CORRECTIONAL Nursing PRACTICE: What Makes This Practice Different?

By Bachmeier, Kathleen | Corrections Today, August 2001 | Go to article overview

CORRECTIONAL Nursing PRACTICE: What Makes This Practice Different?


Bachmeier, Kathleen, Corrections Today


Correctional nursing practice is not for the fainthearted but can be quite manageable with a common sense approach. The obvious difference between correctional and noncorrectional nursing is the patient we care for. Or is it?

Perhaps it is the environment in which we practice nursing. The correctional setting certainly is not the traditional model of nursing practice. The greatest difference, in reality, is how inmates' constitutional rights and court principles interact with nursing practice in the correctional setting. This difference exists because inmates have lost their rights to basic freedoms and live under supervision and government control.

The Eighth and 14th Amendment Challenge

Inmates must rely on correctional authorities to meet their medical needs. Because of this, the courts have interpreted the Eighth Amendment to the U.S. Constitution to mean that failure to provide convicted inmates with necessary medical care and treatment is cruel and unusual punishment. Regarding pretrial inmates, the courts have interpreted the 14th Amendment to require correctional facilities to provide the necessary medical care. Understanding the principles established by the courts will help pave the way for nursing in the correctional setting.

It is a clearly established principle of constitutional law that correctional facilities provide inmates with necessary medical treatment. This applies to the inmates' dental, medical, psychiatric and psychological needs. The nursing practice issue is: What is medically necessary? And in practice, the nurse cannot be deliberately indifferent to an inmate's serious medical need.

Clarifying Deliberate Indifference

Nurses must consider what is meant by deliberate indifference to a serious medical need. This certainly is not a term covered in basic nursing curriculum. But nurses can gain a working knowledge of the phrase "deliberate indifference to a serious medical need" by looking at the components defining the phrase.

Deliberate indifference may have different meanings depending on the particular facts of each case. There are certain generally recognized components of deliberate indifference to inmates' serious medical needs:

* Deliberate indifference is more than an honest mistake. A nurse must act intentionally in response to a serious medical need or must intentionally fail to respond to a serious medical need of an inmate.

* The nurse must exhibit a culpable state of mind. In order to have culpability, the nurse must have had the opportunity for deliberative process or had the knowledge of a problem that without appropriate intervention, there would be a substantial risk of serious harm to the inmate.

* The indifference to a serious medical need must have involved a choice by the nurse among alternatives and the nurse made a knowing choice among the alternatives regarding an inmate's care.

* The nurse had knowledge or appreciation of the consequences that may result from his or her action or lack of action.

* The nurse acted or failed to act with knowledge or appreciation of his or her conduct.

What is a serious medical need?

* The inmate is experiencing significant pain or suffering that may be relieved by medical care.

* The inmate suffers from a condition that has been diagnosed by a physician as requiring treatment.

* The inmate is experiencing a lack of medical or nursing care or a delay of care that may cause deterioration or worsening of his or her condition.

* The inmate has a high probability that his or her problem may result in a permanent medical condition.

* A layperson would be able to recognize that the inmate requires nursing or medical intervention.

What is not deliberate indifference in nursing practice?

* A nurse may engage in good faith disagreements over treatment modalities with an inmate. …

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