The system is bursting at the seams. With the extensive overcrowding in the correctional facility population and various changes that swarm correctional institutions, nursing agencies are finding difficulty in providing proper nursing care to deliver effective rehabilitation for inmates. In Florence Nightingale’s Notes on Nursing: What it is, What it is Not, she tells us that there are five essentials in securing the health of houses “without these, no house can be healthy. And it will be unhealthy just in proportion as they are deficient” (2005, pp. 15). Fundamentally, since people are retained in correctional facilities, the facilities must be classified as houses. Nightingale observed that unsanitary environments contribute significantly to ill health, and that environs can be reformed in order to improve healing. Essentially, in these correctional environments, the health of housing is practically non-existent. Nightingale’s cannon on the importance of maintaining health of housing needs to be addressed in the Canadian Correctional System, given that the condition of overcrowding negatively impacts the quality of air, light, and general cleanliness of the inmate’s living environment.
Overcrowding of prisons is a frequent problem throughout Canada. Correctional Service Canada (CSC) claims that most correctional facilities in Canada currently house more inmates than they were designed for. In 2014, British Columbia’s correctional centers were overcrowded, operating at 140% occupancy an average with individual centers ranging from 107% to 177% (Bellinger, 2015). This problem of overcrowding stems from the increasing number of people in custody, yet to be convicted or sentenced. In the correctional facilities, inmates are now forced into gymnasiums for housing, resulting in limited exercise, lack of cleanliness, poor air quality, and an increase in psychiatric disorders. This creates a unique need for autonomous nursing care to promote health and wellness so as to encourage social rehabilitation.
Air Quality
The most important concern in Canadian Correctional System is the negative impact of overcrowding on the air quality of the inmate’s living environment. The Institut National de Sante Publique du Quebec found that prisoners have a culture of smoking and with such a prevalence of smoking, the air within the correction facilities is unbreathable (Collier, 2013). Health Canada also confirms the upsurge in personal contact, the deficit of ventilation, as well as the shortened time to stay in the open air favours the spread of diseases, and these deleterious impacts leads to dehydration, and respiratory problems (bacterial meningitis, pneumococcal pneumonia etc.). In essence, a smoking ban in Canadian prison will lead to a much-improved air quality. The aim is “to keep the air he breathes as pure as the external air” (Nightingale, 2005, pp. 8). Public Health and Correctional Nurses must advocate the installing mechanical vents such as roof-mounted exhaust fans, interior ceiling-mounted fans and roof mushrooms. These simple roof ventilation systems will permit the evacuation of warm and moist air and also diminish the carbon dioxide buildup. Moreover, detainees must be given more time especially to exercise, outside in the open air daily to facilitate healing whether or not there is artificial ventilation. Nurses are now responsible to ensure asthmatics patients have access to their inhaler when levels of air contamination are higher than normal. In addition, primary care nurses should ensure that patients who fall into the susceptible and sensitive sub-groups (pregnant women, children, the elderly and those with cardiorespiratory conditions) are made aware of the possible health effects that may be experienced in the event of poor air quality.
Secondly, the concern that needs to be addressed in the Canadian Correctional System is the quality of light of the inmate’s living environment. According to the Canadian Centre for Occupational Health and Safety (2018) poor lighting causes depression, headache, falling, slipping, eyestrain, and neck strain. In fact, a place with insufficient lighting is “always an unhealthy house, always an ill-aired house, always a dirty house. Want of light stops growth and promotes scofula” (Nightingale, pp. 17). In light of the overcrowding and the inadequacies of out door time, people in correctional facilities lack vitamin D, and often acquire Seasonal Affective Disorder (SAD), thus increasing the risk of cancer, obesity, and sleep problems (Anderson da Silva Rego, et al, 2017) and creates a favourable environment for the spread of TB (Malenki, 2018). Nurses must call out policymakers, planners and regulators to rethink standards and to encourage the use of natural light so as to minimize the negative impacts of artificially prolonged lighting indoors. Nurses must advocate for proper lighting which is the cornerstone of indoor environmental quality as it encourages faster healing, learning and higher performance in people. To address these problems louvres and grilles must be installed which corresponds to the minimum requirement for access to daylight.
General Cleanliness
The final concern that needs to be addressed in the Canadian Correctional System is the negative impacts of overcrowding on the general cleanliness of the inmate’s living environment. Increased numbers can also compromise the capacity of management to maintain acceptable standards of cleanliness in the accommodation and ablution areas, causing serious negative effects on the physical and psychological health of detainees. “It was the utensils, chamber crockery that was rinse with dirty water and the beds that were never properly shaken, aired or changed” (Nightingale, 2005, pp. 18). Since Hep C is very common in overcrowded prisons and can be transferred through blood, places where blood spills, droplets and blood splatter must be cleansed thoroughly. Therefore, Hep C screening and treatment programs must be increased so as to help control the disease and transmission in inmates (Canadian Nurse, 2016). With the risk of inadequate cleaning practises in correctional facilities, Public Health nurses can put clear protocols in place. This means that a written cleaning plan should lay out expectations for both inmate labour and employee supervisors in a detailed and formal way: covering the cleaning tasks needed to be performed. Nurses must realize that a good cleaning plan should include ongoing training. Nurses must advocate that a minimum of one toilet is provided per cell and that they are culturally appropriate. There must also be sufficient water flow of water to showers and toilets throughout the day. In essence, hygiene promotion must be the nurses first issue to tackle; instructions should include the relationship between basic hygiene and disease transmission and living in a crowded environment.
Prisons do not provide the proper structural functionalism to rehabilitate inmates, since the overpopulation in these correctional facilities affect their quality of air, light and general cleanliness. To be able to provide reasonable care, nurses need the resources not only to provide equitable, socially just care to individuals in corrections, but to facilitate continuity of care in the community to help them successfully re-enter society. Housing is an important determinant of health, and substandard housing is a major public health issue. There must be collaboration with public health, advocacy, education and awareness, critical guidelines, codes and enforcements to reduce overcrowding and thus increasing the health of housing. Due to the security requirements and disciplinary atmosphere, it’s often difficult for nurses to develop the same therapeutic relationship as in other practice settings. Providing the best care for people in the correctional system can be fraught with difficulties (CNA, 2018). The overwhelming majority of prisoners will leave with little change from when they first went in. Disparities in housing causes disparities in health.