3 years ago

DNA Reporter - August 2017

  • Text
  • Correctional
  • Nursing
  • Offender
  • Healthcare
  • Delaware
  • Sepsis
  • Discharge
  • Association
  • Aging
  • Population

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Page 4 • DNA Reporter August, September, October 2017 Nursing Care of the Pregnant Offender ARhonda Osborne, RN ARhonda earned her Associate of Applied Science Nursing degree from Salem Community College in 2016 and is currently enrolled in Wilmington University’s BSN program. She began her career in healthcare back in 2005 where she was a certified nursing assistant in the intensive care unit in Virginia. ARhonda later obtained her LPN certification in 2009 from Patrick Henry Community College. She is currently the dayshift charge nurse at Hazel D. Plant Women’s Correctional Facility where she is responsible for the various healthcare needs of approximately 80 patients. Before becoming a nurse, ARhonda was a Correctional Officer for 7 years! She prides herself in making a difference in her patients’ lives. The best way to contact ARhonda is by email at ARhonda Osborne In the female correctional institution, special attention needs to be given to offenders who are pregnant. When performing nursing care for the pregnant offender, the needs of the offender and the unborn child have to be met. Special attention should be given to the pregnant offender when considering medical care because the offender could experience depression, the unborn fetus could be affected because of lack of proper medical care, and the necessary postpartum care may not be sought if the offender does not have support upon her release. It is the responsibility of the nurse to ensure that the offender is receiving the necessary care she requires to reach the point of conception of a healthy baby and the proper resources to follow-up with postpartum care. In the legal system, pregnant females are being sentenced to prison which will require them to receive prenatal care to the conception of the baby. There are several considerations that have to be taken into account when caring for a female offender: Does the patient require mental health services? Has the patient been receiving prenatal care prior to being incarcerated? Does the patient have preexisting chronic care concerns that can negatively impact the pregnancy? Does the patient have a substance abuse problem? Upon intake, the offender has a physical assessment; part of which requires a urine dipstick pregnancy test. If the offender is visibly pregnant, a pregnancy test is not required, but the offender will be asked what her expected delivery date is; regardless of whether the offender has received prenatal care prior to incarceration, all offenders are referred and seen by an OB/GYN within seven days (Department of Corrections [DOC] Policy E-02 pg. 5-6, 2016) for an ultrasound to determine the expected delivery date and the age of the fetus. Prenatal care is available to all patients while incarcerated as well as postdelivery. During this time it is important for nurses to provide a supportive and nonjudgmental environment, make sure that all necessary referrals have been processed, and that the patient is educated about possible pregnancy related complications. The mental status of pregnant incarcerated females must be evaluated continuously due to the possibility of depression. Considering this population’s environment and situation, it would seem that pregnancy would increase their stress level and negative experience, resulting in a poor experience of pregnancy and possibly depression during or after the pregnancy (Williams & Shulte-Day, 2016). The pregnant offender often verbalizes feelings of melancholy when the thoughts of being incarcerated upon delivery occur; the offender may also experience the shame of being incarcerated while pregnant which could trigger feelings of depression. If a patient experiences depression throughout the pregnancy the chances of preterm labor increases, therefore increasing the chances that the baby will be born with a low birth weight. Because of their pregnancy, offenders have more stressors than the average female offender (Hutchinson, Moore, Propper, & Mariaskin, 2008) such as separation from the infant, not being given time to bond with the infant, and intense sadness. If a pregnant offender is receiving psychotropic medications to decrease depression, there may be a risk to the unborn child because the medications cross the placenta. The first trimester of pregnancy is the most risky because during the first eight weeks of pregnancy, the negative side effects of psychotropic medications are greater in relation to the fetus being affected (Usher, Foster, & McNamara, 