|Author: Esther Martin|
|Respect and Teamwork in a Prison Setting|
|"Teamwork and respect are the keys to success in any setting," states Debra Lange, MSN, APRN, BC, adult primary care nurse practitioner for Correctional Medical Services in Okemos, MI. "However, they are particularly important here in a potentially
dangerous prison setting. I truly value the wonderful people I work with on a daily basis. Together, I feel we are making a difference for each other and for the prisoners while establishing a safe and respectful environment."
Lange came to work for Correctional Medical Services after many years as a registered nurse in more traditional clinical settings. Prior to becoming a nurse, she worked for several years as a police officer in the Detroit Police Department.
Despite her stint on the police force, Lange maintains, "I've always known that I wanted to be a nurse. In high school I was in the Future Nurses' Association. Financially, I could not afford to go to college immediately after high school, so I took one or two classes at a time at Wayne State University while working as an electroencephalograph (EEG) technician at Mount Carmel Mercy Hospital in Detroit.
"In 1977, I was hired by the Detroit Police Department. I accepted this position because it was another way to serve the public, which was my motive in pursuing a nursing degree. I spent three years as a police officer before continuing with my nursing studies. I then went to work as a nurse in both hospital and home care settings," Lange explains.
Lange feels that together, her police work and her hospital experience have thoroughly prepared her for the work she does today. "All of my previous work seems to have led me to the work I am doing today," she says. "While employed at St. Joseph-Mercy Hospital I was able to rotate through many different units, thereby broadening my nursing experience to all of general medicine. While working as a home care nurse for McPherson Hospital I gained valuable experience in working independently in people's homes and learned to make decisions based on my own knowledge, without relying on others, as one so often can in a hospital setting.
"Everything came together for me when I had a 'chance' encounter with a Wayne State University professor of nursing. It was from this individual that I first learned about nurse practitioners. I was really excited. After having been in the nursing field for a number of years, I knew I was capable of doing more with my career. I enrolled in the university's nurse practitioner program, majoring in adult primary care. Upon graduation I accepted my current position as adult primary care nurse practitioner for Correctional Medical Services.
"Correctional Medical Services is a company that provides medical service providers to the state of Michigan. They hire physicians, nurse practitioners and physician assistants for the 50 state prisons in Michigan. I have been assigned to two prisons, the Adrian Regional Facility and the Parr Highway Correctional Facility. One has just over a thousand inmates and the other just under a thousand. There is an M.D. at each facility. I work full-time rotating between these prisons. They are located right next to one another. The smaller one is a Level I facility and the larger prison is rated as a Level II. Prisoners are assigned to facilities by level, with one being the lowest and six being the highest. The nature of the crime is only one criterion that is looked at when inmates are assigned to prisons. For instance, at higher-level facilities inmates will be, among other things, more aggressive. There are men convicted of murder in the Level I setting, but they have worked themselves down to this lower level for varying reasons, one being good behavior.
"The facilities I work for provide health assessments, evaluations, treatment of acute and stable medical conditions and health maintenance. Along with the physician, the staff members I work with include nurses, secretaries and medical record personnel. Other services offered by the Health Services Department are optometry, dentistry, on-site radiology and psychological services. The Level I setting has psychologists and the Level II setting has a psychiatrist, psychologists and a social worker. The higher-level facility also houses individuals with mental illnesses that require medication for treatment and are lodged at what is termed the Residential Treatment Program. There are prisoners with mental illnesses in the lower setting too, but these people only require assessment and counseling, not medication. Not every prison has a psychiatric unit. I treat all patients, including those in Segregation/Detention. Patients are seen by appointment or on an unscheduled urgent basis. Health Services provides the inmates with information including current data regarding diagnosis, treatment, and preventative care. Emergency cases are sent out to a local hospital. If necessary, inmates are sent out for referrals, for example, to a surgeon, oncologist, renal specialist, etc."
Although busy completing a long list of nursing duties, Lange must always remain alert to potential danger on the job. "When I first began working here I did not know how I would feel working behind locked doors with potentially dangerous patients. There were a number of precautions I needed to learn in order to provide care yet maintain personal safety. For example, having awareness of dressing moderately with no jewelry and not revealing personal information. While I have encountered a few threatening situations, on the whole I have found that the majority of inmates realize that I am here to help them. Many of the prisoners have never had access to healthcare before. Many are very concerned about their health and are grateful for the opportunity to receive care."
