Help! I’m Not a Mental Health Nurse! Part 1: A Deputy Calls with an Inmate “Going Nuts”

Funny crazy young doctorIf you work in corrections, you need to understand the basics of mental health conditions and treatments. For one thing, so many of our patients have a mental disorder. Estimates are that nearly 25% of inmates have a serious mental illness while over half report at least one mental condition. Secondly, even if you are providing nursing care for a medical condition, a co-occurring mental health condition can affect the nurse-patient relationship. Mental illness adds complexity to any symptom interpretation and additional potential for medication interactions. Correctional nurses administering medication need to know the reason for the medications they are providing to their patients, along with the effect and side effect profiles of an array of psychotropics. Finally, correctional nurses are regularly the only health care staff in the facility when a mental health crisis is identified by officers. Consider this jail scenario:

A deputy calls to say he has an inmate who is “going nuts.” He wants someone to come up and “do something” about this. The inmate is a 23 year old white male having many prior short stays in the jail without incident. This is the first time he has been held over with a charge of reckless driving. Anna, the nurse staffing the jail for this evening shift, is unfamiliar with the patient and with the deputy.

What is going on here? How should the nurse respond to this crisis? In a situation like this the first step is to gather information to rule out a treatable medical condition that might be causing this patient response. This nurse is preparing to contact a provider but she needs to first have all the necessary information to share with the on-call nurse practitioner. She collects her emergency bag and takes a couple minutes to see if there is any medical record on the patient before heading to the housing unit.

Medical Conditions that Cause a Psychiatric Response

While gathering subjective and objective data for an assessment, it is a good idea to have in mind the medical conditions that could be causing this response. There are several medical or organic causes of psychiatric symptoms – the two most notable are dementia and delirium tremens. This patient’s age and history do not support dementia but delirium from alcohol withdrawal is a consideration. In fact, psychiatric psychosis and alcohol withdrawal delirium are easily and frequently confused. Here is a helpful guide taken from an Academy of Family Physicians article that differentiates the three conditions:

Delirium

  • Rapid onset
  • Visual hallucinations, disorientation, agitation, impaired attention

Dementia

  • Chronic slow onset
  • Disorientation and agitation

Psychosis

  • Usually a slow onset
  • Usually oriented, visual hallucinations rare, auditory hallucinations more common

Another consideration when gathering assessment data is the physical condition of the patient. Patients in substance withdrawal to the point of delirium will be physically sick while dementia or psychosis will not likely present that way. The nurse needs to have all this information available to make a good clinical judgment about actions to take.

Safety Check – Always!

No matter what psychiatric condition is being evaluated, patient and staff safety is always at the forefront. Anna needs to be continually evaluating this patient’s potential for harm to self or others during the assessment process.

The SAFER Model for dealing with potentially violent patients should be part of interventions with a potentially violent patient:

  • S = Stabilize the situation by lowering stimuli, including voice.
  • A = Assess and acknowledge the crisis by validating the patient’s feelings and not minimizing them.
  • F = Facilitate the identification and activation of resources (mental health staff, officers, chaplain).
  • E = Encourage the patient to use resources and take actions in his or her best interest.
  • R = Recovery and referral – Leave the patient in care of a responsible professional.

Anna was able to use a calming voice tone and actions to obtain needed assessment findings. This patient was indeed ill, having insomnia, nausea, and diarrhea. He began hallucinating only recently and the initial screening in the chart indicated no past history of mental or chronic illness. Anna continually reoriented the patient to reality. While awaiting a call back from the nurse practitioner, with the assistance of security staff, she was able to relocate him from the noisy housing unit to an infirmary bed for closer observation and decreased stimulation.

A Medical Condition Rather than a Discipline Issue

Thankfully, the deputy in this case sought a medical solution to this inmate outburst rather than a disciplinary one. This may be due to a collegial and collaborative relationship among staff and management in both custody and health care disciplines. It makes a difference. By contacting medical for help, the correct treatment was provided. This inmate was, indeed, withdrawing from alcohol and in delirium tremens. Through the deputy’s initiation of evaluation and the nurse’s astute assessment, the patient was started on a benzodiazepine; first with a high dose to get the blood level up and then tapered to response. He successfully recovered from the delirium during a short hospital stay. He was referred to substance dependency community services on release from the jail.

