Correctional Nursing Today Podcast

Guest for this episode is Gordon R. Bouchard, RN, BSN, CCHP, Director of Nursing Services, RI Department of Corrections. Gordon has been a correctional nurse for over 18 years and has been Director of Nursing Services at the Rhode Island Department of Corrections since 2008.

Maintaining perspective when dealing with inmate patients is a challenge; especially for nurses who have worked with this patient population over time. The characteristics of the patient group as well as pressures of the work environment can lead to labeling and discounting patient complaints. Nurses must be able to sort out multiple conditions while being alert for alcohol and drug withdrawal symptoms. In addition, many inmates also have mental health conditions that must be considered when determining nursing actions. Nurses are usually the first health care professional assessing the patient in the correctional setting and must determine first actions for medical and mental health conditions.

Suggestions to maintain perspective offered by Gordon include:

·         Avoid too much curiosity with inmate criminal records. Better not to know their offenses when attempting to keep balance in nursing perspective

·         Don’t discount patient complaints. Instead, look for validating objective signs of the condition

·         Assess and treat for the presenting condition, including pain

·         It is OK to be a caring nurse in corrections. The key is how you care.

This episode was recorded live from the national conference of the American Correctional Health Services Association (ACHSA) in San Antonio, TX. The episode includes commentary from regular panelist, Catherine Knox, MN, RN, CCHP-RN, an independent consultant with nursing and leadership experience in the Oregon Department of Corrections, the Washington Department of Corrections, and California Prison Health Care Services. Also commenting is Gayle Burrows, RN, BSN, MPH, CCHP, recently retired Director of Corrections Health at Multnomah County Detention Center in Portland, OR. Both panelists are active in ACHSA and have received the Distinguished Service Award from the association. 

Ethical Issue for Correctional Nurses is the theme this month with several articles highlighting the unique dilemmas we can face.

Hunger Strike

http://www.correctionsone.com/correctional-healthcare/articles/5052075-After-Utah-inmates-starvation-bill-seeks-force-feeding-OK/ 

After a 19-year-old inmate starved to death in his cell in Salt Lake County Jail, the Utah State Legislature passed a bill allowing jailers to forcibly feed or hydrate an inmate on at least a short-term basis. Correctional nurses are involved in monitoring the health of these striking inmates and may have ethical conflicts in participating in forcibly feeding an unwilling patient. Panelists discuss ethic issues involving patient autonomy.

Isolation and Seclusion

http://www.azcentral.com/news/articles/2012/04/02/20120402arizona-accused-abuses-prisons.html 

Amnesty International has accused the Arizona Prison System of abuse in the use of isolation and seclusion interventions.  They claim that Arizona's state prisons overuse solitary confinement in cruel, inhumane and illegal ways, particularly for mentally ill prisoners and juveniles as young as 14. Correctional nurses monitor the health of confined inmates and provide medications and needed treatments while they are secluded. This may lead to the observation of degrading treatment and moral distress in participating in the functions of these confinements.

Restraint Chairs and Pepper Spray

http://www.huffingtonpost.com/2012/01/11/jail-abuse-nick-christie-pepper-spray-florida_n_1192412.html 

A combative and uncooperative 62-year-old Ohioan arrested in Florida for public intoxication died after repeated pepper spraying and a forceful take-down to a restraint chair. Correctional nurses are called upon to review medical charts for contraindications for use-of-force. Participation in these procedures, even peripherally from a medical perspective, can be unsettling and distressing.

The following documents were discussed as guides for correctional nurses grappling with ethical dilemmas in jails and prisons:

The Nurses Code of Ethics: http://www.nursingworld.org/codeofethics 

The International Council of Nurses Position Statement: http://www.icn.ch/images/stories/documents/publications/position_statements/A13_Nurses_Role_Detainees_Prisoners.pdf 

The Corrections Nursing Scope and Standards of Practice: http://www.nursesbooks.org/Table-of-Contents/Standards/Corrections-Nursing-Scope-and-Standards-of-Practice.aspx 

Barbara Curtis, MSN, RN, Director of Nursing Service, Washington State Department of Corrections talks about the high prevalence of traumatic brain injury in the correctional patient population and responses to the condition. Barbara has been an RN for over 30 years with 20 of those in emergency services both as administrator and clinician.  She has been with correctional nursing for 11 years.

