“It’s not what you look at that matters, it’s what you see” – Thoreau
Recently a correctional nurse manager commented that she was getting grief from correctional officers for referring to inmates as patients in the prison medical record. I have heard this issue before and often see medical record charting using inmate to refer to the person receiving health care. I also remember a long discussion with the workgroup as we determined how to refer to our patient population in various sections of the Correctional Nursing Scope and Standards of Practice.*
It may seem a small issue or even unimportant whether you deliver nursing care to patients or inmate. In fact, your perspective on your patient has everything to do with professional nursing practice in the criminal justice system.
Consider this dichotomy. 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
Focus of Nursing Practice
Nursing practice in inherently patient-centered. 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 delivery 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 on seeking health and well-being, an 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; becoming factors in our care decisions.
The Nurse-Patient Relationship
The basis of every nurse-patient relationship is therapeutic. Our patient’s interests are primary in this relationship. In a correctional setting, a patient’s interests can be abrogated by the security system. Nurses must engage in collaborative dialog to advocate for a patient’s health and well-being when the correctional culture is unnecessarily abridging health interests.
While a patient perspective is likely to lead to necessary patient advocacy, an inmate perspective blurs this focus and can unnaturally 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.
Response to the Inmate-Patient Dichotomy
Do we care for patients or inmates in the criminal justice system? Our professional ethic calls us to care for patients and to view our patients from a perspective of human dignity and intrinsic value…..even when they may have shown themselves to be untrustworthy, selfish, or even evil.
The correctional nurse manager dealing with pressure to call her patients inmates has an opportunity to inform and educate the officer corps in her facility about professional nursing practice. The correctional setting is a unique environment with a unique patient population but the principles of nursing practice and the values that undergird that practice remain unchanged in the criminal justice system.
So, what do you think? Patient or inmate? Share your thoughts in the comments section of this post.
*We settled on using the term patient when discussing correctional nursing practice while using inmate when discussing the patient population of our care.