The Circles in Your Practice

On a busy day and in the midst of patient care we are not always aware that much of our nursing practice care is a continuous process. Whether it is completing sick call, medication administration or counseling a patient, we are always “evaluating”. Nursing practice is circular, in that our patients continually respond to our health interventions and as nurses, we observe and act on that response. nursing-process-grid-11-7-16

The American Nurses Association defines correctional nursing as the “protection, promotion and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human response; advocacy for and delivery of health care to individuals, families, communities and populations under the jurisdiction of the criminal justice system”.

The Nursing Process

The American Nurses Association published the Correctional Nursing: Scope and Standards of Practice in 2013. The goals of the scope and standards are to:

  • inform nurses and others about correctional nursing practice
  • guide nurse’s day-to-day practice and resolve conflicts
  • develop policy and procedure and other governance of professional practice
  • reflect on professional practice and plan improvement.

There are 16 standards of nursing practice with the first six delineating the steps in the nursing process. These six elements of the nursing process are circular as well as inter-related to each other.

  • Assessment is data collection about the patient’s health condition. Nurses use all their skills and senses to identify changes in a patient condition. By observing the patient, interviewing the patient, completing the physical examination, collection history information and reviewing of the patient’s health records an assessment is formulated.
  • Diagnosis is the nurse’s analysis of the data gathered and identification of the patient’s problem which results in the nursing diagnosis. The nurse also validates the diagnosis with the patient.
  • Outcomes Identification focuses the nursing diagnosis on the needs of the patient. The goal of nursing care is for the patient to achieve an improved level of functioning that is realistic to attain. Using the SMART technique, an acronym for setting goals that are specific, measureable, attainable, and realistic and time bound, assists in developing the outcome statement.
  • Planning  for the nursing interventions that will achieve the outcomes identified for the patient is the next step. These plans are specific to each patient and focuses on achievable outcomes. Planning, rather than reacting or practicing by rote, is more effective in reaching the goals of patient care.
  • Implementation are the action steps the nurse follows in carrying out the plan of care. Implementation may be one or more nursing intervention steps, and may take place over hours, weeks or months depending on the patient’s condition. Implementation requires the nurse to delegate care to subordinate personnel and communicate with colleagues to achieve completion of the patient’s plan of care.
  • Evaluation occurs all along during the nursing process. It is both the end and the beginning in the continuous process of care that is delivered to the patient. Documenting the patient’s response to interventions, evaluating their effectiveness and the outcomes achieved leads to modification or revision in the plan for care.  This illustrates how each step is fundamental to the circular process of nursing practice.

The nursing process is an integral part of every patient encounter. Expert nurses move through these steps fluidly without stopping to focus solely on each component. Nurses are attentive to their patient’s response to care provided all along the continuum from illness to wellness.

The Patient Plan & Documentation

The S.O.A.P method of documenting patient care is common in most correctional settings and is used as the main communication method in the patient’s health record. In the literature, two additional elements in SOAP charting are recommended; these are Intervention and Evaluation. These two additional elements of documentation align with the nursing process just discussed and support charting of continuous patient care.

  • S-Subjective: reports what the patient says
  • O-Objective: records what the nurse observes
  • A-Analysis: identifies a nursing diagnosis
  • P-Plan: describes nursing interventions
  • I-Implementation: records how those actions were carried out
  • E-Evaluation: reports the actual patient response and outcome.

This systematic approach to detailing patient care keeps us goal orientated and focused on how the patient is progressing in the treatment plan. With an eye toward always evaluating or “continuing” to evaluate a patient’s response to treatment, the nurse is ready to intervene to prevent an exacerbation of illness or unexpected response to treatment.

When nurses respond to requests for care, complete sick call assessments, administer medications and call patients up to check on how they are doing, it is part of the circular pathway of continually evaluating how our patients are or are not responding to care.

Next weeks’ blog topic will explore a third “circular” area of nursing practice, which is the Continuous Quality Improvement Process. Can you think of more circular processes in your nursing practice or insight into the continual evaluation process in nursing care? We would like to know your thoughts about the nursing process and SOAPIE process. Share in the comment section at the end of this post. We like to hear from you.

Read more about the practice of nursing in the correctional setting in our book the Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today!

 

Photo Credit: American Nurses Association NSPS’10_Fig 4. Nursing Process Standards.

