1. Identify the clinical experience and describe the events noting the 4 areas of Community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call.2.
•--------- Can Nurses Care W ith in the Walls?
W h e n a s k e d w h y t h e y c h o s e nursing as a career, most nurses express their desire to make a difference in caring for people.
The attitude and act of caring for others is the very essence of the art of nursing.
In the current healthcare climate, many nurses find there is little room for demonstrat ing interpersonal caring acts; however, there are few more challenging settings for initiat ing caring relationships than in correctional institutions.
Correctional nursing is unique, requiring knowledge, skills, and attitudes that will meet the needs of this vulnerable population while adhering to the boundaries necessary for maintaining security.
Not unlike their counter parts in other settings, cor rectional nurses may become calloused, appear uncaring, and task-oriented. In today's economy, every healthcare set ting is attempting to do more with fewer resources; therefore, some things are getting left by the wayside—including mak ing the human connection and demonstrating authentic caring.
Internal factors that contribute to uncaring behaviors within the correctional nursing arena include:
• Struggles between what the nurse believes is best, what custody believes is best, and what the inmate believes is best.
• Lack of appreciation from the client population.• Demand for immediate gratification and a quick fix to resolve a problem.
• Client's sense that nothing is ever fast enough or good enough.
• Nurse's need to be able to discern between actual prob lems and ulterior motives.
• Valuable time required to respond to grievances or lawsuits.
• Clients who are noncompli- ant with treatment plans.
Leininger (1991) and Watson (2006) emphasize the impor tance of the human connection within the nurse-to-patient relationship to promote holistic healing based on a foundation of mutual trust and respect.
Caring theories also stress the necessity for deliberate caring acts that do not dehumanize the client/patient. Nurses need to remember the dignity of the client/patient as a human being.
The acts of caring intention and behaviors precipitate and result in the forming of relation ships. This relationship building is different in various settings.The ICU nurse may speak soothingly and stroke the brow of an intubated patient. The hos pice nurse will hold the hand of a terminal patient who is crying.
The primary concern within cor rectional culture is for security and safety; safety for the public, the inmate population, and staff.
Correctional nursing frequently mandates a paradigm shift for nursing staff who may be accus tomed to traditional settings.
Literature reviews on cor rectional nursing reveal a search for good intentions to provide "caring" among nurses includ ing self-disclosure and the use of touch to convey comfort (Weiskopf, 2005). Maeve (1997) explained in a research study "the most significant obstacle to caring was that nurses were forbidden to enter into relationships with patients." California's Correctional Nursing Task Force (2005) spoke on the difficulty of advocating for patient care without the cooperation of security person nel. It was generalized there is a great deal of frustration in correctional nursing due to an QUESTIONS ABOUT ISLAM?
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www.Peacetv.tv www.TheDeenShow.com 877-whylslam www.twf.org AMERICANJails SEPTEMBER I O C T O B E R 2 016 | 6 1 ----- • inability to advocate for inmates w ithout a power struggle from custody staff (Weiskopf, 2005; Maeve, 1996).
Despite the obstacles described in the literature, it is im perative for correctional nurses to u n d erstand how to function professionally w ithin established b o u n d ar ies. Nurses w ho blur the lines in forming closer relationships w ith inm ates p u t themselves, coworkers, custody staff, and even the inmate in potential jeopardy. Peternelj-Taylor & Yonge (2003) described the behaviors that fall outside the therapeutic relationship as the "seductive pull of help ing" and meeting the nurse's own needs and agenda by needing to be needed. Peplau (1997) and Pilette, Berck, & Achber (1995) were opponents of self-disclosure. As Peplaustated "the client does not need inform ation about the personal life of the nurse." Also, as the n u rse's intentions may be to communicate caring, the use of touch may be misinterpreted (Wysoker, 2000) outside the task of assessment.
H ow then, in this setting, is a nurse to dem onstrate authentic caring to this client population?
Recommendations include:
• Make eye contact.
• Listen actively. Reaffirm you hear w hat the client is saying.
• Pay attention to details, w hat is said as well as w h at is not said.
• Let the client finish speaking.
• Smile w hen appropriate to show you are human.
• Monitor your own voice tone and facial expressions.