2005). Some of the most serious negative effects on the infant could be respiratory depression and difficulty feeding. Although treating the offender’s depression is worthy of attention, a balance between a healthy baby and the mother’s mental state has to be made. If prescribing a medication cannot be avoided, the lowest possible dose should be considered by the mental health provider during the first trimester or prescribe the medication for the shortest time so that the fetus will not be affected (Usher et al., 2005). If an offender is prescribed psychotropic medications during her pregnancy, she will require education on the risks involved when opting to breastfeed upon her release from prison as well as the risks involved while she is pregnant. Nurses have to advocate for pregnant offenders who are on prescribed psychotropic medications because some of these offenders may have mental health diagnoses such as schizophrenia or bipolar disorder that must be treated with medication; if the offender is not properly medicated, there would be a chance that the baby may not be properly cared for upon release because the mother’s mental state isn’t balanced. In the majority of cases patients must return to prison after the birth of their baby. Prior to the birth of the child, there has to be a plan developed by the interdisciplinary team and the patient that is focused on the psychological problems that the mother may face, the postpartum period, and the care of the infant while the mother is still incarcerated. In some cases, the infant is placed in foster care until the mother is released or a relative opts to care for the child. Another concern to be taken into consideration is whether the offenders will have custody of their infants after they are released; if the offender will have custody of the infant upon release, will financial assistance be available for her and the infant? Knowing that most women involved in the criminal justice system struggle financially, would seem that if mothers were caring for their children there would be evidence of food stamps, Medicaid, or welfare benefits in the mother’s name with their child’s name attached to the case (Pimlott, Kasiborski, & Schmittel, 2010). In some states, government assistance may not be available based on the charges. If the offender has a substance abuse history, it would be harder for her to regain custody of her infant. Social service counselors would have to be involved with referring the offender to human services organizations that provide preventative services so that the offender can have an opportunity to keep her child upon release (Pimlott et al., 2010). Termination of parental rights is also a factor to be considered because there can be a higher risk of child abuse, neglect or injury with mothers who have a criminal or substance abuse history. Social service counselors have to consider the well-being of the child and the child’s safety to enhance the child’s quality of life upon the mother’s release (Pimlott et al., 2010). Overall, the pregnant offender is a very delicate issue that should not be overlooked or taken lightly. It is imperative that nursing staff advocate for their patients, educate their patients, and provide an honest, supportive, and nonjudgmental environment. It is of utmost importance that these patients are followed closely, and, all appropriate referrals are processed so the patient has the best opportunities available to her and her unborn baby while in our care. The goal is to have an uneventful pregnancy as well as a positive outcome for the mother and infant in the event that the offender has to return to prison after the delivery. References Department of Correction Policy Manual (2016, October 28). Policy number E-02. Retrieved from Hutchinson, K.C., Moore, G.A., Propper, C.B. & Mariaskin, A. (2008, December 1). Incarcerated women’s psychological functioning during pregnancy. Psychology of Quarterly, 32(4), 440-453. Pimlott, K.S., Kasiborski, N. & Schmittel, E. (2010, January 1). Assessing long-term outcomes of an intervention designed for pregnant incarcerated women. Research on Social Work Practice, 20(5), 528-535. doi: 10.1177/1049731509358086 Usher, K., Foster, K., & McNamara, P. (2005, December 1). Antipsychotic drugs and pregnant and breastfeeding women; the issues for mental health nurses. Journal of Psychiatric and Mental Health Nursing, 12(6), 713-718. Williams, L. & Schulte-Day, S. (2006, January 1). Pregnant in prison-the incarcerated woman’s experience: A preliminary descriptive study. Journal of Correctional Healthcare, 12(2), 78-88. You’ve earned your dream job. We’ll help you find it at Your free online resource for nursing jobs, research, and events.

