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The number of sentenced federal and state prisoners 65 years or older is growing rapidly. Older inmates often suffer from advanced chronic conditions. Although compassionate release is a possibility, in practice, only a small fraction of prisoners are paroled before their death. The result is that more people are spending their final days incarcerated. The purpose of this study was to examine the values, beliefs, and perceptions held by current and potential future consumers of end-of-life care in prisons to highlight the facilitators and barriers to providing compassionate care for those dying in prison. Response from prisoners in 4 distinct state prisons led to 6 themes: seeking human interaction, accessing material resources, obtaining compassionate care, seeking equitable care, addressing physiological needs, and facing death. Hospice and palliative care nurses have a unique opportunity to share their expertise and knowledge with correctional health care professionals for continued growth and development of prison end-of-life programming. Such collaborations not only provide corrections staff with the tools needed to handle unsettling situations, enrich their work, and aid them in coping with work-related and non-work-related deaths but also will help to ensure that humanity and compassion for the dying do not end at prison gates. [ABSTRACT FROM AUTHOR]

Theoretical Framework: Our approach is based on the theoretical framework for Fostering a Community of Learning. Background: United States prisons are facing sharply increased demands in caring for aged and dying inmates. In response to that need, our prior research used participatory action research methods to adapt best practices in end-of-life (EOL) care to fit the requirements of the restrictive environment of state prisons. Strategies were packaged as the Toolkit for Enhancing End-of-Life Care in Prisons, a print-based product introduced through face-to-face training sessions. In addition, interdisciplinary teams of prison front-line staff were prepared as champions to promote and sustain organizational change in the EOL care delivered in a state Department of Corrections. While the devised Toolkit and train-the-trainer approach effectively addressed EOL careVthe content on geriatrics was limited and the product was not formatted for broad dissemination. Purpose: To demonstrate the scientific merit and feasibility of the development of cutting edge, media rich learning modules focused on geriatric and EOL care for use within the constraints of correctional settings. Methods: We have conducted an environmental scan to ensure a proper fit between the envisioned product and available technology. Through a modified Delphi technique, we are isolating essential geriatric content to be identified for specification in the development of the comprehensive training program. Finally, we will create and evaluate prototypes of media rich, interactive learning modules designed for computer-based learning in the context of corrections. Results: By study end, we anticipate a specifications document for the design of modules in the expanded Toolkit for Enhancing Care of the Aged and Dying in Prisons will be produced; plans for delivery systems that fit with the technology available in corrections settings will be developed; and collaborative relationships with key market segments will be established in preparation for commercialization of the product. Conclusions/Implications: This phase in the development of our Toolkit will firmly establish the potential of our work for commercialization and broad dissemination. We anticipate that the revised Toolkit product and training approaches will ultimately lead to nationwide enhancement of the care of aged and dying prisoners. [ABSTRACT FROM AUTHOR]

The environment of care can have a profound impact on caregiving experiences of families caring for loved ones with a life-limiting illness. Care is often delivered through disease-specific specialty clinics that are shaped by the illness trajectory. In this study, the following 3 distinct cultures of care were identified: interdisciplinary, provider dominant, and cooperative network. Each of these cultures was found to express unique values and beliefs through 5 key characteristics: acknowledgment of the certainty of death, role of the formal caregiver, perception of the patient system, focus of the patient visit across the trajectory, and continuum of care across the trajectory.

The members of the independent and active baby boom generation entering their retirement years may put clinical nurse specialists (CNS) in greater demand than ever before as educators, consultants, researchers, and case managers. Community-based educational programming to promote health and to monitor and manage chronic health conditions of elders is a recognized method for the CNS to meet these growing demands. The application and utilization of Baltes and Baltes' theoretical model of Selective Optimization With Compensation (SOC) in senior health programming holds promise for CNSs to assume more integral roles in optimizing health promotion for and self-actualization in community-living elders. Senior centers serve older adults who want to stay active, involved with others their age, and current, including learning how to promote their health. The CNS can readily infuse the SOC model into the planning and organizing of health programming for older adults at senior centers, which will in turn aid elders in maintaining independent functioning, autonomy, and quality of life. A detailed template for developing such theory-driven programming with an example program focused on nutrition is provided. Finally, a variety of topics for additional SOC-guided program development are presented.