Stress experience and coping mechanisms of female inmates in BJMP: implications to correctional nursing

Studies on female PDLs in the Philippines highlight significant psychological challenges and adaptive behaviors. van den Bergh et al.3 found that stress from family separation, poor living conditions, and future uncertainty often led to anxiety and depression. Harner and Riley⁴ emphasize the need for robust prison support systems, including psychological services and counseling, to help manage stress effectively. These studies suggest that addressing female PDLs’ psychological well-being requires a multifaceted approach combining individual and systemic interventions.

The study explores coping mechanisms among PDLs and their impact on overall well-being. Coping strategies encompass various psychophysical, psychological, personal, and metaphysical aspects, crucial for maintaining life quality. Equitable healthcare provision in prisons is vital, aligning with community standards. Coping mechanisms, consciously applied, aim to manage stress, differing from defense mechanisms, which are subconscious. Healthy coping fosters resilience against stressors, facilitating long-term adaptation.

Health education programs play a key role in stress management, emphasizing the nurse’s responsibility to integrate coping interventions. Female PDLs utilize adaptive coping strategies like seeking social support and engaging in religious or educational activities, mitigating isolation and depressive symptoms. Conversely, maladaptive coping methods such as substance abuse exacerbate difficulties, underlining the necessity for structured programs promoting adaptive coping to enhance mental health and reintegration prospects.

Correctional nursing is a relatively new specialization, emerging in the late 1960s and early 1970s. It focuses on providing care to incarcerated individuals and emphasizes qualities like competence, compassion, and using proven medical practices as highlighted by Goddard et al.⁵, Peternelj-Taylor,⁶ and Shelton et al.⁷ Correctional nurses handle the typical duties of nurses in other settings, including routine checkups, emergency care, and treatment of chronic conditions and injuries. However, they take on the additional challenge of addressing the specific needs of inmates, such as substance abuse and mental health problems.

The correctional nursing, also called forensic nursing, provides healthcare to PDLs in prisons, jails and detention centers. These nurses play a vital role in maintaining the physical and mental health of inmates, many of whom have complex medical needs and lacked consistent medical care before incarceration as mentioned by Dhaliwal et al.⁸ According to the Association for the Prevention of Torture⁹ prisons need to have easily accessible medical care that’s similar in quality to what’s available outside. This is because inmates are a vulnerable group with high risks of mental and physical health problems. Nurses working in prisons should have specialized training to address these issues and promote overall well-being, potentially including programs that improve life expectancy and outlook.

RAM posits that PDLs experience stress from various sources, prompting adaptive responses to maintain well-being. These responses include problem-focused, emotion-focused, and relationship-focused coping strategies. Stress, viewed positively, can motivate growth and adaptation within the challenging prison environment. Additionally, Roy’s model identifies adaptive modes encompassing physiological, psychological, and social aspects of adaptation. Nurses play a crucial role in promoting positive adaptation and reducing stress among PDLs through therapeutic interventions. Lazarus and Folkman’s Transactional Model of Stress and Coping further explains how individuals perceive, respond to, and cope with stressors. It highlights the importance of cognitive appraisal in shaping coping strategies, offering insights into PDLs experiences in the prison environment. This framework aids in understanding the complex interactions between PDLs and their surroundings, guiding interventions to enhance their well-being.

The study aimed to explore the stress experience and coping mechanisms among female PDLs in a BJMP facility in Nueva Vizcaya, Philippines. Specifically, it aimed and explore the following:

• Describe the experiences that caused the stress among female PDLs at BJMP.

• Describe the most common coping mechanisms of the female PDLs.

• Craft pro-active recommendation based on salient findings in relation to correctional nursing.

The researchers used a qualitative approach to understand PDLs’ stress and coping mechanisms. Sirisilla¹⁰ noted that a descriptive design provides an accurate depiction of a population’s attributes and behaviors. By closely observing and collecting data, this method offers deep insights and guides future research. Thus, a descriptive qualitative research design is essential for comprehensively understanding PDLs’ stress experiences and coping strategies in correctional facilities without altering the variables.

The study was conducted at a BJMP facility in Nueva Vizcaya, Philippines, selected for its role in supervising jails and detention facilities. This setting enabled the researchers to explore the high stress levels and unique challenges faced by female PDLs, including confinement, restricted autonomy, and social isolation. The study ensured the safety of PDLs and adhered to ethical standards, with cooperation from BJMP. BJMP provides health services, educational initiatives, income-generating activities, religious programs, and recreational activities for PDLs. The insights from this study can help improve existing programs, guide policymaking, contribute to academic literature, and enhance nursing practices, ultimately benefiting the PDL community.

This study focused on the most vulnerable female PDLs at a BJMP facility in Nueva Vizcaya, Philippines with 10 key informants, though the number could vary due to hearings or new arrivals. Researchers used a respectful approach to gain participation, clearly explaining their role and the study’s aims, benefits, and confidentiality. They emphasized voluntary participation and addressed any concerns. Consent forms were provided and explained thoroughly. The study continued until data saturation was reached. Informants were selected based on safety considerations and their ability to answer the guide questions, as suggested by the jail warden.

The researchers employed a purposive sampling technique to select informants. According to Campbell et al.¹¹ purposive sampling is a non-probability sampling approach in which participants are intentionally selected based on their ability to provide relevant and informationrich insights related to the phenomenon under investigation. The first interview question focused on identifying the experiences that caused stress among female PDLs at the BJMP, while the second question explored their most common coping mechanisms.

