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ETHICAL CASE

Breckinridge School of Nursing

ITT Technical Institution

Ethical Case

A Writing Assignment
Submitted
To Lara Christie
Nursing Program

By
Linda Cort

Crawfordville, Fl.
24 September 2015

ETHICAL CASE

Abstract
Nursing in correctional institutions has a variety of challenges. Maintaining her/his ethics and giving the
best care possible to those in which most of society would rather forget. As an advocate for patients the
nurse kind find herself/himself in difficult situations to uphold the standards of care set forth by the
profession.
Key words: Ethics, corrections, nursing, access.

ETHICAL CASE

The prisons are full of some patients that have committed some of the worst crimes imaginable. Many of
these inmates have never received any type of medical care. Maintaining standards of care and providing
care in a manner that is ethical can be difficult. In the free world, whether to receive medical care or not is
a choice someone is able to make. An inmate does not have this choice. They are stripped of many of the
rights that the free world has. All basic rights, choice in food, when to sleep, work, when to get up, when
to go outside and several others are removed. Access to health care is one right that should not be denied.
Receiving medical care in prison is labeled to be a violation and considered cruel and unusual punishment
when denied. Nurses and health care providers vow to do no harm. How does one in this area of health
care maintain this vow in an environment that is engulfed in removing human rights? As a prison nurse
you are faced with ethical dilemmas more routinely than the private sector.
The first thing as a nurse you are taught when entering the prison system in the State of Florida is you are
to address your patient by inmate. When charting on a patient/client any reference to the individual is to
be replaced by inmate. When addressing an inmate using sir is considered a violation. Inmates are to
address staff using this formal title and language, but staff are not permitted to return the title. Mr. Doe is
replaced by inmate Doe. As a nurse you are trained to care for patients as individuals to not identify them
by disease and to address them using formal title. A nurse must be careful that in addressing inmates per
policy does not change looking at the patient as an individual. An inmates individualism is removed from
them but as a nurse you must be able to see beyond this and give each inmate access to health care.
Access to care is often not thought about in the private sector. A client can easily call their provider and be
seen, drive to the nearest the hospital or even be taken to the hospital by ambulance. This is not so for the
inmates. An inmates especially in closed management mainly has to rely on staff to provide this access.
The primary ways an inmate has to access medical care is as follows.
1. Sign up for sick call.

ETHICAL CASE

2. Inform a correctional officer of the need for medical attention.

3. Complete an inmate request.
4. Declare a medical emergency
The article mentions an additional form of notifying the nurse during medicine administrations times.
This is against policy in the Florida Department of Corrections. Policy is in place stating that access to
medical care outside of sick call must be a medical emergency for the general populations. As was stated
earlier denial of medical care is a violation and the very policies of the department that have been
approved by legislation deny this access during certain times. As a nurse you must determine if the
medical concern is an emergency or refer the inmate to the procedure for sick call when a medical
concern is brought to you attention during your medication pass. To remain ethical it is important to
maintain this standard within the policy guidelines.
The policies are in place to cover many of your task in correctional nursing. These policy can conflict
with what most nurses feel is ethical. The consideration of safety is frequently what has resulted in the
policy and it is possible to work within the policy and still remain ethical. In your communication with an
inmate you must be fair, concise and consistent to be ethically sound. Teaching is priority to maintain
your ethics. By ensuring that the inmates is aware of what and how the policies are to be followed you are
more likely to not be presented with situations that require you to face a difficult situation. In dealing with
what a medical emergency is and what to your patient feels like a medical emergency be considerate of
what level they are on. In the general public if a person has a headache they can simply get some Tylenol
from the store. In prison although the patient can go to the officer and get a Tylenol many times the officer
may refuse to give them one. This situation may have been what has led to what to most would not be
considered as an emergency. How in this situation would you maintain your ethics and remain within
youre the policy that only true emergencies are to be treated outside of sick call. Is it ethical to deny the

ETHICAL CASE

inmate a Tylenol? Is giving the Tylenol and just not document it saying I mean its just a Tylenol
ethical and following policy? What would you as a professional do if that just a Tylenol caused and
adverse reaction and you came back to work to an inmate that had died from such reaction to an unknown
substance. When the blood test are run it is noted to have the presence of Tylenol. As the investigation
unravels it is noted that the inmate had not signed the log with the officers that they had received one but
had declared a medical emergency for a headache and was brought to medical. There is no indication on
the inmates chart of the medical emergency or a refusal has been signed without notation to what his
condition was. Why did the inmate declare this emergency and then refuse. Is what his condition at the
time have an influence on his death. Is this something that is ethical? That it had been given not
documented to just get the inmate and situation done so you could move to your next tasks. Yes this is an
extreme to its just a Tylenol but it is a possibility and harm can be done. As a nurse youre issuing of
that Tylenol and the officers is on a whole separate level. In this situation to maintain both ethics and
policy is as simple as a phone call. As an advocate to the inmate you must ensure that the officer is aware
of policy in regards to refusal to give the Tylenol. With this phone call to the officer informing them of the
policy medical care has not been denied, policy has been followed and the nurse is able to document the
situation in a legal manner that is also ethical.
A nurse should always remember if you are unable to work in an area that you feel you cannot provide
care in an ethical manner you are responsible to change the environment you work in. If you as a
professional find that you are denying an inmate for either his crime or behavior you as an individual need
to evaluate the choice to work in such environment.

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References
Mary V. Muse, M. R.-R.-A. (2012). Ethical and Legal Issues. Retrieved from National Commision
on Correctional Health Care: http://www.ncchc.org/cnp-ethical-legal