Danger Zone – Christmas Week in Jails and Prisons

The week between Christmas and New Year is traditionally one of feasting, family and fun as we celebrate the season and the start of a new year. However, there are many reasons why this time of year is dangerous in our workplace. Correctional nurses need to be on high alert in the days ahead. Here are my three reasons for concern this week.

Reason #1: We lose our focus

The last month of the year is busy with many things. You and your colleagues are taking that final stretch of vacation time. Kids have holiday and end-of-year school activities. Work sites have holiday parties and extra treats in the break room. It is easy to lose focus on personal safety or to be working short-staffed. Those who might do you harm take advantage of opportunity. In addition, your own emotions might be swinging between elation and despair as the holidays approach. Emotional turmoil is a magnet for  inmate psychopaths or sociopaths. Therefore, this is a time of year with increased vulnerability to inappropriate relationship. Check out my prior posts on dealing with psychopaths and signs of unhealthy relationships.

Reason #2: Our patients are not merry

For inmates, the lack of family support and distance from children or spouse is accentuated during the holidays. Guilt over not being able to provide gifts for children and family estrangement can be acute. The holidays can lead to deeper depression, anger and aggressive behavior. Be particularly alert for increased evidence of suicide potential during the holiday season.

Reason #3: Our co-workers and managers are with their families

On occasion I review medical charts in cases involving inmate plaintiffs. A common scenario involves lack of treatment or inaction during a weekend or holiday. Reduced staffing and vacant management offices leave staff with few resources to deal with emergent issues. Be sure to know all administrative contacts when working weekends and holidays. Policy manuals and treatment guides should also be accessible to staff. It is not unusual to find these important materials locked in a manager’s office; unavailable to those who need their guidance in an urgent situation.

Do you have some other reasons to add? Have you had some dangerous Christmas Week experiences in your setting? Share your thoughts in the comment section below.

Photo Credit: © Graça Victoria – Fotolia.com

December 25, 2011 Posted by Lorry Schoenly | Uncategorized | 1 Comment

Critical Thinking for Correctional Nurses

I attended an intriguing session about critical thinking at the recent Updates in Correctional Healthcare program. Is critical thinking more challenging in corrections? I’m not sure, but let’s consider it. Albert Einstein described insanity as ‘doing the same thing over and over again while expecting a different outcome’. Are we working to make change in correctional healthcare without consideration for improving the thinking abilities of the frontline nursing staff who bear a majority of the decision-making about intervention?

It appears that lack of critical thinking is a major issue in all clinical areas. A study by Del Bueno in 2008 found that across the board, new nurse from diploma, associate degree and BSN education backgrounds  do not meet critical thinking competency from 65-72% of the time. Experienced nurses fare better but still are concerning. From 32-44% of experienced nurses in all education categories did not meet critical thinking competency levels.

Nurses working in corrections must often practice at a higher autonomy and frequently work without the usual technology of an acute care hospital. Anecdotally, a small study done by the speakers found that nurses working in corrections with backgrounds in critical care and emergency scored lower in critical thinking in the corrections level than nurses from less high-tech clinical areas. It has been said that correctional nurses must be able to do everything with nothing. Clinical units in jails and prisons do not have high tech monitoring equipment. Nurses must rely on their assessment skills and basic metrics like vital signs, breath sounds and 12 lead EKG readings.

Hear more about critical thinking in corrections by listening to my Correctional Nursing Today interview with one of the session speakers, Tre’ O’Brien, BSN, RN, CCHP-RN.

Tell me what you think. Do correctional nurses need to apply critical thinking skills more than nurses in other specialty areas? Why do you think so?

photo credit: © Jeffrey Collingwood – Fotolia.com

June 18, 2011 Posted by Lorry Schoenly | Uncategorized | 2 Comments

Correctional Nursing Christmas Wish List

This article was originally published by CorrectionsOne.com View the original here

Rapid blood testing speeds onsite treatment

Editor’s Note: The author, Lorry Schoenly, has not tested or evaluated the brands identified in this   column. They are only used as examples of available products.

By Lorry Schoenly

If I could put something under the tree for your medical unit this year it would be equipment for on-site blood testing — also called point-of-service testing. There are several brands available and any one of them could improve your medical services. In addition to streamlining your testing process, blood testing performed onsite can reduce transportation costs at your facility. Here are a few options for Santa to consider.

I-Stat Handheld Blood Analyzer (Abbott)
This unit offers a variety of blood tests including chemistry and hematology, depending on the cassettes selected. With results in minutes, clinicians can make decisions about changes in treatment that once required more complicated lab draws or hospital visits.

Coagucheck (Roche)
This unite allows PT/INR testing at your facility. Inmates taking anticoagulation medication (blood thinners) need close monitoring to maintain an appropriate blood clotting time. Clotting times that are too fast or too slow can cause complications and bleeding emergencies. PT/INR readings provide medical staff with the needed information to make changes in medication before trouble arises.

Instant-View Troponin Testing (American Screening Corp)
Along with onsite EKG readings, Instant-View Troponin Testing can provide clinicians with the information necessary to determine heart damage in a chest pain situation. Although Troponin testing at correctional facilities is somewhat controversial due to the specialized nature of the analysis, cutting-edge facilities are starting to implement this point-of-care diagnostic where sufficient medical staff are available.

Of course, accurately performing onsite blood testing requires more than equipment. Health care staff must be properly trained in using the equipment. Physicians and nurses must understand the application of test results to clinical situations. In addition, facilities must obtain appropriate certification from the Department of Health and Human Services to perform onsite blood testing. CLIA Waiver Certification allows appropriate use of onsite equipment outside a standard laboratory setting for a specific list of blood tests. With all these elements in place, you’ll be on your way to more efficient and effective healthcare within the security perimeter.

If you’ve been very, very good this year, maybe one of these onsite point-of-service blood testing products will be in your stocking this holiday season.

Have you used any of these items in your correctional practice? Tell us about your experiences in the comments section of this post.

December 16, 2010 Posted by Lorry Schoenly | Uncategorized | Leave a Comment