Although an estimated 2% of the general population has sustained a TBI with continuing disability, a meta analysis of studies in the inmate population indicates a prevalence of over 60% . It is suggested that this condition may be under-reported for a variety of reasons. A study performed in the Washington State Correctional System found as much as 89% prevalence. That equates to 9 out of 10 of our inmate patients having some form of brain injury.

The long-term effects of TBI are memory problems, inability to focus, and poor impulse control. Inmates with this condition may respond in anger, aggression or verbal disrespect to cover for their deficits. This means that our patients with TBI often show these behaviors:

·         Act out in anger or irritation

·         Forget rules of prohibited conduct

·         Not remembering where they should be or by when

·         Forgetting that they cannot go into certain areas

·         Increased behavioral infractions

TBI treatment focuses on symptom management and compensation for cognitive deficits. A careful intake history is an important first step to diagnosing TBI and managing symptoms. The CDC recommends that special attention be given to impulsive behaviors, violence potential, sexual behavior and suicide risk if the inmate is depressed.

Barbara suggests nurse interventions that focus on assisting patient to remember and follow direction.

·         Speak slowly and clearly

·         Give the patient time to register the information and respond

·         Provide memory tools like writing down health instructions

·         Give only a few directions at a time and keep it simple

She also emphasizes the importance of awareness of the condition for both custody and health care staff.

In this month’s correctional healthcare news round-up Lorry Schoenly talks with regular panelists, Catherine Knox and Sue Smith, about aging and disability issues in correctional healthcare. Catherine is an independent consultant with nursing and leadership experience in the Oregon Department of Corrections, the Washington Department of Corrections, and California Prison Health Care Services. Sue Smith also has a long history in correctional nursing. She has worked in various capacities for the Ohio Dept of Rehabilitation and Correction including staff nurse, nurse administrator and nurse educator.  

Human Rights Watch reported that the number of aging prisoners is soaring and that correctional officials are ill-prepared to run geriatric facilities. The article includes some concerning statistics including the news that “The number of sentenced prisoners age 55 or older grew at six times the rate of the overall prison population between 1995 and 2010.”  http://www.hrw.org/news/2012/01/26/us-number-aging-prisoners-soaring

Another response to elderly inmates was documented in the news recently with a focus story on the hospice program at Vacaville in the California system. Several responses to aging and dealing with the sick and chronically ill inmates also showed up in recent news. Hospice programs have been growing in the correctional setting. According to the National Hospice and Palliative Care Organization, 75 prisons and jails in 41 states have a form of hospice program available to dying inmates. When the first programs started in prisons there were no standards for delivery of hospice services in correctional settings. Many programs now involve fellow inmates in peer-support roles that benefit both the dying inmate and the care provider.  Correctional nurses have an opportunity to profoundly affect the outcome of terminal illness and assist inmates to have a ‘good death’ even while incarcerated. http://www.seniorhomecareinformation.com/hospice-care/program-at-vacavilles-california-medical-facility-gives-special-care-to/

Some states are looking into alternatives that place older and debilitated inmates in settings outside the wall.  Connecticut is seeking a nursing home option for some of their older prisoners according to an article from the Connecticut Mirror. It says the state is seeking to contract with a nursing home for about 95 beds for parolees and patients from state institutions. Is this a good solution? Some legislators and citizens of the state have concerns. http://www.ctmirror.org/story/15565/state-seeking-nursing-home-take-sick-disabled-prisoners

Texas has a different response to the older and sicker inmate. An article in the Star-Telegram says the state is seeking early release for more and more sick inmates. Says” The Tx Parole board approved 85 medical releases in fiscal 2011- the most in five years and more than double the 40 approved in 2009”. Is this a good solution to the aging issue? http://www.star-telegram.com/2012/02/29/3774188/texas-is-seeking-early-release.html

