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 

Spring Cleaning Comes to Your Workplace

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.Spring Cleaning

With part of the country still experiencing cold temperatures, flooding and high winds, it is hard to think about spring cleaning. However, it is May and that directs our attention to getting our house in order. The big question is what about our workplace? Have you looked around your nurse’s station or clinic exam room lately? How does it look to you? How does it look when the warden or sheriff brings a tour through the medical unit? We get accustomed to our workplace and where to find the things “we” need, but what about the next shift or the new nurse? Nurses use their knowledge and skills to make a pathway to health for our patients; we should expand our viewpoint to include the workplace, by caring for ourselves and each other.

Convenient Work Environment

Some months ago Lorry published a post about the messy medication room and made the point that since medication rooms are very complex, efficiency depends on having areas organized for ease of locating, checking and storing. The set up and maintenance of a medication room can make or break the safety of delivering medications. The same can be said for other work areas, whether it is a nurse’s station, exam room, emergency room or laboratory.

Let us take a look at some important areas in your workplace:

  • Is the phone within easy reach?
  • Is the policy and procedure book/s close by or on the computer?
  • Are medication and other health related reference books nearby?
  • Are emergency phone numbers and facility contact lists posted or easily available and easy to read?
  • Is the desk area, free from clutter, with room to write?
  • Are pens, pencils, staplers, post-it notes and note pads available?
  • Are the forms you use often in files or on shelving close by?
  • Are the necessary logs, notebooks or other materials labelled and close by?
  • Is there adequate lightening for reading and writing?
  • Is the equipment in the exam room all that is needed?
  • Are instruments for procedures organized and stored in labelled cupboards?
  • Are necessary medications and other diagnostic materials available and not outdated?
  • Is the desk and chair you use ergonomically set for comfort and support.

Reality of Work Units

In the world of correctional health care, many medical units in jails, prisons and juvenile facilities are in older buildings or built as an afterthought. Nurses’ stations and exam rooms may be in a storage room or at the end of a hallway. In older buildings the floors, lighting, electrical outlets and location within the building may not be desirable. Fortunately over the last decade, more facilities have consulted with health care personnel when planning the medical area, and the results have been medical units that are located centrally to the housing units, are well lit, with wide hallways, adequate electrical outlets and cabinets. Whether, a medical unit is modern or just one room in an older facility that used to be used for something else, the space must make your work efficient and safe.

Key factors in safe and efficient workplaces are:

  • The area must be clean.
  • The area must be organized.
  • The things you need should be where you need them.
  • There must be a plan for cleaning, maintenance and stocking.

So What About Spring Cleaning

The first thing staff mention when talking about cleaning or organizing the work place, is “we do not have time to do that”, “night shift has more time than we do”, “hire someone to clean medical”. There may indeed be a custodial service that cleans the medical unit with vacuuming, dusting and emptying the garbage. Some facilities have inmate workers or porters that clean. We are not talking about vacuuming alone, we are talking about having the things necessary to do your job nearby, organized and free from clutter. The custodians or porters will not put the nursing protocol assessment forms in order or order more forms.

The National Safety Council published an article on 25 steps to a safer office. Most of the points are translatable to a medical unit. The article mentions having a clutter free environment, adjustable equipment for support, mouse placement that prevents neck and back stress and even electrical cord safety. For more about the suggestions from this organization to assist in spring cleaning just click on this hyperlink.

Quality Improvement Project

Why not make spring cleaning a quality improvement project? This approach helps you to prioritize so the project is accomplished. Use the Plan Do Study Act (PDSA) cycle for this project:

  • Plan-Schedule an agenda item at a staff meeting or shift change time to talk about your workplace. Gather ideas and draw a template or picture of the ideal work station or exam room. Collect the supplies, equipment, files, shelves etc. that may be needed to bring your workplace into alignment with the template.
  • Do-Schedule a specific time period in which to accomplish the project, make assignments and have all the supplies in place. The template shows everyone what the area should look like when cleaned and organized.
  • Study-After a few weeks gather input about what works or needs improvement. For a formal process, send out a survey. Analyze and discuss the feedback to determine the next steps in spring cleaning your workplace.
  • Act-Follow up by making adjustments to the workplace and continue the cycle if more improvements are identified. If the selected work area seems to be in good working order you can move onto another area of the medical unit.

Enjoying your workplace and having a safe and efficient place to work together is what we all desire. The workplace reflects pride in our work and correctional health care.

