Best of the Blog #1: The Five Rights of Delegation

We searched through the stacks of almost 200 blog posts to pull out the most popular ones for this series. If you are new to the Essentials of Correctional Nursing Blog you may have missed some good reads. Enjoy!

This post, written by Catherine Knox, originally aired January 13, 2013.

The post last week included a case example about a licensed practical nurse (LPN) responding to a medical emergency after an altercation between two inmates. The LPN determined that neither inmate required further medical attention. Later in the shift one of the inmates was taken to the emergency room after being found unresponsive in the cell. The inmate subsequently died of the head injury that was sustained in the altercation. This example highlighted the registered nurse’s role in the assignment and supervision of patient care. Correctional nurses use their knowledge of state regulations defining the scope of practice for personnel assisting in the delivery of patient care as well as the employers’ expectations (job description, post orders, policy and procedure) to assign and supervise these personnel.

The American Nurses Association (ANA) describes correctional nurses as responsible for direction of patient care including the assignment and delegation of tasks to others (2007). These responsibilities are unchanged in the draft of the 2013 edition of the Correctional Nursing: Scope and Standards of Practice which was posted at http://www.nursingworld.org/Comment-Correctional-Nursing.html.aspx. Delegation has been described as an essential skill and yet is one of the most difficult responsibilities of a registered nurse. It is a complex process that requires sophisticated clinical judgment about the patient care situation, the competence of staff and the degree of supervision required (Weydt, 2010; NCSBN, 2005).

There are many resources available to help nurses build skill and competency in delegation of patient care tasks. The state board of nursing is an excellent first resource as well as the National Council of State Boards of Nursing (NCSBN) website which can be accessed at https://www.ncsbn.org. A resource suggested in the Essentials of Correctional Nursing is a framework for delegation from the NCSBN referred to as the Five Rights of Delegation (1997). These are discussed in relation to the case example from last week’s post.

1. Right Task: The nurse makes an assessment of the patient or a group of patients and determines that an activity can be delegated to a specific member of the health care team. Knowledge of state practice acts and agency directives are essential when making decisions about what patient care tasks can be delegated. In the case example the registered nurse’s decision to have the LPN respond to the medical emergency was problematic because the LPN was required to assess and make a complex clinical decision about the inmate’s need for medical care.

2. Right Circumstances: The nurse’s assessment of the patient or group of patients also identifies the health care need(s) to be addressed by the delegated task(s) and the goal or outcome to be achieved. The nurse’s decision about which task(s) to delegate matches the staff’s competency and level of supervision available. The registered nurse in the case example did not assess the patient’s needs or identify the outcome to be achieved by the task that was delegated to the LPN. The nurse also made no judgment about what level of supervision or monitoring would be appropriate in the circumstance.

3. Right Person: The registered nurse considers the skills and abilities of individual personnel in making decisions about delegation of tasks. The registered nurse works with each member of the team to improve performance and implements remedies when performance is below standard. In the case example the LPN had considerable experience responding to medical emergencies at the correctional facility and had worked in the emergency department at the local hospital. The registered nurse did not understand that monitoring or supervision of the LPN’s performance was required as part of the state practice act and expected by the employer.

4. Right Communication: The registered nurse communicates specifically what, how and by when delegated tasks are to be accomplished. Communication includes the purpose and goal of the task, limitations and expectations for reporting. In the case example there was no meaningful communication that took place between the RN and LPN. The LPN was not expected to communicate assessment data to the nurse and no limitations on the LPN’s actions were stipulated. The LPN reported the conclusion that both inmates were “okay” but was asked no follow up questions by the RN to amplify the basis for the decision. The LPN did not communicate with the registered nurse when the inmate was later found unresponsive even after the “on call” physician was called.

5. Right Supervision: The registered nurse monitors and evaluates both the patient and the staff’s performance of delegated tasks.  The registered nurse is prepared to intervene on behalf of the patient as necessary and provides staff feedback to increase competency in task performance. In the case example the RN had several opportunities to monitor the patient’s care and to intervene but failed to do so. The nurse was unaware of the responsibility to monitor and supervise the LPN in the performance of the delegated task. The nurse said that the LPN always provided the response to medical emergencies and did not think the RN could alter this “assignment”.

Conclusion of the Case Example: The agency policies, procedures and the description of job duties were consistent with state practice guidelines but were too general. The nurses were not familiar with the nurse practice act and had simply continued practices on the evening shift that had been in place at the time, including staff defining the duties that they were most comfortable performing. The “after action” review resulted in increased staff knowledge of the nurse practice act, coaching of the nurses on delegation of tasks, and increased communication between staff on shift about the goals and process of patient care.

Your thoughts about this subject are important to us. Have you had experience clarifying nursing scope of practice in correctional health care?  What tools or resources did you find most helpful? Please share your experience and advice in the comments section of this post. For more information and discussion about correctional nursing order your copy of the Essentials of Correctional Nursing directly from the publisher. Use Promo Code AF1209 for $15 off and free shipping.

