Posts Tagged ‘Correctional System Forensic Nursing’

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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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Forensic Nursing in Correctional Facilities, comment

February 9, 2009
I’m sure this is a hot topic among may people. I have to admit as an ER nurse who has seen children who have been physically and sexually abused the thought of having to provide humane care to these animals disgusts me. However, as a nurse we are taught we must heal and teach. I try to treat all patients with dignity no matter what they may have done, but I also believe that with any nursing position you shouldn’t go into it for the money but because it is an area you enjoy. I am not a pysch nurse. I don’t believe in all of the mumbo jumbo, but I do love forensics in trying to determine how a crime was committed and discovering the “who dunnit”. The individuals who work with the criminally insane and the prisioners have to be special people because of the horrible things they see and hear that these prisoners have done. It is a “right” I suppose that all individuals receive adequate healthcare but I have to wonder if were able to subject these criminals to an ounce of the pain that they caused some of their victims would we have less crime?

Original Post:
February 2, 2009
Forensic nursing in Correctional Facilities, comment
I have worked in a Forensic Mental Hospital. I am sure your are speaking about other correctional facilities.
In the Forensic Mental Hospital all of the patients are monitored differently that other patients with very strict rules. Only large strong young men can be the attendants because often the patients are “taken down’ But again this is because they are mentally ill criminals who have a history of hurting even killing people.
One of the forensic mentally ill patients was out in the community. A brutally mean child predator who was given large amts of Depo Provera to chemically castrate him. He could not achieve an erection but state he could not get the idea of hurting young girls out of his mind. He was readmitted to the hospital because he took a razor blade to his penis and testicles.  My job was to change the dressings once a day I had to have two strong young men with me when I was with this patient.  Even though people are locked up maybe the reasons they are criminals are not resolved.

I also applied at the State Prison. While I was waiting for my interview I saw young men hand cuffed through a bench. (i.e. one side of the hand cuff was on the patient and the other through the bench holding the prisoner on the bench)
I decided not to apply because the environment was scary. I agree with the article of Forensic nursing in Correctional facilities but feel it is a dream or fantasy to think that nursing can be like this.
These men and women are in a locked house without normal privileges; sometimes they are fighting for their life.  It is good to treat them normally but there is always the underlying ‘roar’ that they may be trying to get something more than they need. After all a large amount of criminals have sociopathic personalities
 
I work in a poor family clinic in a large city. I often have people who have gotten out of prison come to my clinic because they usually do not have money for health care.
It seems that more often then not, these patients continue their pre prison activities.  They come to us with infected needle lesions. They cry that they just cannot stop. They plead and cry for narcotics, show attitude, and sometimes are mean.
I agree we should treat them with dignity but so should show us respect also.  
I try to remember that most of them are in prison because they do not have people skills and have learned how to ‘play’ people to get what they need. How can a small clinic ‘provide nursing care that is free of bias and judgment’s when the patient (a previous criminal) has showed anger and attitude in the clinic. When I have to spend more than 15 minutes with this patient because he/she needs more help and expects it.
My company had to put a break proof piece of glass between the receptionist and the patient because one of these patients threatened the intake person. Now all the patients have to speak on a phone to the intake person.
It seems that even in a correctional facility they have rules and monitors to decrease the roots of violence. Now when the criminals are let out some of them continue the attitude and continue to cause problems.
Where does it end?

