Where to Go from Here

Welcome to the Essentials of Correctional Nursing Blog! This resource has over 200 posts discussing every dimension of correctional nursing practice and compliments the content found in the book – Essentials of Correctional Nursing.

Although the authors are no longer adding posts to the blog, those created from 2012-2016 remain relevant for your practice. Here are a few categories to help you navigate the archives.

  • Assessment – Intake Assessment, Emergency Assessment, Clinical Judgement and more
  • Certification – Options, Preparation, Taking the Exam
  • Dental – Triage, Assessment, Medical Conditions
  • Juveniles – Physical Development, Psycho-social Development
  • Medication – Managing Medication Line, Reconciliation, Contraband, Safety, and much more.
  • Mental Health – Assessment and Clinical Judgement
  • Sick Call – Assessment, Protocols, Practices
  • Withdrawal – Alcohol, Stimulants, Depressants
  • Women’s Health – Pregnancy, Heart Disease, Eating Disorders, and more.

Use the search bar on the left sidebar for more specific blog searching.

If you are a regular blog reader, thank you for your support and participation. If you are a new visitor, we hope you find the information you need.

 

From the Archives: Evidence-Based Practice

Archives4Research published in the Journal of Nursing Administration (JONA) confirms that nurses want to practice based on the best evidence but are not consistently putting that desire into action. Many challenges were identified by the national sample of nurses surveyed for the research study. These challenges may be even more acute in the correctional setting where resources can be lacking and technology limited. These past blog posts review how to find evidence for your correctional nursing practice.

Encouraging Evidence-Based Nursing Practice in Corrections

Evidence-Based Practice: Asking the Right Questions

Evidence-Based Practice: Where to Look

Are you applying evidence in nursing practice in your setting? Share your experiences in the comments section of this post.

Read more about Evidence-Based Nursing Practice in Chapter 18 from Essentials of Correctional Nursing. Order your copy directly from the publisher.

From the Archives: Juvie Health

Archives3If you work in a correctional setting, chances are great that you have patients under 19 years of age. Many jails throughout the country house adolescents onsite. In addition, most states have adult sentencing for some form of juvenile crime. Although the Federal Bureau of Prisons does not house adolescents in adult facilities, 149 federally-sentenced youth were being housed in contracted facilities in 2011. While the criminal justice system struggles with the advisability of incarcerating youth, correctional nurses must establish a program of care that attends to their health and well-being while behind bars. Read these post blog posts to learn the particulars of juvie care behind bars.

Troubled Youth: Adolescents Behind Bars

Troubled Youth: Physical Development Challenges Behind Bars

Troubled Youth: Psychosocial Development Behind Bars

Troubled Youth: Asthma Management

Do you provide health care to troubled youth? Share your experiences in the comments section of this post.

To read more about the unique aspects of juvenile health care in the correctional setting see Chapter 11 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher.

From the Archives: Correctional Nurse Peer Review

Archives1The Essentials of Correctional Nursing Blog has over 200 informational posts to help you in your correctional nursing practice. This month we are searching through the archives to bring back a few series you may have missed. Here are links to a set of posts about peer review in our specialty.

Correctional Nursing Peer Review: What it is and What it isn’t

Correctional Nursing Peer Review: Determining Discipline-Specific and Community Standards

Correctional Nursing Peer Review: Making it Practical

Correctional Nursing Peer Review: Some Examples

Are you developing a Nursing Peer Review program in your setting? Share your experiences in the comments section of this post.

To read more about professional practice issues see Chapter 19 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher 

From the Archives: Moral Courage

Archives2The Essentials of Correctional Nursing Blog has over 200 informational posts to help you in your correctional nursing practice. This month we are searching through the archives to bring back a few series you may have missed. Here are links to a set of posts about the need for moral courage in our specialty. 

Moral Courage: Do You Have What It Takes?

Moral Courage: How Do I Find Some?

Moral Courage: Dealing with Uncertainty

Moral Courage: Being Assertive

Have you needed to confront a moral dilemma in your correctional nursing work experience? Share your thoughts and experiences in the comments section of this post.