The Challenges and Distinguishing Features of Correctional Nursing: Part 3

Tonia FaustThe last two weeks we explored two of the challenges in becoming a correctional nurse and how once mastered, the results are practices that distinguish correctional nursing from other areas of nursing practice. A final cultural challenge for nurses in the land of correctional Oz, a phrase Lorry coined for nurses new to the specialty, is to develop a caring practice, consistent with professional principles. Many correctional nurses lament “how can I be caring when the place where I work exists for the purpose of punishment?” In correctional settings, staff are cautioned against touching an offender, unless it is necessary to perform some task, such as a pat down search. Some places go as far as considering touch, an act for which staff can be disciplined.

Common expressions of caring in nursing such as therapeutic touch or an empathic disclosure of personal information are often prohibited or extremely limited in the correctional setting. These acts earn a nurse derision from other staff, particularly custody staff, and they will be taunted as a “chocolate heart”, “hug-a-thug” or “convict lover.” Correctional officers will not trust nurses who violate the facility’s expectations about maintaining boundaries, to act professionally in other encounters.

Caring however remains a central tenet of correctional nursing and is vital to the therapeutic relationship. Another distinguishing characteristic of the specialty, is that the expression of caring, emphasizes interpersonal communication rather than physical contact and use of self to convey empathy. Correctional nurses express caring when their interactions with patients convey respect, are nonjudgmental, acknowledge the validity of the patient’s subjective experience, are not rushed and are done in the genuine interest of the patient (ANA 2013).

Correctional nurses have described how, it is first, necessary to establish a professional relationship with custody staff before they can negotiate delivery of compassionate nursing care. This means having acting, behaving and speaking in a ways that are consistent with professional practice standards. The most recent version of the Scope and Standards of Practice for Correctional Nursing were published in 2013 and now are identical to those of nursing generally. So a correctional nurse practices as any nurse does; it is only the place and population served that differ.

An example of how a professional relationship with custody staff is established, is in accounting, not just for controlled substances, but for all the sharp instruments as well. This is usually done at the beginning and end of every shift. This means all of the instruments, including those in the dental clinic, those kept in the inpatient and outpatient medical areas, and the lab as well plus every needle on site…it can be an arduous task. This degree of accountability is necessary because sharps can be used as weapons, to do tattooing and to shoot drugs, all dangerous and prohibited activities in a correctional facility. Nurses count sharps because it is necessary for security, not as part of health care delivery. A missing sharp means that the whole facility will be locked down and searched until the item is found. I have experienced an entire facility being locked facility down, for hours on end, because a single insulin syringe could not be accounted for. No other work, even delivery of health care takes place, until the “sharp” is accounted for. Sometimes nurses balk at the requirement for counting or act as though it isn’t as important as patient care. However, failure to account for sharps is not only dangerous, but it undermines the professional relationship with custody staff.

The ANA standards for professional practice are also important because they help to define and protect the role of nurses in the correctional setting. We provide health care in a setting where custody staff, facility commanders and correctional administrators have little or no knowledge of the standards for nursing care, let alone much appreciation for the limits of nursing practice in state law, unlike traditional health care settings. A nurse cannot rely on the correctional facility to have practices and procedures that are compliant with state law or professional practice standards. They may be the only nurse for a small facility and have no other health care professional to provide advice, other than a part time visiting physician. Even in large correctional facilities with many nurses, including nurses in management, practice creep can occur for an individual nurse whose primary interaction during a shift is with correctional officers and inmates who don’t know or appreciate the nurse’s scope of practice. Individual nurses must therefore establish these boundaries on their own, or risk violation of the law and the potential for action on their license.

There are many examples where nurses are asked to perform work that is outside the scope of practice or not consistent with professional standards. A nurse may be asked to approve use of pepper spray or endorse the use of a restraint chair and hood; decisions which are not in the interest of the patient or their health care. For example, another friend of mine, Lynda Bronson, was threatened with insubordination for refusing a direct order from the Warden to forcibly medicate an inmate who was in segregation and screaming obscenities at the officers.

The Warden threatened Lynda three times with insubordination and yet she stood her ground and explained that she did not have a medical order that would allow her to forcibly medicate the inmate. These are tough situations to be in and correctional nurses must be experts in communication, collaboration, and problem solving, with Wardens as well as correctional officers. These skills are necessary to arrive at compromises that solve problems, like screaming obscenities and gravely disordered behavior, while keeping the patient and staff safe.

