The Prison System and Social Justice


I recently came across an article in the New Yorker entitled Madness by Eyal Press. The full article can be viewed here: http://www.newyorker.com/magazine/2016/05/02/the-torturing-of-mentally-ill-prisoners. The article looks at one Florida prison, where mentally ill patients have suffered horrible mistreatment by the prison system. Our largest provider of healthcare for the mentally ill in the United States is the prison system, and yet our leading mental health researchers and providers tend to shy away from or ignore this enormous vulnerable population.

I will warn you that you may find aspects of the Madness article disturbing, and it leads us as nurses to consider many social justice issues, including the right to adequate care, proper diagnosing, safety, and support for health and healing. As the United States has the highest incarcerated population of any country, nurses need to consider how we as a society and a culture care for and treat our very vulnerable mentally ill population. The challenges of advocating for these prisoners and one’s own potential vulnerability when working in this system are clearly highlighted in the Eyal Press article. Until we recognize the mentally ill incarcerated population as traumatized human beings in need of deep caring and support as they proceed along their own healing journey, true transformation of our systems toward ones that can offer rehabilitation and reduce recidivism may remain elusive.

I also found this article to be heart wrenching on a personal level. My brother died in prison at the age of 45, and the unit where he died is indeed either this particular unit as described in the Madness article, or one very similar to it in Florida.

My brother Bryan was a star elite athlete in his youth, holding a national age-group track record set at the Junior Olympics when he was around 15 years old. After sweeping many state championships in high school track, he received an athletic scholarship to a school in the midwest, and while he had been a “difficult hyperactive child” deeper signs of his mental illness began to emerge. He ran up huge gambling and credit care debts, and one Christmas he returned home from school having lost about 25 pounds with no good explanation for why this had occurred.

When he was about 25 years old and had finished college, Bryan had a full psychotic breakdown. He spent several months in a psychiatric facility as they strived to diagnosis and stabilize him. My brother was bipolar with schizoaffective disorder, and sometimes his life was relatively calm, like when he married his first wife and they dreamed many dreams together….other times not so much, like when in the midst of another psychotic break he held a knife to his first wife’s throat; or the time he totaled his own car using his own hands and a crowbar; or when he was found running naked on the Nike compound in Oregon.

In 2008 Bryan went off his medications for unknown reasons. He became incredibly manic, delusional, and he was certainly having hallucinations. He left his wife and young daughter and moved into a shelter setting, which he was kicked out of due to fighting with others. Simplifying the story a bit, I will just say that he was found tampering with his estranged wife’s car at her place of work and the police were called; a high speed chase ensued and my brother was charged with aggravated battery with a deadly weapon (I believe he struck one of the officers with something once his car was forced to a stop), aggravated fleeing and eluding police, and resisting an officer with violence. About two months after his arrest, upon the advice of his free public attorney, my brother took a plea deal and he was sentenced to 3 years in the Florida State Prison System. I believe his mental illness, which he had been struggling with for over 20 years, was never clearly considered in the charges or in his placement. The copy of his charges is here: https://bailbondcity.com/fldoc-inmate-CARROLL/130350 .

As sometimes happens within families of those suffering from mental illness, my brother and I had been estranged on and off for most of our adult lives. My brother would sometimes become violent, threatening, and manipulative when he was off his medication, and I desired a peaceful life for me and my young family. Our childhoods were traumatic, and while I can’t speak for my brother, my adverse childhood experiences were a “5”/ 10, which indicates trauma to the point of potentially having adverse effects on health and low stress resilience. I am certain that my brother also had a high ACES score, and that his mental health issues were compounded by our traumatic youth and family life. [If you want to learn more about how adverse childhood experiences impact one’s health, I have presentation that covers that here, slide 16 begins the information around the ACEs concepts: https://voicethread.com/myvoice/#thread/4492225/22882928/24864974   }.

