Correctional Nursing Alert: Ectopic Pregnancy
A young woman in custody at a large urban jail has continuing abdominal pain over a 14 hour period. She is found unresponsive in her cell and rushed to the hospital where she is pronounced dead on arrival. Autopsy reveals a ruptured ectopic pregnancy. Was this death avoidable?
Ectopic pregnancy, where a fertilized ovum implants somewhere outside the uterus, is an emergency event every correctional nurse should consider when confronted with abdominal pain in a female inmate of reproductive age. Indeed, this condition is particularly common among women with a history of genital infections or infertility. Smoking also increases risk. Therefore, the female inmate population is at increased risk for ectopic pregnancy.
Potential causes of acute pelvic pain are
- Appendicitis
- Ectopic Pregnancy
- Endometriosis
- Ovarian Cyst or Torsion
- Pelvic Inflammatory Disease
Assessment Findings
Abdomenal pain caused by ectopic pregnancy can include vaginal bleeding. If pregnancy status is unknown, obtain a urine pregnancy test while contacting the physician. Patients with this condition can become unstable quickly. If a tubal rupture takes place, the pain will intensify and signs of shock such as low blood pressure and rapid thread pulse will be evident. Intraperitoneal hemorrhage can cause referred pain to the shoulder area and a very tender abdomen.
Nursing Actions
This is a medical emergency requiring fast action and immediate transport to acute care. Initiate emergency protocols which can include establishing an intravenous access and fluid loading. Seek immediate medical evaluation for any potentially pregnant patient with unexplained abdominal pain. Ruptured ectopic pregnancies is a leading cause of maternal mortality in the first trimester resulting in 10-15% of all maternal deaths. Shock and death can follow quickly and immediate stabilization and transport to emergency treatment is necessary.
Have you had an experience with an ectopic pregnancy in a jail or prison setting? Tell us your story in the comments section of this post.
End of Life Care
Many states and counties are reeling from the increased expenses to continue providing healthcare to an aging inmate population. As the average age of US inmates increases, chronic disease and cancers escalate.
In an earlier post I talked about the basics of the aging inmate population. News articles pop up almost weekly about state correctional systems struggling with rising health care costs due to elder inmates and chronic disease.
A growing segment of the aging inmate population is those with cancer and other terminal illnesses requiring specialized care. Recently I spoke with Susan Loeb, PhD, RN, a nurse researcher implementing NINR granted funded research on end of life care in the PA Prison System [Correctional Nursing Today Radio Show]. Her research will lead to a toolkit for facilities to implement to develop a hospice program. It has been reported that at least 70 correctional facilities in the US have some type of hospice program with over ½ of them including inmate caregiver programs. Some facilities are partnering with community hospice services to provide needed staff education and specialty resources. Those with inmate caregiver programs have seen a positive impact on the attitudes and culture of both the inmate and custody community. An independent film was created following 3 dying inmates at the Kansas State Penitentiary. Edgar Berans, film producer, sites multiple positive outcomes of the program in a recent radio interview.
Some progressive correctional systems such as Washington State and California have already created assisted-living and long-term care facilities within their prison systems to accommodate these needs. Elderly inmates can fall victim to predatory younger inmates and require equipment such as wheelchairs and canes difficult to incorporate into a standard correctional system. Equipment of this type can be used as weapons if not properly managed.
Elder inmates also require environmental adaptations not usual in the correctional setting. They are unable to climb to top bunks and can become rattled or agitated by noise stress in prison barracks. Disabled inmates are challenged by stair or are unable to stand for long periods in the various lines that are a normal part of prison life.
How is your correctional system handling inmates at the end of life? Weigh in using the comment section of this post.
Needs of Prisoners with Cancer
Question Mark
What Are the Unique Needs of Prisoners With Cancer?
[By Mark Vrabel, MLS, AHIP, ELS, ONS Information Resources Supervisor]
Accreditation organizations such as the National Commission on Correctional Health Care (NCCHC) provide specialty standards and guidance for improving the quality of health care in jails, prisons, and juvenile confinement facilities. Lorry Schoenly, PhD, RN, CCHP, has been a nurse for 25 years and is on the national taskforce working to develop a correctional nursing certification (CCHP–RN) with NCCHC. Her Web presence at www.correctionalnurse.net provides a forum to interpret correctional health care to the public and healthcare community; I asked her about her experience as a correctional nurse and, more specifically, about information on inmates with cancer, and here is her response.
