Nursing Assessment of Dental Problems

Julia Buttermore, DMD, is Chief Dental Officer, Federal Medical Center, Carswell, Fort Worth, TX. This post is based on her session “Nurses’ Assessment of Dental Problems” taking place at the 2015 National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

Dental conditions can be a great concern for correctional nurses, yet, most received little or no training about dental conditions in nursing school. Most traditional nursing positions don’t involve dental assessments so many nurses enter the correctional specialty unprepared.

What’s the Big Deal?

First of all, a nurse is most often the first person an inmate sees about a dental concern. This is usually at a receiving screening or through the nursing sick call process. So, nurses must be able to determine the nature of the issue and make a decision about urgency of treatment. A dental episode might be remedied with instruction on self-treatment, may need assignment to the next available dental appointment, may need urgent evaluation by a dentist, or may need emergency treatment in the acute care setting. It requires significant clinical judgment abilities to appropriately manage dental issues.

Another reason dental conditions are a concern for correctional nurses is because there are so many of them in our patient population. Our patients are less likely to have received dental care in the past and many have a lifestyle that does not include high levels of dental hygiene. Therefore dental decay and periodontal disease are seen frequently. Our patients come from violent backgrounds that can result in tooth trauma. They also indulge in high levels of alcohol, tobacco, and drug use. All these substances have a negative effect on dental health.  Methamphetamine use, in particular, can cause severe dental erosion and decay. Self-medicating with alcohol and drugs can mask tooth pain. Once incarcerated and withdrawn from these substances, inmates feel increasing mouth pain that leads to dental requests for evaluation and treatment.

Finally, systemic chronic conditions and infections affect dental health. Nurses who understand the relationship of dental conditions to systemic disease can often activate medical evaluation when a dental manifestation is observed. For example, canker sores or herpes can appear on the mouth of an immunosuppressed individual and periodontal infection might exacerbate blood glucose levels in diabetics.

Where to Start

A good assessment starts with an evaluation of the patient’s mouth pain. Here are some important questions to ask.

  • How long has it been hurting? (Just now? 24 hours? 3 months? Years?)
  • Does it hurt spontaneously or when eating, drinking?
  • Does the pain wake you up at night?
  • Describe the pain quality: aching, throbbing, pressure, tingling
  • How long does it hurt? (<1 minute? 30 minutes to 1 hour? all day?)
  • Does anything help the pain?
  • Use the pain scale of 0-10 to determine a baseline level of discomfort

Dental conditions can affect the ability to breathe and swallow. These are two immediate concerns in evaluating any dental condition. Ability to breathe and swallow is affected by infection, traumatic injury, persistent bleeding in the oral cavity, or swelling. Impairment of breathing or swallowing needs immediate emergency treatment. Inspect the mouth for swelling. Take the patient’s temperature.

If this is a traumatic injury, check for a broken jaw. Mandibular fracture is a common injury due to assault or falling. Malocclusion (teeth not fitting together normally) is an indication of a mandibular fracture.

A New Skill

Since most correctional nurses come to the specialty with little training or experience with dental assessment, you may need to develop your own dental training program to develop skill in this important area of nursing practice behind bars. This can involve encouraging your facility dentist to provide in-services and hands-on practice assessing patients under their direction. You may also be able to discuss dental assessments and findings as a debrief of urgent or emergent evaluations. Dental trauma and infections tend to be the most common conditions requiring nursing assessment so these are good places to start.

Do you assess dental conditions in your practice? Share your experience in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

Intensive Medical Management: How to Handle Prisoners Who Self-Mutilate, Slime, Starve, Spit and Scratch (Podcast Episode 106)


Todd Wilcox, MD, MBA, CCHP-A, Medical Director of the Salt Lake County Jail System, joins Lorry to discuss managing some difficult correctional patient situations. He is presenting the session Intensive Medical Management: How to Handle Prisoners Who Self-Mutilate, Slime, Starve, Spit and Scratch at the National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

Providing health care in the criminal justice system brings with it some interesting and challenging patient situations. Patients present with unusual medical conditions, for sure, but also have some difficult behavioral and psychological profiles that lead to safety issues for both the patient and the staff. Dr. Wilcox shares insights on dealing with these patients and provides treatment recommendations based on best practices and clinical experience.