References:

American Nurses Association. (2007). Corrections Nursing: Scope and Standards of Practice. Silver Spring, MD: Author

National Council of State Boards of Nursing and the American Nurses Association. (2006). Joint Statement on Delegation. Retrieved December 31, 2013 at https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf

National Council of State Boards of Nursing. (1997) The Five Rights of Delegation. Retrieved December 26, 2012 from https://www.ncsbn.org/fiverights.pdf

Weydt, A. (May 31, 2010). Developing delegation skills. OJIN: The Online Journal of Issues in Nursing. Vol. 15, No. 2, Manuscript 1 

Photo Credit:   © igor– Fotolia.com

 

Best of the Blog #2: Correctional Nurse Certification Options

We searched through the stacks of almost 200 blog posts to pull out the most popular ones for this series. If you are new to the Essentials of Correctional Nursing Blog you may have missed some good reads. Enjoy!

This post, written by Lorry Schoenly, originally aired July 19, 2012.

Blank award ribbon rosetteHave you considered certifying in the correctional nursing specialty? Most established specialties have a certification process. Correctional nursing has several options for your consideration. Is certification for you?  According to the American Nurses Association, certification validates nursing skills, knowledge, and abilities. In addition, they contend that certification contributes to better patient outcomes. Certified nurses are role models of professional accountability. Certification empowers nurses and validates their understanding of the unique nature of their specialty. It can lead to increased self-esteem, job satisfaction and respect. Certified nurses distinguish themselves through a commitment to lifelong learning and career advancement, according to the American Association of Critical Care Nurses.

In Chapter 3: Legal Considerations in Correctional Nursing of the Essentials of Correctional Nursing, Jacqueline Moore, PhD, RN, CCHP-A, CCHP-RN suggests that another benefit of certification may be decreased liability. Since certification is fairly new in correctional nursing, the jury is still out on that aspect.

Certification is not only important for the individual nurse, it is also important to the correctional nursing profession. The development of specialty certification for correctional nursing is an important milestone. It helps to legitimize the specialty of correctional nursing and validates that professionals possess a unique body of knowledge and skills. It inspires other correctional nurses to seek certification and stimulates interest in correctional nursing research. Correctional nursing certification is another action toward enhancing and fostering professionalism in this specialty.

There are two main certifications available to correctional nurses.  The National Commission on Correctional Health Care (NCCHC) awards the CCHP-RN (Certified Correctional Health Professional – Registered Nurse) to registered nurses working in the correctional setting. The American Correctional Association offers two certifications:  CCN (Certified Corrections Nurse) is a generalist certification and CCN/M (Certified Corrections Nurse/Manager) is a manager certification. Certification requirements and exam content areas are listed below.

Eligibility Requirements

CCN-Licensed RN, LPN, LVN; One (1) year work experience in correctional nursing in present position

CCN/M – Registered Nurse (RN) in good standing with State Nursing Board;  Associate, Bachelor of Science, Master of Science in Nursing, or a three (3) year Nursing Diploma;  One (1) year of Correctional Nursing Management experience; individual supervises other medical personnel and administrative staff

CCHP-RN – Current CCHP certification;  Current, active RN license within a U.S. state or territory or the professional, legally recognized equivalent in another country, not restricted to corrections only;  Equivalent of 2 years full-time practice as a registered nurse (2,000 hours of practice in a correctional setting within the last 3 years);  54 hours of continuing education in nursing, with 18 specific to correctional health care, within the last 3 years

Certification Exam Content Areas

CCN & CCN/M

CCHP-RN

Health care in corrections Clinical management of patients
Legal issues in corrections Promotion of a safe & secure health care environment
Mental health Health promotion & maintenance
Nursing practice & standards Professional role & responsibilities
Managing security & environment
General & offender management
Conflict management
Human resource management

Have you taken one of the certification exams described above? How has it benefited you?

Photo Credit: © valdis torms – Fotolia.com

Best of the Blog #3 – New Scope and Standards of Practice for Correctional Nursing

We searched through the stacks of almost 200 blog posts to pull out the most popular ones for this series. If you are new to the Essentials of Correctional Nursing Blog you may have missed some good reads. Enjoy!

This post, written by Catherine Knox, originally aired June 14, 2013.

On May 27, 2013 the American Nurses Association (ANA) published the new edition of Correctional Nursing: Scope and Standards of Practice (2013).  These are broad parameters defining our specialty area of practice that transcend geographic location (south, east, west, midwest), type of employer (public/private, jail, prison, detention center), and the various populations served in correctional health care (sentenced, unsentenced, juvenile, female etc.).  The standards define who, what, where, when, why and how of nursing practice (ANA, 2010, p.2). The ANA standards are used 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

Correctional nursing was first acknowledged as a specialty practice by the ANA in 1985. At that time, the first standards for the specialty were published as: Standards of Nursing Practice in Correctional Facilities. Since 1985 the standards for correctional nursing have been revised four times.  This revision was the result of collaboration among seventeen correctional nursing leaders representing various settings and organizations. Input from correctional nurses was sought at various conferences, by survey, and during a public comment period over a period of eighteen months. The input from practicing nurses was incorporated into the description of the scope of correctional nursing practice.

Patricia Voermans MS, RN, APN, CCHP-RN, chairperson of the task force described this edition as “expanding the description of the patient population and addressing the challenges of delivering evidenced based care in the correctional setting.  It also discusses the evolving role of nurses in coordinating care, developing policy and continuing leadership in correctional health care” (April 22, 2013).

