Dangers of Labeling Inmates - Stories Sought

tlc365 · Jun 6, 2010

I work at a state facility and due to privatization of some state facilities we do not talk to their computers.

tbrd450 · Jun 6, 2010

I believe that there are many reasons for this type of behavior on the part of the nurses, and that there is some variation in the reasons from one nurse to another. Certainly one reason is that it is so easy to become overidentified with the dominant custody culture, but I recently heard a presentation on
"Failure to Rescue" (based on hospital incidents, not correctional incidents) that offered another, very important reason. The presenter reported that root cause analysis done at the hospital found that the nurses had become overly task-oriented and had lost their ability to stand back and see the big picture for their patients. In our setting, it is extremely easy to become task-oriented - considering the 3 hour (and longer) pill-calls, huge sick calls, relentless intake procedures and endless paperwork. The hospital system making the presentation I attended did a number of things to address this, including the Failure to Rescue presentation.

Absolutely!... You touched on some very good points. The "dominant custody culture" is very powerful. It can be dangerous. A study in conformity was conducted back in 1951. A social psychologist--Solomon Asch--devised an experiment to examine the extent to which pressure from other people could affect one's perceptions. In the experiment only one lone subject (real subject) is joined with 7 others play-acting as subjects (they are control subjects associated with the experimenter). The lone true subject doesn't know the 7 others are plants, or setups, in the experiment. All 8 people were presented with a card containing one (1) vertical line on the left side of the card and three (3) vertical lines of varying lengths on the right side of the card. The experimenter asked everyone to identify the vertical line on the right side of the card that is the same length as the line on the left side. The experimenter ensures they all individually are aware of the choices being made by the others. As instructed by Asch, the seven control subjects all intentionally pick a line on the right that is clearly not the same length as the line on the left. The task is repeated several times.

Asch discovered after conducting this experiment multiple times, with numerous exercises, that about one third (33.33%) of the subjects who were placed in this situation went along with the clearly incorrect line selection on the right side of the card simply because the majority did so. In other words, approximately 33 out of every 100 people will just conform to the group they find themselves in. Asch found that one of the situational factors that influence conformity is the size of the opposing majority. Surprisingly, he found that the subjects conformed to a smaller erroneous majority group of 3 or 4 as readily as they did to a larger majority group. Many subjects later indicated that they assumed the rest of the people were correct and their own perceptions were wrong (even when they clearly were not wrong). Others indicated they knew they were correct (and the majority was wrong) but didn't want to be different from the rest of the group. Still others insisted (even after learning of the experiment design) they actually saw the line length as the majority "claimed" to see it.

However, one thing Asch found was that the rate of conformity to the erroneous majority drops dramatically when the subject has an ally. Asch concluded that it is difficult to maintain that you see something when no one else does. The group pressure implied by the expressed opinion of other people can lead to modification and distortion effectively making you see almost anything.

It is incredibly easy to draw a parallel and application of what we already know about human behavior regarding group conformity, to the correctional environment. It takes a person of strong integrity, character and raw courage to swim up the "custody culture" stream, against the strong opposing correctional officer mindset current. As a nurse in the correctional environment, you have a moral obligation to advocate for your patients. That is why I try to remind new nurses and those seeking advice to hold on to their original nursing convictions (assuming they were there to start with), proclivities toward patient empathy (assuming it was there to start with), and fundamental instincts about humane treatment, and simple right and wrong. In no other place than corrections is such a staunch defense against losing sight of those convictions, caring proclivities, patient empathy and ethical standards more important. Failing to do so can not only mean the greatest ultimate tragedy for a fellow human being (an inmate patient) losing his/her life or further deterioration of his/her health, but it can also mean a sacrifice of the highest order for the failing nurse. He/she stands to lose an important part of him/herself.

Correctional officers are programmed to view these guys differently (note: there are different dynamics at work with female inmates). They tend to universally view these guys through a single lens, a single perspective -- one that is premised on custody first and foremost and almost exclusive, at all costs, focus. It is one that permits them to rationalize a lot of things that would otherwise be difficult to rationalize (delayed responses to help, too much pepper spray, over zealous application of "attitude adjustment", etc.). They appear to far too often be programmed to, or simply accustomed to, viewing inmates as single-minded manipulators always devoted to lying about everything, all the time. I happen to believe it serves, for some, to help them to safely compartmentalize and simplify their responses and reactions. Hearing the whole story (from the inmate) becomes unnecessary and burdonsome. And, by keeping a clear line drawn between "us" and "them," a double standard is easily cultivated and justified, even a double standard that sometimes crosses the line into dehumanization. They often convince themselves that such a narrow perspective isn't narrow, and it is one that is necessary to keep everyone, but mostly themselves, safe from the boogy man.