Have you ever had a similar patient situation? Share your thoughts and tips in the comments section of this post.

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I Found Correctional Nursing and I Love it!

Smiling, happy health care professional, nurse making hand heartThis guest post is written by Sarah Medved, a senior nursing student at Grand Canyon University. She shares her story of finding correctional nursing as a specialty.

Nearing graduation, I get a lot of congratulations and questions about where I want to work. I usually get raised eyebrows when I proudly state that I want to be a correctional nurse. I also get plenty of weird looks and discouragements. Some people don’t even know what I am talking about. “What is that?” they say. It gives me an opportunity to talk about the invisible world of nursing behind bars.

I became interested in correctional nursing through an assignment during my first year of nursing school. The assignment was to research an area of interest in nursing. I looked up all the different types of nurses on the internet and noticed correctional health on the list. I thought it sounded different and kind of exciting so I gathered some information, and presented my findings to my classmates. From that point on, all my classmates knew how interested I was in correctional nursing!

Being involved in my school’s Student Nurses Association allowed me the opportunity to attend the Arizona Nurses Association Symposium/Student Nurses Association Convention. This year there was a raffle for the students to win a coffee date with a professional nurse in various fields. I noticed there was a correctional nurse as one of the options, so, of course, I bought a handful of tickets to ensure I would win this great opportunity!

When I met with the correctional nurse, I was beyond excited because I never had the chance to talk to someone who was actually in the field. She provided a massive amount of information and excellent insight into the profession. I always had a light inside fueling my passion, but that day my light turned into a burning fire of desire.

Since then, I have had the opportunity to network with a new graduate in the field of correctional nursing. I always thought it was impossible for a new graduate to get a job in what seems like such a specialty area. The common advice for new graduate nurses is to work at least a year or two on a medical/surgical unit to gain basic skill. But, I had one inspirational instructor who told me to follow my dream of being a correctional nurse; to go into the area I am passionate about. My coffee date confirmed this. It was important for a correctional nurse to suggest going right into the specialty from school. Are the basic skill sets that much different?

As I reflect on my experience as a student nurse discovering the correctional nursing specialty, I am wondering why more nurses don’t know about this hidden opportunity. It seems like a well-kept secret. I also wonder why the responses I get about correctional nursing are not very positive. Are nurses who work with inmates somehow considered insignificant or inferior among others in the nursing profession?

Nurses take care of millions of people coming from all walks of life. To me, the only difference in a correctional nurse is knowing that the person is incarcerated. Nurses in a hospital take care of people who have been in jail, but they just may not know it. In some cases, people are wrongly accused and end up in jail for things they never did. Anyone can be at risk for going to jail no matter how unlikely that may seem. As a nurse, I want to provide equal and just healthcare to everyone regardless of their criminal background. I am not treating a person based on their lifestyle or circumstances. I am treating a person – PERIOD!

Have you experienced raised eyebrows or discouragement when you shared your correctional nursing background or interest? Share your thoughts in the comments section of this post. Are you a correctional nurse with an inspiring story to share on the correctionalnurse.net blog? Contact lorry@correctionalnurse.net. Correctional nurse authors of posted stories receive an autographed copy of one of Lorry’s books.

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November 2014 News Round-Up (podcast)

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cnt-podcast_cover_art-1400x1400Correctional nurse experts C.J. Young and Sue Lane join Lorry to discuss the latest correctional health care news.

Ohio Prison Inmate Being Treated for Leprosy

The Ohio prison system recently had an inmate diagnosed with leprosy. He was first treated for a bacterial skin infection. When it worsened, he was tested for leprosy. We discuss leprosy, the modern disease is called Hansen’s disease, and any concerns for correctional facilities.

Restraints Cited in Three Deaths at Bridgewater

The Boston Globe reports on three deaths of restrained patients at Bridgewater, a Massachusetts state prison for people with mental illness. Bridgewater is a 325 bed medium security prison that is the only one accepting mentally ill patients that require strict custody, the article described. One patient died of a blood clot after spending 3 days strapped to a bed. Another died of a heart arrhythmia after being immobilized with wrist and ankle restraints for many months, and a third died after being in 5 point restraints for a long period of time, as well. Panelists discuss the physical and ethical concerns of restraints and how correctional nurses might intervene to reduce their use.