Correctional nurses must be adept at a variety of nursing specialties to accommodate the various medical needs of the inmate population. Prisons and jails are encouraged to perform common screenings for major cancers during the medical intake process. The inmate patient population generally has not taken advantage of regular medical care, and correctional medical services are often their first contact with organized medicine. Cancers are found that are well progressed due to a lack of regular medical screening.
Most state prison systems accommodate to some level the needs of inmates with cancer. Larger states have prison hospitals with hospice units. County jails are more challenging because they have fewer resources and the short stays allow only for emergency treatments. Some programs permit fellow inmates to provide nonmedical comfort care to hospice patients after appropriate training, such as the Connecticut Department of Correction Hospice and Palliative Care Program Inmate Volunteer Program. These programs can be a very humanizing activity in a very dehumanizing environment. Penn State University was recently awarded a National Institutes of Nursing Research grant to study end-of-life care in the Pennsylvania prison system. This will help give greater attention to patients with cancer in the later stages of their condition. The National Prison Hospice Association is a useful resource for obtaining additional information on hospice and end-of-life care in the correctional setting.
Mark Vrabel, MLS, AHIP, ELS, is the information resources supervisor for the Oncology Nursing Society. He replies to any and all questions sent to library@ons.org or clinical@ons.org (indirectly, sometimes assisting the nurses who handle this Clinical Questions service), and you can ask him questions by following him on Twitter at www.twitter.com/ONSmark. Read more articles by Mark Vrabel –
Used with permission from ONS Connect: The official magazine of the Oncology Nursing Society
Transgender Inmates: He Said, She Said
THE SITUATION: You’re working medical screening for new detainees at a large urban jail. Your next case arrives for assessment with make-up and bright female clothing, although you also see male-pattern facial hair and muscle structure. What do you do?
Transgender individuals are over-represented in the inmate population. If you work in corrections, you are likely to come face-to-face with your attitudes and emotions about these individuals. Nursing ethical principles require those of us in the profession to provide nursing care with concern and respect for human dignity, no matter the life choices the individual has made.
Transgenders (also called trans or cross-genders) are individuals with an incongruity between their felt gender and their anatomic gender. The majority are male and can have a DSMIV diagnosis of gender identity disorder (GID). Your inmate-patient may be in the midst of hormonal therapy or have partial or complete sex reassignment surgery (SRS).
Conversation
Your first concern is how to address the person. Do you use the term ‘He’ or ‘She’? Though it may seem trivial, your sensitivity in this area will establish needed repoire. Often you can avoid using gender terms or you can clearly see which term to use. For example, the individual above is likely to desire to be referred to as ‘she’, especially if the clothing involves a dress or skirt. When in doubt, your best option is to ask the individual how they would like to be addressed. Let them be in control of this small issue – control of so much else is gone. Attempt to be as matter-of-fact and non-judgmental as possible in all interactions.
Destination
Unless your system has special facilities for the transgender inmate, such as the new 30-bed transgender Italian prison, administration will need policies in place to determine housing designation. This is a vulnerable population requiring some type of protective housing. The nature of the condition predisposes the inmate to a higher potential of assault or in-custody violence. In addition, those with GID are more likely to be depressed, suicidal or self-injurers. Keep this in mind when assessing these inmates for any health conditions.
Change Management
What if the person is in the midst of hormonal therapy or SRS? What responsibilities are there for maintaining or continuing escalation of therapy? Policies regarding transgender treatment differ among state and county systems. Investigate the policy at your facility before you need to use it. Discuss the situation with your manager and medical director.
In a recent survey of correction system policies about transgender treatment, the majority of responding facilities had policies for the continuation of hormonal therapy, at least at the current level. Abrupt discontinuation of hormonal therapy can lead to physical and psychological side effects and should be avoided. Many facilities will use a ‘freeze-frame’ approach which continues the current therapy but does not escalate or advance the gender-change process.
Autocastration – Medical Emergency
Be aware that disturbed individuals may resort to autocastration or autopenectomy to reduce testosterone levels. The elasticity of the testicular arteries allows them to retract into the perineum making it very difficult to staunch the flow. Emergency transport, critical care and blood transfusion may be necessary.
