Thanksgiving

Graphic typographic montage illustration of the word Thanksgiving composed of associated terms and defining words in neutral tones. A pair of autumn leaves completes this dramatic, inspirational design.

This week we celebrate Thanksgiving, an American holiday to give thanks for the abundance of the previous year and the fall harvest. Many, but not all of us, get together with family and friends to enjoy a meal and the company of others as fall turns to winter. Some of us will be working, sharing the holiday with our colleagues and patients. No matter what specific plans we each have for the holiday, it is a time of reflection, to identify and give voice to that for which we are thankful.

Lorry, Gayle and I are thankful for you, the readers of the Essentials of Correctional Nursing. Lorry wrote the first post almost five years ago just as we finished editing, our text, The Essentials of Correctional Nursing. We have posted a new blog nearly every week since then. We are grateful to Gayle for joining our blogging adventure this past year and enjoy her take on issues in correctional nursing.

Our purpose in writing the blog is to amplify the material included in the book and to further explore new and recurrent issues in correctional nursing practice. Our most frequently viewed posts address the subjects of delegation, certification in correctional nursing, vital signs, withdrawal, spiritual distress, the ANA Scope and standards of professional practice, and evidence-based practice. As we look back over our files we are thankful for the opportunity the blog has given us to explore subjects in depth.

Day by day, week by week, year by year our readership has grown. We average over 150 hits on the blog every day and have had over 300 hits on some days. Our readership is from all over the world and we have benefited from our contact with correctional nurses from all across the globe. We have more than 200 regular subscribers on email, over 4,000 on Twitter and more than 700 on Facebook. Thank you for your interest and support for the Essentials of Correctional Nursing.

We published The Essentials of Correctional Nursing in 2012, along with eight contributing authors, to reflect the distinguishing features and practices of this specialty in the field of nursing. In doing so we benefited from the support of many colleagues who peer reviewed the manuscript and offered insight about issues in correctional nursing. The text has since been recommended as a resource applicants use to study for certification in correctional nursing. Lorry also has written a series of posts on this blog about how to study for the certification exam and her own journey becoming certified. We are grateful for the growing legion of nurses who are certified in correctional nursing; you are the voice of the profession! If you are not yet certified, perhaps this could be your goal for the new year. It is easier than you think and there are many benefits.

At the end of every year Lorry and I discuss how we are doing with the blog and decide whether to continue and if so, what subjects we are going to tackle in the coming year. This year we decided that with other opportunities and commitments, it is time to move on and no longer will post on the Essentials of Correctional Nursing blog. However we are maintaining the site and the collection of 220 or so posts as a continuing resource for correctional nurses. Next week’s post will be the last and includes a table of contents so that each of our previous posts can be easily accessed from this page!

We continue to support correctional nursing practice through our writing, consulting, and speaking. Here are some helpful links to other correctional nurse resources that we support and endorse:

CorrectionalNurse.Net Blog

Correctional Nursing Today Podcast

CorrectCare Magazine

The Essentials of Correctional Nursing can be ordered directly from the publisher or from Amazon today!  Lorry and I, or any of the contributing authors, are always glad to sign and personalize your copy of the text.

Have a safe and grateful holiday!

Photo credit: © gdarts- Fotolia.com

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.

Photo Credit: © Sensay – Fotolia

JUST – A Dangerous 4-Letter Word

Kelley Johnson, Miss Colorado, delivered a unique monologue about being a nurse at the 2015 Miss America Pageant. In her two and a half minute presentation she explained how she was describing herself as ‘just a nurse’ to her patient Joe, an elderly man with Alzheimer disease. Joe finally shared his perspective that Kelley was not ‘just a nurse’ but a very valuable and effective healer in his life.

Every nurse can relate to Kelley’s presentation of our role in health care. Few nurses have never felt as she did – that we are ‘just a nurse’ and can’t do much in a particular situation. Yet, as her story reveals, JUST is an incorrect and misleading adjective to describe our role to our patients and to society.

