Table 1.

Article Characteristics

Author & Date	Purpose & Design	Sample, Setting and Theoretical Framework	Measures/Study Concepts and Results	Limitations	Evidence Level, Quality
Almost et al., 2013	To explore the work environment of nurses working in provincial correctional facilities Mixed methods: cross-sectional survey and semi-structured interviews	N= 11 (8 correctional nurses (RNs/ RPNs) and 3 healthcare managers) completed interviews; N= 297 (270 correctional nurses and 27 healthcare managers) completed survey responses. Convenience sampling 5 correctional facilities in Ontario, Canada Aiken’s Magnet Status 56.1% survey response rate	Survey collected data on role overload, autonomy, control over practice, nurse-physician collaboration, adequacy in staffing, intragroup conflict, bullying at work, respect, burnout, job satisfaction, intent to leave, and role overload to evaluate the relationship of variables with workplace stress Key stressors included limited resources, challenging work relationships regarding conflicting values, inadequate staffing and demanding workloads Other stressors included limited control over practice and scope of practice as a result of security concerns Reasons for those who intended to leave their job in the next year included: demanding workload, low support, low pay, long hours, no full-time positions, no advancement opportunities, and dissatisfied or too stressful Majority of participants reported emotional abuse (from patients and others), and bullying in the past year Little educational advancement opportunities	Large sample size of nurses was reported as representative of correctional nurses in Ontario. However, the healthcare manager sample remained small in both qualitative and quantitative parts of the study Numerous instruments were used to evaluate concepts of interest in the survey and components were described. However, validity and reliability were not reported for every measurement The face-to-face interview process and questions were not described so the qualitative design quality and procedures cannot be assessed thoroughly The article did not discuss the researchers' steps to reduce bias in qualitative interviews or how they were trained for data collection	Level III B
Kalra et al., 2016	To assess satisfaction, attitudes, and beliefs in relation to ethics and burnout of health care employees in NYC jails. Mixed methods: cross-sectional survey and 5 follow up focus group sessions	N= 677 correctional healthcare employees completed the survey Non-probability purposive sampling 12 jail facilities in New York City, U.S. 49.5% survey response rate	Main sources of stress that lead to burnout among the sample included: strained relationship of provider and patient, stemming from dual loyalty conflicts, multiple security points, and smaller workspaces Most commonly reported ethical challenges were violations of patient confidentiality, a focus on quantity of care over quality, and poor treatment of patients by carceral staff Results revealed a strong association (p < .01) between the measures of job satisfaction and ethical compromises 499 participants reported ‘ever been physically assaulted’, which is significantly correlated to ‘feel your ethics as a healthcare provider regularly compromised by work environment’ (p = 0.001) 25% of respondents frequently or occasionally felt physically afraid or intimidated in the workplace (p < 0.000) 91% felt unable to maintain patient confidentiality	The study design was not clear, and the sample was not well defined IRB approval was not mentioned The specific survey questions were included in a table without explanation or rationale for use. The source and quality of the survey cannot be assessed with the provided information Reliability and validity of measurement tools were not provided Despite major limitations statistical analysis was well described, and a table was included which comprised specific survey question variables, their corresponding correlation coefficients and p-values, adding understanding of results	Level III C
Flanagan & Flanagan, 2002	To measure the job stress and job satisfaction of correctional nurses and determine the correlates of job satisfaction and job stress. Nonexperimental correlational/cross-sectional: mailed survey delivered by nurse managers	N= 287 registered prison nurses Convenience sampling 56 correctional facility units in state prison systems in the southwestern U.S. Stamps and Piedmonte Job Satisfaction 58% survey response rate	Measures of Index of Work Satisfaction (IWS) and Nurse Stress Index (NSI) were used to evaluate the relationship between work stress and job satisfaction Sources of stress included time pressures, little organizational support and involvement Stress, age, and years of experience produced a multiple correlation coefficient of .60 [F (3, 188) = 35.18; p < .001] explaining 35.3% of the variance in job satisfaction	The research aims were clearly identified The instruments were explained with supported reliability (IWS: Cronbach’s alpha .92; NSI: Cronbach’s alpha .92) The IWS had reported content validity. However, validity within this context was not addressed for the NSI measure Nurse managers distributed surveys and may have influenced the response rate and responses to the questions	Level III B