Correctional nursing is defined 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, and delivery of health care to individuals, families, communities, and populations under the jurisdiction of the criminal justice system” (ANA, 2013).  It is the location of nursing care, with its unique population demographics, environmental constraints and ethical dilemmas that defines our specialty practice (Voermans, Schoenly & Knox, April 22, 2013).

There are sixteen standards of correctional nursing practice in the new edition. The first six standards delineate the steps used in the nursing process. The next ten standards define the professional role of nurses in the correctional setting. This edition emphasizes the importance of communication and collaboration in the delivery of safe and effective patient care. The areas covered by the standards are listed in the table below.

Table 1: Scope & Standards of Practice for Correctional Nurses
     Practice      Professional   Performance
1. Assessment 7. Ethics
2. Diagnosis 8. Education
3. Outcomes Identification 9. Evidence-Based Practice and Research
4. Planning 10. Quality of Practice
5. Implementation 11. Communication
6. Evaluation 12. Leadership
13. Collaboration
14. Professional Practice Evaluation
15. Resource Utilization
16. Environmental Health

Correctional nursing: Scope and standards of practice. (2013). 2nd Edition. Silver Spring, MD: American Nurses Association.

Each standard is further defined by the competencies registered nurses and graduate-level prepared or advanced practice registered nurses (APRN) are expected to demonstrate in meeting the standard. Competency is defined as the integration of knowledge, skills, abilities and judgment needed to achieve an expected level of performance (White & O’Sullivan 2012). The registered nurse is responsible for maintaining professional competence and accountable for each of the decisions made in their nursing practice.

Standard 16 on Environmental Health is a new standard and requires the correctional registered nurse to practice in an environmentally safe and healthy manner. Environmental health is the assessment and control of factors in the environment that can potentially affect health.  Two of the competencies of the correctional registered nurse in this area of practice are:

  • Knowledge of environmental health concepts, with implementation of environmental health strategies.
  • Reducing environmental health risks for workers, patients, and others in the correctional setting.

To experience how the ANA standards are applied in day to day practice they have been interwoven into every chapter of the Essentials of Correctional Nursing which can be ordered directly from the publisher. If you use Promo Code AF1209 the price is discounted by $15 off and shipping is free.

Copies of Correctional Nursing: Scope and Standards of Practice, 2nd Edition (2013) can be ordered from the ANA at http://nursesbooks.org/Homepage/Hot-off-the-Press/Correctional-Nursing-2nd.aspx. When you receive your copy of the new edition of the ANA standards one suggestion is to assess your competency to practice in conformance with each of the standards.  Select one or more areas that you would like to improve and develop a plan to do so.

We will share more about how to use the standards in correctional nursing practice in future posts.  In the meantime what experiences have you had applying the ANA Correctional Nursing: Scope and standards in your daily practice?  What tools or resources did you find most helpful? Please share your experience and advice in the comments section of this post.

References:

American Nurses Association. (1985). Standards of nursing practice in correctional facilities. Washington, DC: American Nurses Association.

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

Schoenly, L. (2013). Overview of Correctional Nursing. In Schoenly, L. & Knox, C. Essentials of Correctional Nursing. New York: Springer.

Voermans, P., Knox, C., Schoenly, L. (April 22, 2013). Correctional Nursing: Applying the New Scope and Standards of Practice. NCCHC Spring Conference 2013, Denver, Co. Accessed May 8, 2013 at http://ncchc.sclivelearningcenter.com/index.aspx?PID=4622&SID=172421

White, K., O’Sullivan, A. (2012). The Essential Guide to Nursing Practice: Applying ANAs Scope and Standards in Practice and Education. American Nurses Association. Silver Springs, MD.

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

Best of the Blog #4 – Barriers to Effective Delegation

Human Intelligence and CreativityWe searched through the stacks of almost 200 blog posts to pull out the most popular ones for this series. If you are new to the Essentials of Correctional Nursing Blog you may have missed some good reads. Enjoy!

This post, written by Catherine Knox, originally aired February 11, 2014.

If delegation is a fundamental aspect of nursing practice why do nurses find it difficult? Part of the reason is that as the resources to provide care shrink and the environment for care becomes more complex the importance of delegation has become more apparent. Nursing care today is delivered in correctional settings by a wide variety of personnel (registered nurses, practical or vocational nurses, unlicensed assistive personnel, etc.) each with different educational preparation and scope of allowable practice. Correctional nurses also work in a very restrictive and challenging environment with a very diverse patient population which has complicated health care needs. The National Council of State Boards of Nursing (NCSBN) identifies delegation as a “complex process of professional practice requiring sophisticated clinical judgment” (2005) and yet many nurses received little formal training in delegation during their education and employers rarely evaluate and develop nurses’ delegation skills as they do other clinical competencies (Weydt, 2010). Well no wonder nurses find delegation challenging!