Well done, this is experienced as practice autonomy, one of the most preferred and distinguishing characteristics of correctional nursing. Nurses who are clear about the standards and boundaries of their practice in correctional settings earn the respect of custody staff and are able to negotiate better outcomes for their patients.

To sum up, correctional nurses provide health care from within the justice system, to a disparate population of prisoners with great disease burden. These features; the location and population served, along with the nurse’s independent negotiation for care, define and characterize correctional nursing.

They say that once a nurse has resolved these cultural challenges, he or she will stay in the Land of Correctional Oz forever. As Tonia Faust, the nurse from the Louisiana State Penitentiary said in The American Nurse “There is a purpose for me here”. Those that don’t survive the transition, leave, usually within the first year.

Do the challenges portrayed over the last three weeks fit the experience you had transitioning into the field of correctional nursing? Are there aspects of your practice in correctional nursing that are different from other nursing fields that have not been highlighted in this series? Please share your thoughts about these questions by responding in the comments section of this post.

If you would like to read more about caring and professional practice in correctional nursing see Chapter 2 on the ethical principles of correctional nursing and chapter that discusses the elements of professional correctional nursing practice in our book, Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today!

If you would like to order a copy of The Wizard of Oz Guide to Correctional Nursing go to Lorry’s website, Correctionalnurse.net to order through Amazon.

Photo credit: Jaka Vinsek, Cinematographer The American Nurse

Empathy: A Practice not an Emotion

Young man on reception at psychologistEmpathy has been discussed as a basic component of effective nursing practice since the 1960s. It is important because empathy produces insight into an patient’s experience and coping with illness. These insights facilitate the nurse’s diagnostic accuracy, problem solving and care becomes more patient centered. When patients feel understood they become engaged in a helping relationship with the health care professional and are more likely to adhere to treatment recommendations and advice about healthy lifestyle changes (Wiseman 2007).

Concerns about expression of empathy in correctional settings

Correctional nurses sometimes express concern about being empathetic with inmates. A simple definition of empathy is that it involves the ability to see the world through another person’s eyes. In correctional practice this definition is sometimes misinterpreted to mean that you have to think, feel and act like a criminal or a murderer or a sex offender; an impossible and unethical expectation. Another misunderstanding about empathy in correctional nursing is that the nurse is letting their emotions or feelings guide their actions and they are at risk of being manipulated by the inmate. Empathy in nursing practice is not a subjective emotion or feeling but is instead a professional interaction (Dinkins 2011, Mercer & Reynolds 2002).

If empathy isn’t an emotion, what is it?

A more descriptive definition of empathy is that it is the ability to perceive and understand the meanings, feelings and concerns of another person and to communicate that understanding to the other person. Empathy involves perceiving, thinking and communicating about another person’s experience and concerns. You do not have to think or feel like the other person to practice nursing empathically. There are three parts to empathy in nursing practice, sometimes referred to as the Empathy Cycle, these are:

  1. Listening, reasoning and understanding. Essential skills are the ability to listen attentively and the sensitivity to perceive another person’s experience, concerns or perspective on a subject. Understanding is a cognitive process that involves reflection and the suspension of judgment.
  2. Conveying understanding of the other person and your intention to help. Communication must be patient centered, accurate; not judgmental or blaming.
  3. The patient’s awareness that the nurse has communicated understanding and believes it to be genuine and accurate (Mercer & Reynolds 2002, Wiseman 1996, Wiseman 2007).

An example of empathy in correctional nursing practice

Last week I observed a nurse in sick call. She was seeing a 19 year old man for complaints of headache and acne. During her assessment she checked his medication administration record and noted that he had missed several days of thyroid medication. At first she lectured him about the importance of taking it each day. He looked at his feet and mumbled his understanding and agreement. Next she asked why he wasn’t taking it and he replied that he was still bed when it was time for morning meds. They talked some more about why he couldn’t get up and the impact of not taking the medication. Finally she said “Staying in bed in the morning is more important to you right now, isn’t it?” He nodded yes. Her reply was “I understand; let me see if the doctor will change the medication time to noon or the evening. Would that work better for you?” He nodded and indicated verbally that it would help.

