Jennifer’s heart sank as she looked at the shift post assignments. She was scheduled to cover Ad Seg. Two days ago, when last she was assigned there, she endured a barrage of explicit language while moving down the catwalk with the office while she conducted medpass, did the ordered physical assessments and ensured that no one had an immediate health concern. One patient in particular really struck a chord with her. The officer told her he was found guilty of sexual assault and murder. The inmate made it a point to grab his crotch while she was in front of his cell (even with the officer in close proximity) and his eyes seem to bore right through her as she asked about any medical complaints.
Proposition One: Respect for Human Dignity
The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.
Jennifer is struggling with a real ethical dilemma in correctional nursing practice – how to practice with compassion and respect. How can she be without prejudice toward this patient who has done some offensive things and is not treating her with even basic respect?
Acknowledge Your Feelings
Jennifer won’t help herself much by ignoring her anxiety or telling herself to ‘just get over it’. Instead, acknowledging her emotions is the first step toward making a positive change. When one has a negative emotional response to a patient’s words or actions, it is good to analyze that response. Think about other situations where you have not bonded with or liked a patient. How did you get over it? Will that work in this situation?
Now, consider the current challenging patient. What would make this different? If Jennifer didn’t know the crimes of this patient and his aberrant behavior was something different, even less threatening (like talking gibberish or picking his nose while the medication was being administered) would she be able to look past it? Making that mental switch can be helpful.
Work Your Core
Core muscles provide support for all the other muscles in the body. That is why strengthening these muscles can make such a difference in overall physical health. It is no different in nursing practice. Strengthening your core values will make a difference in your overall nursing practice. Our core professional values come from the Code of Ethics, so knowing the Code and using the principles in real situations is a key step in finding a way through an anxious situation like Jennifer’s. She might do something as simple as intentional mental rehearsals such as:
- I am a professional
- I care for every patient, no matter what he/she/they are like or what he/she/they have done
- What I do in this situation is more important than what he/she/they are doing
- I will do what is best for this patient, no matter how he/she/they are acting
KNOW THE RULES
Jennifer also needs to be sure she knows the inmate rules about language and behavior. The officer who is escorting her is the one responsible for enforcing these requirements, but correctional nurses must know the boundaries and what is reportable. These rules can vary greatly among facilities and adherence can be variable based on the disposition of a particular officer or the culture of a particular unit. Although it is not recommended that nurses bring charges against their patients as it can negatively affect a nurse-patient relationship, Jennifer could still request that the officer maintain order in the unit when she is present.
What Does This Patient Need?
In an intimidating situation like Jennifer’s, it is natural to focus on how you are feeling and your need to escape the discomfort. Ethical practice, though, is to remain patient-centered in the interaction. Thus, this patient needs healthcare attention as well as structure. Therefore, Jennifer is helping herself and her patient by standing her ground and continuing to deliver the needed healthcare without regard for the antisocial and inappropriate behavior being presented. For many of us this requires practice. Look around you and see if any of your nurse colleagues are doing well in this regard. If you find someone, use them as a role-model…or even a mentor who can help you role-play through intimidating situations. Learning appropriate responses to inappropriate behaviors is no different than learning a psychomotor skill like starting IVs or drawing blood – it takes intentional and regular practice.
Jennifer can find the courage and moral strength to meet the demands of her post duties by using the Code of Ethics for Nurses – Provision One. What about you? Have you had to deal with an ethical dilemma on the Ad Seg Unit? Share your experiences in the comments section of this post.
Christine says
I LOVE your analogy of core values and the core physical body.
Great read and as a provider- whether in an ethical dilemma or not/ we could all use this as a self-reflection exercise 🙂
Christine
Lori Roscoe says
Thanks Christine!!
Seth says
I really like how the article highlights professional boundaries, and delineates what the nurse is responsible for, and also what they are not responsible for in the scenario. I’ve see many instances in similar scenarios where we allow our strong emotions to lead us to take rash actions that either escalate the situation, reinforce negative behavior of the inmates, or shrink back in pain, disgust, or frustration.
One thing that I have found useful in helping to provide structure to the disruptive inmate in Ad Seg is to calmly and politely request that the they engage in appropriate behavior, such as “Please use respectful language when speaking with me.” Oftentimes this is disarming and achieves the desired result. If the inmate continues the disruptive behavior, especially egregious behavior, sometimes the escorting CO/jailer will make a determination that the inmates’ actions constitute a refusal of services, due to safety and security considerations, and the encounter is ended. I know this is a delicate issue and doesn’t always apply especially with things like med pass, but sometimes it works as a helpful boundary that promotes appropriate patient-provider interactions.
If the inmate who grabbed his crotch had exposed himself or was masturbating over his clothes, in most jurisdictions this would be a sexual assault of the nurse. While prosecutions of these kind of assaults are rarely sought due to the unique nature of correctional environments, as mentioned, it is still important for the heath care worker to acknowledge to themselves that an assault has occurred, be aware of the effects trauma that they have been exposed to, and engage in adequate self-care.
The work environment described in the narrative is hostile, which the nurse is entitled to be free from being exposed to. The prison administration is responsible for addressing the inappropriate behavior of individual inmates participating in the harassment in order to create and maintain a non-hostile work environment. If this is not being done, it is well within the rights of the nurse to request, through her immediate supervisor, that the administration take sufficient actions to accomplish such objectives
Lori Roscoe says
Thank you, Seth, for your comments! One must be very careful about determining that an action constitutes a refusal of services, especially if it is the CO, a non-medical person, who is making that determination. I appreciate your acknowledgement that this would not apply to certain activities, like medpass. This would be a wonderful topic for another CN.N post! Again, thank you so much for your comments.
Deborah Shelton says
Thanks Lori, this was an excellent discussion.