Struggling to Define Caring in Correctional Nursing

Correctional nurses face a daily struggle to care for their patients while delivering much-needed healthcare in a restricted environment. How can correctional nurses truly care for and care about their patient population? This is a question many of us in the specialty deeply consider as we try to elevate the professional status of correctional nursing. Caring has been described as the essence of professional nursing practice, therefore we must establish the characteristics of this concept as it is carried out in the criminal justice system.

Weiskopf studied nurses’ experience of caring for incarcerated patients and discovered a number of limitations in our setting .  Nurses in this study described the need to negotiate boundaries between the culture of caring and the culture of custody to establish relationships with custody staff in order to be effective. One interesting finding of the study was the extent to which the negative attitudes and behaviors of other correctional nursing staff affected nurses who were attempting to provide compassionate nursing care.

Many nurses working behind bars feel an obligation to care and often struggle to find ways to do this in a security environment not primarily healthcare-focused. Yet, developing a structure and process for caring may be the core defining characteristic of our specialty. Here are some suggested ways nurses exemplify caring behaviors in corrections:

• Educating patients about their health conditions and self-care principles
• Maintaining a nurse-patient relationship that is within the helpful zone of professional boundaries
• Advocating for the health care needs of a patient when necessary
• Showing compassion and respect
• Being non-judgmental
• Listening to what the patient is saying
• Following up – doing what you say you will do

Correctional nurses are confronted daily with an organizational culture convinced that we should not be caring ‘too much’ for our patients. Caring for justice-involved individuals often takes courage and perseverance, and perhaps a more serious definition of caring than the superficial application of a warm positive emotional response or empathetic word. Sometimes, our caring in correctional healthcare involves ‘tough love.’

Consider these unusual ways that correctional nurses care for patients:

• Not accepting a gift from a patient
• Letting a patient know that you know the rules and they should not ask you to violate them
• Asking the patient to complete a sick call request for the rash they want treated during pill line
• Being diligent with mouth checks during pill line

All of the examples above constitute an action or activity that is helpful for the patient; whether it avoids penalties, provides boundaries, or prevents self-harm. Caring seeks the best for the other in any situation.