Several times a year Americans pause to thank our soldiers for defending our freedom and protecting us from harm. We acknowledge the sacrifices made by past and present American soldiers to keep us free this Veteran’s Day. Many of those same soldiers who put themselves in harm’s way are now our patients in jails and prisons across this country.
I was surprised to discover the extent of veterans behind bars. A Special Report by the Bureau of Justice lists around 140,000 veterans in our nation’s prisons in 2004 (the most recent available). Are any of them your patients? 1 in 10 prison inmates is a veteran, so it is very likely that some of your patients have military history. A significant proportion of inmate patients have served in the armed forces and participated in defending our freedom.
According to the BJS report, veteran inmates are more highly educated than nonveterans and have shorter criminal histories. One in 5 had actual combat duty. Some of the findings of the report bust typical conclusions we might have about soldiers. For example, veteran inmates are not more likely to abuse alcohol or have mental health conditions than their nonveteran peers. In addition, they are slightly less likely to be using drugs at the time of arrest. These numbers do not vary based on whether they had combat or noncombat duty while serving our country.
Post Traumatic Stress Disorder (PTSD) is implicated in many of the convictions of military veterans. It has been said that the soldier can leave the war but the war may not leave the soldier. This was apparent to me in watching the HBO documentary – Prison Terminal: The Last Days of Private Jack Hall. The primary goal of the documentary was to chronical prison hospice services provided to Mr. Hall as he was dying in the Iowa State Penitentiary. However, during the film, Jack shared his back story; the events that led to his conviction for murder. He talked about the nightmares and flashbacks of his time in a German Prison during World War II duty. He had become an alcoholic after discharge; finally killing a man thought to be his son’s drug dealer. PTSD did not emerge as a specific diagnosis until the 1980’s, but its symptoms abounded among returning WWII vets like Private Hall. These soldiers were said to have traumatic war neurosis, combat exhaustion, or operational fatigue. What they were experiencing, though, were symptoms of PTSD.
Responses to Traumatic Stress
The common pattern of human response to traumatization provide the three key components to a diagnosis of PTSD.
- Intrusive Recollection: The event is persistently re-experienced through recurrent and intrusive distressing recollections, images, thoughts, or dreams.
- Avoidance/Numbing: Avoiding thoughts, feelings, or conversations associated with the trauma. Avoiding activities, places, or people that arouse recollections of the trauma.
- Hyper-arousal: Difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, and an exaggerated startle response.
Helping the PTSD Patient
Veterans are not the only inmate-patients likely to have PTSD. Many in our patient population carry with them violent and abusive histories. Therefore, correctional nurses need to know how to respond to a patient who exhibit acute PTSD symptoms during a medical procedure or health care interaction. Here are some tips from Veteran’s Affairs:
- Speak in a calm, matter-of-fact voice and avoid sudden movements.
- Reassure your patient that everything is okay.
- Continue to explain what you are doing.
- If at all possible, stop the procedure.
- Ask (or remind) the patient where he or she is right now.
- Re-ground the patient: Remind him or her that you are in a medical unit, that he or she is safe and that he or she is having a medical procedure.
- Offer the patient a drink of water, an extra gown, or a warm or cold wash cloth for the face – anything that will make the patient feel more like his or her usual self.
- Provide a change of environment (moving to a different room)
On this day of gratitude for those who help keep us free, maybe that inmate in pill line or sick call is someone who served…..and they deserve our gratitude, as well as our best nursing care.
To read more about characteristics of the incarcerated patient population see Chapter 1 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1402 the price is discounted by $15 off and shipping is free.
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