Original Post:
December 30, 2008
Forensic nursing in Correctional Facilities
This chapter started with a wonderful summary of some of the issues that forensic nurses had to contend with in correctional facilities. These nurses are not concerned about the crime that was committed because that has nothing to do with how the patient is to be treated. The same holds true for a psychiatric patient. The ED seems to be the only area where the entire story of the person is portrayed; for better or for worse. The text succinctly summarized the tasks of the correctional nurse: a. Consult and advocate on human rights issues b. Perform medicolegal examinations (not where employed) c. Teach and perform detailed, unbiased documentation d. Provide nursing care that is free of bias and judgment e. Advocate for healthcare and healthcare education f. Inspire health-care for offenders g. Assist nursing and other professionals in creating protocols with the highest ethical standards h. Assist in providing an impartial and secure environment for offenders and staff i. Develop and implement initiatives that decrease the roots of violence. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Forensic nursing in Correctional Facilities, comment

February 2, 2009
I have worked in a Forensic Mental Hospital. I am sure your are speaking about other correctional facilities.
In the Forensic Mental Hospital all of the patients are monitored differently that other patients with very strict rules. Only large strong young men can be the attendants because often the patients are “taken down’ But again this is because they are mentally ill criminals who have a history of hurting even killing people.
One of the forensic mentally ill patients was out in the community. A brutally mean child predator who was given large amts of Depo Provera to chemically castrate him. He could not achieve an erection but state he could not get the idea of hurting young girls out of his mind. He was readmitted to the hospital because he took a razor blade to his penis and testicles.  My job was to change the dressings once a day I had to have two strong young men with me when I was with this patient.  Even though people are locked up maybe the reasons they are criminals are not resolved.

I also applied at the State Prison. While I was waiting for my interview I saw young men hand cuffed through a bench. (i.e. one side of the hand cuff was on the patient and the other through the bench holding the prisoner on the bench)
I decided not to apply because the environment was scary. I agree with the article of Forensic nursing in Correctional facilities but feel it is a dream or fantasy to think that nursing can be like this.
These men and women are in a locked house without normal privileges; sometimes they are fighting for their life.  It is good to treat them normally but there is always the underlying ‘roar’ that they may be trying to get something more than they need. After all a large amount of criminals have sociopathic personalities
 
I work in a poor family clinic in a large city. I often have people who have gotten out of prison come to my clinic because they usually do not have money for health care.
It seems that more often then not, these patients continue their pre prison activities.  They come to us with infected needle lesions. They cry that they just cannot stop. They plead and cry for narcotics, show attitude, and sometimes are mean.
I agree we should treat them with dignity but so should show us respect also.  
I try to remember that most of them are in prison because they do not have people skills and have learned how to ‘play’ people to get what they need. How can a small clinic ‘provide nursing care that is free of bias and judgment’s when the patient (a previous criminal) has showed anger and attitude in the clinic. When I have to spend more than 15 minutes with this patient because he/she needs more help and expects it.
My company had to put a break proof piece of glass between the receptionist and the patient because one of these patients threatened the intake person. Now all the patients have to speak on a phone to the intake person.
It seems that even in a correctional facility they have rules and monitors to decrease the roots of violence. Now when the criminals are let out some of them continue the attitude and continue to cause problems.
Where does it end?

Original Post:
December 30, 2008
Forensic nursing in Correctional Facilities
This chapter started with a wonderful summary of some of the issues that forensic nurses had to contend with in correctional facilities. These nurses are not concerned about the crime that was committed because that has nothing to do with how the patient is to be treated. The same holds true for a psychiatric patient. The ED seems to be the only area where the entire story of the person is portrayed; for better or for worse. The text succinctly summarized the tasks of the correctional nurse: a. Consult and advocate on human rights issues b. Perform medicolegal examinations (not where employed) c. Teach and perform detailed, unbiased documentation d. Provide nursing care that is free of bias and judgment e. Advocate for healthcare and healthcare education f. Inspire health-care for offenders g. Assist nursing and other professionals in creating protocols with the highest ethical standards h. Assist in providing an impartial and secure environment for offenders and staff i. Develop and implement initiatives that decrease the roots of violence. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Forensic nursing in Correctional Facilities

