Scope and Standards: Population Served

ANA StandardsThis post is part of an ongoing series discussing key components of the Correctional Nursing Scope and Standard of Practice, 2nd Ed. Review prior posts in this series here. Purchase your own copy of this highly recommended book through Amazon.

Many of us entered the nursing profession to help those in need. I can’t think of a needier patient population than those in correctional facilities. The demographic make-up and specific health needs of our patient population contribute to what makes correctional nursing a specialty. Because our patient population is defined by location and jurisdiction, rather than disease or health need (as in most traditional settings), correctional nurses must be proficient in a broad array of conditions and, often, a variety of ages and genders. For example, a small jail may house detained men, women, and juveniles. While, larger systems such as a state or federal prison system have the volume and support necessary to separate populations by gender and age.

Although the majority of prisoners in the US criminal justice system are white, there is a disproportionate number of minorities behind bars. Therefore, conditions found more frequently in black and Hispanic populations are prevalent in the inmate patient population. According to the CDC, blacks are three times more likely to have diabetes and strokes and have a higher death rate from HIV disease. Likewise, the CDC reports Hispanics having higher rates of death from these conditions along with higher rates of chronic liver disease. Therefore correctional nurses must be proficient in assessing for and treating these conditions.

Coming from disadvantaged backgrounds, with less access to regular healthcare services, the incarcerated patient population has many untreated conditions and a high burden of chronic disease. A study of jail and prison inmates found higher rates of diabetes, hypertension, asthma, and prior MI than the general population. The correctional nurse may be a first contact with the healthcare system. Therefore, correctional nurses must be proficient in evaluating symptoms that might indicate an undiagnosed chronic condition. For example, I have seen newly diagnosed diabetes and asthma in the correctional setting.

Our patients are also prone to infectious disease with high rates of sexually transmitted infections, tuberculosis, and blood-borne infections such as HIV, HCV, and HBV. Many have poor hygiene practices and a cramped correctional environment can contribute to the spread of infection, like norovirus, throughout a facility. Correctional nurses often become infection control specialists; containing a varicella outbreak, reporting food poisoning to the health department, and educating patients to reduce transmission.

The inmate patient population has high rates of mental illness. Every correctional nurse is a mental health nurse! Among the mental conditions over-represented in the incarcerated are mania, major depression, psychotic disorders, and borderline personality disorder. Not only must correctional nurses understand the assessment and treatment of these conditions but must be aware of the implications of personality disorder, sociopathic, and psychopathic tendencies on the nurse-patient relationship.

The often violent and abusive backgrounds of the correctional patient population means higher rates of traumatic brain injury, post-traumatic stress disorder, and suicidality. Correctional nurses must be astute in detecting the potential for self-harm and seeking to prevent it. Histories of abuse require sensitivity in nurse-patient interactions to avoid triggering panic, anxiety, or suspicion. An understanding of the effects of traumatic brain injury is needed when providing patient instruction.

Finally, our patient population is highly substance involved. Drugs and alcohol are a way of life for so many under our care. An extensive study found nearly 85% of all U.S. inmates involved with alcohol or illegal drugs. You can bet that means withdrawal concerns when they enter the criminal justice system. Our patients are also willing to coerce others (including you!) to obtain drugs for them while they are ‘inside’. Their desire for alcohol can lead to hooch-making from spoiled fruit and potato peels – that can be deadly. Amazingly, alcohol –based hand sanitizer has also been ingested in the correctional setting.

In summary, it is clear that correctional nurses work with a unique patient population that requires specialized knowledge, skills, and attitudes. Did you see your patient population in this description? Share your thoughts in the comments section of this post.

Scope and Standards: New Definition of Correctional Nursing

ANA StandardsHow has professional nursing practice in the correctional setting changed and evolved over the last decade? When discussing any concept, the first place to start is with a definition. How has the definition of correctional nursing changed over the years?