 Ethical Issues for Nurses in Force-Feeding Guantánamo Bay Detainees

An article from the latest issue of the American Journal of Nursing discusses the ethical issues for nurses in force-feeding Guantanamo Bay Detainees. Military nurses, like correctional nurses, can have conflicting moral obligations in practice. This article discusses the conflicting moral obligation military nurses have to their patients and to their military mission as determined by their superior officers.

The authors contend that the ANA Code of Ethics establishes the nurse’s primary commitment as to the patient and that the code forbids forcing a treatment on a competent patient. Yet the government contends that force-feeding is an ethical matter of beneficence to, in the best interest of the patient, keep him or her from dying.

A Washington Prison Unit Where ‘No One Picks On You For Being Slow’

The Washington State Prison System has created a unit at the Washington Correctional Center for inmates with autism, intellectual disabilities, or traumatic brain injury. It is protective housing for those who are easy prey for manipulation and abuse in the general population. In many traditional correctional settings, these individuals end up in segregation because they are not compliant with prison rules or direction from officers. Segregation is detrimental to even mentally healthy people, but it can be devastating to the mentally impaired.

Share your thoughts on these news stories and panelist’s perspectives in the comments section of this post.

Caring Within The Culture of Incarceration (podcast)

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cnt-podcast_cover_art-1400x1400Dr. Stacy Christensen, a nursing professor at the Central Connecticut State University in New Britain, CT, talks about her work with incarcerated women in the Connecticut State Prison System and her article about the application of Leininger’s theory of Culture Care in the correctional setting. Enhancing Nurses’ Ability to Care Within the Culture of Incarceration” was published in the June 2014 issue of the Journal of Transcultural Nursing.

In this episode she explains the key elements of Leininger’s theory of Culture Care and how incarceration can be thought of as a culture. The incarcerated patient population has a common language, customs, and rituals. Leininger defined culture as the learned, shared, and transmitted values, beliefs, norms, and lifeways of a group. Correctional nurses need to be culturally aware to effectively deliver care in this setting.

News Items

Coffee Consumption and Mortality

Findings from a meta-analysis of more than 20 published studies indicate that coffee consumption is inversely associated with all causes of mortality. Best mortality figures were for those drinking 4 cups per day. They also found no association between coffee consumption and cancer mortality. Although past studies indicated a concern for caffeine related to increased blood pressure, insulin resistance, and elevated lipids, habitual coffee consumption results in a tolerance for the acute effects of caffeine. Researchers aren’t sure what components of coffee are beneficial but indicate that coffee is a major source of antioxidants, which could be part of the positive effect. In addition to reduced mortality, coffee consumption was linked to reduced risk of suicide, Parkinson’s disease, and gallstones.

Increases in Heroin Overdose Deaths — 28 States, 2010 to 2012

The CDC has published data on Increases in heroin overdose deaths between 2010 and 2012 in the latest issue of the MMWR – Morbidity and Mortality Weekly Report. There has been an alarming rise of heroin overdose deaths in the last two years – more than double. Deaths have increased across gender, age, ethinic groups, and geographic region – although the increase is more significant in the northeast and south regions. In a related news story, the study’s co-author Dr. Len Paulozzi, a medical epidemiologist at CDC’s National Center for Injury Prevention and Control, said that the over-prescribing of narcotic painkillers (such as Oxycontin and Vicodin), which has been going on for 20 years, is responsible for the increase in heroin use and overdoses. He continues by commenting that solving the problem of deaths from heroin overdose begins with stopping the addiction to narcotic painkillers. Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing, is also quoted in the news item as saying that there is very little difference between heroin and Oxycontin or Vicodin and that the medical community has to prescribe more cautiously.

Do you think a theory of cultural care would work in correctional nursing? What do you think about the positive effects of coffee? Have you seen an increase in heroin addiction in your patient population? Share your thoughts and insights in the comments section of this post.

Eight Ways to Improve Clinical Judgment

医者の表情Although every nursing specialty has its challenges, correctional nursing involves complex situations that can appear simple, but aren’t. There are many unknown factors in sizing up a situation. Correctional nurses are most-often the first healthcare provider to see the patient situation. As a gatekeeper, the nurse must make a fairly autonomous judgment on what needs to be done and who needs to be involved. Therefore, clinical judgment skills are absolutely essential for nurses working behind bars. Recent posts have discussed the vital role of clinical judgment, reasons correctional nurses need clinical judgment, and clinical judgment booby traps to avoid. In this final post of the series, we are turning to ways to improve clinical judgment. Incorporate these methods from traditional clinical settings and educational programs to improve your clinical judgment and that of nurses you work with.

