Kelly Ranson, a nursing graduate student at California State University, Dominguez Hills (CSUDH), has taken her award-winning class assignment to develop a health improvement process for a chosen population of study and successfully implemented it in the unique place where she works, Kern Valley State Prison.
As chief nurse executive for the level-4 high-security facility for the past five years, Ranson immediately knew she wanted to focus on the inmate population when CSUDH Assistant Professor of Nursing Lauren Outland assigned the project in her Health Promotion and Disease Prevention course. The resulting project was “Improving Glycemic Control Among Incarcerated Men” (IGCAIM), which Ranson designed to help inmates control their diabetes, a national epidemic the complications of which she has seen firsthand behind prison walls.
“The inmate population is experiencing the same health problems as the rest of the country. I was thinking there had to be something we could do to improve the health of diabetic inmates, and I knew that we could also reduce the cost of their care if we could figure out a program for them,” said Ranson, who noted that uncontrolled diabetes can cause people to need dialysis, have amputations, go blind, and have heart disease.
“While I was taking Dr. [Lauren] Outland’s class, a new statewide policy in correctional healthcare allowed inmates to carry diabetic testing supplies, and everything began to fall in place,” said Ranson. “I realized that if I could get approval for inmates at Kern Valley to self-test an intensive nursing education program might help them learn to manage their blood glucose levels better. I decided to make this my class assignment.”
Ranson, who will graduate from CSUDH this fall with a Master of Science in Nursing, nurse administrator option, received an “A” on her assignment in Outland’s class. The IGCAIM also took First Place at the 2014 CSUDH Student Research Day in the Health, Nutrition and Clinical Science.
While still enrolled in Outland’s course, Ranson began the process of getting approval to implement the program at Kern Valley State Prison.
Seeking Approval
Ranson began compiling research. She explored the federal government’s website “Healthy People 2020” to discover its health priorities for the next few years, and conducted research posted by the World Health Organization.
“There was a lot of data on the unique needs of diabetic Hispanic men and about mortality rates of African American men. Both are large populations in my prison,” she said. “I also found a lot of data about how to help people with diabetes in third-world countries who don’t have access to quality healthcare.”
With data to back it up and a draft program in place, Ranson presented it to Warden Martin Biter and prison CEO Michael Hutchinson.
“I said ‘This would greatly benefit the health of our diabetic patients, and if we can teach them how to manage their diabetes better it will also be a significant cost savings for the people of the state. It’s the right thing for the patients.’ They both agreed,” said Ranson.
One of her concerns was that inmates from the general prison population would try to take advantage of those who were in the IGCAIM program.
“We have to be careful to not put them in harm’s way,” she said.
To help prevent this, Ranson met with the Inmate Advisory Committee (IAC), which is made up of inmates who have the respect of other inmates, and can influence their decisions and how they treat each other.
“I went to the Inmate Advisory Committee and talked to those influential inmates. I explained to them what we wanted to do. They said ‘This is a great program. We will support these guys,’” said Ranson. “We still have to be careful about not treating our patients differently because the other inmates will try to manipulate them, but the support of the IAC has helped them stay with our program.”
Getting with the Program
At Kern Valley State Prison not only does the IGCAIM program enable incarcerated patients to carry glucometers to monitor their own blood glucose levels, but each participant is given intensive education and must meet frequently with nursing and other health staff.
Also critical to the IGCAIM’s success is consultation with mental health staff, dieticians, medical staff and peer support services.
“In the program, inmates are taught extensively about their diabetes and low-impact ways to manage their blood sugar, such as exercising more, drinking more water and managing what they eat,” said Ranson. “Nobody in prison gets a special diet, they all eat the same thing. So we teach them creative ways of managing what they should and shouldn’t eat.”
Entering the IGCAIM program is voluntary, and so is remaining in it.
“Inmates who are not willing to comply with the program’s guidelines, or converse and work with us; those who behave improperly, mess with their needles or glucometers, and/or sell their supplies are dropped from the program,” she explained. “But if they do behave we work with them extensively and help them learn how to treat their disease and avoid amputations, blindness, and early death.”
Up and Running
It has been over a year since the GCAID was implemented at Kern Valley State Prison, and Ranson’s program has proven very successful. She was recently accepted to present her process at the World Congress on Public Health in Kalkota, India, which will take place in February 2015.
Many inmates participating in the program have reduced their A1Cs, which is a test that reflects patients’ average blood sugar level over several months.
“If someone has an A1C less than nine there is a great likelihood that he or she will never develop those awful consequences associated with diabetes. Inmates who have A1Cs of nine or greater are encouraged to join our program,” explained Ranson. “Overall, we have had a lot of success. In fact, some people are no longer taking insulin. They now control their blood sugar just through our recommended dietary choices and exercise.”
Ranson has also become a prison representative member of CSUDH’s Institutional Review Board (IRB), which is a committee comprised of faculty, staff and community members who review research studies that involve the use of human subjects. The purpose of the IRB is to protect the rights of human research subjects by ensuring compliance with university and governmental regulations.
Developing processes like the IGCAID is very rewarding for Ranson.
“I love developing processes that reflect really good nursing, strong ethics, and recognition of the limits of our license; programs that are better for the patients and also save the state money,” she said. “This is by far my favorite aspect of my job.”