More Resources on Transgender Treatment
Transgender Guidelines from NCCHC
Pepper Spray: In Your Face
THE SITUATION: A call just came in from cell block D. They are enroute with an inmate for evaluation after being subdued with several applications of pepper spray following an aggressive incident. Two officers also sustained minor injuries during the take-down. What should the nurse prepare to do in the pepper spray evaluation?
Pepper spray is a popular option to subdue violent or psychotic inmates when other de-escalation methods fail. It is preferred over options of lethal force in most correctional settings. A spray of concentrated capsaicin oil incapacitates most individuals due to the noxious odor and burning eyes and skin. Concentrations of the pepper oil can range from 5-15% depending on the product used. Potential health impact is directly correlated to the strength of concentration. If possible, obtain information about the standard products used in your facility to assist with your post-spray assessment.
The effects of pepper spray are related to skin and eye irritation, as well as neurogenic inflammation. When pepper spray comes in contact with eyes, nose and mucous membrane it causes involuntary eye closure and a sensation of shortness of breath. These conditions provide greater chance of apprehension and incapacitation. Officers should use the minimum amount necessary to contain the situation, however, sometimes a great deal of spray is necessary and your patient may arrive having been immersed in oil.
Take Action
Use a well-ventilated exam room to assist in eliminating respiratory effects of pepper spray. Focus on these areas when performing your evaluation and determining follow-up treatment or observation.
- Respiratory
There is some indication that pepper spray is particularly hazardous to those with asthma or a current respiratory infection. Check the medical record (if available) for past history and complete a thorough respiratory evaluation. Capsaicin oil causes wheezing, dry cough, shortness of breath and gagging.
- Cardiac
As some have reported acute hypertension initiated by extreme pepper spray use, a vital sign check and cardiac history should also be undertaken. Symptoms usually clear in the first hour after the incident.
- Skin Irritation
Skin irritation can be intense and include burning, tingling, redness and occasional blistering. Remove any remaining vestige of irritant by having the patient wash exposed skin with soap and water. Change any soaked clothing. Irritation should clear in 30-60 minutes. Cool water or an ice pack can help to relieve a burning sensation.
- Eye Irritation
Redness, swelling, extreme pain, tearing and conjunctival inflammation are experienced with direct contact of the oil on eye surfaces. Eye exposure should be treated as with any other chemical eye contact – flush with water (or normal saline) for at least 15 minutes. Your medical unit should have an eye station for this purpose. Corneal abrasion can also occur, especially if contact lenses are in place. If corneal abrasion is possible, slit lamp evaluation may be necessary.
Caution Warranted
Although the majority of your patients will recover from pepper spray incidents quickly and without need of treatment, several in-custody deaths have been attributed to the chemical. A focused nursing assessment will reveal any issues of concern. Cardiac or respiratory involvement may indicate a brief stay in your infirmary for closer observation before discharge to general population.
Read More
Effectiveness and Safety of Pepper Spray, Dept of Justice
Medical Aspects of Less Lethal Weapons
Photo: © Stocksnapper – Fotolia.com
Alcohol Withdrawal: Jail Nurse Alert
If you work in a jail, it is in your best interest to become an expert at assessing and intervening in alcohol withdrawal syndrome (AWS). It is the most dangerous type of substance withdrawal and the most prevalent. The recently published Behind Bars II: Substance Abuse and America’s Prison Population identifies 85% of all inmates have substance involvement. Over half of American inmates are incarcerated due in some way to alcohol. Once behind bars, withdrawal begins with potential dangers.
Withdrawal from alcohol causes increased excitability in the nervous system leading to nausea, vomiting, sweating, shakiness, agitation and anxiety. A medical emergency can develop when withdrawal leads to delirium tremens (DTs) involving hallucinations, confusion, disorientation, and generalized seizures. Autonomic hyperreactivity can progress to hypertension, tachycardia, hyperthermia, tachypnea and tremors.
Tag, You’re It
A thorough history and assessment at intake can identify inmates who need close watching during the first few days of incarceration. Be sure your intake questioning gathers information about alcohol history and timing of last drink. Ask about any previous withdrawal episodes and if they resulted in hallucinations or hospital visits. Although the mild to moderate withdrawal symptoms will peak and wane in the first 2 days, DT’s occur around 48-72 hours after the last drink. Untreated DT’s can lead to cardiovascular collapse.