The researchers conducted a study at a BJMP facility in Nueva Vizcaya, Philippines. They prepared communication letters that were approved by the officers and developed two guided interview questions. On 20 December 2023, they presented their title proposal, including Chapters 1 and 2, which was reviewed by the University Research Ethics Board (UREB). A letter to conduct the study was sent to the Dean of the School of Health and Natural Sciences (SHaNs). On 23 April 2024, the researchers held an orientation session to build rapport with the PDLs. They introduced themselves, explained the study’s purpose, benefits, and risks, assured confidentiality, and answered questions. Consent forms were given out, and 13 PDLs agreed to participate. The researchers then informed the PDLs’ lawyers, who needed to sign a consent or waiver before the interviews could proceed. The researchers also awaited regional approval to use an audio recorder.

The interviews were conducted in a private, secure room within the facility, with each session lasting approximately 30–45 min. The interviews were semistructured, allowing participants to elaborate on their experiences. Example questions included: “Can you describe a situation that caused you significant stress while in detention?” and “What strategies do you use to cope with stress in this environment?” The researchers took detailed notes and, with consent, audio-recorded the sessions for accuracy.

During the interviews, each participant was escorted individually to a secure room by a jail officer. Three researchers conducted the interviews to minimize intimidation. To ensure confidentiality and safety, the jail officer stayed at a 2-meter distance. The interviews were conducted in Tagalog as requested by the PDLs, and the researchers maintained a neutral and non-judgmental stance, allowing the PDLs to speak freely. After the interviews, the researchers reassured the participants about the confidentiality of their information and expressed gratitude for their participation. There were two interview sessions in total.

The research advisor and BJMP officers played essential roles in the data collection process. The advisor provided guidance on methodology and ethics, while BJMP officers supported logistics, ensured security, and maintained confidentiality during the interviews. This cooperation ensured the research was conducted smoothly and ethically.

Thematic analysis was utilized in the research to uncover key themes. This method involves scrutinizing data to detect patterns, generate codes, and formulate themes. The researchers followed a structured 6-step process, which included familiarization, code generation, theme generation, theme review, theme definition and naming, and report creation. They meticulously executed these steps to generate a comprehensive report that greatly influenced the research findings.

The major cause has to do with interpersonal issues among PDLs with 60% (6/10) of the informants saying that this was the major cause of their stress. In the code of fights and attitude, where this resulted in another source of stress for the PDLs which stems from their family affiliations, in 50% (5/10) of the informants. Additionally, 30% (3/10) of the informants identified their case status as a source of stress. Lastly, 20% (2/10) of the informants cited the prison environment as a source of their stress.

There are four sub themes regarding the cause of stress of the informants, namely, interpersonal issues, family affiliation, case status and prison environment arranged in a descending manner with regards to the experiences of the informants inside. For interpersonal, these are fights and the attitudes of fellow PDLs. Under the subtheme of relationship, only family is being established. On the other hand, under the subtheme of case status, namely, postpone hearings and others. And lastly, the subtheme of environment; namely, the noise and new environment. The distribution of stressors is shown in Table 1.

The coping mechanisms employed by female PDLs can be categorized into three primary themes, listed in descending order: emotion-focused coping reported by 60% (6/10), social coping, and religious coping. Within the emotion-focused category, four distinct strategies were identified: rest and relaxation result of 40% (4/10), isolation result of 40% (4/10), physical activities reported by 70% (7/10) informants and arts and crafts found as it is 80% (8/10) informants. In the realm of social coping, two specific strategies emerged: peer support resulted 70% (7/10) of PDLs and family support resulted to 30% (3/10).

Moreover, the common stress management within prisons revolves around three key coping mechanisms: religious coping result of 60% (6/10) of informants, emotion-focused coping reported by 60% (6/10) of informants, and social coping result of 20% (2/10) of informants. Religious coping specifically emphasizes one religious involvement. Emotion-focused coping includes four - diversion, physical activities, rest/relaxation, and isolation. Social coping primarily one it is family support.

One participant shared, “When I feel stressed, I pray. It helps me feel calm and gives me hope that things will get better.” Another participant mentioned, “I like to draw and paint. It helps me forget about my problems for a while.” These quotes illustrate the emotional and psychological relief that religious and creative activities provide.

Based on salient findings, the following proactive recommendations are synthesized:

• Prisons can improve the lives of PDL women by offering programs that address unique stressors. These programs include trauma-informed care for staff, increased family connection opportunities, and conflict resolution skills training for inmates. This can improve well-being during incarceration and increase success upon release.

• Prisons can significantly improve female inmates’ well-being through various programs. Creative activities (art, crafts): Help with emotional regulation, stress reduction, and self-expression. Physical activities (Zumba, volleyball): Improve both physical and mental health by reducing anxiety and depression. Social support (peer groups, visits): Reduce stress and boost mental resilience. Religious programs: Provide spiritual support and a sense of purpose. Rest and relaxation programs (meditation, reading): Help manage emotions and reduce stress. Stronger family connections (visits, therapy): Provide emotional backing and hope, aiding rehabilitation. These programs create a supportive environment that benefits both mental and physical health, ultimately helping female inmates reintegrate into society successfully.

• Trauma-informed care can be implemented through staff training programs that focus on recognizing and responding to trauma symptoms. Family connections can be enhanced through scheduled video calls or family therapy sessions, which can be facilitated by correctional nurses in collaboration with social workers.