Task-oriented -- Absolutely, I agree. To settle in to a task-oriented approach in handling crisis, one has to detach a little from engaging otherwise natural and organic emotive responses to fellow humans in need. For example, the incarcerated man with a blocked Foley suffering needlessly through the night and next morning in his cage is nothing more than a numbered orange jumpsuit representing an unannounced MD order. One the order comes, then he is human again.

Task-oriented blindness and overidentification with custody culture are different fruits from the same poisonous tree.

Those correctional nurses that establish high ethical standards, hold on to nursing convictions, and dare to see the card's line length for what it really is, are swimming up the fast moving custody culture stream. Make no mistake about it, the opposing current can be very strong.

suesmith48 · Jun 6, 2010

All of your very well-reasoned responses lead us to one thing - the importance of the CQI process in helping us to resolve our dilemmas...

tlc365 - you discuss near constant distractions that delay your med administration process. First, the fact that you are having so many distractions is more than just an inconvenience that slows you down. Accordng to the Institute of Medicine (in the To Err is Human report) distractions during the med administration process is a major contributor to medication error. Some hospitals have moved to place a "NO DISTRACTION" zone around med carts. It sounds like you have some process problems, like medication distribution and communication. Addressing the problems has the potential to save med administration time (which will save $$) and decrease medication errors (which cost $$).

Orca - right on! We walk a fine line between respecting custody for the very difficult job that they have and losing our nursing values. Certainly we need to acknowledge the importance of safety and security, but we can do that and maintain our identity as nurses. It just takes some critical thinking (well, integrity and a good moral compass help as well).

misia84 · Jun 7, 2010

i just passed my nclex and i'm considering working as a correction nurse..my husband doesn't like it but i think this is something different..

Orca, ADN, ASN, RN · Jun 7, 2010

Correctional nursing is a good field to be in, but I don't recommend it as a first job in nursing. It requires a lot of independence, and without prior experience it is difficult to do well. Some agencies hire new grads, mine doesn't. Applicants are required to have at least a year of experience to hire on with us, and I believe that is a good idea given the environment.

tbrd450 · Jul 6, 2010

Hi Lorry,
After 20 years of correctional nursing, I could go on and on and on - here are a couple stories that come to mind (and please keep in mind that these nurses were both known as good nurses):
A nurse from one of our county jails told me this story and another confirmed it. They had a man frequently arrested for various charges, usually drunk and disorderly. He liked to play "tricks" on the nurses and would complain of chest pain, knowing that they would have to see him. Sometimes he'd even laugh and admit to it. One night, a CO came to the booking nurse saying that this man was again complaining of chest pain. She was busy and told the CO that she would see the inmate when she finished seeing the booking detainees. The CO summoned her again in less than an hour - the man was unresponsive. He had suffered a heart attack and did not survive. The family sued the county jail and her (resulting in her termination) and reported her to the state board of nursing (where she did have to defend her actions).
One evening in one of our state prisons, a nurse received a call from one of the housing units - the CO said a young inmate was complaining of an asthma attack. The nurse was busy with other duties, but did review the inmate's medical record. She found no history of asthma and told the CO to have the inmate sign up for the next day's sick call to be evaluated. The CO called back about an hour later - the inmate was unresponsive - he did not survive either. The nurse was disciplined for her actions.
Sometimes inmates do complain of symptoms they are not really experiencing (so do patients on the "outside"). However, the only reliable way to make sure is to see and assess the patient - which takes less time than responding to an emergency, enduring the resulting investigation, defending your actions at work and potentially before your Board of Nursing and explaining it to any subsequent employer.

"Sometimes inmates do complain of symptoms they are not really experiencing (so do patients on the outside). However, the only reliable way to make sure is to see and assess the patient -- which takes less time than responding to an emergency, enduring the resulting investigation, defending your actions at work and potentially before your Board of Nursing and explaining it to any subsequent employer"

AND IN SO DOING A FELLOW HUMAN BEING MAY NOT HAVE TO DIE!