Read more about ethical practice in corrections in Chapter 2: Ethical Principles of Correctional Nursing from Essentials of Correctional Nursing. Order your copy directly from the publisher.http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4 

Contraband: Health or Security Issue? Part III

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 daily work in corrections health, whether a jail, prison or juvenile facility, easily becomes routine. Concerns for personal safety and facility security can fade as reliance is placed on standard operating procedures, custody colleagues, and our own growing familiarity with the criminal justice system. When this happens our safety can be threatened a couple ways. For correctional nurses, this can happen when someone becomes overfamiliar with a patient or when an inmate has been able to manipulate a staff member to bring drugs into the facility.

A news item reporting that a correctional staff member has assisted an inmate to escape from a facility can lead to a reaction like “How in the world could this happen?” Unfortunately, it does happen; even with good orientation, teamwork and communications.  Inmates have persuasive skills that they learned on the streets and staff member may be going through a difficult, vulnerable life situation. This can be a dangerous combination.

Objects and Relationship Contraband

The book “Games Criminal Play” was helpful to me when I entered the correctional nursing specialty many years ago. Although published in the 1980’s, the principles for dealing with inmate manipulation are timeless and remain helpful today. One key principle is that criminals have a manipulation process so subtle that victims rarely realize what is happening until it is too late. That is why it is important for us to be ever-vigilant in avoiding manipulation traps in our nurse-patient interactions. Here are some actual examples of inappropriate staff activities:

  • Forming a relationship while in the jail leading to the patient moving in with the staff member after release
  • Living with a drug dealer and passing on information to inmates
  • Putting money on an inmates books
  • Not reporting when a family member is in custody

Professionalism and Boundaries

Maintaining professional boundaries with patients is safe practice. Contraband can include not only sharp objects but also information, money and personal relationships. By being a skilled health practitioner, sensitive team member and grounded in yourself, you can deliver good health care while avoiding contraband participation.

To read more about the area of safety for the nurse and patient in correctional settings see Chapter 4 sections on contraband, medical contraband and professional boundaries in the Essentials of Correctional Nursing. You can order a copy directly from the publisher or from Amazon today!

Contraband-Health or Security Issue? Part II

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.

Patient Awareness

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 Awareness

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.

For more about correctional nursing practice consult the Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today!

References

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.

Photo Credit: © Sensay – Fotolia

Contraband—Health or Security Issue?

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.

Contraband is found frequently in the corrections literature usually with a focus on preventing objects like cell phones, sharp objects and drugs from coming into the institutions at booking or at visiting times. Inmates and their friends and families can be inventive. Drones are becoming a new threat to security. They are dropping packages and weapons into recreation yards. A jail in Ohio has installed body scanners at intake to identify and remove items found in body cavities of those being booked into jail. The officers report, of the four thousand they book annually, they find something every day.

Correctional nurses must understand what constitutes contraband and the damage it can cause. Contraband can consist of weapons, drugs, food, tobacco and even objects that inmates can use to coerce officers into doing their bidding. Contraband can also include medication or medical items that can be harmful if used incorrectly.

Contraband is a Safety Issue

Learning about contraband begins with orientation to the facility and in health orientation. In these sessions new correctional nurses discover:

  • The definition and examples of contraband at this particular facility.
  • Procedures in place to prevent things entering the facility, such as cell phone detectors, body scanners, strip searches, phone detection dogs, housing sweeps, mail inspections and now drone tracking devices.
  • Procedures in place for health staff such as sign out and shift counts for narcotics.
  • The importance of sharps, needles and scissors control and counts.
  • The practices in place during medication rounds to identify and prevent diversion.

Contraband is a Health Issue

Health staff sometimes feel that contraband is a custody responsibility. Nurses often find out about searches or lock down times when heading out on medication rounds or when evaluating a patient in a housing unit. However, contraband can dramatically and quickly affect a person’s health. Health care staff should know about the health effects of contraband and be alert to this unique area of our practice.