Due to our previous estrangement and my own challenges with balancing caring for a newborn baby and toddler, and working as an adjunct nurse faculty for several different schools, I did not reach out to my brother prior to his incarceration or during that time, though we had been in touch on and off for the three years prior, when our mother had passed away suddenly from a massive MI. So, my father and stepmother kept me informed of Bryan’s prison life and while they did not visit him, they often scanned and forwarded his letters to me. It was clear to me that during his less than one year in prison, he declined rapidly; he claimed to be taken off all of his medications and we know he was transferred to a psychiatric unit (either the same one in this article or another one like it). In the two months prior to his death, he mentioned several times that he was dying or he was going to die, that things were very bad in prison. I encouraged my stepmother and father to reach out to him and the system, which they did not do, and I found that since I was not on Bryan’s “list” I had no rights around communication with him and within the system.

Via an email on the morning of March 28, 2009, I found out that Bryan had died in prison. The official county coroner’s autopsy stated that at the age of 45 Bryan had died of “moderate heart disease”, though it contrarily also noted no signs of stroke or MI. As his sister, I had no rights to request or pay for a second independent autopsy, and my family refused to have one performed, instead opting for an immediate cremation. Over the 7 years since his death, I know I have been suffering from complicated grief; I have felt powerless to create change in the prison system and sometimes I have felt scared to use my voice to call for change and for social justice in the way we manage the health of our growing prison population. I have felt fearful of being stigmatized and ashamed for having a relative who was incarcerated.

However, when I think of the many social justice issues the Madness article brings up, I begin to feel angry; and that anger is now motivating me to speak out and find ways to support the creation of healing within our justice systems.

I know that part of my own healing journey involves moving beyond telling my brother’s story, and beginning to move toward taking action in supporting an end to the injustices our incarcerated vulnerable populations suffer. I recently have been in connection with a beautiful resource at the Maine Prison Hospice Project (http://mainehospicecouncil.org/?q=content/hospice-corrections-partnership-maine-state-prison ), and I hope to help support their research efforts around the benefits of prisoners being of service during and after their incarceration period. I hope to someday serve as an example of how nurses on their own healing path strive to heal in conjunction with others; with those whom we serve. Imagine what we can do when we truly believe we are all on this path together, as interconnected unitary human beings; then the movement toward social justice becomes a part of our calling on this life’s journey.

 

 

Nurses as Healers: Good Work Environments


I remember when I became a new nurse 21 years ago, and a friend asked me what I did at the hospital when I worked those long 12 hour night shifts. His thoughts were that the patients were asleep, so it was probably a job where you hung out and drank coffee, occasionally checking in on a patient. I remember walking him through what I usually did on a 12 hour 7pm- 7 am night shift, including most of the tasks and requirements of the job from receiving report at the start of the shift to giving report at the end of the shift. I made sure to include that if- when I got a break,  it was usually around 2am or 3am when I was finally “caught up enough” to take some 20-30 minutes to nourish and hydrate myself.

As I thought of this telling of what nurses do some 20 years later,  I wondered if I included what nurses are really charged with doing, which is supporting the healing of those we care for. Did I focus on all of the tasks and duties I would complete during that 12 hour shift, or did I also include the time spent rubbing backs, holding hands, saying prayers, educating, and supporting patients and their loved ones? Did I include the story about the time I had to call a deaf woman and tell her husband had passed after she left for the evening? Or the time when the family asked me to increase the morphine drip rate because “the doctor said she would be dead before the morning and we are ready for her to be gone”? What about the man with ALS being kept alive on a ventilator and feeding tube who lay lonely in his bed, unable to verbally communicate, and went for weeks at a time without a single visitor?

I believe that as nurses we need to educate the public not just on all of the technical skills we do each day to support patients’ receiving good medical care, but also on the healing aspects of our unique work as nurses: on how we were likely “called” to be a nurse because we want to make a difference, the skills we have developed that support us in creating caring-healing environments for patients, and the rewards of being able to support others through their healing process. I think we should be making it clear to the public as well that we are committed to our own health and healing, knowing that we can’t support others through health challenges if we are not also dealing with these challenges ourselves. And as nurses, we need to support one another in our own healing process, role-modeling what self-care and stress management look like in action.

