Forensic Nursing Chronicles

The registered nurse does indeed have a unique opportunity to educate prison inmates on health related topics. Some inmates with chronic illnesses such as diabetes may have mismanaged their health for reasons such as poverty, drug addiction, alcoholism or a life style of denial. Once the individual is incarcerated, the nurse has an opportunity to teach and educate. For instance, the diabetic person might be taught the signs and symptoms of hyper/hypoglycemia, the disease process, and interventions he or she can take to slow the disease progression. While some might believe the inmate does not have the freedom to practice proactive interventions, there are many things he could do – such as exercise, food choices at commissary, foot protection and inspection, and learning about medications. Nurses who will be checking blood sugars can educate on this important intervention, as well as drawing up and giving insulin, accuracy and timing of insulin administration, storage of insulin and proper needle disposal. Another important consequence of diabetes is heart disease and hypertension and the inmate could be taught normal blood pressure and pulse values and, as mentioned in the original post, techniques to manage stress and identify signs of heart attack. While prison food might not be the best, some inmates can apply to work in the kitchen and may be able to influence the food preparation and selection. It is important for nurses to remember that the inmate is not a bad person, but a person who has made bad choices; these choices are frequently carried over to their own personal health management. Taking the time to teach may have a long lasting impact on both the physical and emotional health of the inmate, not only during the period of incarceration, but throughout the lifespan of the individual.

Original Post
May 25, 2009
Title: Nurses working with inmates in the prison system
Working in the prison system is part of forensic nursing. The registered nurse working with inmates has a unique opportunity to implement health promotion activities. Patients who are incarcerated have a lot of time on their hands and perhaps some of that time could be used for learning about disease prevention. Many inmates come into the prison system already suffering from multiple medical problems. Many of them have chronic illnesses such as diabetes or hypertension, others have communicable diseases. Mental illness and substance abuse are also common in the prison system. Patients who are healthy when they come into the system are also at risk for developing health problems because of risky behaviors that often take place among inmates. Nurses must assess for some of the risk factors and develop a treatment plan appropriately. As part of the treatment plan, nurses could teach their patients about disease management, disease prevention and health promotion. Some examples of teaching may include having the patient identify signs and symptoms of a heart attack. Nurses could also teach patients relaxation techniques and stress management. Forensic nursing offers a unique opportunity for nurses to really make a difference in an inmate’s quality of life.

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I work as a charge nurse in a long term care facility with a small correctional facility that is a separate building on the campus. I pass meds to an average of 25 inmates. My responsibilities, also, include health assessment, injury care, psychological screening, and abuse assessment. I address, at a minimum, 4-5 inmate-to-inmate abuse incidents per week, ranging from superficial abrasions and mild bruising to severe assaults, encompassing head trauma and deep lacerations. EMS is always called for severe injuries, but the initial triage and investigation falls to the examining nurse. I find that one never gets the truth, in regards to the assault, from the inmates involved. Fortunately, cameras are everywhere. The saying, "a picture is worth a thousand words," always seems to clarify the incident. I have had to go to court multiple times, as the on-site medical officer, offering my recollection of events during my assessment. Good and thorough documentation is essential, as well as adequate injury care. Getting the guards to corroborate the nurse’s findings is necessary to preventing unnecessary law suits. The physician, on call, oversees the triage and care. He is the nurse’s ally. Most of the abuse incidents stem from the inmates being cooped up with other inmates in a closed environment. Frustration, anxiety, and anger are all thrown into the volatile mix. This is what I find difficult to come to terms with. There is very little psychological counseling done on these inmates. They have no valid coping mechanisms taught to them. This makes it frustrating for the nurse, with little psyche training. I am cognizant of the lack of funding for psyche intervention programs, but feel that a more intense and complete psychological screening assessment tool should be incorporated into correctional nursing than just a form, with questions asked of each inmate. There should, also, be ongoing evaluations done on the inmates, as environmental factors seem to have a substantial impact on the mental health of incarcerated individuals.

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I have to agree with the author on the view that some correctional nurses do not treat the inmates as they would a patient in a healthcare setting. The prison population in or area is pretty extensive. In addition to the two local county facilities, we have a state hospital for the criminally insane, level three sex offender unit, three medium level state correctional facilities and one minimum prison. Our prison system is our biggest employer. I do have several friends who have left healthcare for the benefits of a state facility – insurance, overtime, vacation. As I listen to them discuss their day – I often would like to point out the fact that they all sound miserable and loathe the very people they care for. Speaking as a wife of a correctional officer, it’s almost as if the very environment of the prison system breeds contempt. If anyone shows even the slightest act of compassion they are looked at as a traitor or weak – this carries over to the medical staff as well. Sadly, it appears the staff of such facilities are just biding their time as well as the inmates.

