More Circles in Your Practice

cqi-circle-fotolia

Last week’s post reflected on how the nursing process and SOAPIE documentation are circular processes in correctional nursing practice.  This week, a third circular process that is part of every correctional nurse’s tool bag is considered. This is Continuous Quality Improvement (CQI), known to most correctional health care professionals in both positive and negative ways.

The goal of CQI is to improve quality of care and build efficiency into processes and procedures. An article I read recently described the feelings of many family practice providers about CQI as “the mere mention of the words quality improvement can evoke dread in the minds of many physicians” and I would add nurses also.  Often CQI is mistakenly thought of as more work ;focusing on problems and not solutions. However, if you look at CQI as what you do every day to make things better, it takes on a new light. For example when your washing machine stops working, you evaluate the problem, look at what went wrong and fix it. If the machine still does not work, you examine and try again. Out of all this you put in place practices or changes that will prevent the washer from having the same problem again. That is CQI. No matter if you work in a small jail or a large prison system – it only takes ONE person to improve the effectiveness of health care delivery.

What is CQI Anyway?
The National Commission on Correctional Health Care (NCCHC) describes CQI as a pathway to improve health care by identifying problems, implementing and monitoring corrective action and studying its effectiveness. In short, it is a method of continuously examining effectiveness and improving the outcome of care or procedures to deliver service.

There are volumes written about CQI and it can seem very complex but if you think of CQI as a simple process that is done all the time, you will be able to find areas of health care delivery or patient care that can be improved and take steps to find and implement solutions.

A Little History
Even before health care began looking at ways to improve systems, industry had in place methods to look at products that did not work correctly. W. Edwards Deming, PhD., a statistician who revolutionized management theories in Japan and the US, developed the following principles of quality improvement:
• A strong focus on customers—in our case, patients.
• Continuous improvement of all processes.
• Involvement of the entire organization in the pursuit of quality
• Use of data and team knowledge to improve decision making.
In the 1980’s, the Joint Commission set standards for hospital systems to establish a formal program to monitor the delivery of care. The effort to improve the health care provided to patients spread to all health care institutions, hospitals, clinics, care homes and correctional facilities. When the National Commission on Correctional Health Care (NCCHC) developed standards for jails, prisons and juvenile facilities, in the early 1980”s, quality improvement was an essential standard.

Components of CQI
The CQI model requires that you identify the problem area, and your aim or what you want to improve or change. Some common methods for identifying areas for improvement are routine chart reviews by members of the care team, targeted audits to see if forms are completed, referrals made, and labs reviewed. Others might be staff concerns such as equipment not on the emergency cart, missing charts, emergency send outs, or patients not coming to clinic. NCCHC suggests that the areas to study be those that are high-risk, high volume or problem prone aspects of health care. Some program processes to look at are intake, continuity of care through incarceration, emergency care as well as adverse patient events.

Once you have identified the problem area and goal for improvement you bring about the desired changes using the CQI circular model of going through the steps 1. plan 2. do 3. study/check 4. act. Each step is very simple as you can see in the following description:
Plan: Analyze the process, determine what changes would most improve the process, and establish a plan for making the improvement.
Do: Put the changes into motion on a small scale or trial basis.
Check/Study: Check to see whether the change is working.
Act: If the change is working, implement it on a large scale. If the change is not working, refine it or reject it and begin the cycle again.

If you have experience in a quality improvement, you have heard about outcome studies and process studies. If you are new to quality improvement, these two types of studies help to focus quality improvement efforts. An Outcome Study looks at the outcome of a patient’s condition after an intervention has occurred. Examples include: are infections healed with antibiotics, is the A1C in the normal zone, and are chest pain emergency visits reduced when nitroglycerine is kept on person. A Process Study: focuses on procedural or policy oriented issues, such as timeliness of intake screening, physician review of diagnostic results, health assessments completed before day 7 or 14, and TB skin tests read on time.