Flanagan, 2006	To replicate a previous survey of job satisfaction and stress applying the anticipated turnover model. Nonexperimental correlational/cross-sectional: mailed survey to the home address	N= 454 unionized prison nurses Convenience sampling State prison systems in the northeastern USA. Anticipated turnover model 46% survey response rate	The relationship between work satisfaction and stress were evaluated with the Nurse Stress Index (NSI) and Index of Work Satisfaction (IWS) Correctional nurses rated workload and organizational support as the highest source of stress The variables of sex, supervisory status, race, unit specialty, and years in correctional nursing, explained 7% of the variance in stress and produced a multiple correlation coefficient of .28 [F (6,447) = 6.25; p < .000] Nurse stress index scores were higher for males, supervisors, White nurses, nurses working in units with specialties or inpatient beds, and more experienced correctional nurses	A theoretical basis for the study was described Surveys were mailed directly to employee’s homes to decrease the influence on responses and maintain participant confidentiality The included tools were explained and had supported reliability (IWS: Cronbach’s alpha .92; NSI: Cronbach’s alpha .90) The validity of tools within this context was not described for the Nurse Stress Index (NSI) Only one author completed this study increasing the risk for bias	Level III B
Ghaziri et al., 2019	To describe and compare sex and gender role differences in occupational exposures and work outcomes among correctional registered nurses Non-experimental correlational/cross-sectional: web-based survey	N= 95 registered nurses Non-probability purposive sampling Northeastern U.S. correctional healthcare system (which employs nurses working in 16 Department of Corrections (DOC) facilities and 31 DOC-contracted halfway houses (HWH) The Organization of Work conceptual framework 71% survey response rate	Survey contained 71 items to measure concepts of well-being, safety, health, job exposure, justice, stress, conflict, burnout, intent to leave, and job satisfaction The high work stress level among the correctional nurses was indicated by low decision-making authority, low supervisor support, high physical demands, and high psychological demands Male nurses reported a higher risk for exposure to blood-borne pathogens and body fluids (p < 0.05) Male nurses reported a higher sharps-related injury risk (p = 0.06) More than 95% of participants reported having been victims of workplace violence perpetrated by an inmate	High response rate achieved by using a multi-tiered approach where participants received a pre-survey, followed by an invitation, a follow-up email, and a final email reminder Manuscript provided an organized and well-structured summary of the study Sample of male nurses was reported as adequate, supporting the study goal to assess sex and gender role differences Cross-sectional design limited the ability to support causality Although there was a rigorous design for the survey, there remains the risk for bias due to the nature of the self-reported survey Reliability was reported for the instruments (Bullying Negative Act Questionnaire-Revised α alpha = 0.90; burnout α = .731; CPH-NEW adapted Job Content Questionnaire: justice α = 0.648; civility norms α = 0.597; masculine culture α = 0.93; BSRI-SF: Femininity scale α = 0.89, Masculinity scale α = 0.82)	Level III A
Lazzari et al., 2020	To investigate the moral distress of nurses who work in Italian correctional settings and validate the Moral Distress Scale for Correctional Nurses (MDS-CN) Non-experimental cross-sectional: survey emailed via Survey Monkey	N= 238 correctional nurses, including those with a bachelor’s degree, nursing diploma, educated provided by a hospitable, or those with post-bachelor education Convenience sampling of nurses working in multiple Italian correctional facilities, affiliated with the Society of Medicine and Penitentiary Health 51.6 % response rate	The MDS-CN included 20 items, measured with a Likert-type scale from 0 (minimal distress) to 5 (maximum distress) Nurses working in correctional facilities indicated overall moderate moral distress (median score= 46.5) Distress was affected by years of work experience in a correctional facility 108 participants (45.38 % of the sample) reported an intent to leave correctional nursing The MDS-CN was supported as a valid and reliable tool	The MDS-CN had reported content validity (Content Validity Index-Scale (CVI)= 0.99), internal consistency reliability (α = 0.91) and test–retest reliability (Spearman’s Rho = 0.99; p < 0.001) The sample was reported as adequate for factor analysis (Barlett’s sphericity (p = 0.001) and KMO = 0.74) Authors acknowledged their study limitations as not knowing the characteristics of those who did not participate in the research	Level III A