In an intake or receiving facility, one common situation is when the arresting officer or custody witnesses someone swallowing baggies of drugs. Sometimes the inmate will become scared and notify the nurse. With a witnessed contraband incident, plans can be made to send the inmate to the hospital for observation and treatment.  It is the unwitnessed situations where harm can occur, such as the collapse of a patient from a leaking baggy or overdose from swallowing drugs. Sharp items can cause stomach or intestinal perforations.

Contraband Risk Reduction

Contraband prevention and identification can become part of everyday patient care practice. Here are some examples of ways to incorporate contraband awareness into clinical practice.

  • Questions included in the booking screening process to identify that contraband is a health issue.
  • Intake evaluation can include discussion of the health problems of hiding objects in body cavities.
  • An evaluation for abdominal pain or even constipation, can include inquiry as to any object swallowed or placed in the rectum.
  • General education during health encounters can elicit information from patients.

Is Contraband a Health or Security Issue?

With the wide variety of contraband brought into a facility, custody has processes in place to locate items with screenings, searches and equipment. Health staff have responsibility for procedures like counts, medication checks, knowing what is on your carts, and locking up sharps and medications. Some items do not cause any health concerns and others can cause death. Since, the safety of the institution is everyone’s responsibility, reviewing the policies and procedures for the facility and health will give guidance.

Next week we will continue to review this complex topic of contraband from a health perspective. It will be interesting to know how your facility handles contraband. Share your experience in the comment section at the end of this article.

To read more about personnel and patient safety in correctional settings in relationship to contraband and other areas, see Chapter 4 of the Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today!

Photo Credit: © Africa Studios – Fotolia

What Can One Person Do? Ask Lillian Wald and Dorthea Dix

Never believe that a few caring people can’t change the world. For, indeed, that’s all who ever have – Margaret Mead

What Can One Person Do?

Can nurses bring social justice to the correctional environment? Are we too few in number and without power in the criminal justice system? Margaret Mead thought a few caring people can change the world. In fact, caring people have changed the world for similar vulnerable and marginalized patient populations. What can we learn from the actions and outcomes of social reformers like Lillian Wald and Dorthea Dix?

Lillian Wald: Helping the Disadvantaged

Lillian Wald was born to a life of privilege in the late 19th century; yet, as a nurse, she saw the needs of disadvantaged immigrants in New York City and took action. She started the Henry Street Settlement (originally called the Nurse’s Settlement) in 1893 to provide health care and education to immigrants on Manhattan’s Lower East Side. She is widely regarded as the founder of public health nursing. Nurse Wald was moved to action by observing the living conditions of the urban poor.

Dorthea Dix: Reforming Treatment of Prisoners and the Mentally Ill

Dorthea Dix, although never trained as a nurse, was a social reformer in the mid 19th century and managed nursing services during the Civil War. Her greatest accomplishments were in agitating for improved health conditions for the mentally ill and prisoners who were often housed together. She struggled with her own mental breakdown early in life that brought her into contact with British social reformers during a rest-cure trip to England. Upon returning to America she launched a review of the conditions of mental illness treatment in New England and found inhumane conditions of extreme neglect. Her efforts brought about sweeping changes to the treatment of both prisoners and the mentally ill.

Be One of the Few that Changes the World

Margaret Mead thinks you can change the world. Lillian Wald and Dorthea Dix provide proof that one person can make a difference.

  • It just takes one. Lillian Wald and Dorthea Dix started as a single individual who saw a need and acted. It can seem overwhelming to consider being a force for good in your setting. Yet even small actions can create momentum and change. Maybe you have heard the story of the little boy on the seashore.

Every day a little boy would go to the shore to pick up starfish left by the tide, walked them down to the water’s edge, and tossed them back into the ocean. One day a hurricane left hundreds of starfish on the beach. The little boy went out as usual and started picking them up one at a time and returning them to the water. A man walking his dog stopped to watch the little boy. Finally the man said to the boy, “Why do you keep picking up those starfish? There are so many of them you can’t make a difference”. The little boy picked up one starfish and looked at the man and said, “To this one I can make a difference”.

  • People wait for a leader. Are others waiting for someone (like you!) to take the lead? Malcomb Gladwell, in his highly recommended book, The Tipping Point, suggests that people don’t act in the face of need in a group setting for two reasons.