I am especially struck by the danger of the word JUST in describing our role as correctional nurses. Our responsibility for our patient’s health and well-being goes beyond the boundaries of a specific nurse-patient relationship. The inmate population of our correctional setting is a patient community that requires the broad application of our nursing role.  Here are three ways correctional nurses go beyond the conventional perspective of being ‘just a nurse’.

Holistic Viewpoint

The increased burden of mental and physical disease in our patient population can strain the resources of correctional officer staff. Their perspective and training is, rightly, focused on public and personal safety. As a nurse, our viewpoint is holistic. We naturally see  any situation as potentially caused by a health or wellness issue. Thus, what may appear to be a behavioral or discipline issue to our correctional colleague, is evaluated as a health need or treatment side effect. More than ‘just a nurse, correctional nurses can contribute knowledge and clinical judgment in a behavioral situation that can lead to a positive resolution.

Healthy Living Perspective

Correctional nurses frequently deliver care in the living areas of a facility. Traveling about the compound, we have opportunity to observe working and living conditions through the lens of healthcare. Cleanliness, containment, and the reduction of disease spread are inherent nursing principles. Nurses ‘see’ things that may go unnoticed by other professionals in the facility. The availability and use of handwashing resources is just one observation a correctional nurse may make while in the course of  daily activities. Others might include inmate hygiene practices, cleanliness of recreational equipment, or the practices of inmate barbers and porters. Correctional nurses can address unhealthy living practices to improve the health of the larger patient community.

Moral Presence

Abuse of power can easily result from situations where one group of people has control over the lives of another group. Although many correctional systems have an organizational culture that discourages and sanctions this abuse of power, just as many do not. Unfortunately, a significant portion of correctional settings are places of disrespect and incivility. Some, in fact, are even mentally or physically abusive of the inmate population. Correctional nurses have the opportunity, even the responsibility, to address issues of human dignity and patient safety in these situations. Our ethical code calls us to make every effort to protect our patients from mental and physical harm.

Falling under the spell of the adjective J-U-S-T in describing correctional nursing practice is dangerous to our understanding of our role and to the health and well-being of our vulnerable and marginalized patient population. Join me in eliminating this 4-letter word from our self-talk and our practice perspective.

Have you ever been called upon to be more than ‘just a nurse’ in your correctional practice? Share your story in the comments section of this post.

Correctional Nursing and the Ethic of Social Justice

Have you ever been asked what you do as a nurse and found yourself launching into a discussion of sick call and medication passes? It is easy to get lost in the weeds on our professional journey. That’s why it can be refreshing to periodically return to the defining qualities of the nursing profession to see the big picture.

The definition of nursing as found in the ANA Scope and Standards of Practice is

  • The protection, promotion, and optimization of health and abilities
  • Prevention of illness and injury
  • Facilitation of healing
  • Alleviation of suffering

We do this through the diagnosis and treatment of human response and we advocate in the care of

  • Individuals
  • Families
  • Groups
  • Communities
  • Populations

As correctional nurses, we fulfill this definition in the criminal justice system. The location of nursing care delivery establishes our unique patient population, environment of care, and ethical dilemmas of practice.

It is invigorating to be reminded that nursing care goes beyond the post duties and task list for the shift. Certainly caring for patients in a one-on-one situation is the majority of many of our job descriptions. However, I was recently struck by the inclusion of communities and populations in the nursing definition. How do we advocate for care and alleviate the suffering of communities and populations as a correctional nurse?

What is Social Justice?

Social justice is a broad term used to describe equity in the distribution of resources and responsibilities among members of society. According to the Canadian Nurses Association social justice in health care involves “working to prevent negative effects of oppressive practices such as discrimination against individuals on the basis of gender, sexual orientation, age or any other social factor that might affect health and well-being. In correctional nursing, social justice would include reducing dehumanizing practices within the criminal justice system and extend toward improving the health and well-being of the homeless, impoverished, and under-educated communities from which our patients and their families enter into the criminal system.

