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.

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