How to Write a Professional Capstone and Practicum Reflective Journal

Week One 

A correctional facility is a demanding setting due to security protocols. While I was persistently confronted with issues related to security, I had to perform my assigned duties within a context of competing interests or conflict between custody and caring. I noted that the potential for spreading tuberculosis within the correctional facility is high because of various health concerns. The history of substance abuse and disparities in the correctional environment predispose inmates to multiple illnesses (Dhaliwal & Hirst, 2016). However, the correctional environment is largely nurse-driven. A nurse must provide care without any disparity, fear, or favor. Nevertheless, the potential for violence is high because I was in an all-male correctional facility. Before my practicum, I perceived working with offenders as stressful and dangerous. Research shows that care providers should always be aware of the psychological and physical risks involved while working in correctional facilities (Dhaliwal & Hirst, 2016). Therefore, my intentions largely shifted from providing care to coping with security.

I was confronted with the security-versus-caring conflict. How can I control the spread of tuberculosis in a caring manner without risking my security? In other words, should I prioritize my security concerns or provide caring care? In some instances, I experienced reduced care towards some offenders. I knew this is approach will hinder the development of the nurse-patient relationship. However, I realized that I had to apply ethics in order to provide individualized assistance and care. Caring is a mandate for nurses. While correctional facilities may pose security risks, nurses must provide care and assistance in a caring manner (Dhaliwal & Hirst, 2016). My goal was to point out challenges and offer possible recommendations to enhance caring in correctional nursing.

Reference 

Dhaliwal, K., & Hirst, S. (2016). Caring in correctional nursing: A systematic search and narrative synthesis.  Journal of Forensic Nursing ,  12 (1), 5-12. https://doi.org/10.1097/jfn.0000000000000105 

Week 2 

Nurses are the main care providers in correctional system. Therefore, a nurse needs to use expertise and knowledge, which may include evidence-based decision-making aimed at improving nursing practice. I noted that the correctional institution focuses on supervisory care and security. The controlled and penal settings present new contextual challenges for the nursing practice (Almost et al., 2013). It is essential for nurses employed in correctional system to obtain on-going training that would broaden the scope of their practice (Almost et al., 2013). The use of evidence-based practice or EBP is necessary for nurses working in correctional facilities. One of the examples of EBP is infection control. The last thing I wanted to do is to treat acquired tuberculosis within the facility. In addition to wearing protective gear, I advised the population of interest to keep their rooms clean, cover their mouths when coughing, and wash their hands always.

Some of the new practices that increase the care of patients include hourly rounds and reorganization. Periodic visits help to reduce the stress of infected inmates. Increased access to nurses reduces the use of distress buttons. Regular interactions inmates feel loved. The purpose of hourly visits was to enhance their experience. I also made timely reports and shared them with patients and nurses. The aim was to reduce unnecessary patient questions when new nurses report for their shifts. I also ensured the needed resources were within reach. Reorganization of supplies is vital in the correctional facility, especially when patients need emergency care.

Reference 

Almost, J., Gifford, W. A., Doran, D., Ogilvie, L., Miller, C., Rose, D. N., & Squires, M. (2013). Correctional nursing: a study protocol to develop an educational intervention to optimize nursing practice in a unique context.  Implementation Science: IS ,  8 , 71. https://doi.org/10.1186/1748-5908-8-71 

Week 3 

It is vital to balance medical provision and security in the correctional facility. Interprofessional collaboration between nurses and officers in a correctional facility is necessary. In most instances, I realized that prisoners tend to see nurses as “soft” and officers as “hard.” There were times when prisoners brought family-related issues to the nurses’ attention. However, even though nurses are “carers,” they have to remember that they are working with prisoners (Foster et al., 2012). I think that collaboration is vital because, as a nurse, I cannot close some boundaries. Sometimes, I felt that some individuals were faking illness. Therefore, faking illness was the main reason for disagreement and tension between the officers and the care team. I think that collaboration helps to reduce manipulation from the side of the prisoners.

