Identifying Clinical Problems Diabetes Non-Compliance among Incarcerated Patients

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IdentifyingClinical Problems: Diabetes Non-Compliance among IncarceratedPatients

IdentifyingClinical Problems: Diabetes Non-Compliance among IncarceratedPatients

Beingimprisoned in the United States constitutionally guarantees primaryhealthcare to an individual. Many prisoners have been known toreceive their initial adult healthcare access in prisons.Approximately, 80 percent of prisoners receive health care inincarceration, with 30-50 percent being diagnosed with a new chroniccondition. Besides, the swelling population of older prisoners hasraised the prevalence of chronic diseases, with diabetes being one ofthe leading ailments (Wang, 2014). Caring for people with diabetesand other long-term medical conditions in prison should not be anydifferent with the care provided to other sectors of the community.However, inevitable complexities in the provision of care to theprison population have been a major source of concern (Leivesley &ampBooth, 2012). Type 2 diabetes is adding on to the affected populationas problems of obesity and inactivity continue to become prevalent inthe prison environment (Wang, 2014).

Themanagement of diabetes in prisons poses situation-specific challengesthat are common in normal community settings. However, adopting thesenational guidelines to the needs of the correctional facilities hasnot been easy (Spark, 2012). At any particular moment, there are morethan 2 million inmates in prisons in the United States. Statisticsshow that approximately 80, 000 (4.8 %) of these have diabetes,though its prevalence, alongside related complications andcomorbidities, is expected to rise with increasing number of agingprisoners and the escalating occurrence of diabetes in the younggeneration (Edwards, 2015). The heavy disease burden does not makethe situation any easier for the prisons. This is initially becausetheir overall mission is the protection of public safety andreduction of recidivism, and not the improvement of individual orcommunity health. As a result of this, some of the prisons lackadequate clinic space to cater for healthcare requirements (Wang,2014).

Discussthe evidence-based solution chosen for the identified problem

Personswith diabetic conditions in correctional facilities must receive carethat is in line with national standards. With this in mind, solutionsmust be availed for the problem of non-compliance among incarceratedpatients. The first solution is based on budget constraints. Despitethe fact that medical care is not the primary goal of thecorrectional facilities, it is necessary to provide adequate fundingis to ensure that there is sufficient medication, staffing, andnutrition. Nursing recruitment and retention rates are improved whenqualified and competent professionals are engaged, a factor thatinhibits high turnover rates, while enhancing the quality of care.However, owing to the strained work environment in prisons, this isnot always an easy feat, thereby requiring additional incentives interms of financial benefits and rewards (Curley, 2012).

Medicalnutrition therapy must be enhanced in managing the diabetes situationin prisons. Despite the bulk purchase and preparation of food at thefacilities, individual nutrition meal assessments, and plan designmust be carried out and supervised by registered dieticians. Thiswould ensure that individual inmate patients are personally counseledin regards to healthy eating (Curley, 2012). Efforts must be made tohandle medications with care and specificity, in spite of prisonguidelines that are geared towards maximizing security, efficiencyand maintaining order.

Theseconditions cause rigidity because patients receive care at designatedtimes, usually before the evening meals. The timing may beproblematic for many. Self-management education involves teachingpatients skills to make lifestyle changes and effectively managetheir conditions in a bid to delay or totally avoid diabetic relatedcomplications.

Inadequateexercise has been cited as one of the factors leading to inactivityand obesity among prisoners, ultimately causing type 2 diabetes.Prison management is of the opinion that overweight, inactiveprisoners are less of a security threat. In order to correct thisanomaly, it is crucial to lay down policies and procedures that equipstaff with sufficient skills and knowledge to direct and managepeople with diabetes (Buskey, 2014). Knowledgeable correctionalofficers will be better placed to make regulations that are sensitiveto the needs of people with diabetes.