To start with, the very name of our specialty has moved from corrections nursing to correctional nursing. This name change indicates a movement away from purely defining nursing practice based on location. Similar evolutions have taken place in such specialties as emergency nursing (no longer Emergency Room Nursing) and Perioperative Nursing (no longer Operating Room Nursing).

Definition of Corrections Nursing in 2007

Corrections nursing is the practice of nursing and the delivery of patient care within the unique and distinct environment of the criminal justice system.

As the general definition of nursing has progressed, so has the definition of correctional nursing. This edition of the Correctional Nursing Scope and Standards of Correctional Nursing unveils an expanded definition of correctional nursing which mirrors the 2010 ANA definition of nursing.

Definition of Correctional Nursing in 2013

Correctional nursing is the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, advocacy, and delivery of health care to individuals, families, communities, and populations under the jurisdiction of the criminal justice system.

Nurses practice professionally in every setting. Therefore, the core components of correctional nursing include protecting, promoting, and optimizing the health and abilities of patients. Nurses in all practice settings, including corrections, prevent illness and injury while alleviating suffering. Correctional nurses, as those in other settings, diagnose and treat the human response to illness and injury. They advocate for their patient’s health and deliver health care to individuals, families, communities, and populations.

The location of care – under the jurisdiction of the criminal justice system – does give context to the practice of nursing. The criminal justice system presents the unique environmental constraints and ethical dilemmas of our specialty. In addition, the criminal justice system creates a unique patient population for nursing care. This patient population has demographic characteristics and illness patterns that require specialized nursing knowledge. The combination of environment and patient can lead to specific patient advocacy situations for correctional nurses.

What do you think of the new definition of correctional nursing? Share your thoughts in the comment section of this post.

The full Correctional Nursing Scope and Standards of Practice, 2nd Ed. Is available through amazon.com.

Top Six Posts of 2013

six balloonsThank you for being a part of CorrectionalNurse.Net this past year! Your comments and suggestions make this blog a helpful resource for nurses new to the specialty and those interested in keeping abreast of the latest news and information important to working in jails and prisons. In fact, my goal for this blog is:

Informing, encouraging, and inspiring nurses who care for vulnerable, marginalized patients in the low resourced, ethically challenging criminal justice system.

This blog has been around for more than 4 years now and has over 250 informational posts in a variety of categories. Search by key word using the search field in the upper right or by category using the drop-down menu on the right sidebar.

Here are the six most popular posts in 2013. Check them out if you missed them when they originally aired. Stay tuned for more great information in the year ahead. I hope you visit often and include your views by commenting frequently.

#6 Confidentiality, HIPAA, and the Correctional Nurse

Concern continues for the confidentiality of patient medical information. Correctional nurses must navigate within a security system that often requires the exchange of medical information for safety and good patient care. What medical information can be shared? This post provides information directly from the HIPAA code that specifically addresses the correctional setting.

#5 Women’s Health in Prison

Women may only constitute 7-12% of the incarcerated population, but their healthcare needs can be great. Maybe increased interest this year can be attributed to the popular Netflix show “Orange is the New Black” – a portrayal of life in a female federal prison.

#4 Taser Injury – The Stunning Truth

Correctional nurses take care of an extensive variety of conditions and some that are rare in more traditional settings. Taser injury is one such unusual care situation. This post covers assessing and treating post-taser wounds as well as what conditions render persons at high risk for increased injury from being tased.

#3 8 Medication Rights – Not 5?

Just when you think you are up-to-date something changes. That is life as a practicing nurse. This post adds three new ‘rights’ to the classic 5-rights of medication administration and is actually reposted from the blog of a fellow nurse. A great review!

#2 Interview Guide: Part I   Part II

Many nurses discover this blog while looking for help in preparing for their first interview for a correctional nursing position. This 2-part series shares tips for determining if a correctional setting will be a safe work environment along with questions that may be asked during the interview.