The most tested assessment tool for the identification of persons at risk for alcohol withdrawal is the CIWA-AR Scale. It uses a numbering system to objectively determine severity of withdrawal and can be used over time to document the course of AWS for an individual inmate. Experts recommend twice daily CIWA-AR assessment for those determined to be vulnerable.
Hydrate Pronto
High on the list of non-pharmacologic interventions for AWS is hydration. Alcoholics are often dehydrated, which increases nervous system excitability. Encourage withdrawing inmates to increased fluids by mouth. Some facilities provide electrolyte replacement fluids, such as Gatorade or other sports drink to withdrawing inmates, as alcohol-dependent individuals are often electrolyte depleted.
Food for Thought
The chronic drinker is likely to be glycogen-depleted and malnourished. These conditions enhance AWS symptoms. Get these folks into the meal system pronto. Encourage nutritious eating to replace stores. Good choices to have available are milk, sandwiches and peanut butter crackers.
Get ‘em Mellow
Reducing nervous system excitability will decrease chances of life-threatening DTs. Providing a short-term (5 day) taper of Librium, valium or other barbiturate will decrease the chances for respiratory and cardiovascular collapse. Of course, a physician order is needed for this intervention. Examples of pharmacologic treatment can be found in many sources, including the Merck Manual. A standard protocol for barbiturate treatment with stock medication available can smooth the initiation of effective treatment on hectic, high-load weekend nights. Encourage your facility to have a treatment system set up for AWS.
Don’t be Afraid to Package and Ship
If you are unable to forestall seizures, hallucinations or hemodynamic instability, arrange for emergency transport to the nearest emergency room. Jails are not equipped to monitor and manage life-threatening situations. Pack them up and send them to the next level of care.
With the patient population entering your jail every day, you need to be ever vigilant for potential alcohol withdrawal. With solid assessment tool, close observation and early intervention, you will be ready before trouble strikes.
What do you do at your facility to recognize and treat alcohol withdrawal? Share your thoughts in the comments section of this post.
Exertional Rhabdomyolysis: Inmate Bodybuilder Disaster
The majority of our inmate patients are still fairly young. Many of the youthful inmate population spend available time in sports and bodybuilding activities. These individuals are prone to contracting exertional rhabdomyolysis (rhabdo). Correctional nurses need to be alert to the potential and respond effectively to stave off a disastrous outcome.
What Causes Rhabdo?
Rhabdo is the breakdown of muscle tissue causing an outpouring of intercellular contents including myoglobin, potassium, and creatine kinase (CK). These three elements cause the life-threatening effects of the condition. Non-traumatic rhabdo can be caused by severe over-exercise, major drug ingestion, or as a result of statin use. Many corrections-related incidents of rhabdo appear in the literature including 110 knee-bends performed as a part of an inmate hazing event, narcotic overdose and intravenous drug use.
Silent Symptoms
Rhabdo can start innocuously and may be overlooked as delayed onset muscle soreness (DOMS) from over-exertion. However, if the overly sore muscles are accompanied by brown (coca-cola) urine or urine irregularities such as nocturia or anuria, beware. Further assessment is warranted.
Nursing Actions
A good history and assessment is necessary, including any unusual activities over the last 48 hours and a medication review. Many of our patient population are now on statins, which can complicate exertional rhabdo. If Rhabdo is suspected, labs for CK, potassium, and myoglobin should be drawn while monitoring urine output and cardiac rhythm. Under medical direction, fluids should be administered to assist the body to flush out the muscle breakdown byproducts. If not caught early enough, renal dialysis and/or cardiac interventions may be necessary.
Patient and Officer Education
One of the best nursing interventions for rhabdomyolysis is patient and officer education. Inmate bodybuilders should be aware that brown urine is a bad sign that should lead to a medical visit request. Officers should understand the adverse effects of hazing activities that might be a part of a particular inmate culture. Our aggressive and macho patient population can fall prey to competitive weightlifting challenges that go beyond rational sense, requiring intervention. Prevention or early treatment of rhabdo can avoid renal failure and life-threatening arrhythmias.
With awareness, education and vigilance, correctional nurses can reduce the chances of life-threatening results of rhabdomyolysis.
Have you experienced a rhabdo incident at your facility? Share your experience in the comments section of this post.
Excited Delirium – Out of Control!