Documentation and communication of CQI results are extremely important. Each CQI study should be written up and shared with others along with the changes in practice, procedures or training. Most important is to CELEBRATE the successes with staff and be PROUD of the CQI work the team accomplishes.thumbs-up-picture

In summary, the key points of Quality Improvement are:
• It is focused on making processes better.
• The first step is finding key problem areas.
• Identify and prioritize potential change projects. Then use the PDSA cycle to study and implement the change

On reflection of nursing practice, the American Nurses Association, Standards of Correctional Nursing Practice, Standard 10, Quality of Practice, talks about the contributions to quality practice is a responsibility for all of us. One of the competencies is to participate in quality improvement activities with the purpose of improving nursing practice, healthcare delivery and the corrections system.

CQI is a continuous and ongoing part of correctional nursing practice, like the use of the nursing process and SOAPIE documentation discussed in the last week’s post. At the center of each of these processes is the NURSE and the important, skilled and thoughtful care nurses deliver.

Have you participated in CQI projects that improved patient care? We learn from each other so please share with us your successes and examples in the comment section below.

Read more about the practice of nursing in the correctional setting in our book the Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today!

Photo Credit: © canbedone- Fotolia.com & © naruedom- Fotolia.com

Remembering Meaningful Milestones

ncchc-40th-celebrationThe National Commission on Correctional Health Care (NCCHC) held its national conference in Las Vegas last week (October 24th through the 26th).  For the over 1600 attendees, it was a recognition of the profession of correctional health care and the path from the beginning to present day.

40 Years of Educational Offerings

For 40 years, NCCHC has been offering educational opportunities during four educational sessions each year. Edward Harrison CCHP, former NCCHC president was at this conference to bestow some awards and meet friends. His words reflect some of the highlights accomplished along the way.

  • Correctional health care providers were caregivers for AIDS patients before the disease had a name and before many in community health care settings overcame their fear of the disease.
  • Although decades ago telemedicine was widely promoted throughout the country, it advanced in correctional health settings more so than in many community environments.
  • Treating sexually transmitted and other infectious diseases in the community often relies on the interventions provided patients in the correctional system .
  • Correctional systems picked up the slack when community mental health programs lost their funding.
  • Health care for all, regardless of one’s ability to pay, was the established practice in corrections 30 years before the Patient Protection and Affordable Care Act.

During the conference the foundation of correctional health and the early leaders were recognized.  To add to our recognitions, nothing is more noteworthy than our next celebrated milestone.

Estelle vs Gamble- 40 Years Ago

The 40 year milestone of this court case, which is considered the basis for correctional healthcare, forces us to reflect on the advancement of quality care that today is provided across the country to all our detainees. This court case forced everyone to look at care in the jails and prisons across the country and build health care delivery systems that were comprised of qualified health professionals, identified illness, treated disease and prevented harm and suffering.

Estelle vs Gamble is a case brought forward by a prisoner in Texas in 1976. Even though the state “lost” the case, the decisions by the courts provided the foundation for care of all prisoners and the basis of deliberate indifference. During initial orientation, each new employee in correctional health care hears about Estelle vs Gamble and learns that detainees have:

  • The right to access health care in all settings.
  • The right to a professional medical opinion
  • The right to the care that is ordered.

The first standard in the NCCHC’s Accreditation Standards is “Access to Care”. The discussion states that “this standard intends to ensure that inmates have access to care to meet their serious health needs and is the principle on which all National Commission on Correctional Health Care standards are based. It is also the basic principle established by the U.S. Supreme Court in the 1976 landmark case Estelle v. Gamble.” (A-01, 2014 standards, page 3)

Remembering the foundations of correctional health, will provide us with a vision that expands the quality of health care and integrates us into the communities in which we practice.

Certified Correctional Health Professional (CCHP) for 25 Years

The third celebration was to honor the 25 years that the special certification for correctional health professional has been in place. Before 1991, a group of correctional health leaders, worked to develop a test that would reflect the unique challenges and foundation upon which correctional health is practiced across the country. Other health care specialties already had in place specific  certifications, such as ICU nurses, emergency nurses, IV nurses and some mental health specialties. These certifications recognize the knowledge base and competencies required in a specific field or specialty area of practice.

