Screening for Abuse in a Correctional Facility

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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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