Often, disruptive inmates who slime, spit, or scratch incur charges, restricted contact, and lost of privileges. Extreme outbursts and violent behavior can lead to physical restraint. However, treating these individuals punitively rarely has a good outcome; and can sometimes end in injury or death. Things can get out of control with escalation on both sides. A measured approach, focusing on de-escalation and crisis intervention is warranted.

Self-injury, whether mutilation or starvation, are two of the most challenging behaviors to manage successfully. An understanding of mental illness is needed by both healthcare and security staff. While policy and procedure are important to set a framework for managing these behaviors, a one-size-fits-all approach will not work. Often interventions for individual patients must be tested out to determine response. For example, some patients respond well to increased stimuli while others need to be taken away from noise and audience.

Crisis Intervention Training (CIT) is recommended for those who deal with behaviorally challenging inmates. Dr. Wilcox initiated the training for staff working in the Salt Lake County Jail System and they have seen a 95% reduction in the use of force to manage behavioral issues.

How do you handle patients who self-mutilate, slime, starve, spit or scratch? Share your tips in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

Common Pitfalls in Interpreting NCCHC Standards (Podcast Episode 105)


Episode 105Tracey Titus, RN, CCHP-RN, Manager of Accreditation Services for the National Commission on Correctional Health Care joins Lorry to discuss common pitfalls in interpreting the National Commission’s Accreditation Standards. She is presenting the session Tips, Tricks and Troubleshooting: Common Pitfalls in Interpreting NCCHC Standards at the National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

The National Commission accredits jails, prisons, juvenile facilities, and opioid treatment programs through a voluntary program based on quality standards developed by experts in the field. Facilities seek accreditation to establish a system for providing health care services to incarcerated populations. Preparing for accreditation includes accurately interpreting the Standards and then applying them to the specific setting. Misinterpretation of the intent of any standard can lead to inappropriate application.

Common Reason for Misinterpretation

NCCHC has analyzed implementation of standards in a wide range of facilities and has found that standards can be misinterpreted by being only partially applied or even omitted. In addition, now that there are new editions of the standards (2014 for Jails and Prisons, 2015 for Mental Health and Juvenile, and (soon) 2016 for Opioid Treatment Programs), one common mistake is applying the older standards rather than the most recent ones. To help with correct interpretation and implementation, the Standards themselves offer compliance indicators, definitions, and a discussion section, often with examples of how to comply. It’s important to keep in mind, however, that a common misinterpretation is to consider an example prescriptive when the example might not be the best or only way to apply a standard in a particular context.

The Most Difficult Standard to Interpret

Based on NCCHC surveys, the most often misinterpreted NCCHC standard is Continuous Quality Improvement. This may be because leaders see CQI as a simple audit of their health care system rather than a process designed to focus on problem issues and develop meaningful solutions. Other common standards where compliance has proved challenging for some facilities are Chronic Disease Services, Initial Health Assessment and Health Record Format and Contents.

Tips for Interpreting the Standards

Here are some tips for better standards interpretation.

  • Read the intent of the standard (first sentence of Discussion) within the context of the standard itself
  • Determine what the standard is attempting to achieve
  • Consider how it could be achieved in your facility
  • Review the examples provided for common facility solutions

Where to Get Additional Help

NCCHC offers several ways to obtain assistance with interpretation and application of the Standards and to increase your knowledge.

  • Email NCCHC for help: or
  • Attend the preconference seminars at NCCHC’s Spring and Fall conferences
  • Read the Standards Q&A topics for specific questions about various standards
  • Read the Spotlight on the Standards column for in-depth discussion about selected standards

Are you preparing for an NCCHC accreditation visit? Share your tips for preparing and interpreting the standards in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

Your Next Steps in Professional Development: Certification!

Your Next Steps in Professional Development-Matissa Sammons, CCHP, is Director of Certification at National Commission on Correctional Health Care. This post is based on her session “Your Next Steps in Professional Development: CCHP and Specialty Certifications” taking place at the 2015 National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

Correctional health care is a specialty like no other. Where else do health care staff get a pat down on the way into work, account for every needle used in the delivery of care, care for people who have been living on the street, or administer medications through a letter-sized metal door flap? Of course, those are only a few of the peculiarities of the field. The patient population and environment of care result in an unusual mix of conditions and situations. Those who enter the corrections field often need to seek out professional development to gain the knowledge to operate in the specialty. One way to establish expertise in a specialty like correctional health care is to seek certification.