The first CCHP exam was in 1991 and was a take home exam with multiple choice and essay questions. At the conference, we honored 17 CCHP’s who completed the test in 1991 and are still certified today.

As the years have progressed, the test has expanded to a proctored exam at various conferences and sites.  Also other exams for specialties within correctional health have been developed. After you obtain your CCHP certification you may add to your credentials by taking a specialty exam. These include the CCHP-RN, CCHP-Physician, CCHP-Mental Health and CCHP-Advanced.  Achieving professional certification is the surest way to demonstrate that you have the qualifications and expertise to meet the challenges of delivering correctional health care in any setting.

As we go through our daily work, it is good to take time to reflect on how we achieved this proud and important professional career, and all the people who came before us and showed the dedication and leadership to improve care and show us the way.

Do have a reflection on the history of correctional health care that you would like to share? Please reply in the comments sections of this post.

Read more about legal foundations of correctional health care and the professional organizations that support correctional nursing in our book the Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today!

Photo Credit: NCCHC,org, education and conferences link

Stay at home ways to build continuing education credits

Man sitting at a computer, learning at home.

I have a friend recently who was lamenting that personal circumstances did not allow her attendance at the National Conference on Correctional Health Care that took place in Dallas Texas this week. She was worried that she would not have enough continuing education hours to satisfy the requirements for recertification as a Certified Correctional Health Professional (CCHP). In addition to professional recertification, many states require evidence of continuing education when nurses renew their license. There are times when life events or circumstances make attending a conference or other educational activity just impossible and then we worry about having enough CEs. This post is written to provide information about some CE resources that can be done at home and are free or inexpensive.

CCHPs and CCHP-RNs recertify once each year. In addition to the renewal fee of $75 the applicant must attest to having obtained 18 hours of continuing education of which 6 hours are specific to correctional health care. CCHPs and CCHP-RNs should maintain a record of the continuing education that they have attested to, in case they are audited. One way to do this is to keep a CE log that includes the following information:

Your name Date Title or subject # of hours

In addition to conference attendance, continuing education credit may be obtained by attending in-service at a correctional facility, writing an article for a journal, or making a presentation at a conference. Another way to obtain CEUs that may be more practical or achievable when life becomes hectic is self-study or independent learning. The following are some self-study options:

The Journal of Correctional Health Care is provided free as one of the benefits to CCHPs and CCHP-RNs. The Journal is published four times each year and contains six to ten scholarly, peer reviewed articles that are specific to correctional health care. If you are not certified an annual subscription costs $125 so this is a tangible return on the investment in certification. You can earn 1 continuing education credit for each article if you complete a corresponding exam. Any article published by the Journal of Correctional Health Care within the previous two years is eligible for continuing education credit. All of this material would meet the requirement of CCHP for 6 hours specific to correctional health care. For more information about this resource go to this link http://www.ncchc.org/journal-of-correctional-health-care.

Medscape is another resource for continuing education credit. This site offers clinicians access to timely clinical information and educational tools to stay current in practice. There is no cost to join and you can access resources that are selected specifically for nurses. For example 0.25 contact hours can be obtained for previewing a slide show and web discussion about motivational interviewing, behavioral action and collaborative care in Strategies for Effective Communication with Patients with Major Depression. There is an easy to use CE Tracker that will keep track of the courses and credits accumulated through the year which can be saved or printed out as necessary. This last year I took two classes, one on the guidelines for prevention of bedsores and the other on prescribing antibiotics and both were easy to access, informative and the exam very simple. For more information about this website go to this link: http://www.medscape.org/

The American Nurses Association is a favorite on-line resource of mine for continuing education. You do have to belong, but an on-line membership only costs $45 a year. Membership benefits include three publications, American Nurse Today, The American Nurse, and the Online Journal of Issues in Nursing. There also is a large library of on-line courses with continuing education credit that can be accessed when it is convenient for you.  I have taken several courses from ANA this year, including a session on the new ethical guidelines for nurses, a course on preventing medication errors and another on the JNC guidelines for managing hypertension. As a member I receive announcements of upcoming Webinars that are offered with continuing education credit and at no charge. This year I took a whole series on building a healthy workplace. Go to this link to find out more about the continuing education resources through the American Nurses Association: http://www.nursingworld.org/JoinANA/E-Membership-Only.