A recent study research from www.mountainmiraclesmidwifery.com/, showed that supporting nursing and creating “good nursing environments”, with adequate nurse staffing, leads to better long term patient outcomes, with fewer deaths one-month post surgery (http://mobile.reuters.com/article/idUSKCN0UZ2XL). It pays for hospitals to invest in having enough nurses, in treating those nurses well, and supporting nurses in what we have been called to do: create healing environments that support patients toward their greatest health potential. Healthcare facilities need to be moved to support nurses in managing their stress and enacting self-care in order to potentiate the healing of the patients these facilities serve. Good staffing is just the beginning of creating “good nursing environments”: nurses should be empowered to begin dialog with their employers regarding what a healthy and good work environment for nurses looks like in consideration of the healing work that nurses do.

 

 

Nurses and Global Peace


This blog posting will be a bit different from others I have written, but I believe the NurseManifest page is a place where we can open our hearts and souls to the essence of nursing, which is healing, caring, love, and compassion. In a world seemingly torn asunder from fear, violence, and anger, nurses are called forth to support healing on a local and global level. The call comes from something beyond ourselves, and if you stop and listen closely, I believe you will hear that calling. You are a nurse and there is a reason you were drawn to nursing: to support healing through loving kindness and caring.

A few nights before the recent violence spread around the world, from Beruit to Paris, I lay in bed cuddling my 7 year old daughter close. Every night I am blessed to be able to spend some time reading to my daughters and cuddling as they drift off to dreamland. For a few moments that evening, I found myself floating in a space where I felt like the mother of the universe was whispering to me, not in words, but through a deep felt intuitive process. I knew the goodness, the light, and the powerful strength of peace as they came through clearly to me, carrying with them the message that the mother of all, the earth as a complex system, will heal itself. After the moment of certainty passed, I was left with the usual feelings of uncertainty: how will the good and the light prevail in these times of darkness? Who will help make this happen? What is my role in this process?

Then tragedy struck, and violence and war continue to grow. The feelings of uncertainty have not dissipated, so I sit with those, but I also do remain strongly rooted in the belief that as nurses, we can support global peace and healing through our own efforts of creating local peace and healing. And that local peace starts at the place closest to us all, right from our hearts.

As we practice our own healing, creating our own peace and loving-healing processes, we can begin to spread that healing, peace, and love to others. A practice I try and do daily is called loving kindness meditation. I feel on many levels this practice is about my own healing and self-care so that I can be a better nurse, wife, and mother… and it is also about bringing that healing into the world.

I start with focusing on myself, in my heart space, and intending for myself healing through the following words:

May I know peace, joy, love, and ease. May my heart be full. May I be safe, healthy, and happy.

I than send this intention to the loved ones in my life, wishing them all love, peace, ease, happiness, health, and safety: family, friends, pets, students, and colleagues. As the circle of intention spreads outward, I send the intention and feelings of love and peace out to my “enemies” and challengers, and I end with the whole planet, with every being being sent the intention of peace, love, and healing.  The process takes  5-10 minutes.

As nurses supporting healing, we can think and act both locally and globally. Imagine if every nurse sent out an intention, a prayer, a positive thought for healing and peace for the entire mother earth and all of the beings living here. Consciousness studies show that our thoughts and intentions impact our environment and reality.  I think of Jean Watson’s call for us to practice loving kindness and  Martha Rogers’ concept of Unitary Beings. We can reflect the patterns before us, we can create shifts in consciousness to support healing.

Despite the medical system’s over-emphasis on technology-cure-illness management, I still believe that nurses are truly called toward the healing that all beings are capable of experiencing. If you have been called to be a nurse, can you return to that calling, can you spare a few moments to consider the global situation, and what you can do as a nurse to support healing from the truly local level (yourself) and on to the global level?

I would love to hear from nurses and how they are supporting peace and healing around the globe. The call has been made, how will you answer?

 

peace-signs-clip-art-peace-signs-clip-art-10h call has been made… how will you respond?

 

 

Gun violence: A nursing concern?


Once again we find ourselves reeling from a mass shooting, this time in a small community college in Oregon. One of the most disturbing reports of the Umpqua Community College incident was that the dead victims’ cell phones were ringing when police and rescue workers arrived on the scene, as their families and friends tried to make contact with them. The heartbreak for this community is palpable; for nursing educators, the concern of wondering if this could happen in our classrooms, in our schools, is unsettling. Some of us might recall the 2002 Arizona nursing faculty mass shooting, where 3 nursing professors were gunned down and killed by a student who had failed a pediatric class and decided that he had the shooting authority and was angry enough, I suppose, I don’t understand really, why.

