Correctional Nursing Questionnaire.

1. Using the common nursing stereotypes (battle ax, angel of mercy, etc) describe your relationship with inmates.

My relationship with inmates is little different than my relationship with patients when I worked in a hospital. Obviously allowances have to be made for security, and I have to be more aware of maintaining professional distance. The "touchy-feely" approach to nursing doesn't work well in this environment. Using terms of endearment with opposite-sex patients are far more likely to be misinterpreted as romantic interest when dealing with inmates, and they should be completely avoided. These people are not in prison because they have sound reasoning skills or exercise good judgment.

I don't believe that I fit any stereotypes. I use a variety of approaches depending upon the situation. Sometimes using humor is appropriate. Sometimes being very blunt works better. It depends upon your audience. As far as how I treat inmates, I treat them with respect without coddling them. The custody mantra of "firm, fair and consistent" also has nursing applications in this environment.

2. What are some methods that you use to build repore and trust with inmates?

Being truthful and honest with them about their health issues goes a long way. I also try to make sure that I explain things in a way that the inmate can understand, because many of them are not well educated. Listening to them, even if you believe they are feeding you a line, also helps. For many inmates, it isn't even important to them that you believe them as long as you hear them out. Also, deliver what you promise, and don't do things for one inmate that you would not do for another.

In a correctional environment seemingly minor details make a big difference to inmates, because they don't get much. Any interaction they have, positive or negative, is a bigger part of their day than it would be on the outside.

3. Are you ever aware of the charges being held against your patients, if so does that effect the way you care for them?

I make it a point not to even try to find out, because I don't want my personal feelings to affect the care I deliver. In the cases in which I cannot help but know (high-profile crime, extensive television news reporting) I block that out and concentrate on the task at hand.

4. How do the inmates attitudes and philosophy related to healthcare compare to non-inmates?

We have to be aware of things that don't come into play as much in hospitals. Proximity of the sharps container. Making sure the inmate doesn't see the entry code for the medication room. Never being in an examination room alone with an inmate. We also have to be ever mindful that custody is job one, and issues of security must necessarily take top priority. We must operate within the confines of that environment.

5. Can you explain the inmate culture as it relates to healthcare?

Many inmates try to manipulate the system to get as much out of it as they can. Exaggerating and feigning symptoms is common, and your assessment skills come into play a lot. Others, sometimes trying to appear tough to fellow inmates, will not report a problem until it is well along. You also have to do a lot of education. You cannot assume even a rudimentary knowledge of health principles, because many (perhaps most) inmates have had little or no education about how to stay healthy and when to seek medical attention.

6. How were your perceptions of nursing changed or effected when you began taking care of patients that were being held against their will?

Not at all. Of course, it helped that I worked in and around corrections in various capacities for many years before going into nursing.

7. Do you believe that the bedside manner you use with inmates would be appropriate in other fields of nursing? Please explain.

In most cases, yes. There are some times, depending upon the security level of the inmate or the situation, that I have to alter my practice to allow for security concerns. Most nurses don't do dressing changes with a custody officer standing by.

8. Would it be difficult for you to acclimate to another field of nursing? What would you have to changed?

I have worked in several other areas, so acclimation wouldn't be difficult. Willingness is another matter. I have no intention of leaving correctional nursing at this point.

9. What events led you to becoming a correctional nurse?

I was working a per diem job in a hospital at the time I signed up for the Department of Corrections' newly-created per diem nursing pool. I was just looking to pick up a few hours to supplement my income. I simultaneously got full-time offers from both the prison and the hospital. The prison's offer was for more money for less work and headaches, and I liked the job. It wasn't a difficult choice. The same hospital later offered me a nurse manager job - for less money than I was making as a line-level nurse at the prison. I politely told them "No, thanks".

10. Has it been your ambition since nursing school to be a correctional nurse?

I never gave it a thought. The ironic thing is that I initially went into nursing to get out of corrections.

1. Can you explain how you know once an inmate trusts you. What signs and behaviors of trust are most common?

The more questions an inmate asks you and the more they relax and share with you about what they are feeling or experiencing is usually a good sign that they trust you.

2. How do you ensure accurate patient education when using slang or non-standardized terminology?

I will usually use both standard and non-standardized terminology or slang to make sure the inmate understands what I am saying and relate the two terms together. I also will have the inmate repeat back to me what I have instructed him to do if I am not sure he understands me and doesn't ask me questions.

3. What are some reasons why a nurse would prefer providing care to an inmate rather than a non-inmate?

I prefer providing care to an inmate rather than a non-inmate because I only have to deal with the patient, not family. Also, inmates tend to be more appreciative of the care they are receiving and the fact we are willing to take the time to explain things to them and to provide advice. They don't tend to have the unrealistic expectations that non-inmates and family have of nurses.

4. What are some reasons why a nurse would prefer providing care to a non-inmate rather than an inmate?

I miss the technical aspects of nursing, the resources, and the fact that I was surrounded by patient advocates "outside the walls."

5. What are some ways in which inmates can gain the trust of their nurses?

I don't believe this is a setting where an inmate can expect to gain the trust of a nurse. There is always going to be some doubt in my mind about the inmate's true intentions when soliciting nursing care. I am going to be suspicious of an inmate who is trying too hard to gain my trust.

I just wanted to thank everyone that participated in our groups questionnaire, our project kicked butt!