Original Post
August 26, 2009
Ethics, comment
I consider myself a very ethical person and when faced with the realization that many of the nurses in the facility where I work did not care one way or the other about the people placed in their care. I work at one of the largest county jail in the country and although these human beings have committed some type of crime, there is no excuse for not being given respect and the proper medical care as indicated in a timely manner. Daily I noticed that when it was announced that there was some type of emergency involving an inmate, the nurses would just sit there and look at each other, it seemed like whichever one drew the short straw was the one who would have to go and check on the inmate. During many of these cases the only respondents to the area was me and a deputy, then a few minutes later a nurse would come as slowly as possible with the crash cart would stand and just stare at the inmate before ever touching them. I finally had seen enough neglect and notified my program manager who notified the nurse manager of these nurses which made no difference in their performance. My next step was to notify the board of nursing who took forever to investigate the incidence without ever finding fault or reasons for disciplinary actions. To this day the neglect continues but I have been removed from the area (which was not my idea) and now work where I do not have to be exposed to this hypocrisy daily. To me this was a slap in the face to all the people who are there to do the best job possible regardless of who the patient is or is not. It seems ethics takes a back seat for these nurses once they enter the job-site, but then again a leopard cannot change his spots. Original Post August 26, 2009 Title: Ethics Really enjoyed the chapter on ethics from my textbook in Dr. Johnson’s class; I was lucky enough to attend a 2 day seminar in Ottawa that was mostly focused on ethical dilemma’s in the workplace. We presented different scenario’s which were really useful for future guidance. Of particular interest was the Nurse-Doctor relationship; when to step out of bounds as a patient advocate. We are often faced with difficult decisions regarding treatment of our pts. Do we agree or disagree with what the Dr. has prescribed? In one case I knew if I followed through on the treatment plan that the pt. could suffer undue harm therefore I was left with no choice but to report the problem to a senior medical advisor. It caused an uncomfortable situation for the Dr., and myself however after much discussion he was able to understand I was only acting on behalf of the pt. The chapter really gave me some knowledge of how to handle these situations. Forensic Nursing Online Introduction Course Forensic Nursing Online Certificate Program, Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Ethics, Forensic correctional nursing ethics

I consider myself a very ethical person and when faced with the realization that many of the nurses in the facility where I work did not care one way or the other about the people placed in their care. I work at one of the largest county jail in the country and although these human beings have committed some type of crime, there is no excuse for not being given respect and the proper medical care as indicated in a timely manner. Daily I noticed that when it was announced that there was some type of emergency involving an inmate, the nurses would just sit there and look at each other, it seemed like whichever one drew the short straw was the one who would have to go and check on the inmate. During many of these cases the only respondents to the area was me and a deputy, then a few minutes later a nurse would come as slowly as possible with the crash cart would stand and just stare at the inmate before ever touching them. I finally had seen enough neglect and notified my program manager who notified the nurse manager of these nurses which made no difference in their performance. My next step was to notify the board of nursing who took forever to investigate the incidence without ever finding fault or reasons for disciplinary actions. To this day the neglect continues but I have been removed from the area (which was not my idea) and now work where I do not have to be exposed to this hypocrisy daily. To me this was a slap in the face to all the people who are there to do the best job possible regardless of who the patient is or is not. It seems ethics takes a back seat for these nurses once they enter the job-site, but then again a leopard cannot change his spots. Original Post August 26, 2009 Title: Ethics Really enjoyed the chapter on ethics from my textbook in Dr. Johnson’s class; I was lucky enough to attend a 2 day seminar in Ottawa that was mostly focused on ethical dilemma’s in the workplace. We presented different scenario’s which were really useful for future guidance. Of particular interest was the Nurse-Doctor relationship; when to step out of bounds as a patient advocate. We are often faced with difficult decisions regarding treatment of our pts. Do we agree or disagree with what the Dr. has prescribed? In one case I knew if I followed through on the treatment plan that the pt. could suffer undue harm therefore I was left with no choice but to report the problem to a senior medical advisor. It caused an uncomfortable situation for the Dr., and myself however after much discussion he was able to understand I was only acting on behalf of the pt. The chapter really gave me some knowledge of how to handle these situations. Forensic Nursing Online Introduction Course Forensic Nursing Online Certificate Program, Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Ethics, Forensic correctional nursing ethics

Working in the prison system is part of forensic nursing. The registered nurse working with inmates has a unique opportunity to implement health promotion activities. Patients who are incarcerated have a lot of time on their hands and perhaps some of that time could be used for learning about disease prevention. Many inmates come into the prison system already suffering from multiple medical problems. Many of them have chronic illnesses such as diabetes or hypertension, others have communicable diseases. Mental illness and substance abuse are also common in the prison system. Patients who are healthy when they come into the system are also at risk for developing health problems because of risky behaviors that often take place among inmates. Nurses must assess for some of the risk factors and develop a treatment plan appropriately. As part of the treatment plan, nurses could teach their patients about disease management, disease prevention and health promotion. Some examples of teaching may include having the patient identify signs and symptoms of a heart attack. Nurses could also teach patients relaxation techniques and stress management. Forensic nursing offers a unique opportunity for nurses to really make a difference in an inmate’s quality of life.

Technorati Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Correctional Nursing