What is our community? Where do the parameters extend? Are there other nursing roles as yet undetermined? We are accustomed to working with the county health departments, the Visiting Nurses' Association and the community clinics. We are not attuned to working with some of the other health care workers in the community, particularly those in a correctional or "jail" facility. The population that makes up the society in a jail have multiple health needs; these needs must be met in a different environment than that which is traditionally related to health care.
To encourage students to be more knowledgeable of the health workers in their community, the nursing faculty of a baccalaureate nursing program in central Florida have successfully utilized a jail facility clinical experience for senior students.
The faculty selected this agency, in part, because of its reputation. Since June 1980, the health care program at the Orange County Jail facility has been accredited by the American Medical Association (AMA). The agency accreditation was the first in the state of Florida. In October 1983, the agency was accredited for an additional two years.
The faculty focused attention on the role of the nurse in a correctional facility. This role is both unique and varied. The nurse sees and interviews the inmate as soon as he/she has been fingerprinted and has had a picture made. Also, the nurse determines whether the health status of the inmate is stable enough to continue the booking procedure. If so, the health assessment and interview are completed. If the inmate requires immediate medical attention, i.e., hemorrhage from a stab or gunshot wound, the nurse determines whether the inmate will be sent to an emergency room.
Upon completion of the assessment procedure, the nurse determines the inmates placement within the jail. Placement determinants may include, but not be limited to, the following: diseases requiring isolation, possible suicide, threatening behavior, seizures, or changing levels of consciousness. Some considerations for single cell occupancy would be suicidal precautions and threatening behavior. Inmates with history of seizures or vertigo would be placed in lower bunks for safety reasons.
The inmate is made aware of the process he/she must follow to have health needs met. The evening and night nurses make up the next day's "sick call" lists for the MD, the RN, and the psychologist. The inmate must put the complaint in writing; the correctional officers gather the written complaints and present to the Charge Nurses on the two tours of duty. Any requests for care of minor complaints such as a headache are referred to the Charge Nurse during the tour of duty and the medicine/treatment nurse attends to these requests at once. If an inmate's request cannot be met in this way, the day tour Charge Nurse will assess the problem during '?? sick call" and the inmate may then be referred to the MD and placed on the "MD sick call" listing.
The student's role closely parallels the staff nurse role. The student initiates care and/or referrals through counsel with the staff nurse. The clinical period allows for a 16- to 24-hour assignment to one or two jail facilities within the Orange County Sheriffs Department. In both facilities the students participate with nursing staff in the daily "sick call" procedures, both RN and MD.
The students accompany and assist the staff nurses as they move throughout the various cell blocks to administer medication and carry out routine treatments associated with the medication regimen. Upon evaluation by the MD an inmate with such medical problems as diabetes, cardiovascular disease, urinary tract infection or respiratory disease is provided follow-up therapy. The overall plan of health care provides for therapeutic treatment, both psychologically and physically. Female inmates are provided routine gynecological health care, including monitoring of pregnancy during time spent in the jail.
The students assist in carrying out a variety of nursing skills: interviewing; health intake inventory; physical assessment; use of breathalyzer equipment; pap smear cultures; specimen collection; venipuncture; nutritional assessment; checking for fetal position; checking fetal heart tones; observing for initial contraction; dealing with anxiety and stress-related behaviors; hostile, combative or threatened suicidal behaviors; substance abusers; persons exhibiting or practicing alternative lifestyles for monetary purposes and the "lost souls," either young or old, who virtually utilize the jail as their refuge, to name a few.
During the spring semester 1984 clinical assignment to the jail facility, the faculty developed an assessment tool. This tool is proposed as a supplement to the intake forms currently in use.
To acquaint the students with health care protocol, each student is encouraged to peruse the two-volume set of signed, dated, typed protocols on hand at each nursing desk. During the 6 A.M.-2 P.M. tour of duty, the MD is generally available for consultation, but the protocols serve as their "set of orders" from 2 P.M. through 6 A.M. These protocols provide for nursing intervention for both the usual types of illnesses and any emergency situation.
The student also sees a health team approach to the inmate's problems. The nursing staff, the MD, the psychologist, and the dentist all provide professional care as required by the exhibiting signs, symptoms or behaviors. If any specialized health care is required, the inmate is provided referral and transported to the specific service.
Nursing theories or models are brought into focus in this type of health care environment. The students have been able to apply Dunn's Theory of Wellness, Maslow's Hierarchy of Needs and Henderson's Basic Needs of the Patient. Other theories and models, especially those related to stress/adaptation/roles can be readily applied.
In summary, a "jail" experience is a good choice for enhancing clinical skills. The students benefit by building upon the skills of physical assessment, psychiatric/mental health approaches, therapeutic communication, nursing diagnosis, patient care management and health team planning and implementation as well as the referral process. The students also benefit by identifying with a communitybased health care program where maintenance of health and prevention of illness are the focus.