Stephenson & Bell, 2019	To discover the positive job attributes and challenges of working in a prison environment Qualitative: emailed survey requiring written responses to open-ended questions	N= 269 prison healthcare workers, such as physicians, physician assistants, nurses, nurse practitioners, dentists, as well as alcohol and drug counselors. Conveniently sampled from one state Department of Corrections in the Mid-Atlantic region of the U.S. 26% response rate	Open-ended questions were: What is your favorite part of your job? If you were given the opportunity to change one thing about your job, what would it be? Is there anything else that you would like to share about your role as a health professional in the DOC delivery system? Themes for positive job attributes emerged as meaningful work, stability, variety, and feelings of support Themes for challenges emerged as: ineffective leadership, job constraints, perceived inequity, and culture	Coding procedures were clearly explained Sample size was large for a qualitative study Triangulation and maintaining an audit trail were reported, adding to author credibility and trustworthiness No theoretical basis reported to inform the survey questions	Level III B
Walsh, 2009	To examine the emotional labor of nurses working in prisons Qualitative: reflexive methodology with semi-structured interviews, clinical supervision, and documentary evidence	N= 9 registered nurses working in prisons completed the interviews; 2 nurses met monthly with the researcher as a clinical supervisor over a 6-month period Sampling method not included 3 adult prisons in England and Wales	4 key questions guided the interviews: How do you see your role as a prison nurse? What is it like to be a nurse in this environment? Is nursing in prison much different to that outside? Can you describe to me, without naming names, an example of caring for a prisoner who you found difficult, and another who you found rewarding? A challenge of working in prison environments is the experience of emotional labor as a result of care vs. custody conflict Emotional labor included managing their emotions appropriately to meet the expectations of their discipline Care towards patients was negatively impacted by a lack of time and constraints on practice related to security Clinical supervision could improve nurse confidence	Sample included registered nurses only in prisons Although reflective journaling was mentioned to decrease author bias, only one researcher completed the analysis A theoretical basis was not reported to inform the interview questions Saturation was not addressed	Level III B
Weiskopf, 2005	To examine the experiences of nurses delivering care to incarcerated persons in a correctional setting Qualitative: phenomenology with a face-to-face interview	N= 9 full-time registered nurses Purposive sampling through computer list serv Jails or prisons in the Northeastern U.S. and Canada Husserl’s (1931) phenomenology	5 themes were discussed: negotiating the boundaries between custody and caring, struggling to create a caring environment, striving to turn a life around, a risky situation, and staying vigilant Working in the correctional environment was reported as complex and conflicting	Saturation of participants was not mentioned A guiding framework to develop interview questions was not described Authors modeled their approach based on credibility, fittingness, and auditability from Guba & Lincoln (1981)	Level III B
White et al., 2014	To examine the impact of the prison context on the health professionals working within it Qualitative: field observation and semi-structured interviews that happened at or away from work (depending on participant preference)	N=13 healthcare employees: 6 medical doctors and 7 registered nurses 2 women’s prisons in New South Wales, Australia	In the interviews, participants were asked to reflect on when they learned about ethical practice and what principles arose in their work. Then they were asked to reflect on situations of ethical significance in their work where one was resolved, and one was not Healthcare staff were challenged by the ethical and professional obligations they have to their patients Interviews provided a nuanced view of the dual loyalty complex of correctional work. Themes were found as physical context, security, discipline and order, access, equivalence of care: inside and outside, and divided loyalties	Thematic saturation was noted Interview questions were not reported to be informed by a specific theory Lack of tables and explicit mention of themes hindered clarity of results	Level III B
Husted & Dalton, 2021	To explore frontline healthcare worker's experience in and perceptions of providing care within a low-to-medium security hospital Qualitative: semi-structured one-to-one interview	N= 8 participants (6 healthcare assistants and 2 registered mental health nurses) Purposive sampling from gatekeeper access to the hospital floor, distribution of recruitment flyers, and emails A medium secure hospital in the United Kingdom	Participants explored the question of what motivated them to do their job Three themes emerged as: living with threat, need for support, and unique environment The theme of living with threat involved two subthemes of ‘acceptability of threat’ and ‘daily threat’ The theme of need for support included two subthemes of ‘importance of talking’ and ‘organization vs. the individuals’ The theme of unique environment involved two subthemes of ‘environmental challenges’ and ‘making a difference’	Reflexivity was addressed and anonymity of participants was discussed, adding trustworthiness to the authors The thematic map facilitated understanding of themes The specific correctional setting was not described in detail Saturation was not specifically mentioned, although authors reported the sample size as appropriate Interview questions were not informed by a theory but were based on literature according to the authors	Level III A