The American Nurses Association (ANA) recently asked nurses what barriers to delegation they were experiencing as part of the process of updating the Principles for Delegation (2012). Three major barriers were identified and each is discussed below:

Poor partnerships: It is difficult to delegate when the nurse does not know the staff or their capabilities. It is also not practical to assess each of the staffs’ skills in all areas before making a delegation decision. Participating in the orientation of new staff is one way to get to know what skills are evaluated and to become familiar with the capabilities of individual staff.  Nurses should also periodically review staff competency records. Working together is an opportunity to build partnerships with each of the staff.  Good quality partnerships are correlated with improved patient safety (McCoy & Duffy, 2013).

Attitudes: Nurses express concern that delegation results in loss of control over patient outcomes. Another way of saying this is …“If I am held accountable for the patient, why should I delegate?”  This was discussed in last week’s post on the principles of delegation. The staff person accepting delegation is responsible for performing the assignment and accountable for accomplishing it safely and correctly. Therefore the nurse’s accountability is for the patient, not the staff’s performance. This is because the nurse retains authority to direct the patient’s ongoing care. Knowing how to identify and evaluate patient outcomes are critical aspects of accountability and delegation of patient care. These competencies are described in Standard 3 of the ANA’s publication Correctional Nursing:  Scope and Standards of Professional Practice and can be used by nurses as a resource in developing delegation skill (2013).

Sometimes the nurse goes on to say “…especially someone I either don’t know or don’t trust?” Trust comes from concentrating on building good interpersonal relationships while working together.  Delegation is an invitation to participate in the delivery of care and when delivered in a respectful and conscientious manner it promotes communication. When meaningful two-way communication is increased the quality of patient care improves (Corazini et al. 2013).

RN Leadership: The third barrier identified was lack of sufficient registered nurses to support effective delegation. Contributing factors were nurses’ lack of experience with delegation, insufficient ratio of registered nurses in the staff mix, and administrative work that supersedes clinical care.    Many correctional facilities do not have a strong structure to support professional nursing practice with policies, procedures, job descriptions and other directives or guidelines that are consistent with state laws and regulations. Uninformed or ill-advised managers may not fully support a healthy workplace that includes developing the delegation potential of registered nurses. Traditionally, little focus has been placed on developing the leadership responsibilities of nurses to ensure delivery of patient care by delegating and supervising care provided by other members of the nursing staff (Weydt 2010).

The ANA articulates the expectation that correctional registered nurses are competent to delegate care in Standard 15: Resource Utilization (2013).  Nurses can develop delegation skills by, first, becoming familiar with the laws and regulations concerning scope of practice, reviewing job descriptions and other workplace guidance that defines the roles and responsibilities of staff. The next step is to understand how the principles of delegation can be applied to patient care in the correctional setting. The use of a decision tool such the one included in the Joint Statement on Delegation (2006) helps guide nurses through the critical thinking that results in a delegation decision. As experience using structured critical thinking  increases delegation decisions are accomplished with speed and confidence. Using simulation or case review and reflection are also effective ways to build delegation skill (Weydt, 2010). Nurses can do this on their own or with a proctor or mentor at the worksite.

Your thoughts about this subject are important to us. Do these three barriers resonate with your experience as a correctional nurse?  Does your communication contribute to good interpersonal relationships? Are registered nurses sufficiently involved in clinical care to effectively delegate? Please share your experience and advice in the comments section of this post. For more information and discussion about correctional nursing order your copy of the Essentials of Correctional Nursing directly from the publisher. Use Promo Code AF1209 for $15 off and free shipping.

References

American Nurses Association (2012) Principles for Delegation by Registered Nurses to Unlicensed Assistive Personnel (UAP). Silver Spring, Maryland. Accessed on 1/29/2013 at http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStandards/ANAPrinciples/PrinciplesofDelegation.pdf.aspx 

American Nurses Association (2005) Principles for Delegation. Silver Spring, Maryland. Accessed on 1/29/2013 at http://www.indiananurses.org/education/principles_for_delegation.pdf

Corazzini, K.N.; Anderson, R.A.; Mueller, C.; Hunt-McKinney, S.; Day, L.; Porter, K. (2013). Understanding RN and LPN Patterns of Practice in Nursing Homes. Journal of Nursing Regulation. 4(1); 14-18.

Correctional Nursing: Scope and Standards of Professional Practice (2013). American Nurses Association. Silver Spring, Maryland: Nursingbooks.org

McCoy, S.F. & Duffy, M. (2013, March 20). Navigating the Complex World of Delegation [Audio podcast]. Retrieved from http://www.nursingworld.org/MainMenuCategories/CertificationandAccreditation/Continuing-Professional-Development/NavigateNursing/Webinars/Nav-deleg.html

National Council of State Boards of Nursing and the American Nurses Association. (2006). Joint Statement on Delegation. Retrieved December 31, 2013 at https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf

Weydt, A. (2010). Developing delegation skills. Online Journal of Issues in Nursing 2 (1)

Photo Credit:   © freshidea – Fotolia.com

Best of the Blog: #5 – Spiritual Distress

We searched through the stacks of almost 200 blog posts to pull out the most popular ones for this series. If you are new to the Essentials of Correctional Nursing Blog you may have missed some good reads. Enjoy!

This post, written by Catherine Knox, originally aired September 3, 2013.