If you have completed spring cleaning or improvements in your workplace, share with us in the comment section below. We enjoy hearing about your accomplishments and what might assist others with plans for spring cleaning!

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

Photo credit: © Monkey Business – Fotolia.com

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.

Patient Safety: Four Easy Pieces

Could this happen in your work setting?

An inmate was evaluated for a heart condition and found to have several blocked coronary arteries. He was scheduled for cardiac stents at the local hospital where the prison had an agreement for services. He had the stents placed and returned to his cell block the following day. He returned with one discharge order sheet that included a note at the bottom to “see page 2”. No second page was included with the discharge order sheet. A nurse practitioner reviewed his one page of discharge orders, confirmed them, and wrote on the medical order sheet that there were no changes to be made. This was interpreted to mean no changes to the patient’s pre-procedure medications and he was returned to his prior medication regimen. Meanwhile the 2nd page of the discharge orders was faxed directly to the prison medical director. The medical director reviewed them during office hours the next day and placed the orders in his outbox for transcription and return to the chart. That order sheet never got to the chart. The patient told the medication technician who administered medications on his housing unit that he was supposed to be getting Plavix after his procedure. The med tech told the patient that there was no order for Plavix and he was mistaken. The patient continued to ask about the Plavix at subsequent medication lines with similar response. One staff member told him the medication was nonformulary and there might be a 3-5 day delay in obtaining it. Six days after the procedure the patient had crushing chest pain and returned to the hospital where it was found that two of his stents had occluded and required emergency treatment. Fortunately the patient survived the experience.

In a previous post I explained how, even though I am nervous about crashing when flying, there are more deaths each year from clinical errors than from airplane crashes. We would do well to focus in correctional health care on patient safety as there is such a significant return on our time investment. But, where do we start?

Patient safety experts developed a 3-part model for explaining components of a safety paradigm in the traditional health care setting. I adapted this model to the correctional setting and added a 4th element – the care environment to the original representation. As many of us practicing in the criminal justice system know, the environment in which we work has a significant effect on care delivery and outcomes.

Consider how each of these four patient safety elements might have affected the outcome of the case presented above.

Environment of Care

The environment is primarily the organizational culture of the workplace but can also include the physical environment such as the design of the care delivery setting and the available equipment and supplies. The secure environment of the criminal justice system adds intensity to the environment of care by also imparting a unique set of values and cultural norms. There can be a true culture clash or a struggle with dual loyalties among the care staff. We often talk about the impact of the security culture on health care delivery. The inmate culture also has an effect on patient safety. There develops a culture of mutual mistrust that can poison the patient-practitioner relationship. How might the organizational culture in the case presentation have affected the actions of the care team?

Systems for Therapeutic Action

Patient care is delivered through a complex system of intertwined processes. Patients and practitioners interact with these systems within the environment of care. Patient safety principles can increase the reliability of care systems; reducing error and improving outcomes. Do you think there were some real system failures in the case above?

Patient

The patient is also a vital part of the safety framework. Interacting with health care workers and the systems of therapeutic action within the environment of care, patients have opportunity to actively participate in and monitor care delivery. There are many barriers to engaging patients in the criminal justice system that must be considered and overcome. Was the patient a factor this critical incident?

Practitioner

The competence and judgment of health care staff is a major factor in patient safety. Staff interact with the patient and take therapeutic actions to deliver health care. Internal and external factors such as fatigue, work stress, impairment and shift rotation affect our abilities to deliver safe care. Emotional issues like burn out, vicarious trauma and compassion fatigue affect our clinical judgment. Could any of these be attributed to the actions taken in this case?

By using this model of patient safety in correctional health care, a full evaluation of the missing Plavix case can be undertaken and system improvements initiated.

Share your thoughts on what you would investigate further in the comments section of this post.

Of Airplanes and Patient Safety

Let me tell you a little secret. I’m not very fond of air travel. In fact, when I am preparing for a flight like the one that I took recently to speak in Sacramento, I had to distract myself from picturing all kinds of plane disasters. But, really, what were the chances that my plane would be hit by lightning or have engine malfunction and crash over the Rocky Mountains? Pretty slim, right? In fact, the most fatalities from air travel were clocked in the year 1972 when 2,429 people died in air crashes around the world. Most years are well below 1000; and this is worldwide. Much can be said for the safety mechanisms hardwired into high-risk airline industry.

How do you think that compares to deaths from medical errors? A 2013 study in published in the Journal of Patient Safety found there are as many as 440,000 deaths from hospital errors each year; and that is just in the United States! This is equivalent to 1000 jumbo jet crashes a year or wiping out the entire city of Colorado Spring…every year.