Social Justice in the Criminal Justice System

You would think that a system with justice in its title would be just but there is a lot of social injustice in the criminal justice system. You don’t have to look very far to see oppression in the power structure of many correctional settings. The need to maintain discipline and provide for personal and public safety can lead to severe punishment and even brutality in the organizational culture in some settings. As correctional nurses, we may not ascribe to the incivility but are often required to view or even participate in the culture in order to delivery necessary health care. For example, have you ever had to witness a violent inmate take-down during an emergency man-down that resulted in the use of a severe restraint device? Did you feel there might have been a more humane way to deal with the safety issue but were afraid to speak up or felt you had no voice in the matter? How might a nursing response to restraint practices across the criminal justice system embody advocacy for the alleviation of suffering among our patient community and population?

But This isn’t a Patient Health Care Situation

As nurses in the criminal justice system we can easily get tunnel-vision about our role within the system. Certainly we are helped in this narrow focus by those criminal justice professionals who clearly see nursing as attending to the direct health needs of specific patients. Yet, our definition of nursing practice speaks otherwise. Our patients are the entire community of inmates within our facility and our role, among other things, is to promote their health, prevent their injury, and alleviate their suffering. Correctional nursing, then, is more than serial one-on-one patient care situations.

We Are All in This Together

Correctional nurses, as a group, can be a significant force in the criminal justice system. Our definition and Code of Ethics calls us to consider the human dignity of our patient population and the significant suffering that our patient community bears up under. Working together we have an opportunity to bring about social justice in an institution, a correctional system, and the entire criminal justice system.

 

Job, Career, or Calling? It’s Up to You

“It’s not what you look at that matters, it’s what you see” – Henry David Thoreau

Your CallingCorrectional nursing can be a job, a career, or a calling based on your perspective – what do you see?

  • If you see your work life as an endless string of shiftwork passing pills and triaging sick call slips then you may have a job perspective
  • If you see your work life as a stepping stone to an advanced position then you may have a career focus
  • If you see your work life as meaningful to the lives of others and personally fulfilling then you may have a calling focus

Those who research job satisfaction have found that those who see their work as a calling do work they care about. They consider their work to be more than a means to an end, but an opportunity to find meaning and do something important. These researchers also found that those who viewed their work as a calling were healthier, had greater satisfaction with their life and missed less work than those in either the Job or Career categories.

Knowing your work orientation can help you find ways to motivate yourself and craft a better work situation without having to change jobs. Job crafting, in fact, is a primary way correctional nurses can move from a Job perspective to a Calling perspective regarding their work life.

Dimensions of Meaning

Experts have determined five dimensions of meaning that can be found in work.

  • Money: Although correctional nursing salaries can be competitive, it is not the one of the highest paying nursing specialties
  • Status: Correctional nursing practice has made advances of the last decade but nurses working in jails and prisons can still be stigmatized by their patient population and work setting.
  • Making a difference: Correctional nurses can make a significant contribution to the health and well-being of a marginalized and disadvantaged patient group.
  • Following your passions: What motivated you to become a nurse? How would that align with correctional nursing practice?
  • Using your talents: Many passions also end up being talents. What nursing talents do you have that are applied in a correctional nursing position?

What is Job Crafting?

Job crafting is a way to redesign work perspective, relationships, and tasks to improve job satisfaction. Job boundaries can expand or contract over time based on the individual in the position and the aspects that are emphasized or de-emphasized. It starts with determining the areas of a role that are the most meaningful, provide the most satisfaction, and are aligned with gifts and talents. While in many situations other areas of the role cannot be neglected; focusing on extending time and effort toward gaining experience and expertise in areas of fulfillment craft the position.