Explainthe process used by the organization to change

Theprocess of changing the situation involves a number of stepsincluding assessment of the current problem, identifying the specificchallenges and quantifying them. The constraints include theprevalence of diabetes in the various prisons, the number of trainedpersonnel handling these cases, the adequacy of finances, medication,and information availability. These should then be compared with theideal situation, where specific existing gaps in care are identified.For instance, the number of qualified health staff handling diabeticpatients in the prisons should be compared to the required number ofstaff. If they fail to tally, it means that there exists a deficitand therefore a gap. Identifying gaps presents the opportunity fordiscussing the likely causes of the problem, which must then befollowed by identifying viable solutions to the problems at hand.

Solutionsmust be specific to the problems identified. In addition, there mustbe more than one viable solutions after which a deliberation processcomes up with the most practical and effective solution in regards tofinancial, political, medical, and social factors. At this point, thegroup/ committee must then plan the implementation process of thesolution. The process and resources required to smoothly implementthe plan must be articulately designed at this point, consideringfinancial, human, legal, and medical resources. Being a federalinstitution, all policies and amendments must be in line with federallaw and therefore these must be put into consideration beforeimplementation can take place.

Implementationof the policies is the final step that involves setting the plan inmotion. At this point, the recommendations are put into practiceaccording to the committee’s plan of execution. Based on the goalsset up at the onset, the progress of the plan must be measuredregularly, with notes being taken to check whether the plan is onschedule and whether the outcomes are having a negative or positiveoutcome (Edwards, 2015).

Discusswhat you would do differently now

Ithas been noted that diabetics are at their optimum when medicationand meals are administered appropriately. When this is done,complications associated with diabetes are reduced, or eliminated.With this in mind, I would advocate for education targeting inmates,healthcare officials and correctional officers. The education wouldinclude the basics of diabetes, the signs, and symptoms, riskfactors, hypo and hyperglycemia, monitoring of glucose, issuing ofmedication, exercise and nutrition. Education is the ultimate courseof action for the maintenance of diabetic situations in correctionalcenters and communities (Mills, 2014).

Explainthe risk to the organization by not making the change

Incase the problem of diabetes non-compliance among incarceratedpatients is not addressed, there are bound to be detrimental outcomeson the well-being of the patient and the country’s healthcareexpenditures. As stated earlier, the United States experiences closeto two million new cases of diabetes annually, with a significantfraction of these being in the correctional facilities. According tothe American Diabetes Association, $176 billion was spent on diabeticrelated medical costs in 2012 alone (Barnes, 2013). This kind ofexpenditure, in addition to the toll taken by the disease onpatients, is likely to affect the community adversely. Incorrectional facilities, more prevalence of the problem would lead tounhealthy conditions that would further result in more cases ofdiabetes. If not checked by implementing the changes prescribedabove, there will be additional medical care costs. In addition tothis, complications from the disease may lead to high mortalityrates.


BarnesV. (2013). Diabetes education: state and pharmacy partnership goesbeyond medication treatment. CorrectionsToday.Retrieved from

Buskey(2014). The Effect of Blood glucose self-monitoring among Inmateswith Diabetes. Journalof Correctional Healthcare.60 (7) 390- 397

Curley,A. (2012). Population-based nursing: concepts and competencies foradvanced practice. New York N.Y: Springer Publishing Company

Edwards,L.L. (2015). Managing diabetes in correctional facilities. DiabetesSpectrum. 18(3) 146-151

Leivesley,K. &amp Booth, D. (2012). Nurse-led diabetes clinic in a prisonsetting. Journalof Diabetes Nursing.13 (10) 390- 396

Mills,L (2014). A Prison-based nurse-led specialist diabetes service fordetained individuals. WileyOnline Library.11(2) 53-57

Spark,A. (2013). Nutritionin public health: principles, policies, and practice.CRC Press

Wang,E.A. (2014). A tool for tracking and assessing chronic illness carein prison (ACIC-P). JCorrect Health Care.20 (4) 313-333

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