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

How punishment affects our practice

Close-up Of Brown Gavel And Medical Stethoscope

Currently I am working on understanding more about the challenges of providing culturally competent nursing care in correctional settings. The population of patients we serve are not only culturally diverse but also some racial and ethnic groups are disproportionately represented. Many will agree that the prison, jail or detention facility is a culture as well, the culture of incarceration. Culture is described by Madeline Leininger, a well-known nursing theorist as “the learned, shared, and transmitted values, beliefs, norms, and lifeways that guide thinking, decisions, and actions…” (2006).

We all know that correctional settings have their own vocabulary, rules, practices and expectations that prisoners, correctional officers, nurses, and visitors must comply with to survive in the environment. These values, beliefs, norms and ways of being arise from philosophies about punishment in our society. The culture of incarceration and our beliefs about punishment in civil society affect how individual nurses provide “care” in the correctional setting.

Today I came across a tremendous article by Sally Gadow, Professor Emerita at University of Colorado College of Nursing that describes how different philosophies about punishment are manifest in the practice of correctional nurses (2003). Ascribing to a belief about the role of punishment and incarceration in society is necessary for nurses to address the ethical conflict between care and punishment.

It has made me consider how my nursing practice is affected by my beliefs about the role of incarceration and punishment. Here is a summary of the article.

Punishment as an immediate or reflexive consequence of wrong doing: The violation of community values, morays or laws results in an automatic or reflexive consequence for a wrongful act. In this system of beliefs the punishment occurs automatically and enforcement of the law or rule is unquestioned; there is no consideration of the circumstances or characteristics of the situation. Punishment for violation of norms in this system of beliefs require practices that exile the offender, deny freedom and loss of respect for the individual.

Nursing practices that are congruent with this philosophy about punishment include those that assert the authority of the law, morale principle or norm. In other words, nursing care that extends the interest of punishment. An extreme example would be participation in an execution. Other examples are writing infractions, participating in disciplinary hearings, collecting forensic evidence and approving use of force. When nurses comply with the expectations of the correctional system uncritically, they are at risk of providing care that advances the system perhaps at the expense of the individual. The American Nurses Association provides guidance in professional practice standard 11 on Communication stating that correctional nurses must be competent in questioning the rationale of processes and decisions when they do not appear to be in the best interest of the patient (2013).

Punishment as a logical consequence of wrong doing: An emotionally detached and reasoned approach to punishment and it’s meaning in relation to wrongdoing. Punishment still serves to exile the offender, deny freedom and express loss of respect for individuals who violate society norms and laws. Included in this category are the philosophies of “just desserts” which may also be known biblically as “an eye for an eye”. This is a belief that the degree of punishment should be equal to the severity of the violation. An example of this is the death penalty sentence for murder. Another belief is that of “fair play” when the benefits for a group (society) are achieved only when all comply with the rules. When someone fails to respect the rules a debt to society is owed and punishment is necessary to repay the debt. When we say that incarceration is the punishment, not the further denial of health care or programming during incarceration, this is an example of “fair play.” The last belief in this subset is that of “deterrence” which is to establish punishment severe enough to prevent harm or to protect the community. The punishment chosen is not constrained by the concept of fairness or reciprocity. An example of this would be three strikes laws which serve to deter recidivism and to remove repeat offenders from the community.

Correctional nursing practices consistent with this set of beliefs suppress emotion, embodiment and relationships with patients. The practice of nursing is with objective detachment. By being disengaged the nurse avoids being influenced in a negative or positive way by their personal knowledge of the offender. Many nurses adopt this approach to nursing practice believing that the best way to avoid being “conned” or manipulated by a patient is to rely solely on the nurse’s objective data discounting the patient’s report. With-holding analgesia because of a patient’s history of drug abuse is an example. Delays in responding to requests for health care attention because the problem is not significantly urgent would be another example. However there are numerous competencies listed in the ANA Scope and Standards of Practice (2013) that call for nurses to do more than adopt this disengaged approach to correctional nursing practice. The ANA standards for delivery of care in the correctional setting require nurses to elicit the patient’s personal experience and preferences with regard to illness, discomfort or disability and to partner with them to evaluate their care (Standards 1, 5-7) in a manner that preserves and protects the patient’s autonomy, dignity, rights, beliefs, and values.

