Table 2.

Essential elements of prison hospice: The inmate hospice volunteer model

Inmate Hospice Volunteer Model
Concepts in Context	Definition and Dimensions	Exemplary Quote
Peer-to-peer care	Use of inmate volunteers to provide direct end-of-life care to their peers. The connection volunteers share with their fellow inmates facilitates quality continuity of care; volunteers identify with and advocate for patients, are resourceful and find innovative ways to meet patient and unit needs.	“They'll [volunteers] even tell us things like, he's depressed, and they'll know the reason why. You know, it may be something going on in his life that we don't know about.” (Nurse)
Direct 1:1 care	Volunteers receive 1:1 patient care assignments that begin upon admission; provide a wide range of direct patient-care activities encompassing clinical, emotional, spiritual, and after-care; also includes being on call 24/7 during vigil, performing symptom and pain assessment, innovative non-pharmacological symptom and management techniques. Volunteers do all of the bedside care, with the exception of taking vital signs, testing blood sugar and administering medication, extending the staffing model to relieve nurses of such care; nurses rely on volunteers to be their “eyes and ears”.	“The nurse is not there to sit and just watch the patient. You got to be the one to sit there, you got to watch the oxygen tanks and...whether he's in pain, so you got to be able to communicate with the nurse.” (Volunteer)
Beyond orderlies	Differentiating unpaid volunteer role from orderlies who may receive compensation; key characteristics of the volunteer role include: being surrogate family; taking a team approach; dedication (i.e. volunteering during free time and being available on-call); considered the backbone of the program. Volunteers demonstrate dedication by keeping their word with patients, choosing to care for patients during their free time, often missing other recreational and social opportunities to attend their patients.	“Well, the orderly, he doesn't have to care about you. And if you need a shower, all he has to do is...shower you...put you back in the bed, and he's gone. It's like it's no relationship there...That's the whole point of not dying alone, knowing that somebody is there, that have to do that role.” (Volunteer)
Education/experience	Volunteers are highly trained; receive ongoing formal education (hospice education, clinical psychology, spiritual) and in-services, as well as informal education through hands-on apprenticeships or mentorships with experienced volunteers. Volunteers also deliver education to patients and to others outside the hospice program; volunteers often speak at conferences and participate in radio shows.	“I watched the guy that I knew was sincere...and when I tutored I got a little bit from this one and a little bit from that one. And I acquired what I knew, and became the volunteer that I am today.“ (Volunteer)