December 30, 2008

This chapter started with a wonderful summary of some of the issues that forensic nurses had to contend with in correctional facilities. These nurses are not concerned about the crime that was committed because that has nothing to do with how the patient is to be treated. The same holds true for a psychiatric patient. The ED seems to be the only area where the entire story of the person is portrayed; for better or for worse. The text succinctly summarized the tasks of the correctional nurse: a. Consult and advocate on human rights issues b. Perform medicolegal examinations (not where employed) c. Teach and perform detailed, unbiased documentation d. Provide nursing care that is free of bias and judgment e. Advocate for healthcare and healthcare education f. Inspire health-care for offenders g. Assist nursing and other professionals in creating protocols with the highest ethical standards h. Assist in providing an impartial and secure environment for offenders and staff i. Develop and implement initiatives that decrease the roots of violence. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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TB in the workplace

November 6, 2008

Ever since the HIV epidemic in the 1980’s the incidence of Tuberculosis has been increasing steadily the past 2 decades. It was almost considered to be eradicated in the united states, and I don’t think I have to explain why working in a correctional setting as a nurse makes me feel a little uncomfortable with this disease becoming more prevalent. Poor hygiene and the crowded conditions of course contribute to the growing numbers of active cases. But I don’t think I can blame the governments or jail administrators for this risk factor. The system is just overwhelmed. There is less money in the budget, more people getting arrested than ever before, and an increasing strain on the healthcare system. What does make me mad is that there are risk factors that can be managed much better and officials continue to ignore them.
There is a jail standard that inmates MUST be screened with a history and physical with a PPD test, and assessment of TB risk factors. That’s all good, except that the standard says that it does not have to be done until the inmate has been incarcerated for 14 days! 2 weeks is plenty long enough for an individual with an active case to be sitting in an open housing, general population cell to cause a small epidemic. As a nurse manager I try to use professional relations with the correction officials to understand that even though it looks like it costs more to staff a few more nurses to get this type of screening done sooner, in the long run their potential costs for medical expenses, and possible law suits could be far outweigh the initial costs. Their side of the story is based on the statistic that most inmates that are arrested have an average stay of 10 days. This is true for many smaller facilities. But there is another statistic that says if you are arrested once you are usually arrested many times in your whole lifetime. I try to relate that to them, the possibility of an infected person spreading TB around for a few days, then leaving and coming back a few months later and doing the same thing. If we can document his infection one time and start treatment, then the next time he comes in at least there will be a record (hopefully computerized) that alarms medical staff for the need to isolate, continue treatment, or whatever is necessary before the patient has a chance to keep spreading TB around in a setting that is basically one big Petri-dish.

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Nursing Care For Inmates

September 24, 2008

Providing quality healthcare to patients is challenging, especially when those patients are inmates; housed in an environment completely unsuitable for healing. Nursing theorists have long taught the importance of having basic health needs met. Hygiene is one of the most significant interventions, as this begins with a person’s ability to fix oneself in a clean environment. The patients I have cared for are inmates in a jail. A facility that houses people in tight living quarters, limits the use of showers and restrooms, and generally is comprised of people with a history of poor hygiene practices. Secondary infections prevent primary wound healing; contagious diseases are rampant (especially for the immunocompromised). This is when it is important for the nursing staff to be diligent to encourage good habits, educate based on education level, and work with correctional staff for the potential of the facility to be reached. This is the kind of nursing that started to save lives in the beginning, and it is these concepts that all nurses must acknowledge from time to time. Nurses must have a strong foundation in the basics to make all interventions capable of working.

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Recent events at my place of employment – legal and documentation concerns

September 4, 2008

I am a correctional nurse; I work in jails and prisons. Working in this environment medical staff must not only be vigilant of medical needs for our patients, but also for legality issues and security threats.
Last week a female inmate was being housed in a disciplinary unit by correctional staff. During this move the inmate’s roommate notified an officer that she had stuck contraband (in this case a crack pipe) in her vagina. The inexperienced sergeant insisted that medical staff on duty do an x-ray or cavity search of some kind. They never should have asked that of the nursing staff, it is a standard that corrections are responsible for any kind of security threat or contraband search. Unfortunately the officers were apparently so intimidating that the medical staff ( 1 LPN, 1 charge RN, and 1 Physician’s Assistant) agreed to do so. With the help of several officers, some of them male, they held the inmate down, and the PA digitally searched her vagina for a crack pipe. The legal ramifications are of course atrocious. According to the medical records/notes that I reviewed as a manager:

1. The inmate verbally was refusing the examination to be performed.
2. Males were present during the examination (there are plenty of qualified female officers present to handle these types of situations with female inmates).
3. The documentation was poor at best from both corrections and the nursing staff.
4. I have to discuss the possibility with staff and my superiors that this is possible a violation of a person’s 4th amendment rights.