Engagement as a paradox of punishment: Punishment is not an essential feature of justice but instead the focus is to restore trust and engagement between the offender and society. Detention may be necessary to engage the violator in the actions that are necessary to restore trust. The offender is not objectified and exiled but is made to relate in meaningful ways with the community. Examples of these beliefs in action include strengths based programming, drug and alcohol rehabilitation, probation and community corrections, half way houses and work camps. The meaning of the experience for offenders is the product of their engagement with others rather than an absolute defined by society.

A correctional nurse under this set of beliefs accepts the contradiction between care and punishment and does not need to embrace a particular viewpoint to resolve the conflict. The nurse assumes responsibility for defining their practice in the interest of the patient and does not accept someone else’s interpretation of how their practice should conform to some moral or ethical norm. Nursing actions are designed to assist prisoners to recover their ability to participate in the community and use their relationship with the patient as the crucible for this work. Engagement is characterized as accepting the possible validity of the patient’s perspective and the potential that the nurse’s opinion can be altered by the patient’s perspective. The nurse’s opinions or beliefs can be held firmly (not to be manipulated) but they are not absolute and open to the possibility of revision based upon experience with the patient or their situation. Dignity and respect for the patient is recognized as necessary to the caring relationship. An example is when nurses individualize a patient’s plan of care rather than apply the same intervention for all patients with the same condition. Patients are regarded as individuals rather than inmates. The ANA’s Standard 13 on Collaboration is explicit in that nurses promote engagement and participate in building consensus in the context of care for the patient (2013).

Conclusions: Correctional nurses often talk about the conflict between care and custody. Custody is a manifestation of beliefs about punishment. Nurses in correctional settings are influenced by the correctional culture, affecting their relationship with patients and ultimately their practice. I was surprised at the extent to which beliefs from all three of these descriptions have affected my practice environment. It is a relief to know that it is enough to recognize the care and custody conflict in order to find my way practically in this field. It is not necessary or even recommended that the conflict be resolved in order to provide ethical nursing care.

I suggest that correctional nurses reflect on the ways in which beliefs about punishment are manifest in their nursing practice. Reflection may suggest areas of practice that warrant more review and development. There may be aspects of practice that are unintentionally harmful or conflict with an ethical premise related to the nursing imperative of care. This material has been provided in the interest of stimulating dialogue among correctional nurses not to suggest a particular standard of practice.

For more on the ethical issues in providing nursing care in the correctional setting see Chapter 2 in our book, Essentials of Correctional Nursing. Order your copy directly from the publisher or from Amazon today!

 

Photo credit: © Andrey Popov – Fotolia.com

 

 

References

American Nurses Association (2013) Correctional Nursing: Scope & Standards of Practice. Silver Springs, MD: Nursesbooks.org.

Gadow, S. (2003) Restorative nursing: toward a philosophy of postmodern justice. Nursing Philosophy. 4: 161-167.

Leininger, M. M. & McFarland, M. R. (2006) Culture care diversity and universality: A world wide nursing theory. Boston, MA: Jones and Bartlett.

Correctional Nurse Self Care: Resilience

 

 

Peligro, cuerda rotaLast week’s commentary on the burden of moral distress brought forth the concerns and experiences of several more correctional nurses. Each of these courageous nurses described a turning point where they chose to act rather than stay silent and address the needs of their patients; each also paid a price, including termination, depression, failing health and so forth. I too, had to leave a position I had been in for 17 years because I was “in the way” of achieving the cost savings the organization had promised. This past year I witnessed a colleague being walked off the job because while she was trying to improve nursing practice she didn’t have the full support of the facility health authority. These are tremendous consequences for nursing professionals committed to quality patient care. One nurse commented that it is “easy to blame the nurses that are working with the inmates daily” rather than look up the chain of command to the organization itself and the managers responsible for the delivery of services. These experiences and the accompanying reality are the reason resilience has been identified as an essential quality to nurture as part of the caring practice of the nursing profession (Tusaie & Dyer 2004, Hodges et al. 2005, Warelow & Edward 2007).