Mr. M. is 52 years old and in the infirmary for treatment of dehydration resulting from diarrhea that occurred after receiving chemotherapy for colon cancer.  The physician recently discussed with Mr. M. permanent assignment to the infirmary for end-of-life care. Mr. M. is listless and unengaged while in the infirmary. He expresses loneliness and frustration that he has no visitors especially now that he has cancer. He is estranged from family because he was physically abusive to his wife and daughter. Mr. M. was convicted of child sexual abuse and has been incarcerated for 10 years. As you leave the room Mr. M. says to you “God must be punishing me for all the bad that I have done in my life. How am I ever going to make amends?”

This is a patient in spiritual distress. Spiritual distress is defined by the North American Nursing Diagnosis Association (NANDA) as “the disruption in the life principle that pervades a person’s entire being and that integrates and transcends one’s biological and psychosocial nature” (2001). A patient in spiritual distress loses hope, questions their belief system, or feels separated from personal sources of comfort and strength (Gulanick et al., 2003). Assisting patients to address spiritual distress is one of the competencies for nursing care of patients at the end of life established by the American Association of Colleges of Nursing (2004). Chapter 8 in the Essentials of Correctional Nursing discusses spiritual distress in the correctional population, provides cues to identify the condition and recommends nursing interventions to address spiritual distress.

To summarize nursing care for a patient in spiritual distress involves four components:

  1. A nurse-patient relationship. Patients report that their distress was relieved when the nurse cared for them as a person, not as a number; gave patients freedom of choice when possible and when the nurse listened and gave the patient a chance to talk (Creel, 2007; Sellers, 2001).
  2. Spirituality is a coping mechanism and can be used by patients to transcend illness and suffering (Emblem & Halstead, 1993).
  3. Active listening and facilitating the patient’s verbalization of concerns are skills vital to provision of spiritual care. Nurses do not need to know about specific beliefs, religions or spiritual practices to provide effective spiritual care (Martin, Burrows and Pomillo, 1983).
  4. Spiritual care resembles psychosocial care in that it involves demonstration of respect for the patient, listening and appropriate self-disclosure (Sellers, 2001; Taylor, 2003).

Nursing interventions for a patient with symptoms of spiritual distress include:

  • Developing an ongoing relationship with the patient that demonstrates trust to reinforce the patient’s connectedness to others.
  • Respect and support the patient’s faith and religious belief system by making appropriate referrals.
  • Assist the patient to sort out ethical dilemmas in health care decision making.
  • Be aware of the patient’s suffering and act to ease suffering by showing compassion.
  • Encourage reflective prayer as a means to transcend immediate experiences of pain and suffering.
  • Allow the patient to verbalize anger and fear.
  • Help the patient deal with feelings of guilt and instill hope (Villagomeza, 2005).

Pitfalls to avoid in addressing issues of spiritual distress include:

  • Trying to solve the patient’s problems or resolve unanswerable questions.
  • Going beyond the nurse’s role or expertise or imposing personal spiritual beliefs on the patient.
  • Providing premature reassurance to the patient (Lo, B. et al., 2002).

What do you think would be the best response to the questions posed by Mr. M. in the case example at the beginning of this post? How would you address his distress? For more on spiritual distress in End-of Life Care see Chapter 8 of the Essentials of Correctional Nursing which can be ordered directly from the publisher. If you use Promo Code AF1209 the price is discounted by $15 off and shipping is free.

References and Resources:

American Association of Colleges of Nursing. (2004) Peaceful death: Recommended competencies and curricular guidelines for end-of-life nursing care. Retrieved My 16, 2011 from http://www.aacn.nche.edu/Publications/deathfin.htm

American Psychosocial Oncology Society. Distress Management Training for Oncology Nurses. Retieved September 1, 2013 t http://www.apos-society.org/professionals/meetings-ed/webcasts/webcasts-ican2.aspx#.

Creel, E. (2007). The meaning of spiritual nursing acre for ill individuals with no religious affiliation. International Journal for Human Caring 11(3): 14-21.

Emblem, J. D. & Halstead, L. (1993). Spiritual needs and interventions: Comparing the views of patients, nurses and chaplains. Clinical Nurse Specialist 7(4): 175-182.

Gulanick, M. , Myers, J., Klopp, A., et al. (2003) Nursing Care Plans: Nursing Diagnosis and Intervention. 5th ed. St. Louis: Mosby

Lo, B., Ruston, D., Kates, L.W. et al. (2002). Discussing religious and spiritual issues at the end of life: A practical guide for physicians. Journal of the American Medical Association. 287(6): 749-754.

Marie Curie Cancer Care (2003). Spiritual and religious care competencies for specialist palliative care. Retrieved September 1, 2013 at http://www.mariecurie.org.uk/Documents/HEALTHCARE-PROFESSIONALS/spritual-religious-care-competencies.pdf

Martin, C., Burrows, C., & Pomilio, J. (1983). Spiritual needs of patients study. In Fish, S. & Shelly J. (Eds) Spiritual care: The nurse’s role.  Downer’s Grove, IL: Intervarsity Press.

North American Nursing Diagnosis Association. (2001) Nursing Diagnosis: Definitions and Classification. 2001-2002. Philadelphia.