What has changed since those 2002 shootings? If you scroll through your facebook feed today, it is likely you will find many postings about the statistics of mass shootings, thoughts about how nothing has changed, and debates over stricter gun control. Meanwhile, I feel that nursing should be viewing the gun violence issue as a public health issue, and we could be the ones helping to lead the way in preventing future mass shootings. We have a strong voice, as we recently proved with the “#Drsstethoscope ” and “#nursesunite ” movements; and now perhaps we could unite over some issues that deeply impact the health of all beings on this planet.

The American Public Health Association (APHA) has made clear statements that gun violence is preventable (https://www.apha.org/~/media/files/pdf/factsheets/gun_violence_prevention.ashx). APHA recognizes that gun violence is contagious and has become an epidemic in the United States. APHA recommends that we:

  • Use surveillance techniques to track- gun related deaths and injurious shootings.
  • Focus on identifying the many risk factors for gun violence.
  • Create, implement, and evaluate interventions that reduce these risk factors and support resilience for those who are suffering.
  • Institutionalize prevention strategies.

We also clearly need more research in this area; we need to examine what common sense gun policies might look like, what have other countries implemented; what worked for them, and what has not worked for them.

Nurses and educators can begin in their work places, looking at their own risks within the workplace, and working toward implementing prevention strategies and trainings around what to do should an issue of gun violence begin to emerge.

We need to also reach out to communities, particularly school settings, and develop and support education around gun safety, bullying, mental health issues, and how to ask for help. We need to have mental health services in place that can truly identify and properly intervene with those who are at risk for gun violence.

Nurses could also bond together, #nursesunite, and create a clear voice around stricter gun control. We could do our own research around what has worked in other countries and what that might look like here, and then bring these ideas forward to our lawmakers. At the very least, we could be calling for better access to mental health services for those in need, and early identification of those who might be at risk for perpetuating gun violence. Childhood traumas likely play a role in this issue as well, and supporting the creation of trauma informed schools should be a nursing advocacy issue.

We have power in our numbers; let’s put it to great use. #nursesunite

Humor in Health Care


There has been plenty of discussion about Kelley Johnson’s monologue and comments from The View. I just took a look at the response from the President of the American Nurses Association, who said, “Nurses don’t wear costumes; they save lives.” and its true, you won’t ever see a nurse wearing joker teeth welcoming a patient.

I am grateful to all the people who have stood up for nurses by responding, supporting, and making us feel like the honorable, trusted, and caring profession that we are. I am also thankful to Pamela Cipriano for her quote above, because that has encouraged me to take a lighter approach in this blog article. Everything doesn’t always have to be heavy or philosophical or serious, right?

While I understand what Pamela meant by “Nurses don’t wear costumes,” I will share that I did wear a costume once, when I was a staff nurse on an adolescent unit. It was Halloween and most of the nurses dressed in costumes that day. I was taking care of a particular 14-year-old boy who needed a new IV placed. In all my costumed glory, I went in and put an IV in this adolescent’s arm. His dad sat by the bedside as I did so. And his dad was a VP of the hospital. I never knew if that patient’s father was amused by my costume or annoyed thinking I wasn’t taking my job seriously. He didn’t say anything to me about it.

I sometimes think back to that experience, especially around Halloween, and wonder when it’s ok to infuse humor into health care. I sometimes use humor with patients I see for diabetes education, but then again those visits are not life or death situations. Hospital staff where I work still dress up every year, but I have never worn a costume to work again.

Personally, I like and appreciate humor. But when I’m the patient I do expect health care professionals to use it appropriately. I remember when I was a patient in room # e111, a joke that I didn’t “get” was sort of an issue I didn’t want on my mind. I’ve noticed in the Diabetes Online Community that people often discuss with frustration the jokes that are told about diabetes. Sometimes funny things happen to nurses at work, and those times (and memories) can help us get through tough jobs. In fact, humor can be one way nurses take care of themselves. Are there ways we can use humor to help people heal?

How do you use humor in health care? Or what funny thing that has happened while you were working in a health care setting? What did you learn from the experience?