Clinical Practices

 Case Review

Case review is one of the best ways to develop clinical judgment, especially with nurses new to the specialty. Although you can use cases developed purposefully it may be even better to include review of actual cases as a regular part of the process of unit management. For example, reviewing actions, reactions, and interactions of a recent complex or emergent patient situation can allow nursing staff an opportunity to learn from the experience and from each other. Much can be gained by providing an opportunity for staff to dialog about clinical judgment and reflect on their practice and the practice of others. Of course, this dialog must be carefully facilitated so that team members develop abilities to critically review a case without being critical of each other. You want this to be an empowering experience rather than a disempowering one. Careful guidance is needed until staff develop the skills necessary to be encouraging, purposeful, and thoughtful in their dialog.

Peer Review

Guided peer review is another way in which staff can develop clinical judgment skills. Similar to traditional physician peer-review, nursing peer review is a analysis of written documentation of past patient care on an individual practice basis. This process, by the way, is also helpful to encourage more thorough documentation. Learn more about nursing peer review in corrections from this series.

Reflection

Reflective practice is another clinical activity encouraging development of clinical judgment. Reflection on an actual significant clinical experience such as an unexpected death or near-miss experience can yield a wealth of wisdom for the nurses involved. By guiding the discussion toward analysis and synthesis of information, the experience can expand both individual and group learning. New staff members can be asked to keep a journal of their patient experiences that is reviewed periodically with the nurse manager or a senior staff member. The journal activity helps with reflection and the documentation can guide discussion into deeper meanings of assessments or a better understanding of facility processes.

Simulation

Another clinical activity that builds clinical judgment is simulation. Simulation allows a safe practice experience while developing procedural skill and team kills in collaboration and coordination of care. Use the disaster drill and man-down simulations to encourage clinical judgment development. Debrief the simulations as you would an actual experience and guide staff to truly think about why various decisions were made.

Educational Practices

Clinical judgment development can also be infused into standard educational programming. Many in-services involve a lot of information with little application. Instead, a better way is to provide foundational information and then engage staff in a dialog about how to apply this information in practical and realistic situations. An example of how not to do this is an inservice I taught on dealing with chest pain in correctional settings. It had a ton of information about assessment, interventions, and facility policy. We even talked about how to deal with the on-call physician. Participants left with a head full of what and how but not much application or critical thinking about dealing with chest pain. Here are some ways this program could have been improved to help develop clinical judgment.

Dialogue

Adding interaction and dialog to a learning experience engages the learners in thinking and applying the information. Providing real life examples and cases is an excellent way to encourage discussion.

Probing Questions

Probing questions combine with interactive dialogue to fully engage participants. A probing questions looks beyond yes or no and moves the thinker from reaction to reflection. Questions such as “What do you think would happen if……” or “Why do you think that might happen?” encourage learners to analyze a situation and work through possible solutions.

Mind Mapping

Mind mapping, also called concept mapping, is a creative method of displaying information and how it connects together. This process is gaining popularity in undergraduate nursing programs to help students think about the various elements of a clinical situation. Why not use it with practicing nurses? A mind map is a visual organization around a core concept. Here is an example of a mind map developed during a presentation on chest trauma.

mindmap

Algorhythms

An algorhythm is a decision tree that guides through a particular situation. While a mind map is based on relationship of information, an algorhythm is a decision tree and is expressed in a linear fashion, often answering questions of yes or no and then moving on. This example is from an ACLS course on responding to bradycardia. For the chest pain inservice I described earlier, I might have asked participants to develop algorhythms for respond to chest pain.

algorhythm

The key to clinical judgment development in an educational setting is to engage the learner with the thinking processes and to reflect on their own practice and how they might incorporate this new knowledge into their practice.

Do you have ideas for how to apply these eight processes in clinical and educational practices in your setting?