While providing care in a correctional facility, there is always a conflict between security and care. However, collaboration helps to establish when security becomes paramount. Nevertheless, it is vital to recognize the fact officers have the duty to enhance security, and hence, hold a commanding rank in the correctional setting (Foster et al., 2012). Nurses and doctors, for instance, have to make referrals to some patients. Hence, they have to collaborate or inform the officers to plan for security. Collaboration makes a correctional facility an enjoyable environment. I felt that we all play a crucial role in making our communities safer. Although officers are not health care professionals, they are regarded as part of the team. In a normal care facility, an interdisciplinary team is made up of care professionals from different specializations. In the correctional facility, officers are a crucial link. They offer security and protect care officers from possible harm.

Reference 

Foster, J., Bell, L., & Jayasinghe, N. (2012). Care control and collaborative working in a prison hospital.  Journal of Interprofessional Care ,  27 (2), 184-190.  https://doi.org/10.3109/13561820.2012.730073 

Week 4 

Clinical independence is vital in the provision of nursing practice and expertise in correctional settings. The link between caregivers and patients appears to be a forced one because prisoners have no choice. In such a case, therefore, the provision of optimal medical care in correctional facilities is challenging. Independence in terms of providing care is a critical component of health, yet the correctional facility did not meet this standard. For instance, legal regulations, security, and working terms cannot allow prisoners to make a free choice. The correctional facility had guidelines that govern clinical systems and care delivery (Pont et al., 2018). Most of these guidelines tend to focus on security. Care providers have to work within the recommended legal system when dealing with some prisoners.

During the provision of care services, health care services often report to correctional officers as opposed to health care leadership. There is a military-like structure and chain of commands, which the team has to follow. In the delivery of care, the care team is often forced to take part in custodian measures. This a challenge that complicated the control of tuberculosis spread within the facility. Some prisoners feel that the care team is working hand-in-hand to monitor them (Pont et al., 2018). I thought that the care systems in the care facility tend to lean towards security. The system largely overlooks the care of patients. I feel that correctional structures and laws tend to conflict with health care ethics. The patient is not the priority; instead, security is the concern.

Reference 

Pont, J., Enggist, S., Stöver, H., Williams, B., Greifinger, R., & Wolff, H. (2018). Prison Health Care Governance: Guaranteeing Clinical Independence.  American journal of public health ,  108 (4), 472–476. https://doi.org/10.2105/AJPH.2017.304248 

Week 5 

Recognition and inclusion of patients' cultural preferences into the tuberculosis care plan in the correctional setting require a nurse to negotiate between care and custody. The penitentiary environment requires a nurse to be fair, firm, and consistent in making decisions. Even though I did not encounter the cultural inclusion issue, I learned that there are firm boundaries between caring and custody. In most instances, there must be teamwork when negotiating custody and caring. Correctional officers have to ensure security comes first. However, I feel that effective treatment and controlling the spread of diseases must incorporate patients' cultural preferences. Nevertheless, it may be challenging to address issues related to culture and ethnicity because there is a negotiation between caring and custody (Clark et al., 2017). Hence, failure to address the issues mentioned above can increase health disparities in the correctional system.

Controlling the spread of tuberculosis in a correctional facility may not be easier because of structural barriers. In particular, care providers and officers must follow policies, regulations, and laws in regard to incarcerated individuals. In general, I realized that there is a constant tension between care and custody goals. Research also reveals that medical care goals are constantly at odds with custody or the prison system (Clark et al., 2017). I think that there is a need for interventions at different levels to improve cultural inclusivity. For instance, policy and structural changes will help to foster inclusion. Moreover, the medical team and correctional officers need to collaborate to enhance the delivery of care. I feel that teamwork is the most feasible solution for now.

