Archive for March, 2007

Response to the listing “Medical Errors”

March 28, 2007

This is in response to the listing “Medical Errors”

Currently working as a Quality Director at facility that has been functioning less than a year, believe me I understand the all the issues regarding medication errors. I am responsible for researching each and every medication error and finding a solution to the problem. I know that a large percentage of the time it is a systems problem. A ‘systems problem” leaves numerous opportunities for failure. I know that the medical profession in general no matter what the mistake was, would like to find one person to take the blame. I am in a position where I can follow the bread crumbs look into the “systems problems.” I am not sure of what the answer is at the moment. But, when I reach it I will let you know.

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Dead Can Still Tell

March 27, 2007

While reading an article in The Florida Times Union, a local newspaper here in Jacksonville, Florida, I came upon this interesting article. This article in detail explains on how the medical examiners office usually identifies a body. Step 1- Friends and Family: About 90 percent of all bodies are identified using friends and family to look at the body or person. If the facial features have been destroyed or damages, other distinguishing marks such as tattoos are used or birthmarks. Step 2- Fingerprints: Although the database for fingerprints is not unlimited, the technique is usually successful in identifying some bodies. Some problems such as burn victims, bodies washed ashore can make fingerprinting hard to determine. Step 3- Dental Records: Just like a snowflake, no two mouths are alike, and once the records are available, comparing teeth is an easy process. The problem is not everyone goes to the dentist like they should. Also, investigators need to have ah idea of who they are looking for to compare records, because there is no dental database. Step 4- Medical Records: Certain medical evidence such as bone fractures, pacemakers, AICD’s, scars, or any previous surgeries can be used for identification. Just like dental records, investigators need some idea of what and whom they are comparing. Step 5- DNA: Medical examiners typically exhaust all other resources before DNA is tested for identification. DNA tests can be expensive and take a good amount of time. Not everyone’s DNA is available for comparison. Medical examiners’ offices still keep several DNA samples on file in case of future investigations or for reference. Step 6- Forensic anthropologist: If a body is very decomposed and all that is left is skeletal remains, an anthropologist can be involved to examine the bone structure to give clues about race, gender and age of the deceased body in question.

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The Choking Game

March 23, 2007

I as a mother of a teen would like to make all parents aware of this game a lot of teenagers are playing to “get high.” It is called the “choking game.” Teens are asphyxiating themselves or each other to “get high.” There have been several hundred teens die from this deadly game. They use their own hands, belts, ties, or anything that can go around the neck with pressure applied, depleting the oxygen to the heart and brain. They actually apply enough pressure until the child passes out! Some kids say it makes you forget what happened and feel tingly all over. Some parents have reported long-term disabilities with their children such as strokes and brain damage, as a result of their child playing this game. Some of the signs your child may be playing this game is: unusual markings on the neck, blood shot eyes, and frequent headaches. I think this is very important for all parents to be aware of and also I believe it is important for any emergency room nurse to know these signs if a child would come into the ER as a result of asphyxiation.

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Innocent Prisoners

March 19, 2007

I have been doing some research on people that are wrongfully imprisoned. I find this a very interesting topic, as I am sure there were hundreds or maybe even thousands of inmates that were on death row and died before the courts allowed DNA to be presented after a person was convicted. There are an estimated 15-20% of the U.S. inmates that are innocent of the crimes they were convicted of. There have been several cases where the inmate was released from prison after the courts allowed the DNA to be entered after the person was convicted, and was certainly found to be innocent. I just can’t imagine being in prison, possibly serving a life sentence, or even on death row knowing that I was totally innocent. I cannot find a date that the first inmate was released from prison after being found innocent though. I believe that with the DNA database in place now that a lot more cases will be dismissed or they will find the right person responsible for the crime.

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Assessment of a Rape Victim

March 16, 2007

Forensic Nursing provides a continuity of care from the emergency department and/or crime scene to courts of law.
This is another area where nursing assessment and forensic nursing overlap.

In cases of rape the forensic nurse will do initial examination and continue with the nursing care for the patient accordingly. The involvement of male police officers is limited which works to the advantage of the victim as well.

There is nothing so hurting than having to tell your story to a male when you were raped by another man. You even feel the police officer will be taking sides.

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Memory loss and the law

March 14, 2007

A forensic nurse will be quick to determine a genuine case of memory loss and a fake one. This helps in fast tracking cases. Someone involved in an accident might have a temporary loss of memory and the police officers might think it is a fake and punish him while they are worsening the case.
During the health assessment phase the forensic nurse quickly determines the mental status of the victim without compromising the evidence needed for the case.
With more forensic nurses with good health assessment capabilities things would be much better for attorneys and doctors.

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Violence against women

March 13, 2007

Violence against women has gone on for years. A large population of women form the 50’s and 60’s just accepted as part of the norm for a marriage, because that is what they experienced growing up. Violence against women has never been acceptable, but has occurred. Women of recent years have not grown up in that environment and have begun to change the attitude of people toward violence against women. It unfortunately still does occur. Violence and abuse affects all kinds of people every day. Violence does not discriminate. Abuse can be physical, mental and emotional. Abuse is not only against women any more abuse against men is escalating also.

