A Relational Ethics Approach to Understanding and Addressing Pain in Correctional Settings: An Interpretive Description

Abstract

Background: The assessment and management of pain in forensic settings are complicated by contextual factors, including past experiences with pain, adverse childhood experiences, and mental illness and addiction. Nurses in correctional settings have few tools to rely upon to fully understand and respond to the pain that people who are incarcerated experience. Given the complexities of pain, nurses working in forensic environments require a nuanced and contextualized understanding of the pain experience to provide safe, effective, and ethical clinical interventions. Purpose: The first purpose of this research was to understand the pain experiences of incarcerated men. The second purpose was to demonstrate how to co position relational ethics with interpretive description (ID). Methods: The first research question guiding this study was: what is the experience of pain of men who are incarcerated? The second research question was: how can relational ethics be explicitly co positioned in ID research? To answer these question, relational ethics theory was co positioned alongside ID and guided the overall research design. Twelve male participants from a correctional facility in Alberta, Canada were interviewed. Transcripts of the interviews were analyzed to identify patterns and themes. Findings: The findings of this study provide an understanding of how men experience pain during periods of incarceration and reveal how pain is experienced in relationship to being dependent on the correctional health and justice staff, institutional processes, peer relationships, one’s own knowledge of one’s body and pain etiology, and a toxic hypermasculine culture. Conclusion: Nurses hold substantive power in the nurse-patient relationship which must be understood to ensure that effects of such power differentials are mitigated. Relational ethics provides a space to understand patients’ anger, frustration, repetitive requests for help, drug diversion, peer relationships, depression, helplessness, and sense of injustice as they exist as part of the pain experience amongst people who are incarcerated. Interventions to develop individual and site-specific pain management interventions are located within the nurses’ understanding of these contextual factors.