Resilience refers to the ability to bounce back or recover from adversity (Garcia-Dia et al. 2013). Others describe resilience as the ability to grow and move forward in the face of misfortune or adversity; to adapt to adversity while retaining some sense of control and moving on in a positive manner (Jackson, Firtko & Edenborough 2007). Resilience has been suggested as a strategy for nurses to manage the emotional and physical demands of caring for patients as well as reduce their vulnerability to workplace adversity (excessive workload, organizational restructuring, lack of autonomy, bullying and violence).

The good news is that resilience is not a personality trait, that we either have or not, but instead consists of behaviors, thoughts and actions that can be developed and fostered to strengthen and adapt to our circumstances. Strategies that help build personal resilience include:

Professional relationships which are supportive and nurturing

A key component in the lives of resilient people is positive social support; having one or more people in the profession who are role models and can be called upon for guidance and support when needed. At least some of these individuals need to be from outside the immediate workplace so that support is unbiased and safe to receive, especially when the workplace is laden with tension. Another feature is that the relationship needs to be nurturing and one that fosters offers encouragement, reassurance, and individual professional growth; such as a mentoring relationship. In thinking about this, my professional network was developed among the members of the Oregon Chapter of the American Correctional Health Services Association. We meet twice a year and each meeting includes training, social time and the opportunity to discuss the workplace challenges we each struggle with. The relationships built through this local organization with other correctional nurses over the years have sustained me during many periods of crisis and change.

Maintain positivity

Positive emotions, including laughter, increase energy, change perceptions and help cope with adversity. Positivity comes from optimism or an ability to visualize potential benefits or positive aspects of an adverse situation. Considering a situation in a broader and longer-term perspective can build optimism. Indeed forcing oneself to think positively develops a greater range of resources and broadens the inventory of possible solutions in the midst of adversity (Jackson, Firtko & Edenborough 2007). The readers’ comments about their experiences with moral distress express an optimistic and positive view that reaching out to each other will create a collective voice to improve conditions in correctional health care. Techniques suggested to support positivity include visualizing what one wants rather than what is feared, identifying what brings joy to one’s life, maintaining hope for a positive outcome and laughter.

Develop emotional insight

Emotional insight is the capacity to identify, express, and recognize emotions; to incorporate emotions into thought; and to regulate both positive and negative emotions. When faced with adversity, emotion is inevitable, however we often are focused on the “who, how, what, when and where” of what is happening; unaware of how emotion is effecting us. When we can identify our emotional response to a situation we can switch our parasympathetic nervous system on and respond in a calm and rational manner and not suffer the effects of a “fight or flight” response. Understanding our emotional needs and reactions provides further insight into how we cope and may yield new ideas about how to improve our response in the future. Specific techniques suggested to develop emotional insight are relaxation exercises, guided imagery, meditation, deep breathing, journaling and reflection. See an earlier post about the use of reflection for professional growth.

Achieve life balance and spirituality

Highly resilient persons express existential beliefs, have a cohesive life narrative and appreciate their own uniqueness. This has also been described as having an anchoring force in life. In nursing, we often use the term achieving a work-life balance which is to engage in activities that are physically, emotionally and spiritually nurturing. This includes being clear about our mission in professional life, the reason for being a correctional nurse, so that we aren’t distracted in challenging times. Activities that support a balanced life include getting enough sleep, eating healthy, regular exercise, and maintaining a spiritual practice. You may want to revisit a recent post introducing self-care for correctional nurses. Another suggestion is to write and then send a letter to yourself recognizing your strengths and expressing gratitude for the work that you do.