The nurse accurately understood that for this young man, the consequences of not taking the prescribed medication were so remote compared to his desire to stay in bed that he would forgo the medication even after having listened to the information she provided. She acknowledged his reality that staying in bed was more important to him and used the information to problem solve a way to increase his medication adherence.

At this same correctional facility where I observed the nurse conducting sick call, the correctional officers are taught in training academy to offer empathy in their interactions with inmates. The curriculum notes that empathy establishes a dynamic that allows the officer to assist the inmate in problem solving, to feel understood and supported. Empathy is described as the “crown jewel” of active listening technique. The fact that correctional officers are taught in training academy how to use empathy really seems to support correctional nurses’ use of empathy in their interactions with patients.

Empathy and the Standards of Professional Practice in Correctional Nursing

Several of the professional practice standards for correctional nurses published by the American Nurses Association describe empathy among the competencies that nurses must demonstrate to meet the standard. The nurse in the example given above demonstrated all of the competencies in her brief interaction with the patient during sick call. These include:

Standard 1 Assessment: The correctional nurse elicits the patient’s values, preferences, expressed needs, and knowledge of the healthcare situation to utilize such information as appropriate within the context of the correctional setting.

Standard 4 Planning: The correctional nurse develops an individualized plan in partnership with the patient considering the patient’s characteristics or situation, including but not limited to values, beliefs, spiritual and health practice preferences, choices, developmental level, coping style, culture and environment, safety of the patient, and available technology.

Standard 5 Implementation: The correctional nurse advocates for health care that is sensitive to the needs of the patient, with particular emphasis on the needs of diverse populations.

Standard 7 Ethics: The correctional nurse maintains a therapeutic and professional nurse-patient relationship within appropriate professional boundaries.

Standard 13 Collaboration: The correctional nurse promotes conflict management and patient engagement (2014).

Reasons for lack of empathy in nursing practice

The primary factor that has been identified as impacting the practice of empathy among health care professionals is a fixation on the tasks and technology of care coupled with time compression. Other reasons identified as impeding empathic practice include:

Difficult patients Anxiety about patients Feeling belittled or insignificant
Unsympathetic colleagues Lack of role models Fear of making a mistake
Individual nurse’s personality Intimidating environment Pressure on task completion

(Ward, Cody, Schaal, & Hojat 2012)

Every one of these factors could be present in the practice environment of a correctional nurse. How many of them factor into your practice environment and to what extent have they impacted your use of empathy in the delivery of patient care? Empathy is not solely a personality trait; it is a skill that can be taught and developed (Wiseman 2007). Taking a moment to reflect on our practice environment may identify opportunities to improve our empathic response in patient interactions. From there it is possible to create a plan of professional development in this area.

Empathy reminders for our practice

Helen Riess, Associate Professor of Psychiatry at Harvard Medical School gave her TEDx Talk audience (2013) the following mnemonic which she uses to help health care providers develop empathic responses in their patient care encounters.

E              Eye contact – this is first indication that we have acknowledged an individual and it begins the interaction

M            Muscles of facial expression – are the road map of human emotion, notice the patient’s facial expression

P             Posture – an open or closed posture indicates receptivity (or lack thereof) to interaction (both yours and the patients). Maintaining an open posture facilitates the patient’s interaction with the health care provider.

A             Affect – is a term for expressed emotion; try to identify label the patient’s emotion, and listen to the patient with that perspective, it will improve your understanding of what the patient is communicating

T              Tone of voice – is an indicator of emotion, vocal chords are located in the brain close to the same area that activates fight or flight response, changes in tone of voice may be an early indicator of emotion

H             Hearing the whole person – more than the words that are said, understand the context of the patient’s experience, and be non-judgmental in order to comprehend

Y             Your response – pay attention to your feelings; we respond to others all the time; know what you are conveying and manage your part of the relationship professionally.

Are the challenges of using empathy in your professional correctional nursing practice similar to those described here? If so what resources have you found helpful in addressing these challenges? Please reply by responding in the comments section of this post.

For more on the nurses professional practice relationship with patients in the correctional setting see Chapter 2 Ethical Principles for Correctional Nursing as well as Chapter 19 Professional Practice in the Essentials of Correctional Nursing. You can order a copy from Springer Publishing and get $15 off as well as free shipping by using this code – AF1209.