Reference 

Clark, K. A., White Hughto, J. M., & Pachankis, J. E. (2017). "What's the right thing to do?" Correctional healthcare providers' knowledge, attitudes and experiences caring for transgender inmates.  Social science & medicine (1982) ,  193 , 80–89. https://doi.org/10.1016/j.socscimed.2017.09.052 

Week 6 

Individuals who undergo through the correctional system experience considerable rates of acute, chronic, and behavioral health concerns than the general population. I noted that the correctional facility has the highest number of inmates from low-income families, and hence, medically underserved. I noted that the correctional facility had high health disparities because of there is a lack of connection between care providers and the criminal system (Trotter et al., 2018). For instance, while the inmates have a high potential for tuberculosis infection, they have limited access to care providers. Sometimes, a health care provider must treat some high-risk individuals in the presence of officers.

Several factors contribute to health care disparities in the correctional facility. For instance, cultural insensitivity results in disconnect between care providers and patients. I think that cultural sensitivity can help in controlling the spread of tuberculosis. Prisoners may not listen to the care providers because we do not consider the views (Trotter et al., 2018). Secondly, care providers understand the importance of ethics and respecting patients’ opinions. However, there is tension between custody and caring. In the correctional setting, custody becomes a priority. This means that care providers have to collaborate with officers to provide treatment. Moreover, nurses have to work within the stipulated laws, policies, and regulations. In most instances, regulations limit the inmates’ rights and freedoms surrounding the provision of care. In general, high health disparity in the correctional facility can affect infection control efforts. I think that nurses should lobby when necessary. I believe that teamwork allows care providers to lobby for inmates’ medical access.

Reference 

Trotter Ii, R. T., Camplain, R., Eaves, E. R., Fofanov, V. Y., Dmitrieva, N. O., Hepp, C. M., Warren, M., Barrios, B. A., Pagel, N., Mayer, A., & Baldwin, J. A. (2018). Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study.  JMIR research protocols ,  7 (10), e10337. https://doi.org/10.2196/10337 

Week 7 

Health begins at homes, workplaces, and communities. The incarcerated population is vulnerable to various health disparities. For instance, the incarcerated population may not eat well to boost their immune system. Besides lacking constant screening and testing, they have limited access to health care providers. Therefore, a myriad of different factors influences the health of the incarcerated population. In the context of controlling tuberculosis, the correctional facility exposes individuals to cross-contamination. Factors such as economic and social opportunities influence a population’s health. I interacted with the incarcerated individuals and realized that regulations and policies hinder effective access to care services. Healthy People 2020 talks about the need to improve the social components of health. In other words, the correctional procedures and regulations need to create the physical and social environment that enhances health for all.

There is a need for the care providers and correctional officers to collaborate to enhance the physical and social factors that influence health. I think that the correctional system needs to provide an opportunity for all incarcerated individuals to access quality care (Social Determinants of Health n.d.). Poor population health outcomes in the correctional facility can lower the health status of a community. The incarcerated individuals interact with the outside community, such as the nurses, officers, the justice system, and relatives. Outsiders who come into contact with these individuals are exposed to tuberculosis. In general, while correctional officers may focus on custody, I think that there is a need for creating a caring environment to improve population health.

Reference 

Social determinants of health | Healthy people 2020 . (n.d.). Healthy People 2020 |.  https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health 

Week 8 

A professional nurse must demonstrate respect and compassion for all patients. In week eight, I focused on practicing dignity and treating all individuals in the correctional facility as unique, despite their social and economic status. However, the provision of care in the correctional setting presents an ethical dilemma. How can a nurse ensure human dignity and integrity in providing care in a correctional facility? I realized that it is challenging for the correctional system to observe fairness and dignity towards individuals who have committed cruel things (Zirak et al., 2017). I realized that nurses have to acknowledge how they feel towards individuals in correctional facilities. For instance, I learned to acknowledge my emotions in order to make positive changes. When I expressed negative emotions, patients tend to disconnect.

