Some patients have severe mental health symptoms such as delusions that influence their decisions not to eat. Refer the case to a mental health professional. Sometimes it is something as simple as, “I sent a sick call slip for my diabetes 5 days ago, and I’ve heard nothing back.” Sometimes these situations can be resolved fairly easily with a small amount of information that wasn’t previously known to the patient, but can be shared.ģ. In the above scenario, the reason is known, but in other instances I am sometimes surprised to learn that no other staff member has spoken with the patient about this yet. The hunger strikers as a group are the responsibility of the prison administration.Ģ. Each person’s health is different, and individuals all respond differently when interacting with nursing. Always approach the striking patients individually. Here are helpful steps that I have found:ġ. Great topic! I’ve encountered hunger strikes a lot over the years. What do you think about Nurse Darden’s situation? What should she do, if anything? Share your suggestions in the comments section of this post. Patients who are mentally, psychologically or physically disabled may be particular targets of inmate or officer coercion and need special attention. Work with Individual Patients – Particularly vulnerable patients may need one-on-one intervention to be sure they understand the implications of all potential decisions.Seek Leadership and Peer Support – Talk about the situation with management and peers to determine ways to encourage patient autonomy within the organizational culture.Encourage Informed Consent – Develop informational materials about the physical, mental, and emotional effects of hunger striking.Here are some ways Nurse Darden might respond to the ethical situation she has encountered in her institution. Nurses have a moral obligation to preserve, protect, and support patient self-determination in issues related to their health and well-being. However, forced psychotropic medications must be administered for the safety and welfare of the patient, and for as short a time as possible. Mentally ill correctional patients in crisis can sometimes be restrained and given medication against their will for the purposes of order and the safety of others. A more challenging area of self-determination is that of taking psychotropic medications. Individual self-determination, then, is limited by the rights, health, and welfare of others. For example, a patient with active tuberculosis can not choose to forgo treatment. While nurses need to respect patient autonomy, individual treatment choices can sometimes affect the health of others. Self-Determination Can Not Risk the Health of Others This may be a family member, the courts or a legally appointed advocate. Patients who truly lack the capacity to make a health decision need a formally designated surrogate. Correctional nurses may need to use other methods such as pictures and simple verbal explanations to be sure patients fully understand treatment decisions. Written information may be helpful, but many correctional patients have learning disabilities or are unable to read. In order to make an informed decision, patients need accurate and understandable information, and the time to process it. Loss of health care autonomy is not part of the punishment of incarceration. While these extreme abuses have been stopped, undue influence can still be exerted on those whose rights are already affected by incarceration. Prisoners, in the past, have been subjected to experimentation and been the unwilling objects of research projects. Incarceration does not take away all human rights. The incarcerated patient population may not be behind bars voluntarily, but correctional nurses have an obligation to assure that health decisions are made freely even though our patients are inmates. Two conditions are necessary for a patient decision to be autonomous. In the case above, Nurse Darden may not be able to put words to her concerns, but she is seeing examples of coercion that is affecting the health of her patients. Autonomy in health care refers to the patient’s right to “accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or prejudice” (Code of Ethics, 2015, pg 2). Patient self-determination is based on the principle of respect for autonomy. She also sees hunger striking patients being offered special privileges by prison staff to break their fast. Nurse Darden works in one of these prisons where she witnesses some of her patients being coerced by other inmates to participate in the hunger strike. Consider this situation: The inmates in several institutions in a large state prison system have organized a hunger strike to protest excessive use of solitary confinement of gang members.
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