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Three Clinical Judgment Booby Traps to Avoid

Risk concept. Sign question on bear trap.Over time, as we develop our practice, we store up clinical reasoning helps that can speed our decision-making for commonly reoccurring scenarios. We begin, for example, to develop rules of thumb and analogies resulting from common pattern recognition that originate from past successes. The formal term for this is heuristics. In fact, clinicians rarely use formal computations to make patient care decisions in day-to-day practice. Rather, we develop an intuitive understanding of probabilities combined with a concoction of rules of thumb, educated guesses, or mental shortcuts.

Without care, other factors can cloud our thinking. In particular, we must be mindful of our biases, cultural background, and assumptions when making clinical judgments.

Biases

Biases are rooted in our human nature and hard to avoid. We can, however, mindfully consider them as we reflect to improve practice. A few biases of importance to avoid when making clinical judgment are described here.

Premature closure is one of the most common errors. In this bias clinicians make a quick diagnosis (often based on pattern recognition), fail to consider other possible diagnoses, and stop collecting data (jump to conclusions). In fact, even the suspected diagnosis is not always confirmed by appropriate testing. A premature closure issue common in correctional nursing might be “I know this patient-he is faking this condition to get attention”.

Confirmation bias occurs when clinicians selectively accept clinical data that support a desired hypothesis and ignore data that do not. Clinicians who rely heavily on pattern recognition and become overconfident in diagnostic abilities can fall prey to premature closure and confirmation biases. If a patient is acting erratically and an officer shares a high breathalyzer reading, a nurse may settle on an alcohol intoxication diagnosis when there are also signs of a head injury.

Availability bias results in overweighing evidence that comes easily to mind. This could be recent evidence or what we perceive as meaningful events. For example, if you have ever had a legal claim against you for a particular diagnoses or clinical action, you have had heightened awareness of that diagnoses for some time afterward.

Assumptions

Assumptions about what is and isn’t present can also affect our thinking and judgment. A simple example can underscore how assumptions can get us tripped up. Consider this puzzle that you must solve. A donkey is tied to a 6 foot rope. A bale of hay is 8 feet away from the donkey. Without biting through the rope, how can the donkey get to the bale of hay? Answer: He just walks over to it. There is not mention that the rope is anchored to the ground. Most people hearing this story, though, assume that the donkey is tethered. Sometimes we need to see what isn’t there as well as what is there when evaluating a patient, too.

Culture

Our culture can lead to unconscious ‘habits of the mind’ that affect clinical judgment. Repeated personal experiences and cultural socialization are absorbed into our ways of thinking about the world around us. For example, over time, correctional clinicians may absorb a jaded view of inmate intentionality or the surrounding security culture of the facility. Attitudes about patient motivation can cloud our judgment and alter subjective interpretation of symptoms.

Sometimes getting over our biases, assumptions, and culture in clinical judgment is as easy as changing the questions we ask ourselves. Imagine seeing a drawing of 2 triangles a square and a circle. If you ask yourself the question “What is this?” You may answer – 2 triangles, 1 square, and 1 circle. How might that change if you ask yourself “What could this be?” Maybe the answer now is – a jack-o-lantern or a clown face. Sometimes self-questioning can break us out of our biases, assumptions, and cultural norms.

How have you seen biases, assumptions, and culture affect clinical judgment? Share your experiences in the comments section of this post.

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Five Reasons Correctional Nurses Need Clinical Judgment Skill

Green plant mazeIn corrections, nurses are usually the first health care professional to assess a health concern or complaint. Patients present with virtually every type of health problem, and many have co-occurring conditions that can complicate the diagnosis and plan of care. Therefore, correctional nursing practice requires knowledge and experience with a broad array of conditions and presenting problems to make clinical judgments about the nature of the problem, actions to be taken, and urgency of response.

Correctional nurses also coordinate and negotiate for the delivery of care within the restrictions and expectations of the organization, which requires decision-making conviction. Clinical judgment guides direct care delivered by the nurse as well as communication with others to coordinate care and ensure patient safety. Accuracy in judgment improves patient outcomes and quality of care by eliminating unnecessary actions and reducing delay in definitive care and treatment.

Although every nursing specialty has its challenges, correctional nursing involves complex situations that can appear simple, but aren’t. There are many unknown factors in sizing up a situation. Correctional nurses are most-often the first healthcare provider to see the patient situation. As a gatekeeper, the nurse must make a fairly autonomous judgment on what needs to be done and who needs to be involved.