August, September, October 2017 DNA Reporter • Page 5 Discharge Planning in the Correctional Institution Heather Trembler, RN Heather earned her ADN from Cecil College in May of 2016. After graduation she took an interest in Correctional Healthcare and obtained a position as the evening registered nurse at Hazel D. Plant Women’s Correctional Facility in New Castle C o u n t y, D e l a w a r e . Heather is responsible for facilitating the healthcare needs of patients on her shift Heather Tremble including: admissions & discharges, medication administration, and managing emergency health care needs. She loves her position and looks forward to serving this population. Heather is now enrolled in the University of Maryland’s BSN program to further her education. The best way to reach Heather is by email at Successful and precise discharge planning is imperative in the correctional institutional environment to an offender’s successful reentry into society. It can interfere with the continuity of care of the offender; which directly correlates with the offender’s ability to transition from a correctional environment to a community. It impacts the likelihood of offenders returning to jail/prison, returning to addictive behaviors, and the expensive relapse of communicable diseases, chronic diseases, and mental illnesses. In order for a nurse to be successful in the correctional environment and to be a true advocate for the offender, the nurse must skillfully provide discharge planning and reentry education. Offenders and their nurses will face many challenges when it comes to discharge planning, but nurses must stay true to the code of ethics that a nurse practices by and ensure that the offender’s rights, health, and safety are protected. In the first two weeks of release, former inmates are over 12 times more likely to die from health problems than is the general population (Vigne, Davies, Palmer & Halberstadt, 2008). Discharge planning is especially crucial for this population to ensure successful reentry from incarceration to the community. By definition, continuity of care is the quality of care that is given over a period of time. It is the process by which the offender and his/her care team are cooperatively involved to facilitate in an ongoing health care management plan; focusing toward the shared goal of high quality, cost-effective medical care. Offenders and healthcare providers face many obstacles when it comes to an offender being discharged from a correctional facility and receiving continuity of care. An offender may be distracted, ensuring that their basic needs are met such as clothing, food, and financial resources; but as a healthcare provider one must also be concerned and concentrate on an offender’s ability to access healthcare, acquire insurance, and receive the proper follow-up treatments upon release. Continuity of care reduces fragmentation of care, thus improving offender safety and quality of care. The lack of proper discharge planning increases the likelihood of offenders returning to jail/prison, returning to addictive behaviors, and the expensive relapse of communicable diseases, chronic diseases, and mental illnesses. Studies have shown reduced recidivism rates when the offender follows up with community based aftercare (Baron et al., 2008, p.48-56). Once it is understand that successful and effective discharge planning is essential to continuity of care, the nurse will be more successful in the correctional system. Research has shown that public health is critical to public safety, so discharge planning is becoming increasingly prioritized. Discharge planning can be broken down into three segments; admission, incarceration, and discharge. Discharge planning begins when the offender is admitted to the correctional facility. During incarceration, treatment begins when the offender seeks healthcare or is seen as part of a mandatory health assessment. His/her healthcare is aimed at rehabilitation, stabilization, and prolongation. Discharge is when the offender is being released from the correctional institute. Discharges cannot always be anticipated. Reasons for this include but are not limited to bail being posted, charges being dropped, or sentences being reduced. For this reason, it is important that there is appropriate and sufficient coordination between the correctional facility and next step resources in the community during the period of incarceration (Mellow & Greifinger, 2006). What are some of the obstacles for discharge planning that offenders face? Many offenders have on the importance of funding for reentry programs designed to help keep recidivism rates low and their long-term cost saving value using evidence based practice. Be proactive in discharge planning. If discharge planning starts at admission, as it should, then the unknowingness of the impending discharge will still be a smooth process. Advocate for the offender. Upon discharge, instructions on how to obtain medical insurance and proper identification can help the offender immensely. It would also be beneficial to provide them with a list of local health facilities, drug treatment programs and counseling no form of identification at the time of release, services available in the community. Discharge including birth certificates and social security cards. Without a valid form of