References

American Nurses Association. (2013). Correctional nursing scope and standards of practice. Silver Spring, MD: American Nurses Association.

Dinkins, C. (2011) Ethics: Beyond patient care: Practicing empathy in the workplace. The Online Journal of Issues in Nursing 16(2).

Mercer, S. W. & Reynolds, W.J. (2002) Empathy and quality of care. British Journal of General Practice Quality Supplement 52: S9-S13.

Riess, H. (2013) The power of empathy. TEDxMiddlebury. Accessed 4/25/2015 at https://www.youtube.com/watch?v=baHrcC8B4WM

Ward, J., Cody, J., Schaal, M., & Hojat, M. (2012) The empathy enigma: An empirical study of decline in empathy among undergraduate nursing students. Journal of Professional Nursing 28 (1) 34-40.

Wiseman, T. (1996) A concept analysis of empathy. Journal of Advanced Nursing 23: 1162-1167.

Wiseman, T. (2007) Toward a holistic conceptualization of empathy for nursing practice. Advances in Nursing Science 2(3): E61-E72.

Photo credit: © Africa Studio– Fotolia.com

What’s new and news

Speaker at Business Conference and Presentation.First: What is new with Ebola since the last post? Another nurse from Texas and a doctor in New York are infected. The Centers for Disease Control has held two teleconferences with nurses across the country and issued revised infection control guidelines to prevent transmission of Ebola to health care workers. Also last week the American Jail Association disseminated guidelines developed by two jails in and around Dallas where the first case in the United States originated. I hope you have reviewed and perhaps revised your communicable disease screening and identification procedures as well as the availability and use of personal protective equipment consistent with these new recommendations.

NCCHC Fall Conference: Celebrity Chef Jeff Henderson was the key note speaker at the fall conference took place in Las Vegas last week. Henderson got his GED and learned culinary skills while serving a nine year sentence in Federal prison for drug dealing. Once released he continued to develop his culinary skills, eventually becoming Executive Chef at Café Bellagio and Caesar’s Palace in Las Vegas and writing four self-help books including his autobiography, ‘Cooked’. Now he works with young people to provide alternatives to getting involved in the illegal drug trade and is a motivational speaker. He has appeared on The Oprah Winfrey Show, Good Morning America, The Montel Williams Show, CNBC, NPR’s All Things Considered, People and USA Today.

My favorite of all the stories he told was about buying all the top ramen noodles he could afford from the prison commissary. He wasn’t interested in the noodles which he passed out to everyone on the cell block who wanted some. Instead he wanted the seasoning mix that was included with the noodles. As head chef, he used these to spice up the cheese wiz to make his nachos, now famous in prison lore. Jeff Henderson was a young man in prison when he read his first book, was called “son” for the first time, and had someone acknowledge something that he did well in school. He has a great message about self-help and a convincing perspective for all of us involved in the criminal justice system.

Here is a recipe from Cooked (pages 163-164). When Jeff makes fried chicken he still uses this recipe from Friendly Womack, who was the chief inmate cook at the federal prison outside Las Vegas when Jeff was serving time there.

Friendly’s Famous Buttermilk Fried Chicken

2 tablespoons cayenne pepper                                 2 teaspoons onion powder

3 tablespoons black pepper                                        4 tablespoons kosher salt

2 cups all-purpose flour                                                 1 quart buttermilk

1 chicken cut into eight pieces

  1.  Mix all of the spices together in a bowl. Put half the seasoning mix in another bowl. Add the flour to one bowl, mix well and set aside.
  2. Rub the chicken with the reserved spice mix. Poke all the pieces with a fork a few times and set aside. (Friendly taught me to pierce the chicken pieces with a fork so the buttermilk seeps down into the bird.)
  3. Pour the buttermilk into a stainless steel bowl. Add the remaining spices and the chicken pieces. Cover the bowl with plastic wrap and refrigerate for an hour.
  4. Dip the chicken pieces into the seasoned flour, pat the pieces together and make sure they are heavily coated.
  5. Drop them into a deep fryer or in a deep pan with enough vegetable oil to cover the chicken. Turn the chicken as it browns and remove once done.

