Transcript Ranee Wright Correctional-Nursing Power Point Presentation

Ranee’ Wright, BSN, RN, CCHP
 Is
anyone currently working in corrections
or have ever worked as a Correctional
nurse?
 How
many of you have ever thought about
working in corrections?
 Have
you ever thought about what the role
of the correctional nurse is?
 IAFN
definition and description of forensic
psychiatric nurses and correctional nurses
 Introduction
 Patient
to Wisconsin DOC facilities
Populations that are incarcerated
 Correctional
Nursing Roles


Forensic Nursing came
about by Virginia Lynch
in 1986 when she put
together the first
curricula for the
specialty.
Forensic Nursing is an
emerging specialty in
nursing.

Forensic Nurses need
to have superb
assessment skills, but
before that a high level
of suspicions.

In 2012, the ANCC
recognized Forensic
Nursing as a specialty
and nurses now have
the ability to become
an Advanced Forensic
Nurse- Board Certified.

The IAFN has
adopted this
definition of the
specialty:
Forensic nursing is
the practice of nursing
globally when health
and legal systems
intersect.
The systems in which forensic nurses practice
vary, depending on location, funding sources,
community standards, and legal influences,
and include:
 Healthcare
 Investigative
 Criminal justice
 Correctional
 Public sector
 Social services
 Educational
 Private sector International organizations




Needed to advance forensic
correctional nursing
 Clearly define the role
Nursing is largest group of
health care professionals in
Corrections
 Yet little is known about
them
Forensic Correctional
Nursing is not restricted to
institutions

95% will release

Need collaboration with
other disciplines

Cannot be performed alone,
need security, administrators,
ect.

Need to evolve correctional
nursing

Move Forensic Correctional
Nurses towards selfactualized professional
identity

applies knowledge of psychiatric principles and
nursing theory to the care of persons in acute care,
community-based, or correctional settings who have
psychological or mental disorders.

may encounter patients who commit or are likely to
commit crimes or trauma against themselves or
others because of their mental or emotional state

possesses particularized knowledge and competencies
in the assessment, care, and evaluation of individuals
with mental disorders as they relate to criminal
behavior.

applies principles of forensic psychiatry and nursing
to clinically assess, evaluate, and treat individuals or
populations with crime-related mental disorders.

possesses expertise in providing care for patients
with mental disorders in secure settings and refining
that care to minimize the patient’s risk of
victimization, self-injury, or injury to others.

has interpersonal skills in responding to psychological
trauma and abuse, neuropathology and criminology,
and role transitions in victims and aggressors.
It has a lot to do
with mental health.

1840- Dorothea Dix
Conducted state wide investigation of care for the insane poor in
Massachusetts
 Criminally insane caged and put in cellars


1844- Visited all the counties, jails, and almshouses in New
Jersey

Prisoners chained naked, whipped with rods

1845- First establishment of a state mental facility

1866- after the civil war focused on crusade to improve care
of prisoners, disabled, and mentally ill

WMHI- 1873

1898- Green Bay Correctional Institute established

Pre-1950’s
Lobotomies
 Insulin induced therapies


1950’s
Psychotropic medications
 Moved to half way houses, nursing homes, ect.
 President Kennedy Health Care Reform


1980’s
Community- based care
 Reagan Administration- War on Drugs


Did this increase the prison population?
1986- Oshkosh Correctional has 2,055 inmates
 2016- GBCI population 1,062 with a capacity of 749


A place for the mentally ill???
 2,220,300
in
correctional
institutes


Prisons
Jails
 4,751,400
on
supervision


Probation
Parole
 6,899,000

 427,790

Security and
correctional officers
 Nurses

Unsure exact
 26%
increase by
2020


Agency nurses
Travel nurses
TOTAL
Bureau of Justice Statistics
Bureau of Labor Statistics

Operates 36 adult
institutions

10,000 employees
statewide.

