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Forensics & Forensics & Correctional NursingCorrectional Nursing

A Special Thanks to Katherine Cylke, MSN, RNFor the Clark County Detention Center Photos

J. Carley, MSN, RN, CNEFall, 2009

Reference:Nies & McEwan: Community/Public Health Nursing: Promoting the Health of Populations, 4th EditionChapter 29: Forensic and Correctional Nursing

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The Opposite of Freedom…

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http://www.youtube.com/watch?v=kRiUjXp_BOE

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Forensic NursingForensic Nursing SubspecialtiesSubspecialties

• Sexual Assault Nurse Examiner (SANE)• Death Investigation Examiner• Legal Nurse Consultant & Nurse Attorney• Clinical Forensic Nurse• Forensic Psychiatric Nurse• Correctional Nurse

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SSexual Assault Nurse Examiner (SANE)

Specially trained RN who applies the nursing process during forensic examinations to victims

of sexual assault

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“RAPE KIT”

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DDeath Investigation Examiner

Specially trained RN who evaluates the death scene with a specialized, medically oriented perspective and might interpret the scene differently (GI Bleed versus Murder)

Nurse CoronerInvestigates cause of death

Job Description: County Coroner

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This ad for Deputy Coroner I, Cowlitz County, Washington offers the following description...

Minimum Qualifications:

1. A two-year degree in a medical or legal discipline, or related filed, and one year experience in death investigation (e.g., assisting in autopsies, pathology lab work). Or, any combination of education and experience that provides the skills to successfully perform the duties of this position.2. Familiar with Washington State applicable statutes.3. Obtain basic knowledge of Medico legal death investigations and attend the Washington State Medico legal Death Investigation Course within one-year of employment.4. Possess and maintain a valid driver’s license.

The job description is intended to describe the general nature and level of work being performed by the incumbent, and is not to be construed as an exclusive list of responsibilities, duties and skills required by the incumbent on this position. The job description does not imply an offer of employment, nor a contract for employment. It is subject to change at the discretion of the employer.

Required Skills and Abilities:

1. Knowledge of applicable laws and standard practices related to the duties of the Coroner’s Office.2. Interpersonal and customer service skills to effectively deal with grieving families, and others requiring services. Develop and maintain good working relations with dept. staff, other county employees, other agencies, the public and the media.3. Assist with autopsies, conduct investigations and determine causes of death. Maintain accurate and organized records.4. Excellent communication skills, both orally and in writing, in a professional business-like manner. Skilled at preparing thorough, organized and clearly presented technical reports. Convey medical and technical information in a manner that is understandable to the audience5. Work well independently as well as in a cooperative environment. Multi-task work environment with deadlines.6. Able to exercise judgment and discretion of sensitive or confidential matters.

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LLegal Nurse Consultant & Nurse Attorney

Nurses who provide assistance within the legal system using

specialized nursing knowledge and expertise when interaction of law and health issues arise

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CClinical Forensic Nurse

- Organ Donation / Transplantation Procurement

- Identification of forensic cases (eg Elder & Child abuse)

- Proper collection, preservation, and chain of custody of evidence

- Proper documentation

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FForensic Psychiatric Nurse

Collect evidence by determining intent or diminished capacity in the client’s thinking at the time of the

incident

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Corrections NursingCorrections Nursing

Provides healthcare of inmates in correctional facilities such as juvenile offender homes, jails,

prisons, penitentiaries, etc

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Clark County Detention Center

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Clark County Courthouse

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BookingBooking

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Restraints

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EMT Screening / Triage

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RN Assessment

Comprehensive History & Physical • Vitals• O2 Sat• Mantoux skin test for TB (or isolation)• EKG PRN• Pregnancy Test PRN• Any health concerns / history…• Referral to Nurse Practitioner / Physician Assistant

Mental Health Screening Exam

• Suicide Risk…• Referral To Mental Health Practitioner for further assessment

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Holding Area

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Cell Assignment

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Every Move You Make…Every Move You Make…

• Every aspect of life is controlled • Prisons accelerates the aging process for everybody • There is no such thing as getting to know the real person in prison 

Doing TimeDoing Time

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Safety & Security

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Prison Codes (rules)

1. Official administrative rules and regulations

2. Convict code

3. Color line

4. Gang membership rules

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Violence in Prison

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StandardsStandards

• Care standards created by the National Commission on Correctional Health Care (NCCHC) & American Correctional Association (ACA)

• Certified Corrections Nurse / Manager (CCN/M)

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Healthcare Providers

• Physicians (MD / DO / Psychiatrist)

• Social Services

• Nurse Practitioners (NP) / Physician Assistants (PA)

• Emergency Medical Technicians (EMT)

• Nurses (RN / LPN)

• Radiology Techs

• Dentists

• Pharmacy Services

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Booking

Holding

General Population

Medical Isolation

Infirmary

Mental Health Isolation

Medical Dept

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What do Correctional Nurses Do?

