I’m at the Custody and Caring Conference in Saskatoon, Saskatchewan, Canada this week networking with correctional nurses from various Canadian settings along with correctional nurse leaders from the UK, US, Australia, Sweden, and Germany. Keynote speaker, Dawn Freshwater, shared her developing model of caring in nursing in the offender populations called Custodial Caratis. I was challenged to re-examine my own thoughts on caring in our setting and my own biases engrained in practice. Dr. Freshwater’s colleague, Liz Walsh, followed on with a session on research into pain management in the prison setting in the UK. She started by suggesting the struggle we have against instant disbelief of our patents over time when working in corrections. We have reluctance, for example, to prescribe pain medications in our settings that would be a part of treatment without hesitation in a traditional setting. How do we overcome our own biases to provide compassionate care?
Do you struggle with instant disbelief in correctional nurse practice? Being conscious of the struggle is the first step to overcoming the effect on our clinical judgment. Instant disbelief can lead to early closure on our diagnostic reasoning efforts in a clinical situation. For example, if we determine early on that the patient is faking or overly exaggerating their pain, we are more likely to stop looking for other causes of the pain. This is called premature closure and is one of many decision-making biases that can negatively affect our clinical judgment. Another challenge in the struggle against instant disbelief is confirmation bias. Here we determine a diagnosis early and then look for evidence to confirm the diagnosis; at the same time disregarding evidence that does not confirm our diagnosis.
How can we balance a healthy respect for the potential for illicit activity, secondary gain, coerciveness and manipulation with the need to appropriately deliver nursing care? Often consciously and unconsciously, our nursing care is subjugated by the disciplinary structure of the care environment. Somehow we must balance the healthcare and custody perspectives within the same care environment and work culture. Freshwater suggests that we need a ‘collective commitment’ to caring in our setting that includes all disciplines. But how to do it? Where do you start in your setting? Her response? Enact the power that you have in the position and setting that you find yourself. What difference can you make in your world?
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