DOC is responsible for
22,000 inmates

Supervision of 68,000
adult offenders

500 juveniles committed
by the courts to secure
state juvenile facilities
To achieve excellence
in correctional practices
while fostering safety
for victims and
communities.
Chippewa Valley Correctional
Treatment Facility (capacity
450)

Milwaukee Secure Detention
Facility (capacity 1040)

Columbia Correctional
Institution

New Lisbon Correctional
Institute (capacity 1010)

Dodge Correctional Institute

Oakhill Correctional Institution
(capacity 688)

Fox Lake Correctional Institute

Oshkosh Correctional
Institution

Prairie du Chien Correctional
Institution (capacity 424)

Racine Correctional Institution
(capacity 1798)




Green Bay Correctional
Institute
Jackson Correctional Institute
(capacity 988)
Kettle Moraine Correction
Institute

Racine Youth Offender
Correctional Facility (capacity
927)

Wisconsin Secure Program facility
(capacity 500)

Redgranite Correctional
Institution

Black River Correctional Center
(capacity 114)

Stanley Correctional Institution
(capacity 1550)

Drug Abuse Correctional Center
(capacity 300)

Sturtevant Transitional Facility
(Capacity 1550)

Felmers O. Chaney Correctional
Center (capacity 100)

Taycheedah Correctional
Institution (Capacity 898)

Flambeau Correctional Center
(capacity 80)

Waupun Correctional Institution

Gordon Correctional Center
(capacity 80)

John C. Burke Correctional
Center (capacity 280)

Kenosha Correctional Center
(capacity 115)




Marshall E. Sherrer
Correctional Center (capacity
58)
Milwaukee Women's Correctional
Center (women's prison, capacity
112)

Robert E. Ellsworth
Correctional Center (women's
prison, capacity 333)

Sanger B. Powers Correctional
Center (capacity 70)

St. Croix Correctional Center
(capacity 120 male and 12
female)

Thompson Correctional
Center (capacity 120)

Winnebago Correctional
Center (capacity 250)
McNaughton Correctional Center
(capacity 102)
Oregon Correctional Center
(capacity 120)
 Mendota
Mental
Health Institute
 Northern
 Winnebago
 Sand
 Wisconsin
 Central
Mental
Health Institute
Center
Resource
Center
Wisconsin
Ridge Secure
Treatment Center
Center
Wisconsin
 Southern
Center
Wisconsin
1880- 529 patients
1960- 987 patients
1980- 310 patients
2010- 291 patients

Biological age is older
than chronological age

Higher rates of mental
illness

50 years old is elderly

Higher rates of
traumatic brain injury

Less educated and less
literate

High levels of drug and
alcohol and tobacco
use

Increased risk for
suicide.

Many infectious
diseases
 Medical
Needs
Chronic disease
 Acute illness
 Emergency

 Psychiatric


needs
Medication side
effects
Delusions/
hallucinations
 Psychological
Needs



Personality
disorders
Self-harm
Suicide risk
 AODA


Needs
Withdrawal
Abuse
It sounds easy, but it is not for
everyone!
 Nurses
are the primary care provider,
medical staff are likely to have limited
hours and available on-call.
 First
Care providers to evaluate patient
concerns and triage.
 Nurses
are evaluating patient symptoms
and determining and delivering treatment
based on medically-approved protocols
 The
autonomous nature requires excellent
assessment skills AND good clinical
judgment to make sense of the assessment
 Must
be thorough and accurate and
conveyed to medical and mental health
providers when necessary
 Patients
are less likely to be informed
about health status
 Need
to teach new health habits all the
time and with new diagnosis make for a
good teaching moments
 Learning
disabilities and poor reading skills
require creative teaching skills

Correctional nurses use their full scope of
practice in providing nursing care.

The variety of conditions in non traditional
settings and need to provide as much health
care as possible within the facility maximize
nursing care practice.

Few other roles allow for a nurse to practice to
the full scope of licensure
Nurse Practice Act
 Code of Ethics for Nurses
 Nursing Scope and Standards

MARTHA ROGERS
“Nursing’s story is a magnificent epic, of
, it is about people, how
they are born, and live, and die; in health and
sickness, in joy and in sorrow, its mission is the
.
It is the intellect that synthesizes many
learning into meaningful interactions. Nursing
promotes symphonic interactions between man
and environment, to
of the human field,
and to direct and redirect patterning of human
and environmental fields for realization of
maximum health potential.
, on planet
earth or in outer space.”
 Openness


Non-judgmental
New experiences
 Agreeableness


 Conscientiousness

Self-regulated,
plan ahead
 Extroversion

Need a good
balance
Also need a good
balance
Inmate vs. staff
 Neuroticism


Handling stress
Staying calm

Correctional forensic nurses screen inmates
entering the facility for a variety of immediate
medical and mental health needs:
alcohol or drug withdrawal
suicide potential
trauma
 infectious diseases
 chronic medications




This screening assists custody with housing
placement, initiates scheduling for ongoing
health visits, and determines if the inmate
must first be seen in an acute care setting for
injury treatment.

