What were your first thoughts when you heard the news of convicted Ohio kidnapper and rapist Ariel Castro’s successful suicide while in protective custody in a state prison reception facility? Based on my Twitter and Facebook timelines, there have been a variety of responses in the public, nursing, and correctional healthcare communities. Many are glad that society is saved from the cost of caring for such a heinous criminal. Some are critical of the mental health and security oversights that led to this opportunity for self-injury. After all, Castro’s suicide potential score must have been off-the-chart. Fellow blogger and forensic psychiatrist, Annette Hanson (@clinkshrink), provides a thoughtful post with her take on the subject – Your Patient Died – Who Cares?
This major news item is a reminder of the personal and professional conflict that frequents correctional nursing practice. We care for some pretty unlovely, even monstrous, people. The very definition of professional nursing, however, requires us to consider their well-being and seek their best by preventing illness and injury while alleviating suffering. Are people like Ariel Castro unworthy of our efforts? Many think so. The issue gets to the root of an ethical – and image – dilemma in our specialty.
The Ethical Dilemma
The ethical dilemma stems from a need to feel that our patients are worthy of our good intentions in providing nursing care. From that perspective, Inmate Castro and many others behind bars do not merit our attention. But, is valuing the individual really the basis of our practice? Do we only provide nursing care to individuals who meet our moral standards or expectations? This is where the rubber meets the road in all of nursing, but it is a continual lived experience in correctional nursing.
I would like to suggest that our nursing practice is more about who we are than about who our patients are. In other words, we choose to provide care that goes beyond any consideration of the personal attributes of our patient. That is, in fact, the first and possibly primary provision of the Code of Ethics for Nurses: “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.” Unlike any other specialty, correctional nurses are regularly called upon to look beyond the personal attributes, social and economic statuses of our patients in order to deliver nursing care to murderers, rapists, and kidnappers. Could anything be more challenging?
The Image Dilemma
The image dilemma inherent in correctional nursing stems from being judged with our patient population. This judgment may or may not be conscious. Our own subjective experience is that others in our profession devalue those who choose to care for criminals. Identify your clinical setting in a mixed group of nurses and you see some common reactions, including occasional facial expressions and body language that indicates aversion. Frequent question themes include “Isn’t that dangerous?” or “Aren’t you frightened to go to work?”. Research about correctional nursing practice provides objective support for our feeling that there is a negative stigma to our practice setting. Could this be changed through embracing the unique ethical nature of our care? Could the courage to “practice with compassion and respect for the inherent dignity, worth, and uniqueness of every individual” even murderers, rapists, and kidnappers be what distinguishes correctional nursing practice. I wonder……
The case of the in-custody death of Ariel Castro provides yet another opportunity for consideration of who we are and what we do as correctional nurses. Share your thoughts in the comments section of this post.
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