Archive for the ‘Correctional Nursing’ Category

Perception of Coercion

May 13, 2013

I believe that Ukraine should allow a neutral international team of forensic nurses and experts speak with and exam Yulia Tymoshenko. She is the ex-prime minister who has been jailed since 2011 in Ukraine. I would be happy to take a trip from America to Ukraine to be part of the international team. I would ask for an office for rent in Kharkov and one of the short-term apartment rentals in Kharkov.

The importance of the material covered on health history interviewing cannot be over emphasized in forensic psychiatric nursing. The ability to communicate with accurate empathy, non-judgment and skillful use of specific techniques is essential for accurate risk assessment and monitoring of mental status changes. People who are impaired with paranoid delusions, mistrust, and extreme sensitivity to the motives of others (such as the government of Ukraine), are more inclined to provide information to clinicians that they perceive to be competent. Monahan and colleagues at the MacArthur foundation found that the manner in which providers communicated affected the recipient’s perception of coercion for better or for worse. That is, even when recipients were being subjected to involuntary treatment, their scores on the “Perception of Coercion” scale were lower when the clinician communicated with empathy and respect. Violent events in psychiatric settings can be reduced when staff is competent in assessment and forming working alliances with the patients.

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Cancer screening among jail inmates

March 18, 2013

Many cancer victims can significantly improve the prognosis of the diagnosis with early detection and treatment. Two cancer types that have had improvement in survival rates due to disease screening are breast cancer and cervical cancer. Screening test for breast cancer include breast self-examination (BSE), clinical breast examination (CBE) and mammography. The screening test for cervical cancer is the Papanicolaou (Pap) test. The National Cancer Institute (NCI) released a series of statements of benefit and harm for the above screening tests based on research. In the case of BSE, the NCI asserts that it does not reduce breast cancer mortality and formal instruction and encouragement to perform leads to more breast biopsies and to the diagnosis of more benign breast lesions. In the case of CBE, screening reduces breast cancer mortality. For Mammography performed in women aged 40 to 70 years, breast cancer mortality decreases. The benefit is higher for older women, in part because their breast cancer risk is higher. With the Pap test, regular screening of appropriate women reduces mortality from cervical cancer. In any screening examination, false-positives result in further testing which can carry inherent risks and false negatives may provide false reassurances resulting in a delay in cancer diagnosis. A study conducted at the University of San Francisco reviewed cancer screening of these conditions among jail inmates. The study reviewed the sociodemographic profile of incarcerated persons and suggested they might be at higher risk for the development of certain cancers and for poor outcomes from those cancers. One item the study sought to examine was whether these inmates had received age-appropriate screening. Findings revealed no significant difference in cervical cancer screening between these inmates and other non-incarcerated individuals, however, the women who reported having a Pap test while in jail or prison were significantly more likely to be up to date on cervical cancer screening than women who had never had a Pap test while incarcerated. This suggests that correctional systems may be a principal provider of this preventive test for many female inmates. The researchers report that study results in regards to breast cancer screening was limited by a small number of women in older age groups. Their limited findings suggest, however, that women in the study group were less likely to be up to date on mammography than California women. They also reported that knowledge about breast cancer screening could be improved as most women eligible for screening identified breast examinations rather than mammography as a mean of screening, despite the fact that the CBE and BSE are of less certain benefit than mammography. There is no national registry for tracking disease prevalence and risk factors among incarcerated persons and they are excluded from national health surveys. The results of the cited study were from data obtained by self-report, which are likely to overestimate frequency. A cancer screening registry or statewide computerized medical records in jails would give more significance to this data and may show or confirm that the jail may be an appropriate setting for this type of cancer screening.