Value of Certification

Why should you consider putting in time and effort to become certified? Here are a few reasons professionals seek out certification.

  • Professional Recognition: First and foremost is professional recognition among employers, peers, and consumers.
  • Professional Credibility: Certification denotes a proven knowledge base and documented experience in a given specialty.
  • Sense of Accomplishment: Preparing for a certification exam can be hard work; requiring diligence and perseverance. Completing the process can provide a sense of accomplishment.
  • Knowledge Validation: Certification validates foundational knowledge for the particular specialty – above and beyond initial general professional knowledge for licensure.
  • Marketability: Certified professionals stand out in a crowd of candidates vying for a particular position. It not only validates knowledge but also motivation and perseverance in the specialty.

Correctional Health Care Certification Categories

There are several types of correctional health care certifications. The advanced and specialty certifications build on the foundational Certified Correctional Health Professional (CCHP) designation. Here is a brief overview of the various categories. Full eligibility requirements can be found on the NCCHC website –

Certified Correctional Health Professional (CCHP): Anyone of good character and fitness with interest in correctional health care is eligible to apply for CCHP certification. The certification exam consists of 80-100 multiple choice questions.

Certified Correctional Health Professional – Advanced (CCHP-A): Those with CCHP certification can seek advanced certification after 3 years. This process for advanced certification involves an extensive application detailing the individual’s experience and contributions to the field of correctional health care followed by a four-hour proctored examination consisting of eight essay questions.

Specialty Certifications

Certified Correctional Health Professional – Mental Health (CCHP-MH): CCHP certified mental health professionals must be a qualified mental health professional as defined by NCCHC’s Standards for Mental Health Services in Correctional Facilities with a graduate degree, professional licensure, and the equivalent of three years of full-time practice experience in a correctional setting may sit for the CCHP-MH certification. The exam consists of 80-100 multiple-choice questions.

Certified Correctional Health Professional – Physician (CCHP-P): CCHP certified physicians with an unrestricted license who have practiced in the correctional environment for at least three years are eligible to sit for the CCHP-P certification. The exam consists of 70-100 multiple-choice questions.

Certified Correctional Health Professional – Registered Nurse (CCHP-RN): CCHP certified registered nurses with an unrestricted license and the equivalent of two years of full-time practice as an RN with at least 2000 hours of correctional practice are eligible to sit for the CCHP-RN certification. The exam consists of 70-100 multiple-choice questions.

Are you certified in correctional health care or one of the specialties? What motivated you to prepare and take the examination? Share your experience in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

A Pre-Flight Checklist Before Rolling Out of the Med Room

A Pre-Flight Checklist Before Rolling OutMedication administration is a common and frequent nursing task in most settings. There are plenty of opportunities to get things wrong….even when surrounded by fantastic resources like an onsite pharmacy and electronic information sources. Correctional nurses don’t often have these advantages, though, and medication administration can take on some interesting configurations. I’ve been in quite a few jails and prisons in my correctional consulting career and have seen many a method for medication delivery to overcome environmental and security challenges. Here are just a few of the ways medication may be delivered behind bars.

  • A window in the med room. Patients may line up outside the room in a hallway or in an outdoor area
  • A medication cart rolled to the housing unit and stationed in the common area or a small room in the housing unit
  • A cart, room, or even table near the dining hall
  • A larege utility shed in the recreation yard

In most of these cases (except the first one, maybe) the nurse must take all the medications and supplies out away from the medical unit and must be prepared for any situation. There is little opportunity to ‘run back to the unit’ for something forgotten or unexpectedly needed. This made me think of airplane pilots who need to know they have everything checked out and ready to go before they take to the air. As a passenger on these flights, I am glad the captain doesn’t rely on memory to be sure everything is in order. Cruising altitude is not a good place to be finding out the gas tank is low.

Here are my suggestions for a pre-flight checklist before you take-off on your medication flight.