• Advocate for the well-being of your client.
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•• Remember that kindness and reassurance may be all that is needed.
• Speak in terms the client can understand.
• Maintain your patience.
• Be nonjudgm ental. It is not necessary to know a client's crime to provide care.
• Remind yourself this is a person who deserves to be treated w ith respect.
• Practice true self-reflection— If one questions whether boundaries were crossed, they probably were. Question yourself: "How am I getting m y own needs met?" Each nurse m ust find h e r /h i s own w ay of coping in a chaotic and potentially violent environ ment. It is essential for nurses new to correctional nursing to have a structured orientation and not just on-the-job train ing. Seasoned mentors, who are well-versed in policy, practice, and quality care, will help in keeping frustrations at bay as new nurses acclimate to the environment. Despair is not only present in the client p o p u lation, b u t also w ithin the staff.
D on't expect appreciation, b u t appreciate yourself and w hat you bring to the people w ho are entrusted to y our care. Find meaning for your life outside your workplace. It's a tough w orld inside the walls. ■ R e f e r e n c e s Correctional nurses and collective patient advocacy: Conclusions and recommendations from CAN's first Correctional Nursing Task 6 2 I SEPTEMBER I O C T O B E R 2 016 A M E R IC A N ja ils California Nurse, 101(6), 38-39.
Leininger, M.M (1991). Culture care diversity and universality: A theory of nursing. New York: N ational League of N ursing Press.
Maeve, M.K. (1997). N ursing practice w ith incarcerated women:
Caring w ithin m andated alienation.
Issues in Mental Health Nursing, 18, 495-510.
Peplau, H.E. (1997). Peplau's theory of interpersonal relations. Nursing Science Quarterly, 1 4 ,162-167.
Peternelj-Taylor, C.A. & Yonge, O. (2003). Exploring boundaries in the nurse-client relationship:
Professional roles and responsibili ties. Perspectives in Psychiatric Care, 39(2), 55-66.
Pilette, PC., Berck, C.B., & Achber, L.C. (1995). Therapeutic m anage ment of helping boundaries. Journal of Psychosocial Nursing & Mental Health Services, 33(1), 40-47.
Watson, J. (2006). Caring theory as an ethical guide to adm inistra tive and clinical practices. Nursing Administrative Quarterly, 30(1), 48-55.
Weiskopf, C.S. (2005). N urses' expe rience of caring for inmate patients.
Journal of Advanced Nursing, 49(4), 336-343.
Wysoker, A. (2000). Legal & ethical considerations: Sexual miscon duct. Journal of American Psychiatric Association, 6 ,131-132.
Susan Parrish MSN, RN, is an Education C oordinato r with Cape Fear Valley Health in Fayetteville, N orth Carolina. She worked as a staff nurse fo r 10 years with the NC D epartm ent o f Corrections.
She can be contacted at srparrish@ capefearvatley.com.P res id e n t's M e s s a g e CONTIN UED FROM PAGE 4 argue that jail is too harsh or fails to prepare offenders for release. Governmental entities most commonly demonstrate their beliefs about incarceration when they develop the budget.
Their decisions on budgetary items such as facility condition and officer compensation often reflects their opinions. The cul ture that evolves from this mix of attitudes, beliefs, misconcep tions, myths, dedication, history, commitment, and knowledge determines how our detention facilities fulfill their role in the criminal justice system.
Recently, the VERA Institute of Justice announced an ini tiative called "Reimagining Prisons." I attended this event to share the perspective of jails.
Some of the objectives include addressing mass incarceration and examining the treatment of people in prison. As I par ticipated in discussions about the challenges we encounteras correctional administrators, I recognized that a common thread in many concerns about facility operations is organiza tional culture. In some cases, it is not the job we do that draws criticism; it is how we do it.
As employees, supervisors, and managers of correctional facilities, we must be constantly mindful of the culture we are creating. The manner that we communicate, convey instruc tions, implement policies, and respond to problems will deter mine our organizational culture and our success. A positive environment can improve work ing conditions and build cor rections into a more rewarding career. When managed properly, a correctional facility can be safe, secure, and contribute to a safer community. ■ WAYNE DICKY, CJM, CCE President American Jail Association □ 09 ( ) t i O A .
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