identification, it is hard for any offender to receive medical care. A lack of education about the importance of attending follow-up appointments may prevent offenders from packet contents may vary by site due to location, but all packets should contain the same basic information. Where needed, ensure that the offender has necessary care appointments made for any medical or behavioral health issues before discharge. keeping appointments that have been made to help Provide the offender with the phone number, smooth the transition in to after care. Offenders lose their benefits upon being incarcerated. When they do reapply, public agencies are reluctant to reinstate the offender until they have a permanent address in the community. Not only are they reluctant, but the typical review of an application for Supplemental Security Income/Social Security Disability benefits takes about three months and Medicaid may take up to 45 days (Vigne et al., 2008) What are some of the obstacles that nurses may face when discharge planning? Starting with the fact that annual correctional budget across the nation is billion, and only 12% of that being devoted to health care (and only a portion of that for discharge planning) poses complications on the ability to be able to provide health care in general (Mellow & Greifinger, 2006). The aforementioned unknowingness of discharges by the correctional address, and date of appointment in writing and stress the importance of not losing the paperwork so that the offender does not forget the appointment in lieu of excitement or anxiousness of discharge. It is also important to remember other documents such as reviewing with and having the patient sign a release of information. This will allow their health information to be forwarded to the appropriate agencies for follow up care. Lastly, in compliance with the facilities procedures and protocols ensure that all discharge medications have been ordered to prevent any lapse in medication compliance. Overall there will be many challenges that nurses and offenders will face upon discharge. However, it is a nurse’s duty to always advocate for and protect their patient. Looking at provision three of the American Nurses Association Code of Ethics “the nurse promotes, advocates for, and protects the facility makes discharge planning even more rights, health, and safety of the patient” (Morrisard). difficult because without being able to anticipate a release date, it can be difficult to schedule follow-up appointments with outside providers/facilities in the community. Electronic health records are usually In the correctional facility, the offender is your patient; in order to effectively protect the offender, one must strive for effective discharge planning to allow for successful reentry in to the community. not accessible across jurisdictions, let alone bridged References from the correctional facility to the outside facilities. Baron, M., Erlenbusch, B., Moran, C., O’Connor, K., Rice, This disconnect between correctional institutions and community providers results in lapses of care, repeat (expensive) testing, interruption and errors in K., & Rodriguez, J. (2008). Best practices manual for discharge planning: Mental health and substance abuse facilities, hospitals, foster care, prisons and medication administration, and overall unorganized jails. Retrieved from publicnotices/20150519resource2.pdf transition of care. Medical records can be requested, Mellow, J., & Greifinger, R. B. (2006). Successful reentry: but their preparation takes time and might not be The perspective of private correctional health care available prior to an offender’s follow-up appointment providers. Journal of Urban Health, 84(1), 85-98. in the community. doi:10.1007/s11524 006-9131-9 What can nurses do to provide for better Morrisard, J. (n.d.). ANA Code of Ethics. Retrieved from continuity of care? It starts with education. On a small scale, educate the offender on the importance Vigne, N. L., Davies, E., Palmer, T., & Halberstadt, R. of following up in the community and maintaining (2008). Release planning for successful reentry a guide for corrections, service providers, and community optimal health. On a larger scale, educate politicians groups. 17-20. doi:10.1037/e719382011-001 Welcome New & Returning Members Kathleen Andersen Nichole Baker Caroline Bangi Kayla Bergstrazer Pamela Boyd Annamarie Breeden Valarie Brown Jessica Brown Julia Bucci Jaci Burdett Jane Campbell Kenya Cannon Sonia Canty Naomi Cebenka Stacy Cole Leslie Combs Julia Cortilesso Kathleen Denight Cielito Didomenico Jena Evans Maria Eyekpimi Tara Gades Wilmington Milton Newark Smyrna Townsend New Castle New Castle Clayton Bear Felton Bear Middletown Middletown Wilmington Claymont Smyrna Dover Middletown Bear Milford Smyrna Wilmington Jay Green Cynthia Griffin Janice Heinssen Tiffany Kastle Boyer Danielle LeGates Diana Maroudas Elizabeth Miller Alexis Murray New Christine Parsons Carolyn Ray Michelle Roberts Tracee Sherlock Cornelia Torjilar Renee Tucker Casey Velon Kaitlyn Wasno Brian Wharton Danielle Williams Christina Williams Theora Wisher Hockessin Middletown Wilmington Marydel Lewes Wilmington Lincoln Castle Dover Bethany Beach New Castle Hockessin New Castle Dover Wilmington Wilmington Hockessin Newark Middletown Newark

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