Psychological risk factors in pregnant inmates. A challenge for nursing.

PURPOSE: To explore pregnant prisoners' experiences with childhood violence and substance abuse, their parenting attitudes, and their psychological health. DESIGN: This study used a prospective design to describe incarcerated pregnant women's experiences with childhood violence, substance abuse, parenting attitudes, and psychological health and the relationships among these factors. METHODS: Sixty-three pregnant prisoners in their third trimester were interviewed. Owing to the low literacy of this population, all questions were read to participants to maximize comprehension and reliability. RESULTS: Over 60% of respondents reported experiencing family violence during childhood or adolescence. Almost one-half of the women reported using drugs and alcohol during the past year and in their current pregnancy. Substance-abusing respondents were twice as likely to have been victims of physical abuse. All of the women who had been sexually abused during childhood were substance abusers; women who did not use drugs had no such history. Many women in the study had parenting and child rearing attitudes indicative of risk for poor parenting and abuse. More than 70% of the women reported depressive symptoms above the level considered indicative of clinical depression. Women reported low levels of social support; further, 50% of the women had lost an important relationship within the last year and 80% were not in a relationship with a partner at the time of their interview. CLINICAL IMPLICATIONS: The essential components of caring for pregnant prisoners should include extensive screening for substance abuse as well as history of past and current violence. Pregnant prisoners, with their many risk factors, are a group that could benefit from programs that address substance abuse and violence to decrease mental distress.

The lives of incarcerated women: violence, substance abuse, and at risk for HIV.

High rates of human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs) are seen in women prisoners. These high rates may be related to the nature of their lives, which may include violence, substance abuse, promiscuity, prostitution, and exchange of sex for drugs--all of which increase their risk for acquiring HIV. The purpose of this study was to examine the HIV-related risk behaviors and protective practices of women prisoners in a rural southern state and factors related to these behaviors. The sample included 57 women incarcerated in a medium-to-maximum security prison. Key findings included high rates of substance abuse, extensive past and current violent experiences including sexual abuse, high percentage of multiple partners, and low use of condoms. Additionally, women in this sample did not perceive themselves to be at risk for HIV infection. Practical suggestions for reducing the HIV risks of incarcerated women are offered.

Endocrine causes of amenorrhea.

Amenorrhea is a symptom of a variety of disorders and dysfunctions. It is important for the primary care practitioner to have an understanding of what constitutes normal function and of when to begin a diagnostic assessment of women with amenorrhea. Definitions and the basic principles of menstrual function are reviewed. Causes of amenorrhea are presented, including disorders of the uterus, disorders of the ovary, disorders of the anterior pituitary, and disorders of the central nervous system. The hypothalamic-pituitary-ovarian-uterine axis is used as a framework for the differential diagnosis of amenorrhea. A detailed process for assessing patients with amenorrhea is offered. Components of a amenorrheic-specific history, including menstrual, sexual and contraceptive, life-style, family, and medical histories, are reviewed. A step-by-step laboratory assessment is presented. Management of amenorrhea and health promotion strategies are discussed. The role of primary practitioners caring for amenorrheic women is outlined.

Hard time: the stressful nature of incarceration for women.

This descriptive, correlational study explored the stressful life event of incarceration for women prisoners and examined its relationship to selected health outcomes. Interviews with 55 women during their first week of incarceration and after 6 months in prison provided the data for analysis. Specific stresses of incarceration identified by the women included separation from families, worry about their children, and loss of control of their own lives. Psychological stress at time of incarceration was found to be positively related to depression and weight gain after 6 months of incarceration. Strategies to decrease the stressful nature of incarceration and improve the health status of incarcerated women are recommended.

Pregnant inmates: risk factors and pregnancy outcomes.

OBJECTIVE: To document the risk factors and outcomes of pregnant women incarcerated in a maximum-security prison. DESIGN: Descriptive correlational study. SETTING: Women's correctional facility. PARTICIPANTS: Eighty-nine pregnant women incarcerated during the third trimester of pregnancy. MAIN OUTCOME MEASURES: Medical, obstetric, life-style, and psychologic risk factors during pregnancy; birth weight; weeks of gestation at delivery; and presence of congenital anomalies in the newborn. RESULTS: Numerous risk factors during pregnancy, including chemical dependency, poor nutritional status, poor obstetric histories, high levels of anxiety and depression, and inadequate prenatal care. CONCLUSIONS: There is a need for intensive prenatal education for incarcerated women and for chemical dependency treatment programs designed specifically for incarcerated pregnant women. Interventions that address psychologic distress also are needed.

Determining risk status in a primary care setting.

Nurses working in primary health care settings often care for large numbers of clients in brief periods of time. Both clients and nurses express frustration toward the care provided in these circumstances. Development of a screening tool to identify high-risk clients could assist nurses in targeting interventions to these individuals; in turn, this has the potential for increasing nurse and client satisfaction. A general procedure for identifying persons at risk in primary health care settings is described. The procedure is illustrated with a specific population of clients--incarcerated women. Factors found important in assessing risk were social characteristics such as education, situational factors such as sentence length, and indicators of psychological distress such as depression. These broad categories may serve as a basis for the development of screening tools for a variety of populations.

Factors present when battered women kill.

Twelve women, imprisoned for killing their abusive male partners, were interviewed to determine factors present in battering relationships that end in homicide. Threats to kill made by the abuser, daily alcohol use by the man, and the presence of a firearm in the home existed in the majority of these relationships. Psychological abuse (e.g., enforced isolation, humiliation, and degradation) was perceived as more devastating than physical abuse. Although an escalation in the severity and frequency of violence, the occurrence of sexual abuse, and women's suicidal threats were also present, subjects indicated that these factors were less important reasons for taking lethal action. Knowledge of these factors may guide nurses as they assess and intervene in dangerous, potentially lethal, abusive situations.

Gonorrhea: not a new problem but a serious one.

In order to prevent the variety of complications that can result from a gonococcal infection, accurate and prompt diagnosis is essential. Untreated gonorrhea can have devastating effects on men and women and their offspring. Identification of at-risk clients and management of the disease will also help prevent complications. Additionally, thorough management of uncomplicated gonorrhea, effective client education, and promotion of public education are essential in achieving the goals set by the Surgeon General.

Expecting in prison: preparing for birth under conditions of stress.

When a pregnant woman is separated from her customary support system and placed in a high-stress environment, she experiences concurrent developmental and situational crises. A unique example of this is the incarcerated pregnant woman. A prenatal program developed to decrease the stress of being pregnant in prison is presented. The needs and concerns of the women are described. Nursing strategies are presented, with emphasis on practical interventions. Problems in implementation and ways to alleviate those problems are discussed.