Yikes, I did not have to be a mental health nurse until I came to corrections!

Recently I attended a meeting of correctional nurses and noted that each of the participants introduced themselves by the specialty area that they practiced in before beginning their correctional experience. These nurses introduced themselves as ER nurses, CCU nurses, a labor and delivery nurse, a long-term care nurse and so on. Have you had a similar experience? We seem reluctant to give up the specialty area of practice we identified with before we became a correctional nurse. One of the distinguishing features of correctional nursing though, is that our patients have a wide variety of health problems. In order to appropriately provide care to our population correctional nurses must have a broad base of knowledge and expertise.

This is excruciatingly clear when it comes to the nursing assessment, care and management of patients with mental disorders. For several years there has been mounting evidence that the mentally ill are disproportionately represented in the criminal justice system. In 2006 a U.S. Department of Justice survey reported that nearly half the detainees entering the criminal justice system had a mental illness. A more recent study (2010) found that correctional facilities housed three times more people with mental illnesses than all inpatient psychiatric facilities in the community. See references at the end of this post. Therefore a correctional nurse will assess, evaluate, care and advocate for mentally ill inmates literally every day.

So how does a nurse who does not have mental health experience survive in correctional health care? The first tip is to simplify the types of patient situations nurses encounter. Next, identify the nursing action and patient care goal for each type of encounter. These are listed in the table below.

Type of MH Encounter

Nursing Action & Goal

An acutely mentally ill patient Carefully assess and document symptoms to obtain the best,   immediate intervention.
An impaired patient Acknowledge the impact of the impairment and put tools in   place to mitigate the effects on the patient and manage the environment.
A difficult patient Identify and manage your own negative internal thoughts to   retain a therapeutic relationship and appropriate response to the patient.

Future posts will go into more detail describing each type of encounter as well as the knowledge and skills involved in the nursing action. Sometimes nurses feel overwhelmed by the terminology, description and diagnostic hierarchy of mental disorder when a simpler approach like the one in the table above would be just as useful. Do these categories for the types of nursing encounters ring true for you? Share your experience in the comments section of this post.

Another tip for nurses faced with a challenging mental health patient…take a moment to breathe, to think about what you want to accomplish and the best way to get there. Important clues can be found in the chart, the “old” record, in what the patient does not say or an incongruity between what is said and how the patient looks or acts; if you are rushed you will miss the clue.

Read more about the nursing care of patients who have mental illness in Chapter 12 of the Essentials of Correctional Nursing. Order your copy directly from the publisher at http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4

References:

http://bjs.ojp.usdoj.gov/content/pub/pdf/mhppji.pdf

http://www.cdc.gov/traumaticbraininjury/pdf/Prisoner_TBI_Prof-a.pdf

http://www.treatmentadvocacycenter.org/storage/documents/final_jails_v_hospitals_study.pdf

Photo Credit: © dgmata

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