Inmates are scheduled for regular
appointments in the medical unit to manage
chronic conditions such as hypertension,
asthma and arthritis.

In addition, chronic care clinic visits might be
scheduled to attend to infectious processes or
pregnancy management.

Although a chronic care visit involves contact
with a physician or advanced practitioner,
correctional forensic nurses provide key
elements of chronic care management
including patient education and medication
compliance review.

Because many medications, even over-the-counter
preparations, can be misused in the correctional
environment

These medications must be administered
individually through a medication pass or pill line
process.

Several times daily the inmate population requiring
medication doses report to a nurse for
administration.

This may be centralized in the medical unit or
decentralized with nursing staff administering
medication in the housing unit.

Nurses provide episodic health care services to
correctional patients through a request system
called Sick Call.

Inmates request treatment, usually in writing, and
are seen by a nurse.

Standardized protocols allow administration of
over-the-counter medications for simple conditions
like athlete’s foot, constipation, or the common
cold.

If the nursing assessment indicates an acute
condition, a follow-up appointment with a
physician or advanced practitioner is arranged.
 Dental
 Ear
assessment
assessment
 EKG
 Labor
 Physical
 Respiratory
 Skin
and Delivery
 Phlebotomy
therapy
therapy
assessments
 Splints/slings
 TB
skin testing
 Many
times there are challenging ethical
situations where you need to stand up for
what is right
 Remember
you are a patient advocate, you
need an unshakable core of beliefs
 You
also need to be tolerant of others
beliefs and values
 Are
you generally able to get people to tell
a secret?
 Nurses
need to obtain a truthful response
 Correctional
patients usually are hiding
something:



Drug use
Alcohol consumption
Suicide contemplation
 Patients
are always looking at ways to
manipulate.
 Correctional
nurses need to remain
objectively caring while always being alert
for the con!
 Plenty
of patients talk dirty and pepper
their language with 4 letter words.
 Many
do it for surprise or shock value
 Others
 Listen
issues.
swear to bully or manipulate
past the language to address the real
 Patients
are prone to exposing body parts
or tossing body fluids
 Nursing
rounds on high management units
can be embarrassing and anxiety producing
for nurses.
A
matter-of-fact no-nonsense attitude
toward socially unacceptable behavior will
rule the day.

Hearing patients stories of abuse and trauma
can take its toll.

We may see harsh treatment among staff and
inmates.

As caring healers we may want to take on that
burden.

Effective nursing in the criminal justice system
requires were are fully there for our patients
while keeping balance in our own life.
•
NCCHC's leadership in setting
standards for health services
in correctional facilities.

CCHP Certification

Recognizes the professionalism involved in all
aspects of correctional health care.

Participants have earned the highly regarded
CCHP designation by demonstrating mastery of
national standards

Special knowledge and skills expected of
leaders in this complex and ever-changing
field.
 CCHP-RN



certification makes a difference
to the patients whose care is provided by
certified correctional nurses
to employers who desire top-notch nurses on
staff
to the nurses who attain the credential.

American Nurses Association and International Association
of Forensic Nurses. (2015). Forensic Nursing Scope and
Standards 2015. Retrieved October 22, 2016, from
International Association of Forensic Nurses:
http://c.ymcdn.com/sites/www.forensicnurses.org/resourc
e/resmgr/Docs/SS_Public_Comment_Draft_1505.pdf

Lamb, H. R., & Bachrach, L. (2001). Some Perspectives on
Deinstitutionalization . Psychiatric Services, 1039-1045.

Schoenly, L. P.-R. (2015). Correctional Nursing. Retrieved
October 22, 2016, from International Association of
Forensic Nurses:
http://www.forensicnurses.org/?page=correctionalnursing
Any questions?
[email protected]