  1. Check that the cart is properly stocked.
  • Patient medications
  • Medication administration record
  • Pen, highlighter, notepad
  • Current drug book
  • Pill crusher
  • Calculator
  • Pill cups
  • Water/drinking cups
  • Waste receptacles
  • Any access keys needed such as access to the narcotics box
  1. Perform the following activities while in the Medication Room.
  • Scan MARs for
    • Any new medication orders since last administration.
    • Any new patients
    • That all patients have drug allergies listed or NKA (no known allergies) identified
  • Check to see that new medications are available or, if being processed, are added to the cart before starting administration
  • Check a drug reference book on any new medications that are unfamiliar
  • Perform any calculations for odd dose orders
  • Perform hand hygiene
  1. Each single episode of medication administration should follow the same path in order to habituate safety principles. Here is an example of a workable medication line episode path that includes the safety mechanisms of checking the medication three times and involving the patient in medication verification.
  • Ask the patient to recite their full name while checking ID band or card.
  • Locate correct MAR page
  • Scan page for medications due at this administration time
  • Locate patient medication group in medication cart drawer
  • Take first card and check against MAR while popping pills into medication cup
  • Take next card and check against Mar while popping pills into medication cup
  • Continue in like manner until all pills for this administration time are in the medication cup
  • Recite medications to the patient while preparing them
  • Recheck cup of pills against MAR before handing to the patient
  • Ask patient if he/she has any questions about their medications while pouring water
  • Watch patient take medication. Perform oral check or confirm officer is doing oral check
  • Observe that cups are deposited in waste receptacle and not taken by the patient
  • Move to the next patient
  1. Additional steps in the process might be needed depending on the patient or situation.
  • Crushing some or all medications.
  • Responding to a patient question or confirming a medication if questioned.
  • Unlocking and signing out any narcotics.
  • Obtaining a double-check on high risk medications and complex calculations.

Do you have a mental checklist you use when preparing for and administering medications? Share your tips in the comments section of this post.

July 2015 Correctional Health Care News Round Up (Podcast Episode 103)


Ep103Gail Normandin-Carpio and Denise Rahaman join Lorry to talk about top correctional health care news items for July, 2015.

Callous and Cruel: Use of Force against Inmates with Mental Disabilities in US Jails and Prisons

Our first story is a report out of Human Rights Watch about the use of force against inmates with mental disabilities in US Jails and Prisons. We have been discussing the plight of the mentally ill in the criminal justice system for some time. Our jails and prisons are not organized to effectively treat mental illness, yet growing numbers of inmates have serious mental illness such as schizophrenia and bipolar disorder. The mentally ill are less likely to adjust to conditions of confinement and have difficulty following all the rules that must govern life behind bars. That puts them into confrontational situations with officers who must keep order and control. This report paints a grim picture but also provides some hopeful recommendations.

Bill would give inmates’ families access to prison medical records

New York has passed a bill that would require the State Department of Correction and Community Supervision to provide medical information disclosure forms as a routine procedure for all incoming or transferring inmates. This would give inmates the option of appointing a family member or other person to receive their medical information.

Dating a prisoner: What attracts people on the outside to fall in love with convicted criminals?

This next story is about dating prisoners and comes from a British news source. The recent NY Prison Escape story and follow-on investigation as brought to light something we see in practice all too often – staff getting intimately involved with criminals. Hybristophilia is described as a condition whereby women are sexually aroused by and responsive to men who commit heinous crimes. Often referred to as the ‘Bonnie & Clyde Syndrome’, the person who is the focus of the sexual desire can be someone who is in prison. In some cases, the hybristophile may urge and coerce their partner to commit a crime. This may somewhat explain staff attraction to our patient population.

Florida prisoners train therapy dogs to help veterans

In our final story, a group of Florida prisoners are training therapy dogs for veterans suffering from Post-Traumatic Stress Disorder as part of a new program. Prisoners from the Blackwater River Correctional Facility will train three puppies for America’s Vet Dogs Veteran’s K-9 Corps with plans to expand to 10 dogs by the end of the year. The training program will teach the K-9s to do everything from retrieving medication, to turning lights on and off, to waking veterans from nightmares. Sounds like a nice idea for both the veterans and the inmates.

What is your take on these news items? Share your thoughts in the comments section of this post.

Helping Pregnant Inmates: The Minnesota Prison Doula Project (Podcast Episode 102)


Episode 102Erica Gerrity, Director and Founder of the Minnesota Prison Doula Project and Raelene Baker, a Certified Birth Doula and their Project Coordinator join Lorry to talk about the Minnesota Prison Doula Project, a prison‐based pregnancy, birth, and parenting program. They currently have 8 doulas in 3 facilities. Read more about their program on their blog.