A medical emergency is called in the booking area of a large urban jail. The inmate has ripped off his clothing and is racing about screaming profanities. Custody officers finally subdue him with tazers and have him on the floor securing restraints when he stops breathing. Standard emergency treatment is provided without result. The inmate is pronounced dead on arrival to the local hospital. What just happened?
Excited Delirium (ED) is a rare but deadly condition that can confront nurses working in corrections – particularly jails. Experts differ on the cause or even existence of the condition. However, evidence is mounting in favor of the diagnosis for a variety of unexpected deaths after situations similar to the one described above.
Causes of ED
A prevailing theory is that ED is caused by overstimulation of the brain by dopamine. Cocaine, narcotics or extreme stress can cause an increase in dopamine release. Another biomarker under study is the release of heat shock proteins that leads to problems with body heat. The person’s body temperature rises rapidly without regulation. This combination overpowers the heart and respiratory systems leading to sudden death.
What does ED Look Like?
The challenge of excited delirium in the corrections environment is to quickly identify that we have a medical condition as well as a behavioral issue that needs controlled and treated. An individual in the throes of ED will seem superhumanly strong and intensely hysterical, resisting all attempts at restraint. Often they are pulling off clothing to reduce the overheating. They often seem oblivious to pain and have little response to tazors or pepper spray.
What’s a Nurse to Do?
Correctional medical experts such at Todd Wilcox, MD, Medical Director of Salt Lake County Jail, recommends maximum efforts to subdue the individual to allow immediate medical intervention. This would not be a time for officers to slowly escalate force tactics. Once subdued, benzodiazepines to reduce the agitation is the first treatment of choice. However, corrections nurses should focus on activities to speed transport to an acute care facility able to effectively manage the condition. Temperature regulation along with oximetry and cardiac monitoring are available in that setting.
Have you had an experience with excited delirium? Share it in the comments section for this post.
Learn more about Excited Delirium
http://www.exciteddelirium.org/
EMS Post: Cocaine, Excited Delirium and Sudden Unexpected Death
Excited delirium: Considerations of selected medical and psychiatric issues
Inmate Seizures – They Aren’t All Fake!
Correctional nurses can get jaded about treating inmate seizure disorders. After all, many perks can be claimed by those diagnosed with the condition including a coveted lower bunk and some real nifty medications. So, it would be easy to think that any inmate coming in with a history of seizures or appearing with seizure activity is merely faking it.
Inmates Have More Seizures
Around 1% of the US adult population will be diagnosed with a seizure disorder (1 in 100). In contrast, 4% of the US inmate population has a seizure disorder (1 in 25). That is a huge disparity and gives greater understanding to the frequency of seizure history or activity in our patient population. This patient community has several risk factors which increase the likelihood of seizure activities.
Head Trauma
The incarcerated have a background with greater violence and traumatic injury than the general population. In fact, recent studies indicate that 25-87% of inmates report having experienced a head injury or traumatic brain injury (TBI) as compared to 8.5% in a general population reporting a history of TBI. Head trauma increases the potential for seizure disorders.
Drug and Alcohol Withdrawal
Drug and especially alcohol withdrawal can lead to seizures. These seizures are not chronic in nature and require a specific treatment regimen. Seizure activity in withdrawal can be intensified if the inmate already has a background of epilepsy or TBI. Alcohol withdrawal can increase inmate seizure activity, especially in jails. The Federal Bureau of Prisons recently released revised Detoxification Guidelines.
Domestic, Child and Sexual Abuse
Past traumatic psychological stresses such as domestic, child or sexual abuse can produce a seizure disorder known as psychogenic seizures. These seizures have been described as a physical manifestation of a psychological disturbance and have received increased attention recently. Up to 1/3rd of patients sent for EEG-video diagnostics for seizures are diagnosed with the disorder. These seizures are of psychologic rather than physical origin; however, they are not being faked. Like other stress-induced conditions such as stuttering or fainting, psychogenic seizures are a physical response with only minor controllability from the individual. Psychogenic seizures do not respond well to epileptic medications, but rather to counseling and other psychotropics.
Treat all Seizures as Real
As healthcare professionals, correctional nurses must treat all seizures as valid until proven otherwise. If a witnessed event seems questionable, there are a few easy maneuvers to take in the post-seizure period including raising a arm over the chest and letting it drop (The non-seizing person will guard/the true seizing person will not) or using smelling salts (not effective for true seizing person). It is not recommended to do a sterna rub as this can cause unnecessary injury.