Reflective practice

Reflection is a way to develop insight and understanding about situations so that knowledge is developed and can be used in subsequent situations. A concrete experience, such as losing one’s job or experiencing an ethical dilemma is used as a catalyst for thinking and learning. Journaling is especially helpful in adult learning because putting an experience into writing ascribes meaning to the people, places and events involved in the experience. Reflection is an opportunity for self-discovery; many people report better relationships, greater personal strength and self-worth, a deeper spirituality and heightened appreciation for life as a result of the self-growth that takes place after adversity. One of our readers said exactly that… “I have learned so much about myself, and systems change, and leaders vs managers.” I have to agree based upon my own experience; I am a stronger, more skilled professional than I ever was and have more to give others as a result of the self-discovery that took place after leaving, so long ago, a job I loved.

 

No one wants to experience workplace adversity and professional burnout and yet we know from our own experience and those of our readers, it is a reality in correctional nursing. Recognizing and building resilience personally and within our organizations is a strategy that is becoming part of the profession’s uniform. Below are several excellent resources for developing nursing resilience:

  1. Resilient Nurses: How health care providers handle their stressful profession. Written and produced for Public Radio. Consists of two ½ hour interviews with several leading nursing experts. The second segment includes techniques used to handle unusual strain as well as everyday stressors in nursing. It also includes a relaxation audio, a booklet, a CD and a list of resources.
  2. How can nurses build resilience and master stress? A summary of a 16 week series on Activating Resilience in Nursing and Leadership by Cynthia Howard. Links are included to other posts in her series on resilience.
  3. University of Virginia School of Nursing, Compassionate Care Initiative, is dedicated to teaching nurses resilience and compassion in health care. The site includes a link to “nurses thrive!” an online community of nurses dedicated to promoting resiliency. Also includes resources for building resilience through guided practice and exercise.

Do you recognize aspects of your own path to professional resiliency in these descriptions? What has helped you adjust or rebound from adversity? Please share your experiences or advice by responding in the comments section of this post.

References:

Garcia-Dia, , J., DiNapoli, J.M., Garcia-Ona, L., Jakubowski, R. & O’Flaherty, D. (2013) Concept Analysis: Resilience. Archives of Psychiatric Nursing 27; 264-270.

Hodges, H.F., Keeley, A.C., & Grier, E.C. (2005) Professional resilience, practice longevity, and Parse’s theory for baccalaureate education. Journal of Nursing Education 44, 548-554.

Jackson, D. , Firtko, A., & Edenborough, M. (2007) Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: A literature review. Journal of Advanced Nursing.

McGee, E. M. (2006) The Healing Circle: Resiliency in Nurses. Issues in Mental Health Nursing 27; 43-57.

Sieg, D. (2015) 7 Habits of Highly Resilient Nurses. Reflections on Nursing Leadership 41 (1).

Sullivan, P., Bissett, K., Cooper, M., Dearholt, S., Mammen, K, Parks, J., & Pulia, K. (2012) Grace under fire: Surviving and thriving in nursing by cultivating resilience. American Journal of Nursing, 7 (12).

Tusaie K. & Dyer J. (2004) Resilience: a historical review of the construct. Holistic Nursing Practice 18, 3-10.

Warelow, P. & Edward, K-l. (2007) Caring as a resilient practice in mental health nursing. International Journal of Mental Health Nursing 16, 132-135.

 

For more on moral distress and courage see Chapter 2 Ethical Principles for Correctional Nursing in the Essentials of Correctional Nursing. You can order a copy directly from Springer Publishing and receive $15 off as well as free shipping by using this code- AF1209.

Photo credit: Peligro, cuerda rota@alejandro dans- Fotolio.com

 

End-of-Life Care and Correctional Nursing

baby handWhat do you think are the most common causes of death among inmates? I remember the first time I looked at the information collected annually at my correctional facility and being surprised to find that cancer and heart disease were the most common causes of death.

Since 2000-2001 correctional facilities have been required to report information to the Bureau of Justice Statistics (BJS) about each inmate or detainee who dies while in custody.  Reporting includes demographic information, the inmate’s criminal background and details about the death. This information is analyzed and trends concerning inmate deaths are reported by BJS every year. According to a recent report from BJS over half of all deaths in jails and nearly 90% of all deaths in prisons were the result of illnesses like cancer, heart and liver disease (Noonan, M.E. 2012).