Nurses need to be seen as change makers in the correctional facility. In most instances, we do not know about the crimes of patients. It is essential to look past patients’ mistakes. Our responsibility is to provide care with integrity and without discrimination. While integrity is crucial, nurses need to know the rules and follow them. For instance, I was not responsible for enforcing the rules, but I have to understand the language and behavior of inmates. Therefore, I had to collaborate with officers to know my boundaries (Zirak et al., 2017). Finally, I realized it might not be the best interest of nurses to bring charges against patients. This can affect the nurse-patient relationship negatively. In general, integrity is creating boundaries and working to enhance the nurse-patient relationship.

Reference 

Zirak, M., Ghafourifard, M., & Aliafsari Mamaghani, E. (2017). Patients' Dignity and Its Relationship with Contextual Variables: A Cross-Sectional Study.  Journal of caring sciences ,  6 (1), 49–51. https://doi.org/10.15171/jcs.2017.006 

Week 9 

The corrections department is largely responsible for safeguarding the life of the inmates. The department implements policies that enhance the safety and health of all the inmates. Inmates have rights with respect to information sharing and use. Mainly, correctional facilities experience similar challenges like public health facilities (Butler & Murphy, 2014). For instance, I realized that a correctional facility negotiates how to provide better care at a reduced cost. I think one of the challenges facing the correctional system is the lack of an effective policy. There is a need for a comprehensive health policy that can govern the provision of medical care in correctional facilities. For instance, most prisoners are not ensured. In most instances, I realized that the correctional facility struggled to find inmates’ correct information.

Having a health policy will help in governing the use of information technology. Information technology will enhance the delivery of services. An information system will play a leading role in controlling the spread of tuberculosis. However, once an individual is released, access to medication can be challenging due to the lack of insurance coverage. Therefore, a health policy will go a long way in connecting correctional and the general public health system. I also believe that correctional facilities need to exchange information to enhance patient care (Butler & Murphy, 2014). In general, a policy initiative needs to focus on improving care coverage in the correctional system. As well, a policy will manage the use of information technology. I realized that some prisons still use paper records. A policy can manage the application of electronic systems in the correctional system.

Reference 

Butler, B., & Murphy, J. (2014). The impact of policies promoting health information technology on health care delivery in jails and local communities.  Health Affairs ,  33 (3), 487-492.  https://doi.org/10.1377/hlthaff.2013.1125 

Week 10 

Nursing leadership can go a long way in enhancing the delivery of services in the correctional facility. However, nursing leadership must consider the cost of the services. Firstly, I recognized the need for transformational leadership. Correctional facilities need leaders who demonstrate behaviors that influence patients positively. In other words, leaders need to act as role models. Moreover, leaders must inspire patients in order to form sustainable relationships. In addition, nurse leaders must demonstrate high ethical standards when necessary. However, it is essential to remember that ethics in the correctional facilities are guided by policies and procedures (Dhaliwal, & Hirst, 2018). In general, I think that transformational leadership will help correctional facilities to recognize the importance of caring. In particular, the collaboration will be useful in balancing caring and punitive measures.

Moreover, while I managed to control the spread of tuberculosis, it is vital to remember that correctional facilities do not focus on profits. Therefore, the objective of care in the correctional facility is to offer better care at a reduced cost. It is also necessary to point out that prisoners may lack medical insurance. It is, therefore, the responsibility of the correctional department to offer the needed care. In some instances, the correctional department may lack the needed resources. In general, the correctional care must negotiate different factors such as custody and resources. The economic element can reduce the quality of care. For instance, I did not recognize the existence of performance measures and incentives. In general, the provision of medical care at a reduced cost tends to be basic.

Reference 

Dhaliwal, K. K., & Hirst, S. P. (2018). Correctional nursing and transformational leadership.  Nursing Forum ,  54 (2), 192-197.  https://doi.org/10.1111/nuf.12314