Ways to Job Craft

Even in the most structured of job descriptions, there is room for modifications to make work life more satisfying and meaningful. Researchers found that successful job crafters took action in three areas: perspective, relationships, and tasks. Here are some suggestions specific to a correctional nursing role.

  • Perspective: It all starts in the mind. Mentally seeing your work as affecting the lives and health of your patients is more helpful than seeing your work as a list of nursing tasks that must be completed by the end of the shift. Thus, correctional nursing is not medication administration, sick call, emergency response, and intake screening but “the protection of health, prevention of illness and injury, and alleviation of suffering” (definition from the Correctional Nursing Scope and Standards of Practice, 2013). Successful job crafters reframe the social purpose of their positions to align with their values and concerns. What parts of the definition of correctional nursing do you highly value? Be mindful of those themes during your day-to-day activities.
  • Relationships: The type and extent of relationship with various workmates can be a way to craft a more positive work experience. Hang around unhappy, stressed, and cynical people and you will find yourself mirroring their moods and emotions. The reverse is also true. Honestly evaluate the perspective of each member of your work team and develop deeper relationship with those who will encourage and facilitate your highly valued role components.
  • Tasks: Evaluate which elements of the correctional nursing role give you the most pleasure and fulfillment. Ponder the specific themes of these elements. For example, if you enjoy sick call, which parts? Is it the assessment, the patient interaction, the teaching component? Find ways to do more of the satisfying component. That might not mean the original job task. For example, if assessment is the satisfying part of the sick call process then intake screening is also a task that would provide opportunity for more assessment. If patient teaching is the driving satisfier than chronic care tasks may be an additional option. Once determined, seek ways to increase satisfying tasks while decreasing or streamlining less-valued tasks to accommodate the change.

Just a Job? Just a Step in the Ladder? Just a Way to Make a Difference?

So, what will it be for you? Is correctional nursing just a job that meets your monthly bills and is available until you find something better? Is your position just a step on the career path to a position of more power and prestige? Or, is correctional nursing a way that you make a difference in the lives of others, creating a meaningful professional life of compassion and service? In the end, it is up to you.

“We don’t see things the way they are, we see things the way we are.” – Anais Nin

Four Ways to Jumpstart Patient Safety Efforts

Runner is starting on the running trackPatient safety is an important core value of nursing practice so efforts to overcome barriers to preventing patient harm (like those discussed in a prior post) are worth our energy and attention. Sometimes getting quick results can reduce resistance to the changes needed to decrease clinical error. I’d like to suggest four ways to quickly move forward on improving patient safety in any setting.

Communication Systems

Communication breakdown has been the most frequently cited cause of clinical error so this is an excellent place to start.  If you are a leader, evaluate the various hand-off points in your primary care systems and work to tighten them up. Also take a good look at communication among disciplines, including your staff and officers. For example, are there conflicts and poor relationships that are getting in the way of smooth operations.

Human Factors Engineering

Human factors engineering (HFE) may be an unfamiliar term. It refers to developing systems that take into account human error by implementing safeguards or barriers to common human error points. HFE has reduced errors in other high-risk industries like nuclear power and space travel. Here are a few examples for health care:

  • Reducing reliance on memory with whiteboards or checklists for important care processes
  • Improving information access at the point of care such as easy availability of treatment protocols and drug information where care is delivered
  • Standardizing tasks so that all members of the team perform the task in the same way.

Patient Involvement

Involving patients in their care is not always a popular concept in the criminal justice system. However, if you are returning to your health care roots and centering on the patient, it makes sense to involve them in their care. Patients are able to assist in reaching an accurate diagnosis. Certainly the more  you are able to have an open and honest dialogue with your patient the more likely you will get accurate information to make a diagnosis. Patients can also provide feedback on effects and side effects of treatment. If your patient is engaged as an active member in the care team, he can speak up when something is amiss such as identifying when a treatment or medication is missing or different than expected.