A doula is a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period. Prison doulas provide parenting support, heathy mother information, in-depth interventions and emotional support to incarcerated women during their stressful and often lonely prison pregnancy and childbirth experience.

The Minnesota Prison Doula Project teamed up with the University of Minnesota to research the benefits of doula involvement for pregnant inmates. They found benefit to three groups.

  • Mothers: Women involved in the doula program describe an increased sense of community and an increased feeling of support from front-line staff. So, they are more likely to feel safe and supported.
  • Newborns: Babies show improved birth outcomes as compared to similar at-risk births. The program has had a positive effect on pre-term births. The babies also have additional focus and attention during the birth process as doulas are often the only support person with an incarcerated mother during birth.
  • Front Line Officers: The doula program has increased awareness and officer respect for pregnant and laboring inmates.

The Minnesota Project can be a model for developing doula programs in other prison systems. The speakers encourage correctional nurses working with pregnant inmates to talk about the program in their facilities and gain support for a pilot project. DONA International is a good information source and the Minnesota Prison Doula Project also stands ready to provide support and direction.

In the Nursing News

Lyme Disease Cases Rising

If you work in the northeastern US, be on the look out for Lyme disease symptoms during sick call. A recent report from the CDC indicates cases are on the rise in areas of highest incidence: northeastern, northcentral and mid-Atlantic US states. Lyme Disease from an infected tick bite starts with a characteristic bulls-eye rash that can be missed. So, presentation at sick call could be ambiguous: flu-like symptoms, joint pain, and generalized body ache. Consider requesting an order for an ELISA lab test to detect for antibodies to B. burgdorferi, the bacteria causing the condition.

Exposure to Harmful Chemicals through Douching

Douching is still quite popular even though it has been proven to be ineffective as a vaginal cleansing system; and even harmful to health vaginal flora. Now, a research study is showing that women who douche at least twice monthly have urinary concentrations of diethyl phthalate (DEP) over 150% higher than non-douchers. DEP is implicated in the disruption of estrogen, testosterone, and thyroid hormone action in the body. So, douching is not a good idea and should be discouraged among our patient population.

New Recommendations on Sleep

The American Thoracic Society has a new policy statement on the need for good-quality sleep for both the general public and health care providers. Good sleep is good health, for sure. Sleeping less than 6 hours or more than 10 hours nightly is linked to adverse health outcomes including drowsiness, inattention, and chronic diseases. The society advocates more patient education about sleep hygiene and more health care organization focus on encouraging good sleep patterns among staff. Here is a link to a prior post on sleep in jails and prisons.

What do you think? Would a prison doula program work in your setting? Share your thoughts on doulas or any of the news items in the comments section of this post.

Keep Your Cool: Heat Injury Alert

keep your coolIt’s that time of year again-Summertime. Time to be hot and bothered at work if you are one of many correctional nurses working in a setting that lacks air conditioning. Jails and prisons were not built for comfort and many older ones are without air conditioning or even good ventilation. Heat injuries such as heat exhaustion and heat stroke should be on our minds when evaluating vague patient symptoms during the summer months; especially when the weather is both hot and humid, like many of our southern states. For example, as identified in a recent lawsuit, most of the Texas state prisons are without air conditioning, although some have climate control in the medical unit. So, what should you do to identify and treat heat injuries?

Vulnerable Conditions

Although anyone can succumb to heat and humidity, the young and old have fewer reserves to overcome heat stress. If possible, move patients with the following conditions to special housing or provide with additional monitoring and fluids during high heat alerts.

  • Elderly
  • Heart disease
  • Pulmonary disease
  • Mental illness

A main reason those with the above conditions are prone to heat-related illness is the medication they are likely prescribed. The following medications or substances increase heat injury risk.

  • Anticholinergics (Atrovent, Chlor-Trimeton, Cogentin, Spiriva)
  • Antihistamines (Allegra, Benadryl, Zyrtec)
  • Benzodiazepines (Klonopin, Librium, Valium, Xanax)
  • Beta blockers (Atenolol, Corgard, Lopressor)
  • Calcium channel blockers (Cardizem, Norvasc, Procardia)
  • Diuretics (Chlorothalidone, Diuril, Lasix)
  • Neuroleptics/Phenothiazines (Haldol, Mellaril, Prolixin)
  • Tricyclic antidepressants (Pamelor, Tofranil, Vivactil)

Rapid Cooling and Hydration for Heat Injury

Heat exhaustion and heat stroke are the two most common heat injuries, although sunburn and heat cramps are also often listed.  In heat exhaustion, the body is decompensating having difficulty maintaining normal body temperature in an extended high heat situation. Heat stroke begins when the body becomes unable to keep internal temperatures in a livable range. Without intervention, heat exhaustion can progress to life-threatening heat stroke. Here is a quick comparison of the presentation and treatment of heat exhaustion and stroke.

