This month the Essentials of Correctional Nursing blog welcomes Gayle F. Burrow RN, BSN, MPH, CCHP-RN, Correctional Health Care Consultant from Portland, OR, to the blogging team. Gayle will share insights from her many years of jail nursing experience in a regular monthly rotation with ECN bloggers Catherine Knox and Lorry Schoenly.
The most common examples of contraband we think of are guns, knives (shanks), sharpened toothbrushes, hording medications, and homemade ropes. When inmates attempt to hide contraband in their body, things can go awry. Here are a few examples:
- A swallowed balloon of drugs leaks.
- Eyebrow pencil mistakenly inserted into the urethra instead of the vagina.
- A swallowed ring lodges in the intestine.
- Wrapped razor blades cut into the bowel.
- A wad of money or hidden jewelry causes a vaginal infection.
- Horded medication traded to another inmate causes an allergic reaction.
Inmates know that bringing in or making unauthorized items is against the rules, so they do not want to tell anyone because they know they will receive discipline. They have read the inmate handbook about the rules inside the facility. Also, they do not want to give up their important possessions because this is the same way they kept valuables when living on the streets.
Health staff provide services in chronic disease management, evaluating care requests and medication management and emergency response. The challenge is to find ways to make patients aware of contraband. This can be done by incorporating information into everyday nursing practice. Some areas of nursing practice where the topic of the dangers of contraband can be discussed are:
- At intake or booking, incorporate a statement of awareness that having unauthorized items on your person can have health consequences.
- During health assessments or nursing sick call evaluations, take the time to mention that contraband is a health issue and we want to prevent any harmful consequences.
- Posters or videos can be developed to bring awareness of the possible health consequences of some types of contraband.
- Work with corrections or custody to expand the statements in the inmate handbook to include some health information about the trauma or illness from contraband.
Staff also need reminders to be continually aware of the medical implications of contraband. Here are some ways to keep contraband in the forefront of correctional health care activities:
- Staff meeting or in-service discussing the types of contraband have effects on the health of our patients. Such things as pelvic infections, drug overdoses, perforated bowels, bowel obstructions, rectal bleeding, stomach problems, drug overdoses, trauma or injury can be emergencies from hidden objects.
- Review contraband situations that have occurred in the facility and complete a Continuous Quality Improvement study to see what could be implemented to target areas for improvement. Use the plan, do, study, act cycle and information from NCCHC to evaluate ways to identify and improve care in this area.
- Review procedures for sharps and controlled substances in medical. Reinforce the safety aspects of these important procedures.
- Look at the orientation program to make sure it covers safety from both a custody and health perspective.
- Work with custody to be a part of their procedures to identify and eliminate risk in the institution. Things that health should be notified about are finding stashes of medications, drugs found in housing areas, and finding things for suicide attempt.
- Identify the difference when a provider finds a contraband item during a physical examination and when custody asks medical to perform a body cavity search. One is a consented exam and one is asked to do a forensic procedure only performed by personnel trained in this procedure. Body cavity searches are usually completed at the local emergency room by trained staff. Guidance on the topic may assist in making decisions
- Use a staff meeting or in-service time to outline the physical assessment skills necessary to identify contraband. Some system are the gastro intestinal system, pelvic area, rectal function, and signs and symptoms of infection.
- Invite a custody representative to a staff meeting or in-service session to review contraband, what it is and what are examples found in the facility. Sometimes it is a rope, tattoo gun, sharp shank or maybe it is a cute wallet made from gum wrappers. This increased awareness can change practices and result in discussions about projects or supplies in use by medical.
As a health professional, we have a special relationship with the patients and assist in maintaining their health and overcoming illness. Health staff interview and screen in booking and respond to requests for care and emergencies. We are there as advocates and support. With little in the literature to guide correctional health care in the area of health effects of contraband, we can learn about how to deliver care when things come up.
In the next article will be about a topic that is not easy to discuss. It relates to situations in which custody or health staff contribute to contraband items or comes under the control of an inmates demands.
Share your experiences with contraband in your institutions and share them with us in the comment sections of this post.
Standards for Health Services in Prisons, NCCHC, 2014 edition, Standard P-I-03, Forensic Information, pages 149-150.
Standards for Health Services in Jails, NCCHC, 2014 edition, Standard J-I-03, Forensic Information, pages 149-150.
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