Sellers, S. (2001). The spiritual care meanings of adults residing in the Midwest. Nursing Science Quarterly 14 (3): 239-249.

Taylor, E.J. (2007) What Do I Say? Talking with Patients about Spirituality. Templeton Press: Philadelphia.

Taylor, E.J. (2003). Nurses caring for the spirit: Patients with cancer and family caregiver expectations. Oncology Nursing Forum 30(4): 585-590.

Villagomeza, L. R. (2005). Spiritual distress in adult cancer patients. Holistic Nursing Practice. November/December: 285-294.

Photo Credit: © eugenesergeev – Fotolia.com

Explaining what is it like to be a correctional nurse?

Tonia FaustAll correctional nurses have the experience of explaining to another nurse what it is like to be a nurse who practices in a prison, jail, juvenile detention facility, police lock up, or customs enforcement facility. Many of our fellow nurses respond to our answer with comments or questions like…”I had no idea nurses could be found in there.” “How can you provide care for a murderer or a rapist?” or “Do you feel safe?”

I am having the same experience now as I get ready to give a presentation at the Arizona Nurses Association later this month about the cultural challenges in correctional nursing. This audience will be nurses but very few of them will be correctional nurses. The three cultural challenges for correctional nurses that I am going to describe are:

  1. Balancing the security imperative with the constitutional right to care.
  2. Diversity and disparity of the patient population.
  3. Developing a practice that embraces caring and remains true to professional principles.

In preparing, I went back to The American Nurse which I discussed in an earlier post. This book is a collection of seventy-five interviews with nurses in the United States. It was published in 2012 as part of The American Nurse Project. There were five nurses in this group who talked about their work as correctional nurses. I thought I could use their stories as a starting point to describe the tremendous opportunities in correctional nursing.

While searching through the book I found another resource, a documentary film by the same name that was produced about two years after the book was published. A correctional nurse, Tonia Faust, is one of five nurses portrayed in the film; she is responsible for the hospice program at Louisiana State Penitentiary. She is pictured at the top of this column. It turns out the film will be shown at the conference the night before my presentation, so by the time I talk about correctional nursing every nurse in attendance will have been introduced to at least one already!

In the film Ms. Faust gives a tremendous interview and we are right there with her as she dresses a wound and talks with the offenders in the infirmary. We meet one of the inmate hospice workers and observe the caring he expresses as he helps to shower an inmate. I would think any nurse could identify with the intimacy and humanity of care so apparent in the film taken from inside the penitentiary. Next time you have someone ask what you are doing as a nurse working in a correctional facility have them watch the film, An American Nurse directed by Carolyn Jones.

The best news is the website for The American Nurse Project is fabulous and this post is written to suggest that every correctional nurse visit it. You don’t have to wait because the film can be downloaded for only $9.99 and watched multiple times thereafter or it can be rented and viewed for a period of five days for only $3.99. The other four nurses portrayed in the film work in labor and delivery, home health, a nursing home and for the military. Two of the five nurses are men. The film really does a great job confronting many of the stereotypes there are about nurses and their careers. An hour and a half of CE is also available after watching the film. Finally there is also a blog that that provides more details about filming of each of these fabulous nurses.

Nurses responsible for new employee orientation or professional development should consider using the film to generate discussion about the expression of caring in the correctional environment, what it means to be non-judgmental as a nurse and what it is like to feel purposeful as a correctional nurse. There are two study guides available without cost on the website; one for the general community and one for nurses. Both provide good material for discussion and reflection on correctional nursing practice.

I watched The American Nurse last night and cried. I was so proud of the nurses portrayed in the film, but especially Tonia. I don’t think that others will ever think correctional nurses aren’t among the best the profession has after watching this film. As one commenter said “My eyes were really opened by the nurse who worked in prison. You could see how much she cared about the patients. I learned that there are more opportunities in nursing than just the traditional settings.”

Take time at least to see the film (79 minutes) and get an hour and a half of CE. Does watching the film help you answer the question when others ask you “What is it like to be a correctional nurse?” Tonia Faust talks about having a purpose for being at the Louisiana State Penitentiary and it has made me think about my purpose as a correctional nurse. What is yours? Share your thoughts about the film as well as the questions posed here by responding in the comments section of this post.

For more about the opportunities and challenges in correctional nursing order a copy of our book, Essentials of Correctional Nursing directly from the publisher or from Amazon today!

 

Photo credit: americannurseproject.com

Correctional Nurse Self-Care: Wear That Secondary Trauma Protective Gear!

Firewoman in fire protection suitHave you ever had a patient that really affected you? I still have memories of caring for a severely burned toddler girl in the early 90’s when I was in a clinical rotation for my graduate nursing program in Burns, Emergency, and Trauma. It was an urban teaching hospital and regional burn center and this little girl was pulled from a burning Philadelphia row house. I was swept in to her intense physical pain (burn pain is the worst) and her abusive family history. It affected my personal life, robbed me of sleep, and almost made me physically ill for a time. This experience taught me I wasn’t cut out to be a burn nurse but was also my first experience with secondary trauma.