#1 Dental Issues for Correctional Nurses

By far, dental issues were the greatest learning curve for me in entering this specialty. This post has some great pictures provided by Dr. Stephen Mitchell and is a big help for nurses who need to know what is routine and what is a possible emergency when dealing with dental conditions.

What was your favorite post of 2013? Share your thoughts in the comments below.

Photo Credit: © Kyrylo Grekov – Fotolia.com

December 2013 News Round-Up (podcast)

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cnt-podcast_cover_art-1400x1400Regular panelists Johnnie Lambert, Mari Knight, and Margaret Collatt help us close out the year with discussion of December 2013 correctional healthcare news. Let’s roll……

Story #1: Eye Care Rare Among Low Income Diabetics – Implications for Correctional Nursing?

Our first story, while not specifically about correctional healthcare has a very real connection for our consideration. A Reuter’s news story reports on a study finding that young low-income diabetics are not attending to their eyes. Our inmate population fits this profile – young, low-income and often diabetic. Are their implications for our patient care here?

Story #2: Psychiatrist Shortages in Corrections?

Our next story is from the California Prison System. California Healthline reports that the state prison hospital has had to cut services and reduce admissions due to a psychiatrist shortage.

Story #3: Orange is the New Black and Women’s Prisons Portrayal

Story #3 from the Washington Post lauds the Netflix series ‘Orange is the New Black’ as a fairly accurate portrayal of a women’s prison. Do you think having a program based on a women’s prison might be helpful in raising awareness of incarcerated women and their plight?

Story #4: Mother Antonia Passes

Our final news item is the sad report that Mother Antonia Brenner has passed on. She was dubbed the Prison Angel for her work with the poor and imprisoned in Tijuana, Mexico. She has an amazing story. Her prison worked grew from her charity work among the poor in California where she was a twice divorced mother of eight children. Eventually she moved into a cell in the Tijuana Prison to more fully experience the lives of those she served. Hers is an inspiring story of kindness and sacrifice.

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

Christmas is About the Children

Little child decorating christmas tree

With my grandson nearly 3 years old, our Christmas this year is full of toys and wonder and a reminder of the Babe long ago who brought hope to the world; whose birth we are celebrating. Christmas is definitely a time for children and a reminder of how many children have parents behind bars in our country. These young victims of their parent’s crimes suffer grave consequences, including separation from their parents during the holiday season.

According to the Bureau of Justice, 1.75 million children have a parent in a state or federal prison this Christmas. Many inmates have multiple children and the Sentencing Project estimates that 1 in every 50 children in this country has a parent behind bars. These are sobering numbers amid the lights and glitter of our holiday celebrating.

Children in this situation may be lonely and feel alienated from the season’s festivities. Even if able, visiting a parent in prison during this time of year can bring more sadness than cheer; emphasizing the obvious separation.  Distance and lack of financial resources may make visiting impossible and incarcerated parents may be unable to afford providing even a token gift for a child.

If the incarcerated parent is also the primary care provider, the child may be living in foster care. More fortunate children may have a loving extended family member willing to provide support and supervision during this period. According to an economic study of incarcerated families, children with incarcerated parents are more likely to have difficulty in school with more aggressive behavior noted among boys and an increased chance of being expelled or suspended.

Most of us will not be able to make as great an impact as 2012 Miss America, Lauren Kaeppeler, who is using her platform to bring more attention to the plight of kids of incarcerated parents. Her father was incarcerated when she was a teenager and she has first-hand experience of the effects of a parent behind bars. However, every one of us can do something. Here are just a few of the organizations that are helping our patient’s children cope with the impact of prison on their lives. This Christmas season, consider contributing to one of these charities, or another you may be aware of in your community:

Prison Fellowship: Angel Tree

Camp Spaulding – New Hampshire

Children of Promise – New York City

New Hope – Oklahoma

Does your facility do anything for inmates and their children on Christmas? Could they? Share your thoughts in the comments section of this post.