News about the doings of contributing authors: Authors who contributed to Essentials of Correctional Nursing were also prominent during the NCCHC Conference. Margaret Collatt and Sue Smith gave a presentation about a project to develop guidelines for correctional nurses in chronic care management. In addition to Margaret and Sue, the group working on this project includes:

Sue Lane, RN, ASN CCHP                              Susan Laffan, RN CCHP-A CCHP-RN

Pat Voermans, MS, RN, ANP, CCHP-RN Patricia Blair, PhD, LLM, JD, MSN, CCHP

Lorry Schoenly, PhD, RN, CCHP-RN          Sabrina McCain, RN, ASN CCHP

Lori Roscoe, PhD, ANP-C, CCHP-RN          Debbie Franzoso, LPN, CCHP

They have two guidelines in development right now. One is on management of hypertension and the other concerns seizure disorders. The presenters encouraged nurses to participate in this process by commenting on the format for the guidelines and the topics that are important to correctional nurses. Watch for more news about this important project.

Mary Muse gave two presentations that serve to inspire the practice of correctional nurses. One was from the ANA Nursing Scope and Standards of Professional Practice on two steps in nursing process: Implementation and Evaluation. She used two case examples which always help to make standards real in their application to our daily practice. She also presented a session on the Transformation of Nursing Leadership reminding us of the challenges and expectations for nurses with the change resulting from the Affordable Care Act and the report from the Institute of Medicine (IOM) on the Future of Nursing.

Margaret and Susan Laffan teamed up to give four presentations throughout the conference. These included sessions on the cardiovascular examination, understanding lab values and critical thinking as part of nursing process. As usual with these two presenters, the sessions were full of practical information, fun and door prizes as well.

Margaret and Susan joined with Sue Medley-Lane for a session on Rejuvenation of Nursing Spirit. For Susan Laffan, rejuvenation comes when she dons her pink fuzzy slippers which you will sometimes see her smoozing around the conference in. These presenters discussed the demands of life that can contribute to a loss of spirit and ways to mitigate the cumulative effect of these experiences. They asked correctional nurses to tell the stories and describe the experiences that have inspired their commitment to the field and will collect these and send the collection back out to participants. If you have a story or experience that has been your inspiration for correctional nursing send it to njjailnurse@aol.com by November 30, 2014. The story must include your name, your state and your email address. It should be no more than 300 words long and the names of any patients in the story should be changed.

If you have some ideas about what you think the guidelines for nursing management of chronic care should include or subjects that should be covered please respond in the comments section of this post. If you have an inspirational story about correctional nursing that you would like to share please send it to Susan Laffan at njjailnurse@aol.com by November 30, 2014.

For more on correctional nursing read our book, the Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.

Caring in Correctional Nursing: Concluding Example

This guest post by Elissa Brody, BSN, RN, is taken from her submission to the 2013 Correctional Nursing Celebration Essay Contest.                       

Watson’s Transpersonal Caring: Care is authentic presence where the nurse honors the patient’s dignity and vulnerability.

Chamomile on barbed wireSeveral years ago, one Saturday, I was approached by a 29 year old white female (XX) in Outpatient Services* with lower extremity weakness.  XX reported she was having difficulty walking for several weeks and had gone to many sick calls.  A co-worker recommended for her to wait until Monday. I escorted XX to a treatment room and noticed that XX was holding onto the wall as she walked.  I got her chart, and started my assessment where she had bilateral strength in her upper extremities.  However, her lower extremities presented with considerable muscle weakness. Potential for falls was a nursing concern.

A chart review revealed that XX had had several sick calls for lower extremity weakness and, sure enough, she was referred to our medical provider. Per the medical providers note, an MRI was recommended, approved, and scheduled.  XX reported she had the MRI about two weeks ago but did not know the results.  Upon closer chart scrutiny, I found the MRI report and it revealed lesions in the brain with a radiologist note of probable MS [multiple sclerosis].  The provider, who ordered the MRI, was, luckily, on call that weekend.

The provider was pleasant over the phone and thanked me for investigating the patients compliant; finding the MRI results and calling him.  He ordered XX to be admitted to our inpatient infirmary and he would see her in the morning when he also explained the results of her MRI and started appropriate treatment. XX was very appreciative.

This scenario was an educational moment for the nursing staff to take all patient complaints and concerns seriously. Inmates are a vulnerable population in which nursing must advocate for their needs as they advocate for any patient’s need.  As a nurse educator in corrections, I remind the nursing staff, that they need strong assessment and therapeutic communication skills. The female correctional population has higher instances of physical abuse, sexual abuse, late to prenatal care, substance abuse and lack of medical care than populations outside of corrections.