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Managing the Incidence of Syphilis

March 12, 2013

The U.S. syphilis rate increased for the seventh consecutive year in 2007 according to the CDC. This is a concerning finding given the potentially serious consequences of the disease if it goes untreated. Effective screening is essential and is a big focus for the CDC as well as many advocacy groups for at risk individuals. The disease is mostly spread through sexual contact, but can also be passed from the mother to child in utero. This can have devastating effects including stillbirth, death shortly after birth or death after a period of illness in infancy. In the adult, the disease can go undetected for many years if the lesions in the primary and secondary stages go unrecognized. They can then be in a latent stage for many years before progressing to the late stage where the disease can cause serious and extensive damage to the body. Syphilis has also been called “the great imitator” since it’s symptoms often resemble those of other diseases. Since the disease is highly treatable in the early stages, screening efforts have the potential for significantly decreasing these divesting occurrences. By treating the infected individual you have high probability of cure thus reducing the effects in the individual as well as preventing spread of the disease to others. Widening screening efforts can facilitate earlier identification of the disease. This is important since the secondary stage of the disease is the most contagious when the infectious lesions are more numerous on the body. The CDC put together a report in 2003 with recommendations for surveillance of the disease in an effort to advance a national plan to eliminate syphilis from the United States. In this report is a list of “priority populations” for routine screening efforts. This list includes arrestees, pregnant women, STD clinic patients and patients diagnosed with STDs in other settings, clients at drug treatment facilities, HIV counseling and testing clients, clients in certain specialty clinics (i.e., HIV, family planning, community based), homeless populations and emergency room patients. The next step in facilitating effective control measures is reporting. With adequate reporting epidemic patterns can be assessed and adequate treatment can be assumed to prevent sequelae of infection. It can also be used to identify cases in a timely fashion in order to interrupt the chain of infection by management of sexual contacts and behavioral risk reduction counseling.

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Diabetes and Police Force Article

February 19, 2013

Recently it has come to the attention of the police force and diabetic specialists that greater attention is needed in the area of caring for diabetic patients who are being held in police custody. There have incidences where a detainee has suffered the affects of a diabetic attack while the condition went unnoticed or misinterpreted by the law officers. It is easy to mistake the symptoms of a hypo or hyperglycemic state as the side effects of drug or alcohol use. For the safety of both parties (derangement and violence are not uncommon in metabolic crisis and death can even occur in the patient) some police forces have decided to take the precaution of providing diabetic training and medical supplies for their stations. (Management of Diabetes in Police Custody: a liaison initiative between diabetic specialist service and the police force. Wright, et al. Practical Diabetes International, March 2008, vol. 25.)

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Nurses working with inmates in the prison system, comment

April 2, 2010

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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PRN Medication Administration Within Correctional Facilities

February 15, 2010

PRN medication administration presents a unique set of challenges in Correctional Facilities. Working within the confines of the Department of Corrections regulations, (hereafter known as DOC), the limitations set by the physical environment, subjectivity, manipulation, the prison culture in general, all of these obstacles create an environment that can be difficult in providing symptom management to Inmates. Of particular concern, is the management of pain. Chronic health conditions, acute illness, or surgical procedures, all predispose the Inmate to pain. Since medication administration times are strictly scheduled, obtaining medication for "breakthrough" pain is difficult. Opiod analgesics, such as codeine, are frequently utilized. While the abuse liability is high, the maximal pain relief is low; additionally, without the ability to administer the drug on a prn basis, Inmate’s symptoms are poorly controlled. Stronger opioids were not stocked in medical units. There is a delay in procurement of Class II narcotics which in turn, creates an environment where pain is uncontrolled, subsequently taking twice as much time and repeated doses of medication to manage a symptom that could have easily been managed had the medication been administered within the appropriate time frame. What I frequently found were the medications that the inmates were permitted to "Keep on Person" (hereafter known as KOP) were abused in an attempt to control unrelieved pain. Those medications, usually Acetaminophen, Ibuprofen, Ultram, even Diphenhydramine, were utilized in excess since the pain medication was not being administered within the suggested time frame. This in turn created issues with disciplinary action to the Inmate for abusing KOP privileges, loss of ability for the Inmate to manage even his/her minor pain, creating an atmosphere on non-compliance directed toward the Inmate, and perpetuated a negative feedback cycle with no possible resolution. And in the end, pain was unrelieved. If we as Clinicians are to effectively treat pain, proper administration of medication is mandatory.

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Screening for Abuse in a Correctional Facility

January 8, 2010

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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Correctional Nursing, comment

November 24, 2009

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, , , , ,

Ethics, comment

August 26, 2009

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, , , , ,

Nurses working with inmates in the prison system

May 25, 2009

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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