Photo Credit: © allari – Fotolia.com

Vicarious Traumatization in Correctional Nursing (podcast)

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cnt-podcast_cover_art-1400x1400Have you ever felt traumatized at the end of your work day? Maybe you have gone through periods of feeling very burned out in your nursing practice. In this episode I talk with Tanya Munger about her research into vicarious traumatization of correctional nurses. She surveyed correctional nurses from around the country about their experiences with this phenomenon. Tanya Munger, MSN, FNP-BC, CNOR, CCHP, is Clinical Instructor, Department of Health Systems Science, UI College of Nursing at Rockford, IL. She worked as a nurse practitioner with UIC College of Medicine inside of the Winnebago County Jail, the second largest county jail in the state of Illinois.

What is vicarious trauma?

Vicarious trauma is the result of taking on and absorbing disturbing aspects of the traumatic experiences of others, such as our patients. As correctional nurses we work in a harsh system among patients who often have very painful background full of violence and abuse. Regular contact can result in integration of this post-traumatic stress into our own functioning resulting in a variety of alarming symptoms such as flashbacks, nightmares, intrusive thoughts, depression, and sleeplessness.

What can you do about vicarious trauma?

What should you do if you think you are absorbing the traumatic experiences of others? First, be aware of this possibility and monitor yourself. Be sure to take care of yourself, getting enough rest, health food and activity. Traumatic stress can get you off balance and it might take conscious effort to return to a balanced lifestyle. Find ways to separate yourself from your patient. Remind yourself that this is not your pain. You may be holding it or helping with it, but it is not you. Look for small and large ways to renew yourself. Do what works – which can be different for everyone. Meditation, deep breathing, yoga, creative arts are some small regular options. Larger ways might be taking a real vacation away from your worksite to totally unplug, drain your stress, and re-center yourself. Certainly, if you are experiencing serious or debilitating symptoms, it is time to seek help through counseling or healthcare services. Read more about this condition from the resource links below.

Resources

Burnout, vicarious traumatization and its prevention

For Professionals: Vicarious Trauma

Announcements – Reader Survey

Did you know CorrectionalNurse.Net is running a first-ever reader survey for the month of December? Take the survey and give your input on what you want more of in posts and resources for 2014.

New ANA Scope and Standards of Correctional Nursing

ANA StandardsCorrectional nursing has been recognized by the American Nurses Association (ANA) as a specialty area of practice since 1985.  A new edition of Correctional Nursing: Scope and Standards of Practice was recently published by the ANA and highlights advances in the specialty practice.  How has professional nursing practice in the correctional setting changed and evolved over the last decade?

Using professional experiences and standard professional documents like the Code of Ethics for Nurses, the Nursing Social Policy Statement, and the Nursing Scope and Standards of Practice, a taskforce of 17 correctional nursing experts from various settings across the country created this document over the course of 18 months through a series of monthly meetings. This revision of the standards builds on the prior four versions and expands the definition of the specialty, unique nursing roles, and principles of practice.

The Correctional Nursing: Scope and Standards of Practice book is meant to be a guide to practicing this nursing specialty. Therefore, it needs to be read and used by both front-line correctional nurses and nurse leaders in the field. Here are a few ways to consider using the standards:

  • A self-evaluation of competency
  • Orienting new staff
  • Job description creation
  • Policies and procedures
  • Performance reviews
  • Professional development

Information Outline

Here is a basic outline of the information found in this book:

Definition of Correctional Nursing Specialty

Scope of Correctional Nursing

  • Prevalence
  • Population Served
  • Care Settings
  • Roles
  • Tenets of Correctional Nursing
  • Guiding Principles
  • Trends and Issues

Standards of Correctional Nursing

  • Standards of Practice
  1. Assessment
  2. Diagnosis
  3. Outcomes Identification
  4. Planning
  5. Implementation
  6. Evaluation
  • Standards of Professional Performance
  1. Ethics
  2. Education
  3. Evidence-Based Practice and Research
  4. Quality of Practice
  5. Communication
  6. Leadership
  7. Collaboration
  8. Professional Practice Evaluation
  9. Resource Utilization
  10. Environmental Health

It was my pleasure to serve as a member of the ANA Taskforce that created this version of the Scope and Standards. Future posts will dig in to the various scope elements and specific practice and performance standards with an emphasis on practical application.