Here are five reasons clinical judgment is especially important for correctional nurses:

  1. Detainees or inmates are entitled to a clinical judgment under the 8th or 14th amendment whenever attention to a health concern is requested. See this post for more information on the right to a clinical judgment.
  2. Nurses most often are the first health care provider to see a detainee or inmate for any health concern. The nurse’s clinical judgment will determine if the person sees any of the other health care providers and if so, how soon.
  3. Ineffective clinical judgment affects the patient adversely now and perhaps in the future, it affects other nursing staff and providers. It can also affect our relationship with custody staff.
  4. Correctional nurses must make judgments in a wide array of situations from minor discomforts to life-threatening emergencies.
  5. And, they must do it while navigating the correctional environment with safety, location, and resource challenges.

What other reasons are there for correctional nurses to be skillful in clinical judgment? Share your ideas in the comments section of this post.

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Clinical Judgment: A Vital Correctional Nurse Competency

decisionsRhonda has been called to the booking area to medically screen a 44 year old man brought by the police on charges of driving a stolen vehicle and drinking while driving. On the way to jail he hit his head on the window of the squad car. Approaching the area she sees an obese white male, hands cuffed behind his back, leaning facedown on the booking counter, propped up by two police. The man is yelling that he is going to faint and can’t breathe.  A chair is brought so he can sit and Rhonda notes that he is diaphoretic and flushed in the face. He reports that he has prescriptions for two inhalers but otherwise has no medical problems. His voice tone is belligerent and he is dressed in shorts, a t-shirt and sandals;  inappropriate for the winter weather. Rhonda can see that his legs and feet are mottled and swollen. He also has a swollen area over his eyebrow on the right side and the eye on that side is swollen shut. There are four policemen waiting for the nurse to screen the arrestee and another six custody officers waiting to proceed with booking. 

Christine Tanner, a nurse researcher, has studied expert nurses to determine components of clinical judgment and when it is most specifically needed. She found that clinical judgment skills were particularly important when

  • The clinical problem or concern is undetermined;
  • The presenting data is ambiguous; and
  • When the situation presents conflicts among individuals with competing interests

Our case above has all three elements. Rhonda has a problem to solve and she needs to do it quickly amidst competing interests – the patient’s, the police, and the correctional officers. The patient condition is undetermined at the moment. Rhonda cannot merely review the patient’s medical record for a list of diagnoses. His presenting data is ambiguous and non-specific. The clock is ticking and the pressure is on.

Tanner reviewed 200 studies on clinical judgment in nursing practice. From this review she concluded that a nursing clinical judgment involved the following components:

  • Gaining a grasp of the situation holistically
  • Seeking an understanding of the situation which is beyond just the objective findings on assessment
  • Considering factors contributing to the presentation
  • Attending to the patient’s response to the nurse
  • Deciding an appropriate course of action
  • Reviewing outcomes and making changes as needed

What clinical judgment do you think Rhonda made in this situation? Even though there was pressure to book the man, she was concerned about a concussion and his respiratory condition. She did not approve him medically for booking and he was sent on to the hospital emergency room. There it was discovered that, although he was intoxicated, he did have a mild concussion, and, more importantly, was discovered to have moderate congestive heart failure. He was in the hospital for over a week.

Have you had a challenging patient presentation that seemed ambiguous at the time or had competing interests to consider? Share your story in the comments section of this post.

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What is Your Correctional Nurse Work Style?

Many different beautiful butterfliesA major challenge for many in correctional nursing is adjusting to the work environment. A correctional facility is not run like a hospital and health care is not the primary mission. Correctional officers often have different goals and worldviews than healthcare staff. Nurses can have difficulty assimilating into the organizational culture while maintaining a professional nursing perspective. That’s why I found this research about the work styles of jail nurses so interesting.

Hardesty, Champion, and Champion interviewed 26 registered and licensed practical nurses working in jails in three northern states. Patterns and themes emerged as the transcribed interviews were analyzed. One interesting finding was a proposed typology of jail nurse work styles. This typology chronicles the adjustment of a new nurse to the correctional culture and the effect of that adjustment on their ability to function successfully. The categories are based primarily on the balance the nurse is able to gain practicing professionally while understanding the security perspective and organizational culture.

