Understanding incarcerated populations

AORN Journal,  March, 2002  by Cheryl L. Cooke

• E-mail
• Print
• Link

Pregnancy and other gynecological care needs are a consideration for women who are incarcerated. Many female inmates are pregnant at some point during their imprisonment. Some women may require cesarean section or other gynecological procedures. Restraint systems become an issue, particularly when performing perineum checks or other postoperative checks. Hospital policy should be followed regarding the use of shackles with female patients. Patient privacy is another concern. Male corrections personnel may supervise female inmates. The nurse should inform corrections personnel that he or she will draw the curtain and perform the examination in private.

Concerns regarding pain management. Pain management is an issue for many patients--those with multiple trauma, those with advanced forms of cancer, and postoperative patients. Many people who are incarcerated have a history of illegal drug use; thus, pain management can become an issue, particularly if nurses or other health care providers perceive patients as drug-seeking. As with all patients, appropriate postoperative pain management is an important aspect of quality care. Withholding or refusing to medicate a patient who complains of pain or demonstrates physiological signs and symptoms of pain is a form of patient harm. A complete nursing assessment for pain management is warranted for all postoperative patients, including patients who are incarcerated. It may be necessary to educate other health care providers (eg, other nurses, physicians) about the necessity of self-reflexive assessment, especially for a provider who has difficulty providing adequate pain control for a patient who is incarcerated. A reflexive health care provider is able to recognize when his or her political or moral views interfere with quality and compassionate patient care, regardless of who the patient is thought to be. If a provider seems reticent to provide adequate pain management, a review of the signs of pain (eg, tachypnea, tachycardia, posturing) may help him or her see the need for prompt and complete pain control.

Communicating discharge or transfer information to other health care providers. Discharge is an important time in any patient's hospital stay. A frequently used axiom in nursing is that discharge planning begins at the time of admission. This is especially true for people who receive care while in custody. Nurses will need to determine who should receive discharge plans, who to contact to schedule follow-up appointments, and the patient's specific treatment needs after the procedure. The patient should receive discharge instructions, as he or she may be providing his or her own postoperative care.

Use clear and simple language when explaining postoperative care and treatment to a patient who is incarcerated. Knowing what complications may develop can help a patient more thoroughly explain the need for reexamination and treatment. It also is necessary to contact medical personnel at the corrections facility with discharge and treatment information. Ask this person what records need to accompany the patient to the corrections facility, and make sure that this packet is copied, marked confidential, and sent to the facility at the time of transfer.