What are your experiences with inmate seizures and how does your facility deal with them? Post a response in the comments section.
Bridging Meds
- September2008© by HiLaRioN_
Bridging meds is a process in correctional healthcare of covering the medication gap between what the inmate was taking in the community and what is provided behind bars. Recent reports of inmate death or violence related to not providing prescribed medications in a timely fashion can easily lead to the question – “How hard can it be to get them the right medications?” Indeed, it can be more challenging than it first appears.
The guiding principle is for the facility medical unit to validate any prescribed medications and provide to the inmate necessary medications from stock until an individual prescription can be started for the duration of their stay.
Inmates come in with unknown medications
Many arrestees come in to the jail from the street with their own personal medications. However, they have often been removed from the original containers with the prescription label. The best situation is when the medications are in the original bottles and can easily be validated by the facility healthcare providers. Unfortunately, more often than not, the person arrives with a mixture of unidentifiable pills in a personal container or pocket. Since many inmates are detained for drug charges, it is unacceptable to allow the inmate to self-medicate using unknown and unvalidated medications.
Knowledge of medications and providers
Many people are unable to articulate the medications they take and the primary reason for the medication. This is intensified in the corrections setting. Misinformation abounds and must be sorted out to deliver care behind bars. If the individual is not carrying the medication with them and can not identify their prescribing physician, medication can not be provided until a full evaluation and treatment plan is determined by a prescribing provider (NP, PA, MD).
Connecting with the community provider
The greatest number of arrests do not take place during normal business hours. Delays in medication delivery can take place during weekends and off hours while awaiting communication with the primary provider.
Medication not on formulary or in stock
Occasionally a medication is needed that is not on formulary or not in stock at the facility. This can also lead to a delay while the medication is located. Well-managed correctional healthcare units will have a local back-up pharmacy which can handle emergency need for unusual medications until scripts can be filled through the standard pharmacy channels.
Inmate can’t be found
Seems odd that an inmate can’t be found when behind bars, but it happens. The transient nature of the jail situation, in particular, can lead to missed medication. The inmate may have been released, had a court date, or been transferred. If communication between custody and the healthcare unit is spotty, these gaps in medication delivery can happen.
Summary
For all these reasons, every correctional facility needs a solid system for bridging medications including tracking, good community and intrafacility connections, and extreme diligence to follow-through on medication delivery. Each healthcare staff member must understand the importance of their actions in the information and treatment chain. If there is a breakdown in any of these areas, disaster can strike.
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- Talking About Jail NursingOriginally Posted 04-14-2010: Becky Pinney, MSN, RN joins Lorry to provide an insider look at jail nursing. Becky is currently President, Metropolitan Corrections Systems, for Prison HEalth Services with multi-facility responsibilities for PHS sites and regions. In her current position, she is responsible for the oversight and direction to facility-based sta […]
- ANA Correctional Nursing StandardsOriginally posted 03-19-10: Lorry talks with Catherine Knox, MS, RN, CCHP-RN, about the latest revision of the Scope and Standards for Correctional Nursing. Catherine has 22 years of correctional nursing experience in a variety of settings. She was the Statewide Director of Nursing for the Washington Department of Corrections from 2004 until the Fall of 2008 […]
- Is Prison Nursing for Me?Originally Posted 02-18-2011: Margaret M. Collatt, BSN, RN, CCHP-RN/A, joins Lorry to talk about correctional nursing in the prison setting - What it takes to be a Correctional Nurse. Margaret has over 26 years of correctional healthcare experience and was the Health Services Manager at the Oregon State Penitentiary for 8 1/2 hears. She has developed and ins […]
- Dealing with EmergenciesOriginally Posted 02-09-2010: Lorry interviews SUsan Laffan RN, CCHP-RN/A about how to handle emergency medical issues in a correctional facility. Susan has been a registered nurse for 28 years. She has worked in the ED for 28 years and correctional nursing for 18 years. Susan is currently the chairperson of the Academy of Correctional Health Professionals. […]