This episode's guest is Margaret Noonan, Statistician with the US Department of Justice, Bureau of Justice Statistics in Washington DC. She’s the program manager for the Deaths in Custody Reporting Program at BJS. The program began in 2000 with the passage of the Deaths in Custody Reporting Act, which tasked BJS with collecting deaths occurring in jails, prisons and the process of arrest. The December 2011 report can be accessed at http://bjs.ojp.usdoj.gov/index.cfm?ty=dcdetail&iid=243

Margaret talks about how she got into criminal justice statistics after starting to pursue a medical career. As primary author of the Report - Prison and Jail Deaths in Custody, 2000-2009, published December, 2011 - she has much to say about the findings. Causes of death vary between jails and prisons with jails having more suicide and drug/alcohol withdrawal deaths. Trends in most deaths are flat or downward. Primary chronic disease deaths mirror the general population with cardiac and cancer deaths leading the way. As expected the aging inmate population is affecting death in custody statistics. On a bright note, deaths from AIDs related illnesses continue to decline.

The February 2012 News Round Up focuses on Mental Health treatment in the correctional setting. Lorry is joined by regular panelist Sue Smith and guest Rosanne Harmon, a Psychiatric Mental Helath Nurse Practitioner with the Oregon Department of Corrections.

In early February, MSNBC online reported on a huge jury award - $22 million - to a man held 22 months in Dona Ana County Jail in New Mexico. Most of that time he was held in solitary confinement and alleged to have been denied appropriate mental health care. http://usnews.msnbc.msn.com/_news/2012/02/03/10309751-for-mentally-ill-inmates-health-care-behind-bars-is-often-out-of-reach

The second story of interest is out of Summit County Ohio where the sheriff has announced he will no longer be accepting seriously mentally ill individuals but will send them out for treatment. http://www.policeone.com/corrections/articles/5053246-Sheriff-Jail-will-no-longer-accept-mentally-ill-arrestees/

The National Sheriff's Association published the 2010 report: More Mentally Ill Persons Are in Jails and Prisons than Hospitals: A Survey of States. http://www.treatmentadvocacycenter.org/storage/documents/final_jails_v_hospitals_study.pdf  

What are the issues facing correctional nurses working with the mentally ill inmate? What responses to the increase in mental illness are we seeing in the corrections community?

Communication is a key component of delivering correctional healthcare. Correctional nurses must overcome many communication barriers in order to manage patient care in a jail or prison. Various communication networks are necessary. Nurses must communicate well with other nurses, among the healthcare disciplines and with custody officers to accomplish paitent goals. Guest for this program is Nicole Heffner, BSN, RN, CCHP. She is Health Services Administrator for Lehigh County Prison in Allentown, Pennsylvania, a maximum security jail with an average daily population of 1100 and annual admissions of around 5600. Nicole works for PrimeCare Medical Corporation, which contracts with Lehigh County to provide health services to their inmate population.

The correctional health care news from 2011 is discussed by Lorry Schoenly and regular panelists Catherine Knox and Sue Smith, correctional nurses with clinical, education and management experience. Key themes from the previous year were healthcare legal claims, medical cost shifting, medicaid funding potential and transgender treatment.

Originally aired December 22, 2011: Jeffrey Keller, MD, FACEP, discusses the thorny issue of self-reported food allergies in the correctional setting. There are many misconceptions about what consitutes a food allergy. In addition, food preferences can be inappropriately identified as an allergy. How should correcitonal nurses sort out food allergies? Dr. Keller is the president of Badger Correctional Medicine, Idaho Falls, ID. He has written on the subject in several publications including CorrectCare.

Originally aired October 4, 2011: Lorry chats with Kevin Connor, BSN, RN, CCHP, President of the California-Nevada Chapter of the American Correctional Health Services Association about the image of correctional nursing. Kevin is Communicable Diseases Coordinator for the San Bernadino Sheriff's Department and works out of the West Valley Detention Center in Rancho Cucamonga, CA.