Contraband: Health or Security Issue? Part III

This month the Essentials of Correctional Nursing blog welcomes Gayle F. Burrow RN, BSN, MPH, CCHP-RN, Correctional Health Care Consultant from Portland, OR, to the blogging team. Gayle will share insights from her many years of jail nursing experience in a regular monthly rotation with ECN bloggers Catherine Knox and Lorry Schoenly.

The daily work in corrections health, whether a jail, prison or juvenile facility, easily becomes routine. Concerns for personal safety and facility security can fade as reliance is placed on standard operating procedures, custody colleagues, and our own growing familiarity with the criminal justice system. When this happens our safety can be threatened a couple ways. For correctional nurses, this can happen when someone becomes overfamiliar with a patient or when an inmate has been able to manipulate a staff member to bring drugs into the facility.

A news item reporting that a correctional staff member has assisted an inmate to escape from a facility can lead to a reaction like “How in the world could this happen?” Unfortunately, it does happen; even with good orientation, teamwork and communications.  Inmates have persuasive skills that they learned on the streets and staff member may be going through a difficult, vulnerable life situation. This can be a dangerous combination.

Objects and Relationship Contraband

The book “Games Criminal Play” was helpful to me when I entered the correctional nursing specialty many years ago. Although published in the 1980’s, the principles for dealing with inmate manipulation are timeless and remain helpful today. One key principle is that criminals have a manipulation process so subtle that victims rarely realize what is happening until it is too late. That is why it is important for us to be ever-vigilant in avoiding manipulation traps in our nurse-patient interactions. Here are some actual examples of inappropriate staff activities:

  • Forming a relationship while in the jail leading to the patient moving in with the staff member after release
  • Living with a drug dealer and passing on information to inmates
  • Putting money on an inmates books
  • Not reporting when a family member is in custody

Professionalism and Boundaries

Maintaining professional boundaries with patients is safe practice. Contraband can include not only sharp objects but also information, money and personal relationships. By being a skilled health practitioner, sensitive team member and grounded in yourself, you can deliver good health care while avoiding contraband participation.

To read more about the area of safety for the nurse and patient in correctional settings see Chapter 4 sections on contraband, medical contraband and professional boundaries in the Essentials of Correctional Nursing. You can order a copy directly from the publisher or from Amazon today!

Contraband-Health or Security Issue? Part II

This month the Essentials of Correctional Nursing blog welcomes Gayle F. Burrow RN, BSN, MPH, CCHP-RN, Correctional Health Care Consultant from Portland, OR, to the blogging team. Gayle will share insights from her many years of jail nursing experience in a regular monthly rotation with ECN bloggers Catherine Knox and Lorry Schoenly.

The most common examples of contraband we think of are guns, knives (shanks), sharpened toothbrushes, hording medications, and homemade ropes.  When inmates attempt to hide contraband in their body, things can go awry. Here are a few examples:

  • A swallowed balloon of drugs leaks.
  • Eyebrow pencil mistakenly inserted into the urethra instead of the vagina.
  • A swallowed ring lodges in the intestine.
  • Wrapped razor blades cut into the bowel.
  • A wad of money or hidden jewelry causes a vaginal infection.
  • Horded medication traded to another inmate causes an allergic reaction.

Inmates know that bringing in or making unauthorized items is against the rules, so they do not want to tell anyone because they know they will receive discipline. They have read the inmate handbook about the rules inside the facility. Also, they do not want to give up their important possessions because this is the same way they kept valuables when living on the streets.

Patient Awareness

Health staff provide services in chronic disease management, evaluating care requests and medication management and emergency response.  The challenge is to find ways to make patients aware of contraband. This can be done by incorporating information into everyday nursing practice.  Some areas of nursing practice where the topic of the dangers of contraband can be discussed are:

  • At intake or booking, incorporate a statement of awareness that having unauthorized items on your person can have health consequences.
  • During health assessments or nursing sick call evaluations, take the time to mention that contraband is a health issue and we want to prevent any harmful consequences.
  • Posters or videos can be developed to bring awareness of the possible health consequences of some types of contraband.
  • Work with corrections or custody to expand the statements in the inmate handbook to include some health information about the trauma or illness from contraband.

Staff Awareness

Staff also need reminders to be continually aware of the medical implications of contraband. Here are some ways to keep contraband in the forefront of correctional health care activities:

  • Staff meeting or in-service discussing the types of contraband have effects on the health of our patients. Such things as pelvic infections, drug overdoses, perforated bowels, bowel obstructions, rectal bleeding, stomach problems, drug overdoses, trauma or injury can be emergencies from hidden objects.
  • Review contraband situations that have occurred in the facility and complete a Continuous Quality Improvement study to see what could be implemented to target areas for improvement. Use the plan, do, study, act cycle and information from NCCHC to evaluate ways to identify and improve care in this area.
  • Review procedures for sharps and controlled substances in medical. Reinforce the safety aspects of these important procedures.
  • Look at the orientation program to make sure it covers safety from both a custody and health perspective.
  • Work with custody to be a part of their procedures to identify and eliminate risk in the institution. Things that health should be notified about are finding stashes of medications, drugs found in housing areas, and finding things for suicide attempt.
  • Identify the difference when a provider finds a contraband item during a physical examination and when custody asks medical to perform a body cavity search. One is a consented exam and one is asked to do a forensic procedure only performed by personnel trained in this procedure. Body cavity searches are usually completed at the local emergency room by trained staff.  Guidance on the topic may assist in making decisions
  • Use a staff meeting or in-service time to outline the physical assessment skills necessary to identify contraband. Some system are the gastro intestinal system, pelvic area, rectal function, and signs and symptoms of infection.
  • Invite a custody representative to a staff meeting or in-service session to review contraband, what it is and what are examples found in the facility. Sometimes it is a rope, tattoo gun, sharp shank or maybe it is a cute wallet made from gum wrappers.  This increased awareness can change practices and result in discussions about projects or supplies in use by medical.

As a health professional, we have a special relationship with the patients and assist in maintaining their health and overcoming illness. Health staff interview and screen in booking and respond to requests for care and emergencies. We are there as advocates and support. With little in the literature to guide correctional health care in the area of health effects of contraband, we can learn about how to deliver care when things come up.

In the next article will be about a topic that is not easy to discuss. It relates to situations in which custody or health staff contribute to contraband items or comes under the control of an inmates demands.

Share your experiences with contraband in your institutions and share them with us in the comment sections of this post.

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

References

Standards for Health Services in Prisons, NCCHC, 2014 edition, Standard P-I-03, Forensic Information, pages 149-150.

Standards for Health Services in Jails, NCCHC, 2014 edition, Standard J-I-03, Forensic Information, pages 149-150.

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Contraband—Health or Security Issue?

This month the Essentials of Correctional Nursing blog welcomes Gayle F. Burrow RN, BSN, MPH, CCHP-RN, Correctional Health Care Consultant from Portland, OR, to the blogging team. Gayle will share insights from her many years of jail nursing experience in a regular monthly rotation with ECN bloggers Catherine Knox and Lorry Schoenly.

Contraband is found frequently in the corrections literature usually with a focus on preventing objects like cell phones, sharp objects and drugs from coming into the institutions at booking or at visiting times. Inmates and their friends and families can be inventive. Drones are becoming a new threat to security. They are dropping packages and weapons into recreation yards. A jail in Ohio has installed body scanners at intake to identify and remove items found in body cavities of those being booked into jail. The officers report, of the four thousand they book annually, they find something every day.

Correctional nurses must understand what constitutes contraband and the damage it can cause. Contraband can consist of weapons, drugs, food, tobacco and even objects that inmates can use to coerce officers into doing their bidding. Contraband can also include medication or medical items that can be harmful if used incorrectly.

Contraband is a Safety Issue

Learning about contraband begins with orientation to the facility and in health orientation. In these sessions new correctional nurses discover:

  • The definition and examples of contraband at this particular facility.
  • Procedures in place to prevent things entering the facility, such as cell phone detectors, body scanners, strip searches, phone detection dogs, housing sweeps, mail inspections and now drone tracking devices.
  • Procedures in place for health staff such as sign out and shift counts for narcotics.
  • The importance of sharps, needles and scissors control and counts.
  • The practices in place during medication rounds to identify and prevent diversion.

Contraband is a Health Issue

Health staff sometimes feel that contraband is a custody responsibility. Nurses often find out about searches or lock down times when heading out on medication rounds or when evaluating a patient in a housing unit. However, contraband can dramatically and quickly affect a person’s health. Health care staff should know about the health effects of contraband and be alert to this unique area of our practice.

In an intake or receiving facility, one common situation is when the arresting officer or custody witnesses someone swallowing baggies of drugs. Sometimes the inmate will become scared and notify the nurse. With a witnessed contraband incident, plans can be made to send the inmate to the hospital for observation and treatment.  It is the unwitnessed situations where harm can occur, such as the collapse of a patient from a leaking baggy or overdose from swallowing drugs. Sharp items can cause stomach or intestinal perforations.

Contraband Risk Reduction

Contraband prevention and identification can become part of everyday patient care practice. Here are some examples of ways to incorporate contraband awareness into clinical practice.

  • Questions included in the booking screening process to identify that contraband is a health issue.
  • Intake evaluation can include discussion of the health problems of hiding objects in body cavities.
  • An evaluation for abdominal pain or even constipation, can include inquiry as to any object swallowed or placed in the rectum.
  • General education during health encounters can elicit information from patients.

Is Contraband a Health or Security Issue?

With the wide variety of contraband brought into a facility, custody has processes in place to locate items with screenings, searches and equipment. Health staff have responsibility for procedures like counts, medication checks, knowing what is on your carts, and locking up sharps and medications. Some items do not cause any health concerns and others can cause death. Since, the safety of the institution is everyone’s responsibility, reviewing the policies and procedures for the facility and health will give guidance.

Next week we will continue to review this complex topic of contraband from a health perspective. It will be interesting to know how your facility handles contraband. Share your experience in the comment section at the end of this article.

To read more about personnel and patient safety in correctional settings in relationship to contraband and other areas, see Chapter 4 of the Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today!

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