All of this information is to make the case that correctional nurses take care of inmates with illnesses that are life-limiting or terminal.  Therefore correctional nurses need to be competent in the delivery of end-of life care.  Here is a description from an inmate who witnessed a fellow inmate’s death from cancer

“We sat with him in his cell when we could and helped him to move and the nurse kept popping in to see him-she was upset that he had to stay there. He wasn’t allowed any morphine to kill his pain and died a few days later in agony in his cell and alone (Prison Reform Trust, 2008, p. 4)”. 

Can you imagine what the nurse was feeling while providing care to this inmate during his last days? To watch a patient die and to know you could do better is a powerful incentive to improve. As Susan Loeb and her colleagues point out it is time to harness nurse’s expertise and apply their power of compassion to allow prisoners “to die with a modicum of dignity, respect, and humane care” (2011, p. 483).

Nursing care of inmates with terminal illness includes:

  • Assisting patients to make decisions about treatment, palliative care and life sustaining measures
  • Effectively addressing patient concerns, especially symptom management
  • Coordinating care among multiple providers
  • Communication with the patient’s family and other members of the health care team.

Resources for nurses to gain knowledge and skill in end-of-life care can be accessed through local hospice in the community or at a nearby university. A national education initiative, the End-of Life Nursing Consortium (ELNEC) has made training available to nurses in all 50 states and 77 other countries since 2000 and has many resources on the website at http://www.aacn.nche.edu/elnec. The ELNEC also has established competencies for end-of-life nursing care. The GRACE Project (Guiding Responsive Action in Corrections at End of Life) sponsored by the Volunteers of America has been responsible for supporting the establishment of hospice and end-of-life care in more than 75 prisons and jails in America.  The Central Plains Geriatric Education Center at the University of Kansas Medical Center is continuing to emphasize the development of capacity to provide end-of-life care and the education of health care providers to deliver this care in prisons and jails (McAdoo & Price 2012). To access this resource go to http://www.kumc.edu/landon-center-on-aging/central-plains-geriatric-education-center.html or call 913 588 1464.

“Assessment and then intervention to relieve distressful symptoms is a major role of nurses in end-of-life care” (Knox 2012, p. 145). Use of a standardized assessment tool is recommended.  One assessment tool that is available on-line is the Edmonton Symptom Assessment System-Revised. It assesses nine of the most common symptoms experienced by patients at the end of life.  What do you think these symptoms are and how would you address each of them?

For more on nursing and end-of-life care in the correctional setting see Chapters 8 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1209 the price is discounted by $15 off and shipping is free.

References and Resources:

Howe, J.B., Scott, G. (2012) Educating prison staff in the principles of end-of-life care. International Journal of Palliative Nursing.  18(8): 391-395

Knox, C. (2012). End-of- life care. In Schoenly, L. & Knox, C. Essentials of Correctional Nursing. Springer. NY.

Loeb, S.J., Penrod, J. Hollenbeak, C.S., Smaith, C.A. (2011) End of life care and barriers for female inmate.  Journal of Obstetric, Gynecological and Neonatal Nurses. 40: 477-485

McAdoo, C., Price, C. (2012) Models of Care: End-of-Life Care in Prisons. Presented at Updates in Correctional Health Care. National Commission on Correctional Health Care. May 2012. San Antonio TX. Accessed 8/12/13 at http://ncchc.sclivelearningcenter.com/index.aspx?PID=4622&SID=128752

Noonan, M. E. (2012) Mortality in Local Jails and State Prisons, 2000-2010- Statistical Tables. Bureau of Justice Statistics. Retrieved August 8, 2013 from http://www.bjs.gov/content/pub/pdf/mljsp0010st.pdf.

Prison Reform Trust. (2008) Doing time: the experiences and needs of older people in prison. Prison Reform Trust: London.

