Table 3.

Essential elements of prison hospice: Safety and security

Safety and Security
Concepts in Context	Definition and Dimensions	Exemplary Quote
Security first	This idea is foundational not only because it is a prison, but because this orientation allows them to make this a special space within the prison where hospice can happen; includes the idea of the prison as context or environment, the prison code, protecting the program, and securing the space for hospice (keeping hospice a safe place).	“If they see an issue or something somebody will jump on it real quickly because we want it to run smooth. We don't want the name smeared in any way...we try to clear up anything that goes on. But it's mainly everybody is very proud of it.” (Nurse)
Boundaries not barriers	Not allowing typical boundaries like protocol, procedures, and policies to become barriers to allowing hospice to function; maintaining “fair but firm” professional boundaries while also treating others with respect and avoiding rigidity; examples include allowing touch between inmates, and having clear expectations.	“I think they're [volunteers] given a lot when they first come in. We'll give you the benefit of the doubt, and you can have all this, but then if you can't follow that, and stay within those boundaries, we'll start taking it away.” (CO)
Adaptability	Adapting, changing or bending the rules to permit or support hospice activities; being “fair but firm” and retaining “the human part” of themselves in responding to issues; knowing when to insist on control vs. allowing some space for variation; balancing program needs against protocol, for example allowing movement between various areas of the prison; making exceptions when needed or reasonable; escorting inmates and families during off visit hours.	“These are sick people and these are people that are helping them and you have to work with that, you have to go a little further with them because you have to go that extra mile because they are sick...you have to be that interceptor sometimes, in between different areas and with their families...” (CO)
Patient safety	A sense of protection and responsibility for the vulnerable inmates; includes questioning or highlighting motives, for example making sure people have the “right” motives; maintaining unit structure, and working together to keep the vulnerable patients safe.	“Most of them are bedridden, so therefore, we have to provide security for them so nobody would go in and do anything to them because they can't defend themselves.” (CO)