• Inmate intake assessments (Booking)

• Urgent/Emergent Care

• Acute Inpatient Care (post-op, hospice, pre –natal care, etc)

• “Kites” (Chit)

• Med Passes

• Detox protocols

• Clinic “Sick Call”

• Chronic Care (diabetes, hypertension, seizures, asthma, etc)

Routine Health Care:Sick call is offered five days per week for routine medical care. An inmate seeking medical attention can fill-out a medical request form (Kite). Kites are collected from the medical box, and prioritized according to medical protocol within 24 hours.

Violent offenses include murder, negligent and non negligent manslaughter, rape, sexual assault, robbery, assault, extortion, intimidation, criminal endangerment, and other violent offenses.

Property offenses include burglary, larceny, motor vehicle theft, fraud, possession and selling of stolen property, destruction of property, trespassing, vandalism, criminal tampering, and other property offenses.

Drug offenses include possession, manufacturing, trafficking, and other drug offenses.

Public-order offenses include weapons, drunk driving, escape/flight to avoid prosecution, court offenses, obstruction, commercialized vice, morals and decency charges, liquor law violations, and other public-order offenses.

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http://www.ojp.usdoj.gov/bjs/glance/corrtyp.htm

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Level of Nursing Care• Assessment & ongoing monitoring

• Dressings

• Splints

• Blood draws & specimen collection

• Nebulizer treatments

• Suture removal

• IV starts & infusions

• Injections

• Immunizations

• Accuchecks

• BCLS

• Client Education

• Med administration

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Inmate Health Issues• Most lawsuits by prisoners related to substandard medical

treatment

• Some prisons now contain geriatric wings

• HIV positive (1.9% male 2.8% female)

• AIDS rate is 3 x the general population

• Tuberculosis (TB) rates run higher than general population because prisons provide optimal conditions for the spread of this disease

• Serious mental illness rates are higher in the nation's jail system

HIV / AIDS2005 Statistics

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At year end 2005, an estimated 18,953 males and 1,935 females in State prisons were HIV-infected or had confirmed AIDS.

During 2005 an estimated 176 State inmates died from AIDS-related causes, down from 185 in 2004.

Among Federal inmates, 27 died from AIDS-related causes in 2005, up from 18 in 2004.

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Women in PrisonWomen in Prison

• Rather than form gangs

women tend to create pseudofamilies

• Some of these roles involve homosexual relationships

• About 2/3 of women in prison are mothers

• Many women in prison get pregnant  

• History of being physically & sexually abused and substance abuse very, very common precursor in this population  

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Some Basics• Meds/Drugs are trafficked – Mouth checks

• Everything can be a weapon – NEVER leave anything behind

• Be Vigilant for High Risk Suicide inmates

• Everything happens for a reason - Sneakers vs sandals• Seemingly benign objects can become a weapon !

• Security Emergency Response Teams (SERT)

• Information is power …over YOU!

• Feigned and self-inflicted illness provides chance to escape

• Spider Bites

• Pregnant inmates

• Medical Equipment

• Different levels of danger

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Prisoners in the HospitalSame

Safety & SecuritySafety & Security

Rules Apply

2007 Salt Lake City, Utah: Killed his guard in the Hospital when his metal shacklesWere replaced with plastic ties so he couldGet an MRI

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Fashion !

What does this represent?

Etiology?

What’s the Definition of “Rock & Roll ?”

Pop Cultural Expressions of Prison Culture…

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Is Correctional Nursing for You?

• Very high degree of autonomy

• Thinking on your Feet Required

• Delivery of healthcare is NOT the first priority

• A certain level of personal risk

• Client relationship is severely limited

• This client population reallypopulation really NEEDS your nursing care NEEDS your nursing care and advocacyadvocacy