Heat Exhaustion Presentation

  • Body temperature under 104 degrees F
  • Heavy sweating
  • Muscle and stomach cramps
  • Headache
  • Nausea or vomiting
  • Tiredness, weakness
  • Dizziness and fainting

Heat Stroke Presentation

  • Body temperature above 104 degrees F
  • Hot, dry skin
  • Confusion, strange behavior, seizures, or unconsciousness
  • Rapid pulse
  • Throbbing headache
  • Nausea

As you can see, many of the symptoms are similar as heat stroke is an intensification of heat exhaustion. A differentiating factor is the change from heavy sweating to hot, dry skin. In both cases, treatment focuses on rapidly cooling and hydrating the body. Heat stoke definitely requires hospitalization while heat exhaustion, if mild, can be treated at the facility and may require infirmary monitoring.

Heat Exhaustion Treatment

  • Move to a cool area (Shade, AC)
  • Remove or loosen restrictive clothing
  • Rehydrate with fluids
  • Use evaporation methods
    • Spraying water on the body and fan the air
    • Sponge body with cool water
  • Rest
  • Monitor until body temperature returns to normal

Heat Stroke Treatment

  • Move to a cool area (shade, AC)
  • Removal of restrictive clothing
  • Use evaporation methods
    • Spraying water on the body and fan the air
    • Sponge body with cool water
    • Covering the patient with cold water–soaked sheets
    • Place ice packs in the axillae and groin
  • Supplemental oxygen, if available
  • Prepare for possible initiation of IV therapy
  • Prepare for transfer to acute care

Patient Education for Prevention

Helping patients to manage heat and humidity can prevent heat injury. These reminders are important for officer staff, as well.

  • Keep hydrated. This can be difficult where bad-tasting water and fruit-flavored Kool-Aid are the only options. Advocate for healthy fluid options for your patients when possible. Ask about fluid intake during your subjective assessments.
  • Reducing physical exertion. Now is not the time for basketball competitions or lifting challenges. Many inmates are on outdoor work duty with many hours in the sun. Be mindful of the work status of inmates coming to sick call with symptoms of dizziness, weakness, headache, and general body tiredness. Instruct patients to take frequent rest breaks and seek out shaded areas at work and recreation sites.
  • Use available cooling methods. Teach patients evaporation heat reduction methods to stay cool such as sponging body areas with cool water and body fanning.

Personal Safety in the Heat

Don’t forget yourself in your summer heat preparations. You are also vulnerable to heat injury. Even if the medical unit is air conditioned, many health care activities take place outdoors or in housing units. Be sure to follow all the instructions provided to patients. Stay hydrated and monitor your mental and physical status regularly. Urine output and characteristics can be a good indication of adequate hydration. If you are basically healthy, pale urine is an indication of appropriate bodily fluid volume and generally good kidney function. Concentrated darker urine or decreased urine output can indicate a need to increased fluids. Double up on the fluids you bring on shift. Water is always a better option than sweet or caffeinated drinks.

Do you work in a high-heat setting? How do you keep your cool and manage your patient’s heat regulation during the summer? Share your thoughts in the comments section of this post.

Photo Credit: © OlegDoroshin

June 2015 Correctional Health Care News Round Up (Podcast Episode 101)


Ep101Lorry is joined by Mari Knight and Catherine Knox to discuss the latest correctional health care news items.

New study examines health factors influence on ex-prisoners’ chances of returning to jail

The first news item is a study out of Australia that links health factors to recidivism. In this exploratory study of prisoners from seven institutions in Queensland, those inmates with a history of risky drug use and mental illness were more likely to return to prison while those who were obese or had a chronic disease were less likely to be incarcerated again.