Check out this continuum of jail nurse work styles and see if you can find yourself, or some of your nurse colleagues, in the descriptions.

Idealist

  • Rejects or fails to understand the security perspective
  • Nursing perspective is the primary consideration
  • Poorly socialized to the custody staff culture

Realist

  • Acknowledges and respects the security perspective
  • Nursing perspective remains the primary consideration
  • Socialized to the custody staff culture

Situationalist

  • Alternates between the security and the nursing perspective
  • Nursing perspective is optional
  • Not yet socialized to the custody staff culture

Acceptor

  • Accepts the security perspective
  • Minimally acknowledges the nursing perspective
  • Socialized to the custody staff culture

Identifier

  • Extreme acceptance of and identification with the security perspective
  • Considers nursing perspective not applicable in a jail environment
  • Well socialized to custody staff culture

So, what is the optimum work style? The researchers do not clearly note the best work style and suggest that more research is needed. My vote is for the Realist style as this nurse is able to maintain a professional nursing perspective while understanding the perspective of correctional officers and socializing to the correctional culture. This provides an atmosphere of respect and understanding among peers while allowing for professional nursing practice.

So, what do you think? Which work style is the most favorable for correctional nursing practice? Do you see examples of these work styles in your facility? How does it affect patient outcomes? Share your thoughts in the comments section of this post.

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Four Sources of Fast Correctional Nursing CE for Recertification or Relicensure

Stack of papers and clock isolated on whiteDoes this sound familiar? Notice arrives that your CCHP or CCHP-RN certification or your nursing license is due next month. Plenty of time to get the required continuing education (CE), right? The notice is set aside (if you are like me it gets printed and set on the pile on the right side of my desk) and the next time the paper shows up, submission is due tomorrow. Not that this has ever happened to me (well, alright, it did happen just last month….). So, just in case this might happen to you (I’m sure it won’t, but just in case) here is my list of four quick sources of correctional nursing continuing education that you can access online and complete immediately. First, though, is a clarification of requirements:

License Renewal

States vary as to the number of contact hours needed for a 2 year licensure period. Most states ask the licensee to maintain the official documentation (CE certificates) and attest to having completed the required number of hours. Documentation may be requested in a random audit of licensees. Here is a handy list of current state nursing board CE requirements for relicensure from nurse.com:

Nursing Continuing Education Requirements by State

Some states have specific content requirements as part of the total CE needed. For example, Florida RNs are required to complete 24 hours of appropriate continuing education (CE) during each renewal period, including two (2) hours relating to prevention of medical errors. In addition to these 24 hours of general CE, each RN must complete two (2) hours of domestic violence CE every third renewal for a total of 26 hours. Specific requirements are addressed by state in the link above.

CCHP and CCHP-RN Recertification

CCHP and CCHP-RN certifications have yearly CE requirements.

CCHP CE Recertification Requirements: Participation in 18 hours of continuing education (at least six of which are specific to correctional health care).

CCHP-RN Recertification Requirements: Completion of at least 18 nursing contact hours, with six specific to correctional health care.

If you have an excellent benefits package at work that includes an education allowance, try to get a National Commission on Correctional Health Care conference. You won’t regret it. However, that won’t work for a looming due date. Looming due dates require immediate results. Here are four go-to places for correctional nursing online CE.

Sources of Correctional Nursing Continuing Education

  • Pedagogy Correctional Health Care Campus: I’m a bit biased on this source since I develop the correctional healthcare specific continuing education here. The modules specific to corrections are in video format and have application checkpoints to hold your attention. Here are the ones available so far with more on the way:

o   The Correctional Health Care Patient and Environment

o   Correctional Health Care Processes

o   Safety in the Correctional Setting

o   Chronic Illness in the Correctional Setting

o   Control and Management of Infectious Diseases in the Correctional Setting

o   Legal Origins and Issues Behind Correctional Nursing

o   Psychiatric Nursing in the Correctional Setting

o   Women in Prison

  • Correctional Nurse Educator: Our friends over at Correctional Nurse Educator have some fantastic courses available, as well. Topics include Asthma, Chronic Care, Inmate Manipulation, Suicide Prevention, and much more. All are focused on correctional nursing practice.

That’s it for my quick list of correctional healthcare continuing education. Do you have a favorite online source that I missed? Share your secrets in the comments section of this post.

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