I am proud to be part of Correctional Nursing where correctional facilities are viewed as public health stations that significantly impact the health status of the larger community. Nursing Services Motto is: “DOC Nursing: Caring from Within!”

* Outpatient Services is equivalent to an urgent care service.

Elissa Brody RN, BSN, is at present a Nurse Clinician 1 with the North Carolina Department of Public Safety. She has been a nurse for over 31 years and in healthcare for 35 years.  In addition to correctional nursing, she has worked as an RN in Med/Surg, Pulmonary Care Unit, Labor & Delivery, Mother Baby, Nursing Homes, and as a Clinical Instructor at LPN, RN, & BSN programs. Elissa’s current responsibilities as a nurse educator include orientation of all new Health Services staff, Nursing Orientation, Medication Tech. week long training course, CPR for all Health Services staff, training reports to make sure Health Services staff have their 40 hours annual training requirements as well mandatory classes. 

Read more about caring in correctional nursing practice in Chapter 2: Ethical Principles for Correctional Nursing from Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.

Photo Credit: © Semen Pazekov – Fotolia.com

Caring in Correctional Nursing: More Examples

This guest post by Benjamin S Kanten, MBA, MSN, RN, CCHP-RN, is taken from his submission to the 2013 Correctional Nursing Celebration Essay Contest.

barbed wireCorrectional nurses are sometimes viewed as cool, callous, uncaring, or insensitive to the health needs of patients. The image of Nurse Ratchet might come to mind for some. And there are those in this specialty who have fairly earned such a reputation. Is that any different than any other area of nursing practice? We can all think of a nurse (or many) we have encountered who lacks empathy, compassion, and sensitivity to patients’ needs. On the whole, though, correctional nurses care just as much as nurses in any other setting. Being a successful correctional nurse requires that we live out Watson’s theory on caring every day. Doing anything else would place our patients, and us, at risk.

Correctional nurses must develop the trust of their patients. It is often said in corrections that you must do what you say. If you do not, you will fail to get the trust of your patients and you will not be able to effect individual change or help the population you serve. By being reliable, saying what you will do and then following through, being forthright with patients about what is possible and what is not, the correctional nurse begins to develop rapport and trust in patients. With time, this trust will move beyond the individuals and towards being seen “on the yard” as the nurse who is honest and can be trusted with sensitive matters.

Correctional nurses inspire hope in their patients. Through education and health promotion, we inspire our patients to look towards the future, developing realistic goals for themselves such as weight loss, changing diet selections, implementing an exercise regimen, or becoming familiar with seizure triggers. Though some of these changes are small, such self-care measures empower patients to take control of their health and thus begin to change the path they are on. For some patients in corrections, this may be the first ray of sunshine they experience and can enable them to make other life changes such as moving away from criminality and towards reintegration into mainstream society.

Correctional nurses help patients meet the myriad of human needs. For nurses in short-term detention centers, the focus may be more on meeting the patient’s lower level needs for safety, security, and survival. In all settings, correctional nurses work to meet these needs. We help ensure that the facility provides a safe environment by securing sharps, keeping infections from spreading, secluding mentally ill and violent patients, participating on health committees, and more. In longer-term detention, nurses have the opportunity to address higher-level needs after establishing trust by meeting lower level needs. Nurses can then begin to help patients move towards personal growth. Correctional nurses empower patients to engage in self-improvement such as vocational training, group therapy, reduction of criminal thinking, development of healthy coping strategies, and much more. The correctional nurse works to ensure that the patient is healthy enough to participate in rehabilitation, but also helps inspire the patient to want to participate in the process.

These are but a handful of the ways correctional nurses practice Watson’s caring theory on a daily basis. Correctional nurses are first and foremost nurses, caring individuals committed to the wellbeing of others. The fact that they practice behind bars does not change the fundamental nature of their character and profession. Let us remember that correctional nurses are present with people in their darkest hours, holding forth the lamp of knowledge and let us spread the positive work about our caring specialty practice.

