The House of the Least of These
Submitted by Stefani Clowers, RN
Tags: compassion ethical principles in nursing trauma
A correctional facility is truly the “house of the least of these”. Jails and prisons are full of people who desperately need advocates. Too often it is the oppressed, the orphaned, the under-served, and the vulnerable in society who find themselves incarcerated. This is especially true when the correctional facility is for children. I briefly worked in adult corrections, but for the past five years have been the nurse in a jail for children. I have heard these kids carelessly referred to as "throw away kids" or “animals” by the adults in their lives who should be protecting and encouraging them. This lack of empathy can be bridged by nurses who recognize the value and potential in each person regardless of their social status or story. For far too long, our incarcerated patients have had too few people on their side, fighting for what is best for them, but nurses can change this with advocacy and, potentially, make a lasting difference in many lives.
Corrections nurses can play a pivotal role in changing the destructive “US versus THEM” mentality that is often fostered by both the incarcerated and those in charge. Simply living out our responsibility as advocate, nurses have the ability to both influence the culture of corrections and the way our patients experience their incarceration. Nurses in Correctional Facilities don’t just pass pills and bandage wounds; we have the unique opportunity to demonstrate dependability, trustworthiness, and to provide a positive experience with healthcare providers. Often, those in underprivileged neighborhoods are untrusting of the healthcare system (and for good reasons, in many cases!). I knew of a (non-medical) correctional facility leader who would instruct the guards to “treat all the inmates like they are murderers”.
Unfortunately, this attitude is not uncommon in corrections, but, as nurses, we have an opportunity to combat the negative effects this mindset has on facility morale. (Imagine you were locked inside a building and totally dependent on the people who treated you like you were a murderer. How would that affect your attitude, your emotions, and your actions?) Nurses can combat this by advocating for their patient’s safety and wellbeing. Taking the time to note behavioral and emotional changes in a patient, inquiring about mental well-being, and being an active listener is all part of being an effective advocate. Nurses can further advocate for their patients by making referrals to mental health professionals when needed, ensuring medications are given properly, providing education about the medication (reiterating the medication is not going to work immediately and encouraging patience and consistency), as well as monitoring for effectiveness. The nurse can advocate by demonstrating compassionate honesty when educating on conditions and diagnosis. One of the things I have been tasked with is providing education on sexually transmitted infections. This can be done in a factual, yet age-appropriate way that is nonjudgmental and doesn’t embarrass, degrade, or blame. Maintaining confidentiality is another great way to build trust and create open lines of communication between the patient and the nurse. Nothing says “you are important, you matter” like advocating for the patient. As nurses, we advocate by taking our patient’s questions and concerns seriously. Unfamiliar or new symptoms can be scary, especially when in an environment you have no control over. We can also advocate for our patients by simply believing them. I have heard of incarcerated patients who were locked in a cell alone while experiencing seizures because staff assumed they were “faking it”. Or fractured limbs going untreated and asthma attacks ignored because of the same assumption. We must prioritize our incarcerated patient’s best interests and let them know we are advocating for their safety and their health, especially in a place where they are essentially powerless to advocate for themselves.
The difference nurse advocacy can have in the incarcerated patient’s family is also substantial. Just knowing a loved one has trustworthy people in their corner is invaluable to the family and helps alleviate hopeless feelings, which can be overwhelming. Advocacy matters and is an impactful way to make meaningful change in our incarcerated patients’ lives, while increasing the overall health and safety in our jails and prisons, our “houses of the least of these”.