Have you used the ANA Correctional Nursing Standards in your practice? Share your thoughts in the comments section of this post.

The full Correctional Nursing Scope and Standards of Practice, 2nd Ed. Is available through amazon.com.

November 2013 News Round-Up: Pew Report on Prison Healthcare Spending (podcast)

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cnt-podcast_cover_art-1400x1400Our panel of nurse experts drills deep into the recently published Pew Report on Prison Healthcare Spending to discuss implications and compare their experiences with the report’s recommendations. Panelists include Johnnie Lambert, correctional nurse and Vice-President, Clinical Operations, Policy and Accreditation with Armor Correctional Health Services, Inc. ; Mari Knight, Mid-Atlantic Transition, Training and HSA Support Nurse for Conmed Healthcare Management; and Catherine Knox, correctional nurse consultant from Portland Oregon.

The Pew Report on Prison Healthcare Spending is an extensive document chronicling the rising expense of providing healthcare to our inmate patients. It identifies trends we are all too aware of with familiar causes such as aging patients with high prevalence of infectious and chronic diseases, as well as mental illness and substance abuse. The report also describes challenges we have with location, transportation, and staffing – which we don’t often see in print. Since the mid 1970’s when inmate healthcare was established as a constitutional right, correctional healthcare costs have risen almost 700%. The first part of the report lays the groundwork for why correctional healthcare costs are escalating. The later half of the report documents various state responses to increasing prison healthcare costs. Examples provided include telehealth, outsourcing care, Medicaid financing, and medical or geriatric parole. Panelists provide thoughts on the uses of telehealth described in the report and whether we have fully exploited this technology in corrections. Outsourcing is also explored and panelists agree that this is a promising cost containment strategy. The third theme of the report is Medicaid financing. In some ways this seems like cost shifting (from state to federal tax dollars) rather than cost savings, but there are ways to make it work. The final theme offered in the Pew report is the use of medical or geriatric parole. The report suggests that recidivism is low among elderly inmates but acknowledges this is a political hot potato. Correctional systems need to carefully implement this strategy to make it work.

Correctional Nurse Gratitude for Correctional Officers on Thanksgiving

 

Thank you signI am a whiner – ask anyone who knows me. In fact, check out last year’s post on this topic. But, that’s why I love Thanksgiving – a season when I can re-center myself on all the blessings of life and the people who do so much with so little recognition. This Thanksgiving season I have been pondering the great contribution of correctional officers to both public safety and the personal safety of correctional nurses throughout the criminal justice system. I wish to share a great big THANK YOU To our correctional officer colleagues who keep us safe every workday. Here are my 5 reasons I am thankful for correctional officers:

REASON #1: They have our backs

Correctional officers protect us while we work. In a profession of escalating workplace violence, correctional nurses have a lot of protection – much more than counterparts in traditional settings. Nurse colleagues working in urban emergency units may be taking care of a patient population with a similar violence demographic, but they often have much less protection. Thank you for keeping us safe.

REASON #2: They are healthcare colleagues

That’s right, correctional officers collaborate with correctional nurses about many health issues and are often the first to contact nurses about a medical or mental health situation. Housing unit officers know the lifestyles of their charges and initiate emergency action when a health situation is deteriorating. Thank you for working together with us toward a common goal.

REASON #3: They know the same professional stigma

Correctional nurses know ‘that look’ from a new acquaintance or fellow professional when they find out we work in a jail or prison. Although this is changing, there is still a stigma to working in the correctional setting. Colleagues can question your motivation, consider you unskilled enough for a ‘real’ nursing position, or think you have committed professional suicide by taking a position in our specialty. Correctional officers have that same stigma in the criminal justice system. Police, State Troopers, or the Feds sometimes stigmatize our correctional officer colleagues. We both struggle to take pride in our profession. Thank you for choosing to be a correctional officer!