Stone, K., Papadopoulos, I., Kelly, D. (2011) Establishing hospice care for prison populations: An integrative review assessing the UK and USA perspective.  Palliative Medicine.  26(8):969-978

Photo Credit: © Thierry Dagnelie – 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: An Example

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

hoffnungWatson Caring Principle: Caring is the intention of doing for another and being with another who is in need.

The answer to the question, Do Correctional Nurses Care? is full of possibility and variability. I always remember the Florence Nightingale Pledge that we recited at our Pinning ceremony many years ago.  My favorite excerpts include:

  • “abstain from whatever is deleterious and mischievous”
  • “zealously seek to nurse those who are ill wherever they may be and whenever they are in need”
  • “missioner of health dedicated to the advancement of human welfare”
  • “practice my profession faithfully”
  • “be loyal to my work and devoted towards the welfare of those committed to my care”

Here is an example from my own experience that describes how correctional nursing must be flexible, adaptive, sincere, and persistent when we care for our patients.

We had an inmate at our Work Release Facility who became ill and was taken to the Emergency Room in that city; which happened to be a Level 4 Trauma Center.  After their evaluation he was told he had the flu and was dismissed.

Because it was a Friday evening and his status was not improved, the consensus of the HSA and myself was that we should transfer him to our minimum security facility which has 24/7 nursing coverage.  He was transported to our site and when he arrived he was not at all well.

I examined him and even though I did not know what exactly was causing the problem, I did feel that he had an acute abdomen.  I obtained an order to send him to the local Emergency Room and upon his transport by DOC staff, I called the ER Nurse to give report.  I gave her a brief history of the other emergency room visit and their diagnosis of the Flu.  I also gave her the results of my exam and told her that I really believed that he had an acute abdomen.

In the end, he did have an acute abdomen, caused by a ruptured gall bladder.  He had emergency surgery and after some complications, a transfer to another hospital, 10 days in the hospital and recuperation in the Infirmary at another DOC facility he returned to our site.

Upon his return to our facility he asked the intake nurse to thank me for him and several days later when he was in our clinic he personally thanked my for saving his life.  It is nice to be appreciated and I am very thankful for my knowledge and skill that helped me to care by doing for another and being with another who is in need.

Teresa WaitsTeresa Waits, RN, started her corrections career at Lansing Correctional Facility, Lansing, KS in the Infirmary.  Upon moving back to Winfield, she began working at Winfield Correctional Facility.  Initially she was the Intake Nurse.   Additional positions held include, Infection Control Nurse, Utilization Management Nurse, Clinic Nurse, Director of Nursing and providing education to inmates coming into the facility and staff during Basic and Annual Training.

 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: © Alexander Wurditsch – Fotolia.com

The Caring Challenge in Correctional Nursing

Correctional nurses face a daily struggle to care for their patients while delivering much-needed healthcare in a restricted environment where they may also fear for their own personal safety. How can nurses truly care for and care about their inmate patients? This is a question many of us in the specialty grapple with as we try to elevate the professional status of correctional nursing. Caring has been described as the essence of professional nursing practice, therefore we must establish the characteristics of this concept as it is enacted in the criminal justice system.

Weiskopf studied nurses’ experience of caring for inmate patients and discovered a number of limitations in our setting  . The cultures of custody and caring often clash as mentioned in an earlier post. Nurses in this study described the need to negotiate boundaries between these cultures and establish relationship with custody staff in order to be effective. One surprising finding of the study was the extent to which the negative attitudes and behaviors of other nursing staff affected nurses who were attempting to provide compassionate nursing care.

Many nurses working behind bars feel an obligation to care and often struggle to find ways to do this in a hostile environment. Here are some suggested ways nurses enact caring behaviors in corrections:

• Educating patients about their health conditions and self-care principles
• Maintaining a nurse-patient relationship that is within the helpful zone of professional boundaries
• Advocating for the health care needs of a patient when necessary
• Showing compassion and respect
• Presenting a non-judgmental manner
• Listening to what the patient is saying
• Helping patients through a difficult situation

Have you found it difficult to care for patients in the criminal justice system? Share your thoughts in the comments section of this post.

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

Photo Credit: © Junial Enterprises – Fotolia.com