This calculation of deaths from clinical errors is based on traditional hospital care information. Unfortunately, we have no nation-wide data collection process for correctional health care. What do you think, though? Is our patient care likely to be safer than that provided in hospitals? Possibly. However, there are indications that our delivery systems may be even more risky given the nature of our patient population and environment.

Keeping our patients safe from clinical error, then, is an important part of our professional practice. Patient safety emerged as a concern in the early 1990’s. The Harvard Medical Practice Study published in 1991 is credited with starting the movement when it identified higher than expected rates of preventable medical errors. Over the last two decades, the patient safety movement has developed into a primary focus in traditional settings but is only now gaining interest in correctional health care. Yet organizing health care processes around patient safety can be particularly helpful in a setting such as correctional health care where the fragmented nature of care delivery, the transient nature of the patient population, and the added application of security structures can overwhelm and overshadow patient care.

As health care clinicians, focusing on the best for our patients through a patient safety perspective is a satisfying way to view our role, our values, and our professional goals. In addition, a patient safety perspective allows us as clinicians to fully address the ethical basis of our profession – beneficence (doing good) and nonmalfeasance (not harming).

I made it to Sacramento unharmed; in large part due to the many safety mechanisms in place to be sure the flight was safe. Regrettably, I review many an incident in correctional health care that indicate missing or omitted safety procedures.  How can we make correctional health care practice more like the airline industry? Any thoughts?

On Being Thankful

Be thankful for what you have; you’ll end up having more. If you concentrate on what you don’t have, you will never, ever have enough.” – Oprah Winfrey

Heart shape hands on the blue sky

As a reforming whiner, I often need reminding to be thankful. Yes, given the choice between appreciating a situation and complaining about it, I will regularly choose the later. That’s why I so appreciate having a holiday every year that focuses on gratitude and thankfulness. What better way to re-center our thoughts on the good in our lives and the contributions of others?

With that in mind, I’d like to offer my Thanksgiving gratitude list (not in any particular order):

  • Correctional Nurses: Frankly, I didn’t know correctional nurses existed 10 years ago. When I discovered this invisible nursing specialty, I know I found a home. It has been a blast getting to know so many nurses who work in difficult environments with often-difficult patients. Our patient population is marginalized and vulnerable, frequently forgotten by society and the traditional healthcare system. I am grateful for your work on behalf of our patients and delighted to have meet so many of you in my travels and through this blog.
  • Blog Readers: Speaking of blogs, Catherine and I are energized by the number of visits and comments on our posts over the years. You are our inspiration and the focus of our efforts.
  • Professional Associations: I am truly thankful for professional associations like National Commission on Correctional Health Care and the American Correctional Health Services Association. These organizations do great work in advancing correctional nursing practice and providing a wonderful venue for networking and communication. I enjoyed meeting many of you at NCCHC and ACHSA conferences this fall.
  • Correctional Officer Colleagues: This Thanksgiving season I have been pondering the great contribution of correctional officers to both public safety and the personal safety of correctional nurses throughout the criminal justice system. Our CO colleagues live with similar social stigma and feelings of invisibility. We are all in this together and need to support each other.
  • Family and Friends: Without the support of my husband, family, and friends I could not do what I do. Those I know who have much family stress and drama have no energy left to create new things. I often forget that I am free to write and speak and learn new things because I have a great support system.
  • A God Who Cares: Having a caring God who made me unique and expects me to use the gifts He gave me is also a cause to be thankful. Even when everything is ‘going wrong’ there is a comfort in knowing there is a plan in play and I don’t necessarily need to know what it is. I do need to do my part, though, by making a difference where I am with what I have been given.

Cultivating Gratitude in the Year Ahead                      

I am inspired to renew my efforts to reduce whining and increase appreciation this coming year. Are you with me on this? Here are two ways I’m going to increase my gratitude and decrease my whining:

  • Count My Blessings: Spend regular time meditating on the simple blessings of life such as a roof over my head and food on the table.
  • Say Thanks: Consciously sharing gratitude for friendship, support, assistance, and information provided by others in day-to-day living.

Will you join me in my efforts to ‘keep on the sunny side’ in the days ahead? Rather than concentrating on what is missing, as Oprah states, we can focus on what we have and end up having more!

Leave your suggestions and encouragement in the comments section of this post.

An earlier version of this post first appeared on CorrectionalNurse.Net