Secondary Trauma: Patient Trauma Spill-Over

Secondary trauma (also called vicarious trauma) is the experiencing of the trauma of another through their account or indirect exposure to their trauma. A nurse’s mental or emotional ‘reliving’ of the patient’s traumatic experience can then lead to symptoms or reactions similar to post traumatic stress disorder (PTSD).

Our patient population has high levels of trauma in their lives, past and present. For example, many of our patients, especially women, have history of child abuse, domestic violence, or sexual abuse. Military veterans may enter the system with PTSD from combat duty. Inmates have a heavy burden of current trauma while in the criminal justice system. There can be high levels of assault, coercion, and victimization in inmate cultures.

Depending on the type of nursing care you are delivering, this traumatic stress can spill over onto you and be absorbed into your own system; many times without even realizing it. This is why it is important to guard against secondary trauma and take action when you see signs in your own feelings and behaviors.

Monitor for Warning Signs

Here are some common signs of secondary trauma. Watch for them in yourself and those you work with:

  • Anger and cynicism
  • Avoidance of patients
  • Chronic exhaustion
  • Dropping out of normal social activities
  • Fear
  • Hopelessness
  • Hypervigilance
  • Increased family arguments and agitation
  • Sleeplessness

What to Do About Secondary Trauma – Put on Your Protective Gear

In the first post in this series on correctional nurse self-care, I talked about putting on your oxygen mask first before helping others. We also need to put on our protective gear, just like other professionals. Construction workers have hard hats and football players have extra padding and mouth guards. What protective gear do correctional nurses need to work with traumatized patients day after day? Here are some ideas from the National Center on Family Homelessness:

  • Regularly take your stress temperature – do you see signs of stress in your emotional and interactional responses to daily activities? If so, accelerate your protective activities.
  • Make time for regular decompression. This can include reflection, meditation, or physical activities like yoga.
  • Consider the possibility of a change in work assignment, work shift, or work group for a period of time.
  • Seek out employer-offered programs such as employee assistance or an outside support group for those in helper roles like nursing, social work, counselors, or child assistance workers.
  • Take regular meal breaks.
  • Focus on increasing sleep and nutrition.
  • Find things that make you laugh.
  • Spend time with supportive friends.

Just understanding the possibility of secondary trauma and monitoring for signs of increased stress can make a world of difference in your correctional practice. I didn’t understand secondary trauma back in that burn unit rotation years ago. I might have been able to manage it better if I had. Awareness is a powerful thing!

Have you had to deal with secondary trauma in your correctional nursing practice? Share your experience with our readers using the comments section of this post.

Photo Credit: © Jessmine – Fotolia.com

Correctional Nurse Goals for 2015: Expand Your Knowledge

2015 goals on digital tabletHealth care is advancing at the speed of light. We are expected to apply current evidence to our practice and understand the new technologies, medications, and treatments that are being implemented. It can be difficult to merely keep from sliding backward as the treadmill pace ever increases under our feet. That is why my final suggestion for correctional nurse goals for this year is to expand your knowledge about your practice and keep up with the latest developments. Here are a few ideas to get you thinking about ways to improve your foundational correctional nursing knowledge and keep up with changes in nursing practice. Links are provided for easy purchase or subscription.

A Foundational Book Shelf

Every serious correctional nurse should have access to these texts as they are the basis for our specialty practice.

Specialty Periodicals

Journals and magazines provide updates to changing practice and information on movements in the industry.

Ongoing Information Updates

Digital sources keep us posted on day-to-day changes and news of importance to our practice. Although you could go out and regularly check information websites, but I favor sources that collect up the top items and send them to my inbox for scanning. Here are a few of my favorites.

  • Academy Insider – This free weekly email newsletter from the ACHP aggregates correctional health care news and items of interest for those in our field.
  • Medscape for Nurses – Keep up with research and information in the general nursing field with this weekly synopsis sent to your inbox.
  • ANA SmartBrief – Professional news from the American Nursing Association. Keep current on what is going on in our profession.

I’m sure I didn’t include all the possible places for you to gain knowledge and stay on top of changes in our profession and specialty. Share your favorite sources in the comments section of this post.

Photo Credit: © Marek – Fotolia.com

Correctional Nurse Goals for 2015: Expand Your Network!

2015 goalsIt is pretty easy to feel isolated in correctional nursing practice. We work in a mostly unacknowledged specialty with a patient population that many think do not deserve good nursing care. We can easily feel as vulnerable and marginalized as our patient population. Combine with that the ‘push back’ we can sometimes get from the culture of incarceration (pressure to be less caring and concerned for the well-being of our patients) and it is easy to see why many in our practice settings feel overwhelmed and underappreciated.

That’s why I recommend a goal to network with others in your specialty this year. Developing a network of like-minded nurses who desire to make a difference in their practice in the criminal justice system can be just the ticket to improve your outlook and revitalize your correctional nursing career. Here are a few ideas for how to increase your network in 2015:

Go Local

Nothing beats a face-to-face chat to regain perspective and feel supported. Are there local opportunities to meet with other correctional nurses? For example, does your state prison system host any activities or events that bring nurses together? How about the state nursing association? Some states have specialty practice forums that may include correctional nursing.  Consider a neighboring county jail.  Suggest forming a journal club or meet-and-greet where correctional nurses can gather and develop relationships.