These three resources offer thousands of continuing education hours without ever having to leave your home. Most can be obtained either free or as a benefit of being a CCHP or CCHP-RN. So when time or circumstances make it impossible to access continuing education credits at conferences or on the job, these options may be a help. In my case I’ve chosen to access continued learning through these sites even though I have been able to attend conferences and in-service programs this year.

Do you have resources for continuing education that you would like to share with other correctional nurses? If so, please tell us about them by replying in the comments section of this post.

For more about continuing education in correctional nursing see Chapters 17 Management and Leadership as well as Chapter 19 Professional Practice in the Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today!

 

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An overview of medication management in correctional settings

Isolated, whitespace, copyspace.

The roles and responsibilities of correctional nurses for medication management are broader in scope than other practice settings. In health care settings many other professional and support personnel contribute to delivery of patient care.  However in correctional facilities nurses are relied upon to deliver care without the availability of these other types of personnel. The result is that correctional nurses often work in professional isolation and may feel like they are in a foreign country (Muse, 2012). I think traveling in a foreign country is a good analogy for correctional nursing. Doing this well involves preparation by learning something about the sights to see, building skill using a little of the language, familiarizing yourself with the rules, particularly which side of the road people drive on and finding out how to avoid being robbed or harmed in some way. The thrill of correctional nursing, like the thrill of foreign travel, comes when you realize how much you are enjoying it, especially the independence of professional nursing practice in this field. This post is the first part of a guidebook for your journey managing medication in correctional settings.

State law, rule and regulation

State law serves as the basis for nearly all of the practices and procedures involved in medication management. Most nurses are familiar with the nurse practice act in their state. If not, this is the place to start by reviewing it for definitions and references to medication. The nurse practice act will be especially helpful in describing the training and supervision requirements if non-licensed personnel, such as nursing assistants, administer medication at the correctional facility.

The pharmacy practice act is the most important resource to review. These laws will define how to obtain, store, dispense and account for medication which are often the responsibility of nurses when there is no pharmacist on site.  Even if there is a pharmacist at the facility, being familiar with the law that governs their practice is helpful in understanding the recommendations pharmacists make about drug storage, packaging of medications and accountability.

The medical practice act provides important information about how a physician’s order for medication is lawfully carried out. The medical practice act also has information about how medical assistants and paramedics work as well as the requirements for training and supervision which need to be followed if these personnel are involved in medication management.

This is not interesting reading but it does provide information that nurses can use in determining the responsibilities of personnel for medication management. It also provides definitions and terminology to accurately communicate with the pharmacy that provides medication to the facility and with providers about implementation of orders. Finally it provides nurses a basis to knowledgably resist inappropriate requests from custody and other personnel not familiar with health care laws to carry out tasks that are inconsistent with state law.

Accreditation standards

The National Commission on Correctional Health Care (NCCHC) and the American Correctional Association (ACA) are organizations which accredit correctional facilities for providing services and programs consistent with national standards. The standards are also used by most correctional facilities in developing policy and practices even if accreditation is not sought. Both organizations have standards related to medication management which are summarized in Figure 1. This list is a handy description of all the moving parts and pieces of medication management in correctional settings and nurses are involved in all of these components. This list can be used to review how medication management is handled at a facility and identify areas that may need attention.

Figure 1:   Standards for medication management in correctional facilities
NCCHC ACA
Applicable standards C-05, D-01, D-02 4-4378, 4-4379
1. Facility operates in compliance with state and federal laws regarding medications. Similar
2. There is a formulary and method to obtain non-formulary medication. Similar
3. Policy and procedures address how to procure, receive and account, dispense, distribute, store, administer and dispose medication. Similar
4. Medications are under control of appropriate staff and accounted for. Secure storage and perpetual inventory of controlled substances, syringes and needles.
5. Medication is only prescribed as clinically indicated after provider evaluation. Similar
6. Providers are notified of medication needing renewal prior to expiration. Similar
7. Staff are properly trained to administer or distribute medication. Similar
8. Inmates do not prepare, dispense, or administer medications. Self-carry medication programs are allowed.
9. There are no outdated, discontinued, or recalled medications at the facility.
10. If there is no on-site pharmacist, a consulting pharmacist is available for advice and makes inspections of the facility’s medication program at least quarterly.