KantenBenjamin Kanten began his correctional nursing career in 2004 as a staff nurse with the Federal Bureau of Prison. He spent the next six years working as a nurse, infection control officer, and quality improvement officer at the Federal Correctional Institution at Bastrop, Texas. In 2010 he transferred to the Immigration and Customs Enforcement (ICE) Health Service Corp clinic at Taylor, Texas. After two years as a staff nurse, he assumed the position of nurse manager at that facility in 2012.

Read more about caring in correctional nursing practice in Chapter 2: Ethical Principles for Correctional Nursing from Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.

© Vasiliy Koval – Fotolia.com

Caring in Correctional Nursing: Another Example

This guest post by Patricia Rolling, RN, is taken from her submission to the 2013 Correctional Nursing Celebration Essay Contest.

sunflowers grow in the prison in front of the barbed wireI remember on my first day of nursing school my classmates and me being asked what type of nursing we wanted to practice. I remember some of my classmates answering “pediatrics” and “mother/baby”; after all, babies are cute. The adrenalin junkies in my class answered “ER” or “ICU”. What I don’t remember is answering “correctional nursing”. That’s probably because I didn’t. I didn’t know what correctional nursing was. Fast forward to today and I can’t imagine myself doing anything else. All too often, nurses that choose to practice correctional nursing are viewed by their peers as misfits that somehow can’t make it anywhere else. This is so untrue!

It takes a special level of caring to be able to provide care for those people that society has deemed unworthy.   There is more to nursing, though, than just caring and the prison environment makes some of those other aspects a bit more challenging. Privacy is virtually impossible to come by in an environment where safety is and must be the primary objective. The nurse/patient relationship works best when it is one of equality and mutual respect. The inmate/correctional officer relationship by its very nature is one of inequality and hierarchy.  B. Jaye Anno states in her book Correctional Health Care   “The purpose of medicine is to diagnose, comfort, and cure; the purpose of correctional institutions, although sometimes rehabilitative, is to punish through confinement.” (B. Jaye Anno, 2001) In order for these two diametrically opposing concepts to coexist, a correctional nurse must have a strong, personal and ethical commitment to the patients she cares for. She must be committed enough to her patient’s welfare to be able to advocate for them when their needs and those of the correctional personnel are in conflict with one another.

The third element of Watson’s Transpersonal Caring states, “Care is authentic presence where the nurse honors the patient’s dignity and vulnerability.” Nowhere is this more evident than when working in the Receiving Room. In Delaware, where I practice, we have a jail/prison system. What that means is that because there are no county jails, when I see a patient in Receiving they have been in the custody of the State or local police for perhaps 6-8 hours. They are feeling scared, overwhelmed and very vulnerable. Within the few short minutes after their arrival and before they meet with me, they have been fingerprinted; strip searched and assigned a number that will effectively serve as their identity for the remainder of their stay in prison. In other words they have been stripped of their human dignity. Then I come along and ask them very personal questions such as have they ever been the victim of sexual or physical abuse, as well as asking whether they drink alcohol or do drugs. In order to get the honest responses that will allow me to render the appropriate level of care, I have to quickly establish a rapport that makes it clear that I can be trusted. I have a very short period of time to make it understood that I am NOT security and that what they say to me will be held to the same level of confidentiality as if we were in a hospital or a private doctor’s office. Since I am the first person from the medical department that they have any contact with, it is imperative that I set into motion a relationship based on honesty and respect that will last as long they are in custody. At the same time I have to make it clearly understood that I will not be manipulated or used by them to achieve their own personal goals. It is definitely a fine line to be delicately trod.

I have learned, and am still learning, how to give the level of caring, compassionate and medically appropriate care that I want to give and that my patients deserve to be given while also maintaining the necessary professional distance and keeping the necessary degree of personal safety. Which brings us back to the original question, “Do Correctional Nurses Care?” While I can’t answer for any other correctional nurses I can say unequivocally “This correctional nurse does”!

RollingPatricia Rolling, RN, is a relatively new correctional nurse having started at James T Vaughn Correctional Center in Smyrna Delaware just over a year ago. She has rotated through several positions at the facility and is currently the 11p-7a clinic nurse. She most enjoys working in intake where she is able to set the stage for the new inmate’s relationship with the correctional medical staff. Her next goal is to attain CCHP certification this summer.

Read more about caring in correctional nursing practice in Chapter 2: Ethical Principles for Correctional Nursing from Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.

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