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decision-making model

In the correctional setting, the patient is at the core of professional nursing practice. The fact that the patient is incarcerated is only a circumstance of his or her situation and does not, and should not, change how the nurse practices or how the nurse views the patient. Correctional nursing allows the nurse to practice the essence of nursing while recognizing that all patients have intrinsic value. Achieving and staying true to professional nursing values while practicing in the correctional setting can create a unique set of ethical, legal and professional issues for the nurse. This article will examine some of the ethical and legal issues correctional nurses must address in their practice.

Ethical Concerns
For the nurse in a traditional medical setting, ethical decisions occur occasionally and at times the nurse may face ethical dilemmas. In contrast, the correctional nurse may face ethical situations daily. The correctional nurse makes ethical decisions about care delivery, caring and patient advocacy in planning and providing safe patient care.

There are six ethical principles that arise frequently for the nurse who works in the correctional setting.

1. Respect for persons (autonomy and self-determination)
2. Beneficence (doing good)
3. Nonmaleficence (avoiding harm)
4. Justice (fairness, equitability, truthfulness)
5. Veracity (telling the truth)
6. Fidelity (remaining faithful to one’s commitment)

These principles serve as a guide to the nurse in making ethical decisions. The correctional nurse can find support for ethical decisions by referring to the American Nurses Association’s code of ethics. The code delineates the ethical standards for nurses across all settings, levels and roles, setting expectations as well as providing guidance.

One of the common ethical concerns that arises for the correctional nurse relates to demonstrating caring in a custody environment. Correctional nurses must find balance in displaying an attitude of care and compassion while recognizing and maintaining safe boundaries.

Another area of ethical concern is the nurse’s responsibility for ensuring that patients have access to care. The values associated with nursing practice include nurse advocacy, respect for humans and eliminating barriers to care. The correctional nurse is in a unique position to evaluate the quality and effectiveness of patient care. He or she works with custody to ensure that the health needs of inmates are respected and responded to in a timely manner.

End-of life care is another ethical concern for the correctional nurse. Patients die while incarcerated and the nurse has a role in helping the patient to die with dignity and comfort. In some prisons, nurse participation in execution may arise as an ethical issue. The correctional nurse should not participate in executions. This position is supported by the ANA’s code of ethics and NCCHC‘sStandards for Health Services in Prisons (standard P-I-07). Participation in execution is inconsistent with nursing values.

Finally, professional practice is an area that can create ethical concerns for correctional nurses. Nurses are encouraged to refer to the ANA’s scope and standards of practice for correction nursing and to their state’s nurse practice act in addressing practice issues.