Nursing standards

The American Nurses Association (ANA) has recognized correctional nursing as a specialized field of practice since 1995. The ANA publishes a reference that describes the scope and sets standards for the practice of correctional nurses. With regard to medication management the role and responsibility of correctional nurses is as follows:

  1. To be knowledgeable of medications administered, including dosages, side effects, contraindications and food and drug allergies.
  2. Practices with regard to medication management in the correctional setting meet the same standards as in the community. To do so nurses must be knowledgeable about state practice acts (as suggested earlier in this chapter).
  3. Ensure that patients know what medications they are taking, the correct dosage and potential side effects.
  4. If patients are expected to take medications without supervision the nurse evaluates the patient’s competence to self-manage and takes steps to protect those who are not competent to do so.
  5. Work with custody staff so that patients receive medication in a timely and safe manner (ANA, 2013).

This overview makes me reflect on my first experience with medication management in correctional nursing. I was being oriented to administer medications on the evening shift at a maximum custody men’s prison. A technician rolled a grocery cart filled with stock bottles of all kinds of medication out to me. The cart was full. In giving me the cart he said “You roll this along the tier and stop at every cell. Ask the inmates what meds they want. When you give them the medication then you record it on one of these index cards that has the medication listed at the top.” I remember being shocked and asked the technician why they did it that way. He shrugged his shoulders and went on with his tasks. While this experience is pretty extreme you might use it to review against the ANA nursing standards of practice, the accreditation standards and state law that were reviewed in this post and identify the inconsistencies. Being knowledgeable about the standards and requirements for medication management prevents erosion of professional practice and ultimately protects patients from harm.

Going back to the travel analogy, knowing state law, the national standards for correctional facilities as well as the standards of practice for correctional nurses is like having a guidebook to review the sights to see in place you have selected to travel to. These become a reference point to plan so you can make the most of your time as well as an expectation for what will take place while on your journey.

Is medication management a troublesome area where you practice correctional nursing? Have you looked at the problem through the lens of applicable state law, corrections standards and the nursing practice standards? If so, what have you identified as the problem areas? Please comment 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!

 

References

ANA (2013). Correctional Nursing: Scope and Standards of Practice. Silver Springs: American Nurses Association.

Muse, M. (2012). Professional role and responsibility. In C. Schoenly L. & Knox, Essentials of Correctional Nursing (pp. 364-377). New York: Springer.

National Commission on Correctional Health Care. (2014). Standards for Health Services. Chicago: National Commission on Correctional Health Care.

American Correctional Association. Performance Based Standards for Correctional Health Care. Retrieved August 19, 2015 from http://www.aca.org/standards/healthcare/

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Stimulant Withdrawal: All Wound Up!

Stimulant WithdrawalPrimary concerns in substance withdrawal are alcohol and opiates; and rightly so. Withdrawal of these two drugs of abuse can cause serious health concern. Stimulants such as cocaine, methamphetamine, crack, and amphetamines are also popular among the inmate patient population and can cause significant effects when abruptly withdrawn upon incarceration. Fortunately, stimulant withdrawal, while uncomfortable, is rarely life threatening.

Case of the Jitters

Stimulant intoxication may well be the initiating circumstance landing your patient in booking. Cocaine and meth are used  for a heightened sense of well-being and euphoria. However, they can also lead to aggressive and violent behaviors. Here is a list of common negative effects of stimulant over-use:

  • Emotional instability
  • Agitation, restlessness, irritability
  • Impaired judgment
  • Poor impulse control
  • Aggression

Charges for domestic violence, aggressive driving, or property destruction may result when things get out of hand. Besides the above behavioral observations, other signs of stimulant intoxication that might be noted on booking include:

  • Rapid heart rate
  • Elevated blood pressure
  • Dilated pupils
  • Increased temperature

If a patient presents with these indications of stimulant over-use, probe further into their drug-taking behaviors and usual withdrawal symptoms.  This information will help in developing a plan to manage their withdrawal while incarcerated.