Lange has found that a respectful, matter-of-fact demeanor goes a long way to maintain order and to educate inmates. "Healthcare is a basic right to every person, whether or not they are incarcerated," she states. "I am here to help my patients, not to judge them. I open up possibilities for that person to take responsibility for their own health. Hopefully this will help the prisoners to make a paradigm shift from thinking of the world in terms of victims and aggressors to feeling that they can work with other people to create positive changes for themselves and others.
"The respect I offer is nothing fancy. It is simply common courtesy. I address my patients as 'Mr. Smith', and keep my tone formal and nonjudgmental. I first learned the value of using this method while on the police force. The power of respect is such that it can turn a charged atmosphere into one of cooperation.
"As the prisoners become familiar with seeing me, they grow used to this attitude of respect. Over and over, I see their self-protective 'yard-attitude' drop away as they enter the examination room. Their movements and speech become less aggressive. This makes for a better teaching and learning environment. Many of my patients had no previous knowledge of how to take care of themselves. What I have to teach them is of great interest to them."
Lange meets the healthcare needs of young and old alike. "The inmates range from 20 years of age and older. I see scheduled and urgent/emergency patients. This can be for anything from an ear infection to a myocardial infarction. One of my key duties includes conducting chronic care clinics. This means that every prisoner with one or more chronic diseases is evaluated at regular intervals depending on the severity of their disease[s]. I provide preventive services and see both urgent and routine referrals. I document promptly with required forms and make segregation rounds. In addition, I issue special accommodations/diets/details when medically necessary, request offsite/specialty services when needed and follow patients every 30 days while waiting to see the specialist to determine if the patient needs to be seen more urgently. I also see patients on return from the offsite/ specialty service. In addition, I present educational in-services for staff.
"The other responsibility that I take very seriously is providing education and counseling about their lifestyle and risk factors. It is necessary to get the patient's buy-in and willingness to change their habits if they are ever going to be able to gain control of their diseases. For instance, smokers who eat spicy foods and lie down after eating are going to continue to have gastric symptoms."
A number of Lange's patients face deeper-seated problems than gastric reflux, however. "Many patients have a dependency problem, which is why they are in prison," she explains. "Robbery is often necessary to obtain money for their habits. Therefore, there is a lot of drug-seeking behavior. This makes it especially challenging to determine the real reason for the visit, especially if a specific drug is requested or demanded. For example, many inmates want the medication Neuronton. A custody officer informed me that prisoners mix this with Chlortrimeton, and then snort the combination to become intoxicated. There are also many patients with psychiatric disorders, which contributed to them committing a crime. The other diagnoses I frequently encounter are Hepatitis C and HIV, hypertension, asthma/COPD, dyslipidemia, diabetes and gastritis/GERD/PUD. Most of the inmates smoke and have been doing so for a number of years. This exacerbates their diseases. I am currently on a 'No Smoking' campaign. This is an immense task because almost every prisoner smokes. I discuss smoking with the patient every visit because of the impact it has on their disease[s]. . . As nurses, we know that disease processes are not going to change unless behavior patterns change. I work on having patients consider a different way of thinking. I discuss their need to take responsibility for their health by changing their lifestyle. Meanwhile I will work with them as part of a team, to improve their health for the future. I continually emphasize that they are the only ones who can produce the changes.
"Teamwork is not only important between myself and my patients. I feel very strongly that it is a team effort between myself and my colleagues and coworkers that makes it possible for each of us to accomplish our jobs. I am very appreciative of all the hard work everyone puts in on a daily basis, not only to assist me, but also doing their jobs to the best of their ability every day in a potentially dangerous and difficult environment."
Despite its inherent special challenges, Lange readily points out the positive aspects of her job. "Prison healthcare is a wonderful environment for an avid learner. I love it that I learn something new every day. I am responsible for the healthcare of a group of people who have every major and many atypical conditions. I see things that one might never see in a private practice; therefore I am gaining greater experience."
Debra Lange received her Associate of Science in Nursing from Wayne County Community College in Detroit, MI, in 1986. She earned her Bachelor of Science in Nursing from Wayne State University in Detroit in 1996. In 1999, she again graduated from Wayne State University with her Master's of Science in Nursing.
Esther Martin is a freelance writer from the Philadelphia area. She is on the editorial staff of NEWS-Line for Nurse Practitioners.