- History of Correctional NursingOriginally posted 01-21-10: Mary Muse, MS, RN, CCHP-A, joins Lorry to talk about the hisory of the correcitional nursing specialty and its future direction. Mary has over 14 years of correctional health care experience and was the Chief Nursing Officer for the Cook COunty correctional system for a dozen years. She currently works in the Wisconsin State Priso […]
- HIV Treatment in Jails and Prisons
Lorry Schoenly
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News Briefs- They call us 'jail nurses' January 13, 2012
- Pennsylvania county OKs inmate medical costs program January 13, 2012
- Ensuring standards are standard behind bars January 13, 2012
- Academy seeks scholarship applicants January 13, 2012
- Study: Why is alcohol addictive? January 13, 2012
- California convicts arrive in Los Angeles County with costly mental illnesses January 13, 2012
- Do no harm — and keep an eye on costs January 13, 2012
- Xanax abuse and addiction January 13, 2012
- Prometa protocol: Not effective for meth dependence? January 13, 2012
- Brain activity linked to delusion-like experience January 13, 2012
Corrections One- Contraband: Cell phone carrier pigeonThis photo, taken by the Sao Paulo State Prison Affairs Department, shows a live pigeon carrying a makeshift backpack with a cell phone in it.The bird was caught flying into a prison in Sao Paulo, Brazil. In Sao Paulo, gangs frequently use carrier pigeons to smuggle phones behind bars. Tell us: Have you ever seen something like this at your facility?Have you […]
- Top 3 challenges for women in corrections in 2012I have worked in male dominated professions my entire life. I started in a county jail in the 80s where the only women were me, the nursing staff and a former Jail Matron who had managed to work her way up to Assistant Superintendent. When I got there in the 80's, I had little trouble adapting to jail life. The inmates seemed receptive but I faced chall […]
- 4 correctional healthcare game changers from 2011By Lorry SchoenlyAnother year is here and we can look back on plenty of correctional healthcare news from 2011. What top stories from the past year are most memorable to you? Here are my top picks for 2011 game changers along with suggested action to reduce their impact. #1 Legal eagles rule the roost Healthcare is now the most common legal issue raised by i […]
- Top 10 corrections resolutions for 2012By Robert HoodAs 2011 comes to an end, it is time to make plans for 2012. Many people are thinking of resolutions for the New Year. Each year millions of adults resolve to "get in shape" or "lose weight." While the effort to adopt resolutions shows an optimistic sense of good intent personally, the same idea can be applied to your profess […]
- 5 most dangerous contraband items of 2012By Joe BouchardIt is easier to look back than to look forward. No matter if you are Nostradamus or Jean Dixon or even the modern-day psychic Sylvia Browne, making predictions for coming times can be tricky. This is especially true if your ego makes it difficult to commit an error.No Nostradamus am I! Still. I can make two predictions for the year 2012. First […]
- Private corrections: We can do it better and cheaperBy Charles AlbinoIn the first segment of this series, I detailed some of the conditions that led to the formation of private companies to operate correctional facilities in the United States. As we move forward in Part 2, we will hear from the private sector and why they believe they merit a "place at the table" in correctional facility operations. […]
- When officials fall from graceBy Cherrie GrecoWhen well-known officials fall from grace, members of the general public express a variety of emotions and impose vigorous vocal judgment. Feelings of shock, disgust, and disappointed head-shaking are commonly exchanged at the water cooler. Faith in a system once trusted becomes fragile; trust caves in and is replaced by cynicism. In time, th […]
- Success with one is success with manyBy Eugene AthertonI remember a promotional interview for Warden in our correctional system. I suggested that effective leaders encourage successful relationships among staff in order to achieve success. When asked how that could be done, I answered, "One relationship at time." Now, at the time I was not sure of the meaning of the statement. It soun […]
- Top 10 corrections stories of 2011: A look backBy Carol McKinley Stories come and go throughout the year on our website, and there are so many, sometimes we forget them. So CorrectionsOne looked back at the most popular stories of the year and called the people and facilities involved to get an update. Here's a look back at the top stories of 2011. 1. The 23-year-old California woman who police say […]
- California corrections 2011: A year in reviewBy Bob WalshThis has been a momentous year for the profession within the formerly great state of California. Monumental. Nearly overwhelming. Maybe even disastrous. It depends a lot on who you ask and from which side of the issues you are looking.The Books Not Bars crowd is no doubt deliriously happy about the near-total demise of the Division of Juvenile Ju […]