Stimulant Withdrawal Effects

Coming off stimulant use results in irritating then depressing the nervous system. The patient can expect to first experience agitation, intense drug cravings, and insomnia. Farther into withdrawal this changes to lethargy, fatigue, and dulled senses causing excessive sleepiness.

Stimulant Withdrawal Management

Stimulant withdrawal usually doesn’t require medical management and protocols rarely include medications. For example the Federal Bureau of Prisons Withdrawal Protocols recommends symptom management only. However, cardiac complications can be seen, especially in compromised individuals like the elderly or those with cardiac or respiratory disease. A baseline EKG and follow-up may be warrented.

Stimulant withdrawal behind bars is basically a self-managed event requiring the inmate to initiate health care contact for symptom relief. Therefore, it is important to provide instruction on how to access the medical unit and when to seek out treatment. Explore ways the person has managed periods without the drug in the past and provide options within available processes during incarceration.

Stimulant Withdrawal and Self-harm

Although stimulant withdrawal may not be life-threatening, coming down off uppers can lead to severe depression and suicide ideation. This ‘crash’ may happen quickly with rapidly metabolizing drugs like cocaine or more slowly with longer-acting stimulants like methamphetamine.  Conclusion of withdrawal symptoms follows the same progression with acute cocaine withdrawal lasting from 3-4 days while methamphetamine can last 1-2 weeks. Unfortunately, drug craving can last much, much longer.

Engage available mental health treatment for this patient. Suicide evaluation, drug treatment programs, and group therapy are all beneficial.

Mixed Withdrawal Alert

Like so many of our patients, stimulant users will self-medicate with other substances to smooth out uncomfortable symptoms of their drug of choice. So, be aware that cocaine and methamphetamine users are likely to also use alcohol, benzodiazepines, or opiates to mellow out between fixes or after binges. Specifically ask about what your patient uses to even out their stimulant highs and be prepared to manage possible withdrawal from these substances, as well.

Are stimulants like cocaine, methamphetamine, crack, or amphetamines popular with your patient population? Share your withdrawal tips in the comments section of this post.

To read more about alcohol and drug withdrawal in the correctional setting see Chapter 5 in the Essentials of Correctional Nursing.

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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.

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What’s new and news

Speaker at Business Conference and Presentation.First: What is new with Ebola since the last post? Another nurse from Texas and a doctor in New York are infected. The Centers for Disease Control has held two teleconferences with nurses across the country and issued revised infection control guidelines to prevent transmission of Ebola to health care workers. Also last week the American Jail Association disseminated guidelines developed by two jails in and around Dallas where the first case in the United States originated. I hope you have reviewed and perhaps revised your communicable disease screening and identification procedures as well as the availability and use of personal protective equipment consistent with these new recommendations.

NCCHC Fall Conference: Celebrity Chef Jeff Henderson was the key note speaker at the fall conference took place in Las Vegas last week. Henderson got his GED and learned culinary skills while serving a nine year sentence in Federal prison for drug dealing. Once released he continued to develop his culinary skills, eventually becoming Executive Chef at Café Bellagio and Caesar’s Palace in Las Vegas and writing four self-help books including his autobiography, ‘Cooked’. Now he works with young people to provide alternatives to getting involved in the illegal drug trade and is a motivational speaker. He has appeared on The Oprah Winfrey Show, Good Morning America, The Montel Williams Show, CNBC, NPR’s All Things Considered, People and USA Today.

My favorite of all the stories he told was about buying all the top ramen noodles he could afford from the prison commissary. He wasn’t interested in the noodles which he passed out to everyone on the cell block who wanted some. Instead he wanted the seasoning mix that was included with the noodles. As head chef, he used these to spice up the cheese wiz to make his nachos, now famous in prison lore. Jeff Henderson was a young man in prison when he read his first book, was called “son” for the first time, and had someone acknowledge something that he did well in school. He has a great message about self-help and a convincing perspective for all of us involved in the criminal justice system.

