November 17, 2009 by Admin
In the same vein as TV’s Crime Scene Investigation show, health care organizations are turning to specially trained teams to investigate severe patient incidents. These teams, titled Clinical Scene Investigators (CSI) are responsible for investigating events that result in permanent patient harm or even death. The investigators gather details about the event from the participants and patient charts and may even sequester equipment as the situation warrants. They look at all the details which lead up to the incident, how the situation occurred and then look for opportunities for process improvement. In situations like these, thorough documentation on the healthcare workers part is paramount. Was the caregiver aware of the pending situation and were appropriate actions taken? In addition, the CSI team members must have superior assessment skills, solid investigatory abilities and excellent communication skills. They must be able to paint a picture in order to determine if more investigation is required.
Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Clinical Scene Investigation, Forensic Nursing Assessment
Posted in Forensic Investigation of Death, Forensic Nursing in the healthcare occupational setting | Leave a Comment »
November 10, 2009 by Admin
Posted in Drug Abuse | Leave a Comment »
November 10, 2009 by Admin
Posted in Drug Abuse | Leave a Comment »
November 9, 2009 by Admin
Being culturally sensitive is paramount in the assessment and treatment of pain. It begins before any contact with the patient. It begins with self awareness of how the nurse views pain and the understanding that the nurse’s beliefs are formed by his/her own culture. By self actualization, a nurse is better prepared to interact more therapeutically in the patient’s behalf. The Joint Commission requires that a patient be assessed and reassessed ongoing to pain relief, taking into account the patient’s cultural, spiritual and ethnic beliefs. According to McCaffery (1999), pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does. It is a combined phenomenon with sensory, emotional, cognitive and physical parameters. Pain assessment and pain relief however, may be different for every patient. Nurses should educate their patients and families to report the pain, and to expect relief. It is far more likely that a patient’s pain will be under treated due to withholding or inappropriate prescribing of opioids. The nurse should very familiar with the pain tools and use them consistently, taking into account cultural differences. The signs and systems of pain should be assessed carefully. The nurse should not second guess the patient or family and should not dismiss what is being said. They should also listen carefully to their patients and look for contributing factors. The nurse will want to ask the patient regarding their belief about pain and satisfaction with the current pain level. This information will direct the actions that the nurse will take, both pharmacologically and in providing comfort measures.
Original Post
September 8, 2009
Title: Effective measures toward pain management, comment
This post reminds us that the measurement of pain is primarily subjective. As providers, we must always remember that people respond to and express pain very differently. We must be culturally sensitive when assessing and treating pain. Pain is the 5th vital sign. Pain affects the physical and psychological well-being of our patients. It is our responsibility to ensure that our patients’ pain is being well managed. We must know our own biases and misconceptions and leave them at the door.
Original Post
September 2, 2009
Title: Effective measures toward Pain Management
Pain is an alteration in ones comfort level, which can significantly impact the physical, emotional, and psychological well-being. Pain is a subjective experience that can only be explained by the patient. Cultural and ethnicity are a few factors that influences patients response to pain, to improve outcomes nurses must be able to understand pain from a cultural perceptive. People respond to and view pain differently. Among various groups for various reasons emotions may or may not accompany pain it is viewed by some as an act of punishment or as a spiritual test. Having knowledge of patient’s views and how they define pain is very valuable in that it can assist the nurse in achieving positive outcomes by incorporating this information in the plan of care. Nurses who ignore or refuse to develop cultural sensitivity not only do they violate patients’ rights but also a chance of having a trustful relationship and without this you can expect poor outcomes. Pain is often poorly assessed and poorly managed due to reasons like misconceptions and nurses lack knowledge. This usually leads to under medications and poor outcomes, such as the post-op abdominal surgery patient that develop pneumonia because is unable to perform cough and deep breath exercises every 2hrs secondary to pain because of the nurses’ misconceptions about administering pain medication to a patient with history substance abuse. To achieve goals of effective pain management nurses must first be aware of their values and personal beliefs concerning pain and the behaviors associated with it, this will assist in developing an awareness and sensitivity to the patient’s need. Nurses must be knowledgeable and skilled in collection of both subjective and objective data (by accepting the patients’ assessment of pain by using pain assessment tools and observation of emotional behaviors such as crying or moaning), which will assist in identifying the intensity of patients’ pain and promote better outcomes. Misconceptions must be explored and addressed because these also impact outcomes, such as administering pain med on regular basis will lead to addiction or those who abuse drugs usually over exaggerate their pain, by acknowledging these misconceptions nurses will be able address patients’ pain related issues more professionally and improve steps toward effective pain management.
Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Pain Management, Patient Rights Pain Management, Medication Error Pain Management, Cultural Sensitivity Pain Management, Ethic Sensitivity Pain Management, Forensic Nursing Pain Assessment
Posted in Cultural Sensitivity, Ethnic Sensitivity, Human Rights, Medication Error | Leave a Comment »
November 6, 2009 by Admin
The debate over the legalization of marijuana has been a heated one for decades. Most recently a ski town in Colorado – Breckenridge – voted to legalize marijuana by a greater than 72% majority rule. The ruling will allow adults 21 years and older to have in their possession up to one ounce of marijuana. While this is a symbolic triumph for advocates of legalized marijuana – possession of pot in the state of Colorado remains a crime for individuals without medical clearance. Although there are many credible resources, outlining the scientific research detailing the pro’s of medical cannabis – I think there has to remain stringent government regulations allowing it’s use. It may not be as addicting as alcohol – but as I think back about 20 years to a college dorm room…can we really argue that someone under the influence of such a substance would make a good school bus driver, medical practitioner, teacher, truck driver? Medical use is one aspect – recreational use is quite another.
Original Post
November 2, 2009
Title: Legalization of marijuana
I was reading my local paper today and there was an article about the legalization of marijuana written by a former police officer. He was fully supportive of such an endeavor. He made great points about how difficult it is to close down an illegal drug dealer but how much easier it would be if we made them legal dealers and had some control over their operations. The government could make billions off of legalization of marijuana. If we take the power of money away from the illegal dealers it will not hold the same draw for them. Alcohol, which is legal and a billion dollar industry, causes many problems for those who use it. Marijuana is not physically addicting like alcohol but it is still illegal. I used to be surprised at the extensive use of marijuana in our society. If we know it is not physically addicting and no worse than alcohol why is it taking our society so long to decide that it is helping a lot of people.
Attorney Lawyer Marijuana Use Abuse
Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Marijuana Legalization, Forensic Nursing Drug Abuse, Attorney Lawyer Marijuana Use Abuse
Posted in Drug Abuse | Leave a Comment »
November 6, 2009 by Admin
In addition to medication administration practice for student and graduate nurses, there should also be continuous education on Pharmacology updates and practices for staff nurses. There is a wide variety of resources available, including monthly ISMP news letters providing insight into medication errors – not only showing nursing errors in judgement, but also shedding light on system errors as well. Electronic medication administration records and Physician order entry applications are also computerized tools that can be utilized by organizations to decrease the incidence and cost of medication errors.
Original Post
November 3, 2009
Title: Reduction in medication errors
It has become obvious to me in my practice as a nurse administrator that medication errors are a major liability to a health care facility. Efforts to reduce them are paramount to quality standards of practice.. A combination of education and interdisciplinary approach to error reduction is crucial. By "humanizing" medication directions i.e. at bedtime instead of hs the potential for the wrong med at the wrong time at the wrong dose is minimized. By educating new nursing students to the need for safe practice and insisting on that practice prior to graduating nurses, medication errors as well as quality of care will improve. By utilizing pharmacy consultants to review MD orders for correct utilization of meds the potential for error is again reduced.
Defense Attorney Lawyer Healthcare Medication Errors
Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Medication Errors, Defense Attorney Lawyer Healthcare Medication Errors
Posted in Medication Error | Leave a Comment »
November 3, 2009 by Admin
With the federal CMS reimbursements of October 2008, stating that nosocomial infections and development of hospital acquired pressure ulcers were no longer going to be paid for, one of the areas of concern was pressure ulcers in the operating room. Years ago, we never really thought of pressure ulcers originating in my department, we did our cases and primarily observed for post-operative complications such as respiratory failure or bleeding. The patients were on long term bed rest, the bedding was of poor materials and the only thing we as nurses did, was to turn the patients "frequently” and that was to prevent pneumonia. With research, and projects such as IHI’s 5 million lives campaign, SCIP’s studies, Joint Commission, NYS department of Health reporting requirements, pressure ulcers have been brought to the forefront. For the past year and half, I have been having in-services for my staff on prevention of pressure sores and more use of pressure relieving aids for our patients. It was amazing to find a lot of articles and hearing about the cost of and risks of pressure ulcers at our workshops and the Association for Operating Room Conferences. It was staggering to learn that 25% and as high as 66% of post-operative pressure ulcers were operating room induced, and, that they didn’t present themselves for 3-7 days post-operatively-many times the patient may have been discharged. One pressure ulcer can cost an average of $43,180.00. We always perform a pre-operative assessment on skin integrity (among other things). We obtain a baseline assessment to see if there are any pre-existing areas of concern (for example their nutritional status, whether they are on any pressers, and if they are very thin or immunocompromised). We also look at the length of time the procedure will take, and the position of the patient for the procedure. Pressure ulcers can start to occur in as few as 20 minutes and surgeries lasting for over 2 hours. My facility has been very proactive, as we have had a pressure ulcer team for quite a few years and we as educators and staff, have been updated frequently of the prevention and treatment of pressure ulcers.
Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Decubitus Pressure Ulcers Bed Sores
Posted in Health Assessment | Leave a Comment »
November 3, 2009 by Admin
It has become obvious to me in my practice as a nurse administrator that medication errors are a major liability to a health care facility. Efforts to reduce them are paramount to quality standards of practice.. A combination of education and interdisciplinary approach to error reduction is crucial. By "humanizing" medication directions i.e. at bedtime instead of hs the potential for the wrong med at the wrong time at the wrong dose is minimized. By educating new nursing students to the need for safe practice and insisting on that practice prior to graduating nurses, medication errors as well as quality of care will improve. By utilizing pharmacy consultants to review MD orders for correct utilization of meds the potential for error is again reduced.
Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Medication Errors
Posted in Medication Error | Leave a Comment »
November 2, 2009 by Admin
I couldn’t agree more with the writer of the previous forum about the mandatory immunization of nurses in NYS. I feel it is irresponsible and unprofessional of nurses not to get immunized against the flu. We as nurses are responsible to our patients to not get them sicker while we care for them. Studies have indicated that when tested, 33% of healthcare workers in one study tested positive for the flu last year but showed absolutely no flu symptoms. It is commendable that the nurses who say they don’t want to be immunized would agree to stay home if sick but unfortunately it is not in the nurses natures to think they are sick and as the study indicates many showed no signs of sickness but were contagious. We are required to have yearly Tb tests and I don’t hear people screaming about that. I am confused as to why we don’t want to do what is best for our patients.
Original Post
October 19, 2009
Title: Are we ready for a Pandemic
I thought my state had the right idea in preparation for the seasonal flu and the H1N1 flu that has begun to hit our schools and will inevitably be hitting our hospitals and nursing homes. The NYSDOH (New York State Department of Health) had mandated an emergency regulation, which mandated annual flu vaccinations for all healthcare personnel by Nov 30. This is no different to the already in place regulation of requiring mandatory vaccinations of healthcare workers for measles, mumps, rubella and TB testing. As an educator, I also must regulate the company representatives and vendors coming into our organization, that they also must have all the necessary immunizations prior coming to our surgery department. This is not only to protect our patients, who are already at a compromised state, but also to protect them from contact of our patients. We as educators and leadership began to immunize our healthcare workers to proactively prepare for what was to come. As of last week, we had immunized well over 75% of our workers. We know our hospitals have shortcomings in that we ask our workers to stay at home if they contract symptoms or they must stay home with their children, but on the other side of the coin, we reprimanded them if they are sick longer than three days, as they do not have a note from their doctors, as they cannot go to the doctors offices for fear of spreading the disease. As in everything we see each day, we began to hear grumblings from some of our own nurses. "No one is going to make me get a vaccine". They were going to go to our state capitol to argue and try to block the mandatory flu shots-as the subsequent lawsuit stated it was to "protect the rights of nearly 60,000 medical workers" in New York State. As of today, there is a temporary restrain order blocking this mandate. What is the question here? Do the nurses not want to be vaccinated? Do they not want to be "mandated to be vaccinated"™ I think the state made a gutsy move attempting to be proactive in the wake of a possible pandemic. I went into healthcare many years ago to help people, to care for the sick and dying. I participated in a smallpox inoculation workshop, when the threats of bioterrorism and chemical warfare hit home. What is wrong with these nurses- are they more concerned with going to their unions than they are about their patients? During the legal turmoil that will probably take weeks. I read in the paper just yesterday, that the flu virus has claimed eleven deaths of children and teens during the last week-eighty-six in all. Its effects are now seen in forty-one states. Who is going to care for the very sick people that are going to be coming into our organizations? Did you not learn anything from the HIV virus?
Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Mass Disasters, Forensic Nursing H1N1 flu virus
Posted in Mass Disasters | Leave a Comment »
November 2, 2009 by Admin
I was reading my local paper today and there was an article about the legalization of marijuana written by a former police officer. He was fully supportive of such an endeavor. He made great points about how difficult it is to close down an illegal drug dealer but how much easier it would be if we made them legal dealers and had some control over their operations. The government could make billions off of legalization of marijuana. If we take the power of money away from the illegal dealers it will not hold the same draw for them. Alcohol, which is legal and a billion dollar industry, causes many problems for those who use it. Marijuana is not physically addicting like alcohol but it is still illegal. I used to be surprised at the extensive use of marijuana in our society. If we know it is not physically addicting and no worse than alcohol why is it taking our society so long to decide that it is helping a lot of people.
Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Marijuana Legalization, Forensic Nursing Drug Abuse
Posted in Drug Abuse | Leave a Comment »