REASON #4: They are invisible to the public

Many of our neighbors don’t even know that nurses work in jails and prisons. I certainly didn’t before I started in our specialty. The public would prefer to remain unaware of the thousands of people locked away in the criminal justice system. The invisible nature of incarceration hangs a long shadow over those who work behind bars as well. Thank you for keeping the public safe even when they do not want to know about it.

REASON #5: They are probably working this holiday, too

I know this sounds so naive, but I didn’t realize I would be working holidays and weekends when I started my nursing training. It was a real eye-opener and a lifestyle changer. Like nurses, correctional officers pull duty 24/7 to keep us and the public safe. This is easy to forget when we sit down to our Thanksgiving bounty and the football games or parades that fill on our holiday schedule. Thank you for keeping us safe while we celebrate.

Will you join me in being thankful for our correctional officer colleagues? Share an experience or gratitude in the comment section of this post.

Photo Credit: © Brian Jackson – Fotolia.com

Understanding Professional Boundaries (podcast)

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cnt-podcast_cover_art-1400x1400Cindy Peternelj-Taylor talks about professional boundary violations in this episode of Correctional Nursing Today. Cindy is Professor, College of Nursing, University of Saskatchewan in Saskatoon, Saskatchewan, Canada and Editor-in-Chief for the Journal of Forensic Nursing. She has done extensive research into professional boundaries in the nurse-patient relationship and shares some of her findings in this interview.

Cindy became interested in boundary violations when she saw firsthand boundary crossing and violations in her work in forensic mental health. She shares her story at the beginning of the interview. Later she describes the cardinal signs of trouble in boundary issues and how to spot them in yourself and your colleagues. Correctional nurses are particularly vulnerable to boundary violations and she tells why. She provides advice for how to deal with boundary crossings in our practice and how to support our peers in avoiding violations, including what nurse managers need to do.

Read more about Professional Boundary issues from these past blog posts:

Unhealthy Inmate Relationships: 5 Danger Signs

Sexual Boundary Violations in Correctional Nursing: It Could Happen to You

Maintaining Professional Boundaries: Part I

Maintaining Professional Boundaries: Part II

Thoughts on Under-Involvement with Our Patients

Cindy shares some ways we get overinvolved with our patients in correctional nursing. That is one way we move out of a helpfulness zone of patient relationship. The other way we move out of therapeutic relationship is when we become under-involved with our patients. It is easy to distance ourselves from inmate patients, especially when cynicism or a jaded attitude to the inmate population takes hold. This is a particular struggle to remain objective in practice. Our patient population and care environment can lead us to become skeptical and suspicious of patient complaints. New staff members soon learn that some inmates seek services for reasons other than health needs. The prison culture can value manipulation, deception, and secondary gain. Healthcare staff can unwittingly get caught up in a ‘game’ inmates are playing. Once burned in such a situation, it is easy to assume all inmates are looking for an angle when seeking health care. You can read more about this struggle to remain therapeutic in these blog posts:

Avoiding Cynicism

How to Work with Inmate-Patients: Be Alert for the Con

Legal Risk and the Correctional Nurse

Announcements

I am excited to again be part of a correctional healthcare risk reduction webinar provided by OmniSure Consulting Group. The Unscheduled Clinical Encounter: Reducing Liability and Risk will be held on Wednesday, December 4, 2013at 1pm Central. Also on the panel are Lori Roscoe and Debra Stewart.  Here is a link to the registration form.  Nursing contact hours are being awarded – so mark your calendars to join us!

Did you know there are three ways to listen to Correctional Nursing Today? You can subscribe on iTunes or use the podcast app Stitcher or click on the podcast tab on the correctionalnurse.net blog and listen using the player at the top of the post about the episode. Take us with you on your commute to work, while walking, or while picking up around the house.