Lory Schoeny

Officers in the women’s wing of a large urban jail call down to medical asking for assistance with an out-of-control inmate. They used a standard withdrawal protocol based on the Federal Bureau of Prisons Guidelines that included scheduled evaluations using the CIWA-Ar and administration of lorazepam (Ativan) based on scoring. However, intake screening questions missed this patient’s heavy dependence on diazepam (Valium) along with her alcohol intake. The correctional patient population is less likely to frequent the health care system for these conditions and may obtain relief by self-medicating using street drugs.

Assertive communication starts with a good understanding of your own feelings about the situation and a desire to understand the feelings and perspectives of others in the group. Thoughtfully considering the situation, and your best response to it allows an objective analysis of emotions that reduces the chance for an unhelpful aggressive or angry response. By overcoming the desire to compromise and the fear of conflict, you can respond to challenging ethical situations in your correctional nursing practice. Evaluating your own feelings, seeing the perspective of others, and planning an assertive response will develop moral courage to respond when needed.

Research on the effects of nurse fatigue indicates that nurses working more than 12 hours a day are three times more likely to make a patient care error. Additional research into nurse fatigue confirms that long shift length increases error, close calls, and decreased vigilance. This latter finding can have particular application in the correctional setting where nurses must be vigilant, not only for patient safety but also their own safety in a secure setting. A study of shift workers found that risk of accident escalated over time so that the risk of accident was 17% higher on the fourth straight night of shift work.

The mouth can provide clues to many medical conditions and drug side effects. The impaired immune function of leukemia can also lead to mouth infections such as candidiasis and herpes simplex. * Dry mouth (xerostomia) is the most frequent oral side effect of medications and can lead to increased risk of infection and decay. If any of these medical conditions are encountered during an oral screening, carefully document your findings, initiate appropriate treatment, and communicate this information to medical or dental providers for a diagnostic workup.