1) They see that others are also experiencing this need and no one sees it as an issue. Therefore, they assume they are misinterpreting what they are experiencing.
2) They assume that someone else must be taking care of it; say, someone else in authority. In a group, people often wait for an indication from others as to how they should act.

Maybe like-minded others around you need to know you are concerned, too, and that action is needed. Others rallied around Lillian Wald and Dorthea Dix once they sounded the alarm and took action. It may seem that you are the only one, but you may be one of many.

  • Start where you are. Dix and Wald were women in the 19th century; not a very powerful position to be in. Health care professionals in the criminal justice system are rarely in positions of power; yet, like these two reformers, we have the power to take action that can lead to powerful good. Even small actions can have big consequence.

What can one nurse do? We can speak up when we see social injustice and can band together with like-minded nurses and others to initiate change. Correctional nurses have opportunities to see into the criminal justice system and support necessary change that leads to improved treatment and increased respect for human dignity.

A few caring correctional nurses, you and me, can change the world. Do you believe it? Let’s do it!

Share your thoughts about correctional nursing and social justice in the comments section of this post.

JUST – A Dangerous 4-Letter Word

Kelley Johnson, Miss Colorado, delivered a unique monologue about being a nurse at the 2015 Miss America Pageant. In her two and a half minute presentation she explained how she was describing herself as ‘just a nurse’ to her patient Joe, an elderly man with Alzheimer disease. Joe finally shared his perspective that Kelley was not ‘just a nurse’ but a very valuable and effective healer in his life.

Every nurse can relate to Kelley’s presentation of our role in health care. Few nurses have never felt as she did – that we are ‘just a nurse’ and can’t do much in a particular situation. Yet, as her story reveals, JUST is an incorrect and misleading adjective to describe our role to our patients and to society.

I am especially struck by the danger of the word JUST in describing our role as correctional nurses. Our responsibility for our patient’s health and well-being goes beyond the boundaries of a specific nurse-patient relationship. The inmate population of our correctional setting is a patient community that requires the broad application of our nursing role.  Here are three ways correctional nurses go beyond the conventional perspective of being ‘just a nurse’.

Holistic Viewpoint

The increased burden of mental and physical disease in our patient population can strain the resources of correctional officer staff. Their perspective and training is, rightly, focused on public and personal safety. As a nurse, our viewpoint is holistic. We naturally see  any situation as potentially caused by a health or wellness issue. Thus, what may appear to be a behavioral or discipline issue to our correctional colleague, is evaluated as a health need or treatment side effect. More than ‘just a nurse, correctional nurses can contribute knowledge and clinical judgment in a behavioral situation that can lead to a positive resolution.

Healthy Living Perspective

Correctional nurses frequently deliver care in the living areas of a facility. Traveling about the compound, we have opportunity to observe working and living conditions through the lens of healthcare. Cleanliness, containment, and the reduction of disease spread are inherent nursing principles. Nurses ‘see’ things that may go unnoticed by other professionals in the facility. The availability and use of handwashing resources is just one observation a correctional nurse may make while in the course of  daily activities. Others might include inmate hygiene practices, cleanliness of recreational equipment, or the practices of inmate barbers and porters. Correctional nurses can address unhealthy living practices to improve the health of the larger patient community.

Moral Presence

Abuse of power can easily result from situations where one group of people has control over the lives of another group. Although many correctional systems have an organizational culture that discourages and sanctions this abuse of power, just as many do not. Unfortunately, a significant portion of correctional settings are places of disrespect and incivility. Some, in fact, are even mentally or physically abusive of the inmate population. Correctional nurses have the opportunity, even the responsibility, to address issues of human dignity and patient safety in these situations. Our ethical code calls us to make every effort to protect our patients from mental and physical harm.

Falling under the spell of the adjective J-U-S-T in describing correctional nursing practice is dangerous to our understanding of our role and to the health and well-being of our vulnerable and marginalized patient population. Join me in eliminating this 4-letter word from our self-talk and our practice perspective.

Have you ever been called upon to be more than ‘just a nurse’ in your correctional practice? Share your story in the comments section of this post.