“It’s not what you look at that matters, it’s what you see” – Thoreau
I have been practicing in correctional healthcare for the last 25 years, and the issue of whether correctional nurses care for patients or inmates has been around for at least that long! I have heard nurses say that their correctional officer colleagues get “upset” when they hear the inmates being called patients. I have seen nurses documenting their care of the “inmate,” “client,” “resident,” “inmate-patient,” and “patient” in the health records that I audit. This topic was also debated for quite some time during both the 2013 workgroup meetings that edited our Correctional Nurse: Scope and Standards of Practice, 2nd edition and our third edition workgroup meetings in 2019 (which should be available on October 1, 2020). In the workgroups, there were individuals who represented all types of correctional healthcare programs (jail, prison, community, juvenile; county, state and federal; self-op, public partnerships and private contractors….) and academia, and it was very enlightening to consider the topic from the different perspectives. I learned through that process that correctional nurses do have support for our patient advocacy role from many of our correctional colleagues, but definitely not all, and we must continue to educate them and advocate for our patients. [We ultimately decided to use the term “patient” when discussing correctional nursing practice and use the term “inmate” when discussing the population (in general) with whom we work.]
I have heard comments in meetings and at national conferences stating that what we call the individuals for whom we provide nursing care is unimportant, and even irrelevant, as long as we are abiding by our scope of practice and are providing appropriate care. However, please consider this: When you look at your patient in a health care encounter, which do you see?
A criminal who happens to need health care?
A patient who happens to have broken the law?
I would suggest that your perspective about the person for whom you are caring has everything to do with your professional nursing practice in the correctional setting.
Focus of Nursing Practice
Nursing practice in inherently patient-centered, and as such, our professional values call us to seek the health and well-being of our patients. Our primary commitment, in fact, is to our patients. A patient perspective in correctional nursing practice, then, sets us squarely on a solid foundation clinically, ethically, and legally. The right to health care is universal and transcends all individual differences (Code of Ethics 1.1). In particular, a patient’s social status and lifestyle choices cannot be considered in our provision of nursing care.
On the other hand, seeing the person receiving nursing care as an inmate is inherently custody-centric. Rather than focusing our intentions to seek health and well-being for the individual, as our professional values demand, this inmate perspective can leave us in a defensive position or in an exchange relationship that can be both dehumanizing and depersonalizing. An inmate perspective does take into consideration the social status and lifestyle choices of our patients, which then become factors in our care decisions. Doing so makes our practice in conflict with nursing standards and nursing ethics.
The Nurse-Patient Relationship
The basis of every nurse-patient relationship is therapeutic. Our patient’s needs are primary in this relationship. In a correctional setting, a patient’s health needs can be overshadowed and even ignored by the correctional system. Nurses must engage in collaborative dialog to advocate for a patient’s health and well-being, especially when the correctional culture may not always consider the incarcerated individual’s health needs.
While a patient perspective is likely to lead to necessary patient advocacy, an inmate perspective blurs this focus and can align nurses with a punitive or merely disinterested perspective toward an individual patient and the patient population as a whole. In addition, mutual respect within the nurse-patient relationship is threatened when the patient is viewed as having less societal value, human rights, or inherent dignity.
Correctional nurses dealing with pressure to call their patients inmates have an opportunity to inform and educate their correctional colleagues about professional nursing practice. While our practice setting is a unique environment with a unique patient population, the foundational principles of nursing practice and nursing values remain unchanged in the correctional setting and for correctional nursing practice.
SO, DO WE CARE FOR PATIENTS OR INMATES?
What do you think? Regardless of the correctional setting in which you work, as part of your professional practice it is very important that you think about this, and make your decision from your nursing and personal standards and ethics. Then, if challenged about the term you use for the individuals for whom you care (whether you choose patient or inmate, or something else), you will be prepared to answer as a correctional nurse, with confidence and forethought.
I would love to hear your thoughts about this topic – Please use the comments section of this post to share them.