their mothers. Because this is one of the

Use of Mandated and Other Human Subject Protections

All 45 CFR 46 requirements were observed for these studies. In addition, the option to apply for a certificate of confidentiality that provides a researcher with the right to resist most legal requests for disclosure of subject information was exercised. Although the 45 CFR 46 protections have been described as “exhaustive” (Kalmbach & Lyons, 2003), a researcher must still confront additional concerns in day-to-day implementation of research. The broader ethical principles articulated in the

Strategies to Optimize Ethical and Continuing Participation of Prisoners in Research

The researcher, who has complied with all federal regulations and achieved IRB and OHRP approval for a study as well as a corrections department's permission to do research in its facilities and who also has acquired the necessary funding and resources, must still confront a series of potential obstacles to the implementation of the approved research. These obstacles are associated with the realities of multiple gateways guarded by state and local administrators with varying understanding of

Discussion

Following decades of prison research without scrutiny and a brief period of virtual halt, there seems to be renewed interest in prisons and jails as research settings and in incarcerated persons as subjects. Search of the CRISP retrieval system reveals four times as many National Institutes of Health-funded studies in this area during the last decade than in all the years since its inception in 1972. Nursing and health literature are beginning to reflect study outcomes. A review of MEDLINE,

Summary and Conclusions

There is an intrinsic culture clash between the punitive and restrictive environment that exists within the custody–control–care mission of correctional systems and the open inquiry environment needed for conduct of research by health care professionals. Federal regulations now protect prisoners as human subjects but additional gatekeeping and communication by researchers are required continuously. Assessment of obstacles and implementation of strategies are an ongoing and dynamic process that

Acknowledgments

This research has been funded in part by the Institute for Child and Family Policy (Columbia University), a New York State Department of Health Commissioner's Priority Award, and currently by the National Institutes of Health/National Institute for Nursing (RO1NR 007782-01, 2003-7; M. Byrne [PI], “Maternal and Child Outcomes of a Prison Nursery Program”).

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