Inmates as Patients in Hospital

An issue arose at my hospital during my consolidation as a student, and it had both ethical and legal concerns. I was being trained on a medical/surgical floor, and one of the nurses on the floor believed that inmates were only permitted to ambulate on the floor with their guards after visiting hours were over. Inmates are commonly put on our floor as there are a couple of prisons in the vicinity of the hospital.

The clinical educator and I looked into this in the policy manual, and could only find two items that were relevant:

1. "While attending the Hospital Inmates shall remain in restraints, except as provided by section 6.3 of this policy. Any deviation shall be a result of consultation between Hospital Security, the appropriate Program Manager/Delegate, and the appropriate Correctional Service."
2. "Inmates in restraints shall be transported by wheelchair or stretcher at all times unless ambulation is a necessary component of their health care."

After telephone calls to hospital security, the prison officials, and other managers responsible for policy, it turns out that this is an unwritten rule that the guards choose to follow, and is not formal policy by any of the agencies. Therefore there are no legal concerns for the nurse if she wishes to insist that the patient ambulate during visiting hours, although she may feel ethically concerned for the fear that may arise in the other patients on the floor. Legally, the guards may be at risk for restricting the freedom of the patient in a manner that is not part of their prison sentence. The hospital too may be taking a legal risk by not addressing the situation -- what if a patient died due to something that could have been prevented had the patient been ambulatory more often? Nurses often deal with conflict between the rights of the individual over the greater good of the group, and this is one more example of both the ethical and legal aspects of so many of the issues that nurses face on a daily basis.

The ethical concern arises in the second statement listed above. It is absolutely necessary that a person ambulate after surgery, and therefore wheelchairs/stretchers are only necessary when arriving on or leaving the floor. To restrict a patient to a few hours in the evening is an ethical dilemma for the nurses. On the one hand you wish to provide the best care for your patient (the inmate) and in order to do this they must be able to ambulate as much they can whenever possible. However, the stress level of seeing an inmate flanked by two large guards walking the halls will increase significantly for the other 30+ patients on the floor. Whose needs to you consider first? What are your legal obligations to the other patients and their safety? What is your obligation to the inmate? Are the guards legally allowed to restrict the patient? How do you reconcile this issue in an equitable manner?

In the article, “Caring for the incarcerated in the intensive care unit”, the author describes the many aspects of nursing care that differs in a standard hospital rather than in the infirmary of a prison. However, the theme throughout the article is summarized in the conclusion: “the nurse must respect the worth, dignity, and rights of all patients, regardless of the individual’s lifestyle, values, or state of health”. Adopting this as a personal policy will only benefit a nurse who must work with incarcerated and non-incarcerated patients.

Reference

Graves KE. Caring for the incarcerated in the intensive care unit, Dimensions of Critical Care Nursing. 26(3):96-100, 2007 May-Jun.