4 Care Considerations for Forensic Patients

4 Care Considerations for Forensic Patients

July 3, 2022

Working at a state hospital in Newark, New Jersey, that handles a large portion of forensic (incarcerated) patients in need of surgical care, education specialist Michael Rempel, DNP, RN, CNOR, wanted to make sure his institutional policies reflected considerations for this unique patient population.

Rempel worked with perioperative nurse colleagues Mellecia Beckles, MSN, RN, CNOR, and Ebony Hawkes, BSN, RN. Together, they reviewed the literature and created a special practice guideline that updated current hospital policies with evidence-based best practices to protect forensic patients’ rights while also ensuring safety for perioperative staff.

The team recently earned AORN’s first Diversity, Equity, and Inclusion Poster Award for their poster sharing their work on evidence-based care for the incarcerated patient during surgery.

We asked Rempel why he was driven to advocate for this vulnerable patient population. He says we must strive to do what is right for all patients, especially those in vulnerable situations. “Regardless of their situation, forensic patients need medical and surgical care, and we are there to ensure that their care is being carried out.”

Given the limited amount of research on perioperative care for forensic patients, we also wondered what practices they identified to ensure respectful, safe care:

1. Use the term “forensic”
   Their first step was to replace the term “incarcerated” with “forensic” in describing these patients through their course of care. “Using the term ‘forensic’ destigmatizes and provides compassion in our approach to this vulnerable patient population.”

2. Protect patient privacy
   Forensic patients’ rights were identified in several studies they found, and a right to privacy was an important factor they’ve included in their guideline. “We wanted to enforce that regardless of the patient’s situation, they have the right to privacy, dignity, and respect.”

3. Allow patient autonomy
   The guideline states that forensic patients have the right to make decisions and be involved in their plan of care. For example, he recommends nurses provide privacy (when acceptable) and ample time to discuss the plan of care with their patient. “Incorporate your patient into the decision-making process regarding their treatment options.”

4. Ensure staff safety
   While providing respectful, engaged care for forensic patients, Rempel stresses it’s equally important not to place healthcare workers, security personnel, or correction officers in harm’s way. “It’s important for medical staff that encounter these forensic patients to remember that they pose a high security risk when outside of prison or correction facility.”
   
   He stresses the importance of looking to the evidence to establish safe and compassionate care for this population. “Nurses should be able to provide care in an unbiased manner that corresponds to the practice guidelines and ethnics of nursing care.”
   
   Rempel encourages perioperative nurses who frequently care for this vulnerable population to engage in their own research to understand best practices for forensic patients.