Hayley’s heart sank as she looked at the shift post assignments. She was listed next to Ad Seg rounds. Two days ago, when last she did these rounds, she had to endure a barrage of explicit language while moving down the catwalk with the office making ordered assessments and providing prescription medications. One patient in particular has her rattled. The officer told her he is in for sexual assault and murder. The inmate seems to makes a point of grabbing his crotch while she is in front of his cell and his eyes seem to bore right through her as she asks about any medical complaints.
Code of Ethics Proposition 1: 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.
Hayley 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 cruel things and is not treating her with even basic respect?
Acknowledge Your Feelings
Hayley won’t help herself much by stuffing down her anxiety or telling herself to ‘just get over it’. Instead, acknowledging her emotions is the first step toward making a positive change. When we have a negative emotional response to a patient’s words or actions, it is good to analyses 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 Hayley 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 you administered their medication) 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 engaging the principles in real situations is a key step in finding a way through an anxious situation like Hayley’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 they are like or what they have done
- What I do in this situation is more important than what they are doing
- I will do what is best for this patient no matter how he is acting
Know the Rules
Hayley 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, Hayley 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 Hayley’s, it is natural to focus on how you are feeling and a 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, Hayley 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 confidant 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.
Hayley can find the courage and moral strength to meet the demands of her post duties by using the Code of Ethics for Nurses – Provision 1. 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.
REMINDER: If you are an ANA member, there is still time to review and comment on the proposed changes to the 2001 Code of Ethics. Use this link to review and comment by June 6, 2014.
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