You can also engage some members of your patient population in program improvement activities. For example, trusted patients or inmate councils can provide input into system changes that affect them. The inmate grievance process can also be used to improve patient safety if used to evaluate trends in complaints.

Mindfulness

The final recommendation is simple, yet difficult at the same time. Be continually mindful of patient safety when going about care tasks. Mindfulness is the increasing ability to experience being present with acceptance, attention and awareness. Attention and awareness to the potential for patient harm in everyday clinical situations can go a long way toward averting errors in practice. Just reading about patient safety is likely to increase your awareness but that can fade quickly if patient safety does not become part of the fabric of how health care is delivered in your setting.

Have you overcome barriers to implementing patient safety processes? Share your experiences in the comments section of this post.

Patient Safety – What’s Holding You Back?

Patient safety is a core concept to professional nursing practice. Indeed, we have an ethical responsibility to keep our patients from harm and to always seek their good. I discuss this in an earlier post. Wouldn’t it be nice if we could just say – OK, patient safety is a great model – Let’s do it! Unfortunately, changing a mindset is difficult in any setting; maybe even more so in an entrenched correctional culture.

There are many reasons it can be challenging to embark on a serious journey toward a patient safety culture in a correctional setting. Here are the three frequent barriers to advancing a patient safety model that I found while working with health care leaders in jails and prisons. Would these be barriers in your facility?

Organizational Culture

An organization’s culture is the collection of norms of behaviors that are approved, allowed, or ignored. Culture determines what behaviors are rewarded and what behaviors are punished. Many work cultures in the criminal justice system are built on incivility and disrespect. These cultures are more likely to reward conforming and ‘by the book’ behaviors that rely on administrative controls rather than innovation and initiative. Leaders in this type of environment do not want to hear the ‘bad news’ of a possible safety issue and may marginalize those who try to make them aware of concerns that need addressed to avoid harm.

On the other hand, a patient safety culture builds on a culture of respect and is non-punitive in nature; valuing accountability, honesty, and mutual respect. This has been described as “allowing the boss to hear bad news”. A patient safety culture, then, requires open communication based on trust and positive regard, not always present in our hierarchical and para-military settings.

Broken Systems

Another common barrier to implementing a patient safety mindset is broken or absent systems. Health care, in and of itself, is a complex system of interactions of care providers, patients, diagnostics, equipment and environment. Correctional health care is all of that with an overlay of the criminal justice system and security structure. Not only is health care a complex system but also one that is constantly adapting to changing context and outcomes.

We are in a high-stakes profession where broken systems can mean loss – injury and death – as this case in a prior post illustrates.  Human error is inevitable. We must admit that and embrace it to move forward in designing our health care processes and systems to limit and avoid human error potential.

Nobody Cares

There are many more barriers to a patient safety perspective in corrections but I will close with just one more – Nobody Cares. Granted, there is good reason for developing an uncaring attitude toward our work and our patients. After all, it only takes being manipulated or duped by a patient to be on guard against that happening again. No one wants to be on the other end of deception or exploitation.

Even as healers, we can absorb a pervading “us against them” mentality in many of our settings. If cynicism does not harden our souls, maybe compassion fatigue or secondary traumatization from working with patients in such distressing life situations can zap energy and leave us focusing on merely performing tasks without really considering the people we care for. Layered upon this can be the challenges of dealing with uncivil or bullying peers. All of this can lead to a ‘why bother’ attitude toward our role in patient care and patient safety.

Yet, only clinicians thoughtfully considering their practice and environment will actually see and respond to potentially harmful situations. Only engaged practitioners will reflect on a patient situation to improve the care they provide.

Does this paint a hopeless picture regarding patient safety? I hope not! No matter what your position, you have an opportunity to make a difference and move the organization forward toward patient safety.

Great things are done by a series of small things brought together. – Vincent Van Gogh

What is a small step you could take toward a patient safety culture in your setting? Share your thoughts in the comments section of this post.