Screening, Health Assessment, and Sick Call
Correctional nurses use specialized assessments to screen, triage and evaluate patients to determine the appropriate level of health care services required. The reason for the evaluation dictates the focus and direction of the service.
Nurses in correctional settings use many screening tools and techniques to examine, identify and address the clinical conditions and health care needs that an incarcerated person may have. The key concepts of screening include that it must be completed very quickly; that it identifies all issues that it should; that it uses standardized tools and processes; that it uses the least amount of resource for the most gain; and that it considers patient safety and errs on the side of problem over-identification.
Correctional nurses must be knowledgeable and competent to complete the various screening processes that are used at their facility. They must know the purpose of the screening, the focus of data collected, and the time frame in which the screening must occur. Reasons for screening in the correctional environment include the following:
- Work clearance;
- Segregation: placement in and during confinement there;
- Restraint use;
- Risk for withdrawal;
- Referral to alcohol or drug treatment;
- Transfer to another facility or to court; and
- After a use-of-force incident.
Because screening is simply a process used to identify an individual with a condition, a particular characteristic, or a change in condition that needs attention, quick and effective screening is facilitated using standardized tools and techniques. These enable the correctional nurse to focus on the results obtained during each part of the screening rather than what question to ask next. The quality of the subjective and objective information obtained from the patient is better when the encounter provides auditory and visual privacy, and the correctional nurse’s demeanor is calm, professional, and nonjudgmental.
Correctional nurses use their education, training, and professional judgment to determine the disposition of each individual screened. With intake screening, for example, correctional nurses decide if a detainee has a health condition that is urgent, emergent, or routine, and refers accordingly. An urgent condition needs immediate attention and potential referral to an outside health care facility. If the patient has a condition that needs attention or ongoing treatment, but is not urgent, the nurse will contact a provider and arrange continuation of care until the provider can evaluate the patient. Patients with routine conditions are referred for a nurse or provider sick call appointment as appropriate. The decisions made by correctional nurses as a result of the intake screening include special housing assignments; special accommodations; notification of custody personnel about special equipment (e.g., a wheelchair), supplies (e.g., keep-on-person medication) or other important patient information (e.g., suicide potential); referral and appointments for follow-up by medical, dental, and mental health personnel; and initiating arrangements to provide continuity of care (e.g., requesting health records from previous provider, verifying prescriptions, monitoring blood pressure).
Once completed, the correctional nurse has a responsibility to communicate the findings of the screening and the subsequent decisions made. This includes providing custody or other personnel who are not part of the health care team with sufficient information so that the individual and others are safe. The correctional nurse communicates the screening results and subsequent decisions made to the other members of the health care team through documentation in the health record. The correctional nurse should also share the screening results with the patient, so he/she/they know what to expect and how to request additional assistance, if needed.
Initial Health Assessment
The Initial Health Assessment is an evaluation of the incarcerated individuals’ health status. The content of the assessment is defined by the responsible physician, and should be done as soon as possible, but at least within the first 14 days of confinement for jailed incarcerated persons, and within seven days for those transferred to prison. The health assessment should include, at a minimum, documentation of the patient’s health history, measuring vital signs (including height and weight), and a physical examination by a provider or registered nurse. The physical exam should include a hands-on evaluation to include inspection, palpation, auscultation, and/or percussion of the patient’s body to determine the presence or absence of physical signs of illness (NCCHC standard E-04: Initial Health Assessment, 2018). All abnormal findings must be reviewed by the provider, and specific problems identified should be included on the comprehensive problem list. Subsequent diagnostic and therapeutic plans should be individualized and developed as clinically indicated.
Correctional health care is guided by several fundamental principles, including the importance of access to health care — incarcerated individuals may make a request for health care attention at any time. Requests that are emergent are attended to immediately. Requests that are not emergent are reviewed every day in a process often called Health Service Request or Sick Call triage. Typically, correctional nurses are the health professionals responsible for reviewing and responding to requests for health care attention. If the request describes a clinical symptom, the individual must be seen in a face-to-face sick call encounter within 24 hours on weekdays and no longer than 72 hours on the weekend. Triage of a request for health care attention should include a review of the patient’s health record.
Correctional nurses may use protocols for the face-to-face evaluation of requests for health care attention. According to NCCHC Standard E-08: Nursing Assessment Protocols and Procedures, requirements for the use of protocols include the following:
- Protocols are jointly developed by the nurse administrator and the responsible physician at the facility;
- Protocols are reviewed annually;
- Protocols comply with the state Nurse Practice Act;
- Protocols do not include use of prescription drugs, except for emergencies; and
- Protocols specify the steps to be taken in evaluating a patient’s health status and guide the documentation in the health record.
Every correctional nurse must be trained in the use of the protocols initially, with an annual competency review thereafter. Training is also required whenever a protocol is revised or before a new protocol is introduced. Correctional nurses must have foundational knowledge of normal anatomy and physiology, as well as common abnormalities, communicable diseases, substance use disorder, psychiatric conditions, and oral health. Correctional nurses must demonstrate skill in focused physical examination.
Patient evaluation in response to a request for health care attention should take place in an area appropriate for the delivery of health care. The area must be of adequate size, provide auditory and visual privacy, have equipment for handwashing/hand sanitizing, have an examination table, and have washable hard surfaces. The equipment correctional nurses should have available for sick call evaluation includes a thermometer, a stethoscope, a sphygmomanometer, a handheld light, exam gloves, dressing supplies, germicidal solution, the health record, and reference material (NCCHC Standard D-03: Clinic Space, Equipment and Supplies).
The face-to-face evaluation of a request for health care attention includes several steps:
- Welcome the patient (establish therapeutic milieu);
- Ask for and listen to the patient’s description of the health concern (subjective data);
- Examine the patient; collect data (objective data);
- Assess the collected data and develop a nursing diagnosis (synthesis and critical judgment – dependent upon scope of practice); or present the data to a licensed person who can make that assessment;
- Establish a plan of care, and inform and educate the patient;
- Implement the plan as indicated (patient advocacy); and
- Schedule a follow-up evaluation as indicated by the condition and plan.
Based on the evaluation of the patient, the correctional nurse may initiate treatment using a protocol; provide advice or recommend some form of self-care; educate the patient about an aspect of care or symptom management; refer the patient to a provider for a higher level of care; or contact the provider immediately for consultation.
Although the protocols guide the correctional nurse’s judgment regarding the need for referral to or consultation with a provider and when that should occur, they are not always precisely applicable and definitive to every patient care situation. Thus, in addition to the directives of the protocols, the correctional nurse should consult with a provider when the patient has abnormal vital signs, or physical or mental health findings; when the evaluation requires diagnostics that exceed the limits of the protocol (radiographs, lab studies, etc.); and any time that the patient’s safety requires consultation.
Author Lori Roscoe, DNP, PhD, APRN, CCHP-RN, is the Accredited Provider Program Director for NCCHC, co-chair of the NCCHC Nursing Education Subcommittee, and a member of NCCHC’s Multi-Disciplinary Education Committee. Through her companies, The Correctional Nurse LLC and Correctional HealthCare Consultants LLC, Dr. Roscoe provides accredited continuing education specialized for correctional nurses and maintains CorrectionalNurse.Net, a blog about correctional nursing practice, and offers professional consulting services in correctional healthcare operations, staff training and legal matters.