Here is a recipe from Cooked (pages 163-164). When Jeff makes fried chicken he still uses this recipe from Friendly Womack, who was the chief inmate cook at the federal prison outside Las Vegas when Jeff was serving time there.

Friendly’s Famous Buttermilk Fried Chicken

2 tablespoons cayenne pepper                                 2 teaspoons onion powder

3 tablespoons black pepper                                        4 tablespoons kosher salt

2 cups all-purpose flour                                                 1 quart buttermilk

1 chicken cut into eight pieces

  1.  Mix all of the spices together in a bowl. Put half the seasoning mix in another bowl. Add the flour to one bowl, mix well and set aside.
  2. Rub the chicken with the reserved spice mix. Poke all the pieces with a fork a few times and set aside. (Friendly taught me to pierce the chicken pieces with a fork so the buttermilk seeps down into the bird.)
  3. Pour the buttermilk into a stainless steel bowl. Add the remaining spices and the chicken pieces. Cover the bowl with plastic wrap and refrigerate for an hour.
  4. Dip the chicken pieces into the seasoned flour, pat the pieces together and make sure they are heavily coated.
  5. Drop them into a deep fryer or in a deep pan with enough vegetable oil to cover the chicken. Turn the chicken as it browns and remove once done.

News about the doings of contributing authors: Authors who contributed to Essentials of Correctional Nursing were also prominent during the NCCHC Conference. Margaret Collatt and Sue Smith gave a presentation about a project to develop guidelines for correctional nurses in chronic care management. In addition to Margaret and Sue, the group working on this project includes:

Sue Lane, RN, ASN CCHP                              Susan Laffan, RN CCHP-A CCHP-RN

Pat Voermans, MS, RN, ANP, CCHP-RN Patricia Blair, PhD, LLM, JD, MSN, CCHP

Lorry Schoenly, PhD, RN, CCHP-RN          Sabrina McCain, RN, ASN CCHP

Lori Roscoe, PhD, ANP-C, CCHP-RN          Debbie Franzoso, LPN, CCHP

They have two guidelines in development right now. One is on management of hypertension and the other concerns seizure disorders. The presenters encouraged nurses to participate in this process by commenting on the format for the guidelines and the topics that are important to correctional nurses. Watch for more news about this important project.

Mary Muse gave two presentations that serve to inspire the practice of correctional nurses. One was from the ANA Nursing Scope and Standards of Professional Practice on two steps in nursing process: Implementation and Evaluation. She used two case examples which always help to make standards real in their application to our daily practice. She also presented a session on the Transformation of Nursing Leadership reminding us of the challenges and expectations for nurses with the change resulting from the Affordable Care Act and the report from the Institute of Medicine (IOM) on the Future of Nursing.

Margaret and Susan Laffan teamed up to give four presentations throughout the conference. These included sessions on the cardiovascular examination, understanding lab values and critical thinking as part of nursing process. As usual with these two presenters, the sessions were full of practical information, fun and door prizes as well.

Margaret and Susan joined with Sue Medley-Lane for a session on Rejuvenation of Nursing Spirit. For Susan Laffan, rejuvenation comes when she dons her pink fuzzy slippers which you will sometimes see her smoozing around the conference in. These presenters discussed the demands of life that can contribute to a loss of spirit and ways to mitigate the cumulative effect of these experiences. They asked correctional nurses to tell the stories and describe the experiences that have inspired their commitment to the field and will collect these and send the collection back out to participants. If you have a story or experience that has been your inspiration for correctional nursing send it to njjailnurse@aol.com by November 30, 2014. The story must include your name, your state and your email address. It should be no more than 300 words long and the names of any patients in the story should be changed.

If you have some ideas about what you think the guidelines for nursing management of chronic care should include or subjects that should be covered please respond in the comments section of this post. If you have an inspirational story about correctional nursing that you would like to share please send it to Susan Laffan at njjailnurse@aol.com by November 30, 2014.

For more on correctional nursing read our book, the Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.