Prison break casts spotlight on staff-inmate relationships

The New York Prison Break has been prominent in the news and in this last week of June the two escaped inmates from a maximum security prison in upstate New York have been apprehended. As more information emerges about the planning and implementation of the elaborate escape, light is being focused on staff-inmate relationships and how staff can be manipulated. Resource links on the issue of nurse-patient relationships can be found in this recent post.

Top doc blasts California prison health care

A prison psychiatrist at San Quentin State Prison in the California Prison System circulated a memo about constitutionally inadequate mental health treatment in the prison and seems to have suffered retaliation for doing so. Correctional nurses have felt a need to speak out about inadequate care or conditions of their inmate patient population and have also suffered negative consequences.

Caring for the dying, behind bars

Our final story is about caring for dying patient behind bars. This is an opinion piece written by Dr. Jaime Mayer, an infectious disease physician, and published in the Boston Globe. She basically askes the question – is it possible to have a good death in prison? It is a struggle to balance compassion and correction …or, care and custody in many areas of healthcare behind bars. This essay provides a good example.

How about you, do you have some input or experiences to share related to our news items? Share your thoughts in the comments section of this post.

Could You Be the Next Joyce Mitchell? 4 Prevention Tips

Could You Be the Next Joyce Michell- (1)Many of us have been closely watching the unfolding events surrounding the NY Prison Break over the last month. Here is a timeline of events, concluding with the death of convicted killer Matt and the shooting and capture of convicted killer Sweat in upstate New York. Early in the story Joyce Mitchell, a prison worker who managed the tailor shop with her husband, was taken into custody for her part is assisting the prisoners.

Those unfamiliar with our patient population find it hard to believe that someone would develop an intimate relationship with a murderer and assist them in this way. Yet, unhealthy inmate relationships are a constant threat and should be a continual concern for anyone working in the criminal justice system. No one is immune to this work hazard. Here are my four prevention tips along with some links to prior posts and podcasts on the topic.

Know Your Patients

Prisoners are ten times more likely than the general population to have an antisocial personality disorder (ASPD). That means many of our patients are sociopaths or psychopaths; individuals who use others to gain what they want without remorse, guilt, or conscience. Among other things, that means that they may appear charming and charismatic in their interactions with you. Unfortunately, that charm is often ‘turned on’ in order to manipulate and deceive. Always be aware that things may not be what they seem in the words and actions of patients. Click here for more information about dealing with lying and manipulative patients.

Know Yourself

Most of us became nurses in order to help people in distress – the injured, ill, and suffering. This motivation can make us prey to antisocial patients. Empathetic people are natural targets for sociopaths. We are even more vulnerable when our emotional lives are in turmoil such as when we are having relationship issues (divorce or break-up), work stress (new job, discipline, understaffed), health issues (illness, pregnancy, new baby) or are under financial stress (foreclosure, credit card debt). Be aware of your emotional and psychological state when dealing with this patient population.

Remember Where You Are

Many of us spend the majority of our time at work. What is unusual for most people (working behind bars) becomes normal and common place for correctional nurses. It can become so normal that you forget where you are and who is nearby. This can result in ‘letting down your guard’ and becoming too familiar with your patients. Talking about your personal life around workmates and patients alike can make you vulnerable to those interested in gaining rapport and influence. Small breaches of professional boundaries can lead to great harm. It is unlikely that Joyce Mitchell woke up one morning determined to help two murderers escape prison. But, she is reported to have been very chummy with at least one of them including bringing in meals.

Help Each Other

Manipulative patients will note any friction among staff members and use that to advantage. One of the best ways to avoid being drawn into an inappropriate patient relationship is to have good working relationships with your team mates. Present a united front before the patient population and keep any friction or personality differences for behind the staff-room doors. Talk openly in staff meetings about professional boundary challenges and be willing to confront team mates who may be slipping into danger. It seems hard to believe that no staff member noticed Joyce Mitchell’s over familiarity with Matt and Sweat. Would life be different for her right now if someone had intervened?

Learn from this News Event

Could you be the next Joyce Mitchell? It is easy to become accustomed to your surroundings and lose sight of the relationship goals of some of your patients. We can all learn from the recent events at Clinton Correctional Facility. Take this opportunity to double down on your professional boundaries with patients and have a conversation with your workmates about how to prevent inappropriate relationships from starting.

Resources to Keep You Safe

Working with Inmate-Patients Series

Podcast Episodes

What tips do you have for avoiding unhealthy patient relationships? Share your thoughts in the comments section on this post.

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