Go National

Another way to network with correctional nurses is to attend a national correctional conference. Your facility management may be involved in the American Correctional Association or the American Jail Association. Both have conferences that are attended by health care staff. See if there may be funding for your attendance this year. (TIP: Before requesting funding, research the event and suggest ways some of the presentation content may be applied to make improvements in your facility).

Other excellent national conference to attend are any by the National Commission on Correctional Health Care (NCCHC) or the American Correctional Health Services Association (ACHSA). These conferences are solely for correctional health care professionals and are attended by many correctional nurses. Opportunities for networking abound during exhibit hours, sessions, and round table discussions. Additionally, regional conferences are offered by ACHSA chapters in California/Nevada, Oregon, and the  Southeast Region.

When attending a conference, be careful to mingle with people you do not know and sit at tables with others you would like to meet. If you attend with a group, make plans to attend different sessions and compare notes rather than traveling about the conference as a group. This will expand your opportunities to meet new people.

Go Social

Social networking is now available through social media outlets such as Facebook and LinkedIn. Both of these platforms have correctional nursing groups were nurses in our specialty share concerns and get advice or direction on issues. Consider connecting with other like-minded nurses working in the criminal justice system by joining these groups:

Correctional Nursing on Facebook

Correctional Nursing on LinkedIn

I hope you expand your correctional nursing connections this year and develop a personal network of fellow nurses. We need encouragement and support to recharge our careers, enhance professional practice in our specialty, and improving health care for our unique patient population!

What will you be doing this year to network with other correctional nurses? Share your ideas in the comments section of this post.

Photo Credit: © dolphfyn – Fotolia.com

Correctional Nurse Goals for 2015: One Change that Makes All the Difference!

2014 end and 2015 way signsI love the start of anything new, don’t you? That’s why a new year and a brand new calendar can really brighten my spirits. Although I am not one to make resolutions, I am a big goal-setter. Do you have goals for your correctional nursing practice for 2015?

The Little Story that Changed My Life

Here is a short story I heard years ago that changed my life for the better. I try to remember it several times a year to help center my mental perspective. Have you heard a version of this before?

Two workman were approached by a bystander on a major construction site. They were both performing the same job and were asked what they were doing. The first one said, “What does it look like I’m doing? I’m laying brink.” The second one looked up from where he was crouched and off toward the sky. His response? “I’m building a cathedral.”

Two men doing the same job yet from a very different mental perspective. Which one do you think went home that night feeling like he was doing something that mattered? Which one left the worksite feeling satisfied with his lot in life?

What might you tell a visitor to your work place if they asked you what you do as a correctional nurse? Would you respond like the first workman and say “I pass pills and take sick call”? Or, would you say, “I optimize health, prevent illness and injury, and alleviate suffering.” That last answer comes from the definition of correctional nursing, by the way.

It is All About Perspective

Yes, both those workman were doing the same thing and both had an honest response. And, both the options for describing your work as a correctional nurse would be true…..but what a difference in perspective. The first perspective is of activity while the second perspective is about purpose. Thinking about purpose in our day-to-day work provides the meaning and satisfaction that makes it worth the extra effort.

I have often said that most of us become nurses to help those in need and that there is not a needier patient population than inmates. So, the real effort in the correctional specialty is often to mentally balance the patient-focused purpose of our work with the ever-present struggles of a needy patient population in a challenging environment. It can really get you down.

Mind Your Mind

So, that comes to my first suggested goal for 2015 – Mind Your Mind. What I mean by that is to keep tabs on your attitude toward your work. This is an important goal no matter where you work but it can be a real battle in the correctional environment. In case you haven’t noticed, jails and prisons are not happy places. Most people, including some of our officer colleagues (!), don’t want to be there. Hanging around with criminals all day can be a real downer. Plus, it is always necessary to be on guard for possible physical, emotional, or mental harm. No wonder you are exhausted as you walk out the sally port to the parking lot.

Take Action Right Now on This Goal

I hope you are convinced that keeping a positive mental perspective is a worthy goal for your correctional nursing practice this year. However, this quote says it all:

“A goal without a plan is just a wish” – Antoine de Saint-Exupery

So, here are some action steps to start your “Mind Your Mind” plan:

  • Establish a way to regularly remind yourself of your professional purpose. Maybe you can have it on a post-it note on your car dashboard so you can recite it on the way to work in the morning.
  • On your walk from the medical unit to the facility exit, see if you can list all the ways that you improved health, prevented illness and injury, and alleviated suffering during your shift.
  • On your way home, mentally close the door on all that is going on at the facility so you can truly engage with family and friend and rest during your time away from work.
  • Get some form of regular mild exercise like walking or biking to help your mental perspective.
  • Develop a plan to get the rest you need to be both alert and in a good mental perspective when you are at work.

This one change can make all the difference – changing your perspective. Will you be building a cathedral or merely laying bricks in your correctional nursing practice in 2015? I hope you will join me in cathedral building!

Revitalize your correctional nursing practice by reading the Essentials of Correctional Nursing book. The text can be ordered directly from the publisher and if you use Promo Code AF1402 the price is discounted by $15 and shipping is free.