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Drug and alcohol detox

September 3, 2007

I consider myself very fortunate to be in an occupation where I am able to learn and experience a seemingly endless amount of medical specialties while still being a nurse.

The most recent “new specialty” for me is drug and alcohol detox. Working in a jail presents a great opportunity to learn this, as one might imagine. Especially a jail located in the middle of “sin city.” I did not realize how vulnerable a patient could be when a patient’s constant consumption of alcohol was abruptly ended. The vomiting, diarrhea, chills, and overall feelings of malaise and sickness are symptoms that are very hard to watch another human go through. I have learned the importance of keeping these individuals on medications like Librium that keep the CNS depressed. It made so much sense to me when the doctors on staff explained to the new nurses the importance of allowing the patients time to adjust accelerated levels of function that non-alcoholics are normally accustomed. With the reading material, and verbal instruction that my employer has provided my assessment skills and understanding of this disease process has greatly improved. I now am able to assess acutely detoxing patients of tachycardia, and tremors that require immediate intervention due to the possibility of inadequate medications.

I am still probably a little more ignorant of drug detoxification. Our facility does not currently treat patients who are merely drug addicts. The only protocols for them are assessment of vital signs and/or neuro checks, rarely with any medications prescribed. My understanding of why this is; those detoxing from drugs are less likely to die. I would like to see my facility designate housing specifically for both alcohol and drug detoxing. So, nursing staff most familiar with this process can be assigned to monitory for signs of patients becoming unstable.

I myself will continue to ask questions about this subject when at work. I find it a very intriguing subject in nursing, and would suggest the same to any nurse to understand it better. Because it dose not matter if you are an ER nurse managing the care of a teenager that has overdosed, or a psych nurse taking care of a drug induced schizophrenic, drugs and alcohol affect all of us in the medical field.

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Medication Errors

August 19, 2007

I am interested to know if any other nurses out there are experiencing the same problems that I do in my facility.

I am a charge nurse a County Detention Center. I have experienced a wide range of dynamic and challenging nursing related problems while in this facility. But one of the worst is the medication error. When an inmate is arrested he/she MUST be screen by a registered nurse in booking. In about 10 minutes a complete health and physical must be obtained, as well as a mental health screen. When there are hundreds of arrests made in one shift, mistakes are made. First of all getting accurate information from an inmate that is under the influence of controlled substances, they are either not competent enough to discuss their medical history or their memory is impaired. Also, even if an inmate reveals a chronic medical condition they are usually ignorant to the names and uses of any medications they have recently been taking.

With such a rough start to providing someone medical care; often inmates are not started on the correct medications if they are started on them at all. This is a major problem with inmates diagnosed with physical AND mental disorders.

I also believe some of the medication errors that are made are so because all the medications in our facility are labeled by generic name. But, all the medications are ordered by BRAND name. This causes quite a bit of confusion with the med pass nurses. Sometimes they have as many as 200-400 inmates to pass meds to at one time. They are rushed, have little time to cross reference names of the medications, and don’t realize they are making errors.

I have suggested to our corporate office to send medications labeled as they are ordered by their brand name. Also I have stated my belief that using a paper based system to manage the healthcare of approximately 4,000 inmates (that may be housed in jail for a couple of days to a year) is not appropriate. A computer system of ordering medications and using MAR’s that are printed instead of hand written should dramatically reduce the amount of medication errors made.

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