It was painful to read the account of practices in a Michigan Women’s Prison where inmates were required to submit to a vaginal inspection for drug smuggling or not be permitted to receive visitors. According to the news story “Michigan’s is the only prison system in the nation to routinely use such searches as a matter of policy”.  This story was published the same week I was reviewing the recently revised International Council of Nurses (ICN) Position Statement on the nurses’ role in the care of detainees and prisoners. I had read the document before but this time two words caught my eye – degrading treatment. The ICN Position Statement on Care of Detainees and Prisoners reads:

• ICN believes national nurses’ associations (NNAs) and individual nurses should be protected from reprisals related to advocacy for or providing care to detainees and prisoners or those who refuse to participate in torture, cruel, inhumane or degrading treatment (emphasis mine).

Great strides have been made in reducing nurse involvement in practices that jeopardize the nurse-patient relationship such as body cavity searches and collecting forensic evidence. Accrediting bodies such as NCCHC and ACA support ethical practices of informed consent and right to refuse treatment.

As patient advocates, I wonder about correctional nurse responsibilities to speak up and address inhumane and degrading correctional practices that are not specifically health care related. For example, what are our responsibilities for calling out degrading practices we see in an administrative segregation setting while doing nursing rounds or ‘take down’ procedures seen while assessing the medical condition of an inmate?

The moral distress that results from regularly observing inhumane treatment can lead to physical and mental stress-related symptoms. What can correctional nurses do in a situation where inhumane or degrading inmate treatment is witness? The ICN Statement suggests action is needed:

• Nurses who are aware of abuse and maltreatment take appropriate action to safeguard the rights of detainees and prisoners.

Response to Degrading Treatment

• Speak up: Identify to the custody officer in charge that you have concerns about a procedure that you are witnessing. Be direct, clear and calm in manner. You are expressing a professional opinion in advocating for a person in your patient population.
• Use the chain of command: Address your concern with your manager. Ask for guidance and support in dealing with the situation. Follow all internal policies and procedures to initiate a complaint or concern.
• Discuss with your nurse colleagues: If you find that an inhumane culture is pervasive in your facility, seek ways to support each other in professionally responding to individual situations from the ethical perspective of patient advocacy.
• Ask for outside support: Professional nursing organizations such as the American Nurses Association or your state nurse association may have additional support and advise to guide appropriate response. Make contact and request confidential advice.

As correctional nurses, we have an ethical and moral responsibility to advocate for the well-being of the patient community for which we care. Have you successfully challenged an inhumane or degrading treatment in your work setting? Share your tips and experience in the comments section of this post.

 

Photo Credit: © Phase4Photography – Fotolia.com

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Manifesto Proposition Six: Responding to Degrading Treatment