health28, 47, primary healthcare65, borderline situations1, 26, tropical and parasitic diseases44, multiculturalism1, 43, 45, disabilities46, drug abuse1, 6 and the correctional context12, 68. Currently there are two institutions which offer specific degrees in terms of correctional nursing aimed at meeting these training needs: the American NCCHC since 1991 and the Facultat de Ciències de la Salut Blanquerna of the University Ramon Llull since 2013 by means of postgraduate education. In countries such as the United Kingdom and Canada, in addition to general training, specific training in mental health is needed and in France UCSA teams providing healthcare in correctional facilities are specifically trained before taking up their job. Therefore, nurses providing care in correctional facilities need a specific training in specialized knowledge, skills and awareness on the context unlike in external health centers1, 4, 12, 67, 68. CORRESPONDENCE Montserrat Sánchez Roig Email: msanchezr@gencat.cat Rev Esp Sanid Penit 2016; 18: 110-118 49 M Sánchez-Roig, A Coll-Cámara Prison nursing and its training — 116 — REFERENCES 1. Coll A. El fenomen de la infermeria penitenciària: Una proposta formativa [Tésis]. Barcelona: Universitat Ramon Llull; 2014. 2. Marín N, Navarro C. Estudio de prevalencia de tratorno mental grave (TMG) en los centros penitenciarios de Puerto I, II y III del Puerto de Santa Maria (Cádiz): nuevas estrategias en la asistencia psiquiátrica en las prisiones. Rev Esp Sanid Penit. 2012; 14: 80-5. 3. Descriptors Estadísitics Serveis Penitenciaris i Rehabilitació [Internet]. Barcelona: Generalitat de Catalunya; 2015. [actualizado 1 de jun 2015; citado 1 jul 2015]. Disponible en: http://www. gencat.cat/justicia/estadistiques_serveis_penitenciaris/ . 4. Schoenly L, Knox CM. Essential of Correctional Nursing. New York: Springer; 2013. 5. Zulaika D, Etxeandia P, Bengoa A, Caminos J, Arroyo-Cobo JM. 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Efectos psicológicos de la estancia en prisión.The nursing profession has an obligation to advance nursing in all roles and settings through scholarly inquiry, professional standards development, and the generation of nursing and health policy. Nursing in secure treatment facilities such as prisons, jails, forensic hospitals, and juvenile treatment centers have made advances in research and professional standards. In many forensic settings, especially rural forensic settings, there continues to be challenges to quality care and the maintenance of a professional environment. This article provides the organizational context, sociopolitical history, and motivation for systematic change in rural forensic nursing. Thoughtfulness, organization, and leadership are emphasized in the plan for increasing networking for rural forensic nurses. Through networking of forensic nurses and creation of transformational nursing leaders, change can emerge. Word Count: 121 Key words: Forensic nursing, correctional nursing, rural nursing, system change Cultivating Change 5 CULTIVATING SYSTEM CHANGE IN RURAL FORENSIC NURSING Contemporary cultural and political influences on the criminal justice system have created an atmosphere ripe for system-wide change, especially in forensic health care. The years of utilizing untrained, unlicensed staff to treat health needs, correctional officers preventing access to healthcare professionals, and exploitive