Violence against women can affect women of all ages, race, socioeconomic, & educational backgrounds. Statistics show that 1 in 3 women is a victim of violence. The historical aspect to this is that women used to be considered property to their spouse and the male dominated in the household. It was considered his right to treat his wife how he felt necessary.

The World Health Organization has been advocate for deterring violence against women. In 1996 the World Health Organization adopted the definition of violence against women that had in 1993 been defined by the United Nations General Assembly. The definition comes from the Declaration of the Elimination of Violence against Women. The definition states “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.” The definition is very clear and precise that violence against women is against the law.

There are three kinds of abuse, psychological, physical, and sexual. Psychological abuse is emotional, isolation, using others, obfuscation, economic, coercion, and intimidation. Physical is hitting, chocking, pushing, kicking, or use of weapons. Sexual is forcing someone to perform sexual acts against the will of the victim. The contributing factors to violence against women can be childhood experiences, what an individual saw in the home growing up. Male dominance, the gender role that male is in charge of the home, which can stem back to childhood experiences. Marital conflicts, a great deal of stress in the relationship which can be for multiple reasons, which can include unemployment of one of the people, low socioeconomic status, stress, or the feeling of inadequacy.

There are three phases of abuse against another person. The first phase is tension building. The abuser needs to demonstrate power or control. There are lots of arguments and blaming. This phase has no real time limit it may last from days to years. The purpose of this phase is to make the victim feel as though it is their fault. The second phase is the incidence of abuse. This is the period of destruction. The third phase is the honeymoon period. The abuser becomes loving, kind, is very sorry for what they did. This is also the time when women are very vulnerable and accept promises and wants to believe that the abuse won’t happen again.

The nurse can be the first line of protection for a person that is being abused. When doing an assessment on a patient the nurse needs to become a very good listener and a very good examiner. There are signs that the nurse should be aware of when does a patient assessment. The proper management of a suspected abuse victim is crucial. The signs and symptoms to be aware of are if injuries do not match the explanation, if the patient has a delay in reporting the injury, the patient may exhibit psychosomatic complaints, the patient may not have eye contact when questions of abuse arise, Nervous when the abuser is present.

The nursing interventions are very important. The nurse needs to build a rapport with the patient so that the patient will have trust in them. The patient needs to be reassured of confidentially. The nurse needs to be nonjudgmental. Let the patient tell her story at her/his own pace, if they are comfortable and do not feel rushed they will be more likely to open up and feel that you are concerned and that you will help them in any way that you can.

When that abuse has been established we then need to do what we are taught in nursing school, teach. The patient needs to be taught what they can do to protect themselves and their children, if any are involved. The patient needs to be set up with agencies, if the patient is willing; to help them, and a through follow up needs to be done with the patient. Some of the immediate interventions the nurse can do is to instruct the patient to develop a plan, I.e. have cloths packed in case they need to leave in a hurry, have extra car and house keys hidden, have money and important paper hidden, set up ahead of time a safe place to retreat to if needed. Have all of the important telephone numbers either written or stored in a cell phone, i.e. police, abuse hotline, family.

One of the most important steps that we as nurses can take is to push your clinic, doctor’s office, hospital emergency room or where ever you may work for universal screening of all women for signs of abuse. Universal screenings are not mandatory but we need to, as health care workers, persuade our government officials to pass laws for universal screenings. This can be done through your professional organizations, or just by making a call to your representatives. Violence against women is on the rise and it needs to be halted.

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Human Rights

March 12, 2007

Human rights is a subject that all of human kind should be very concerned about. The abuse of human rights has an impact on everyone. As of recent and the past we have seen this in WWII and of recent in Iraq. We as a nation got involved because of respect for human rights. We as a nation and globally have set up standards for countries to follow to protect human rights. The United Nations has tried to police these standards however; there are still “78 countries, a third of the UN members” that still participate in government sanctioned human rights abuse.
Amnesty International is one of the policing arms that the United Nations relies on for investigating and reporting human rights abuse. Amnesty International mission statement is “to undertake research and action focused on preventing and ending grave abuses of the rights to physical and mental integrity, freedom of conscience and expression, and freedom from discrimination within the context of its work to promote all human rights.” Amnesty International has a varied network of members and supporters from around the world. The last count was 1.8 million members. These members all come from different walks of life with different political and religious views all with the same goal, to make a world where everyone has the same human rights.
The present conflict the United States and other countries are involved in Iraq is primarily based on violations of human rights. The discovery was made of human rights violation committed by Saddam Hussein on his own people. These atrocities were committed because these people had and voiced different opinions than the Hussein government had. It was genocide of his people and his nation. He was caught and brought to trial and convicted and punished, hanged.
I retrieved a recent article from the Internet, which is from the Amnesty International newspaper. “Amnesty International deplores execution of Saddam Hussein.” The article goes on to state that the trial was unfair because political interference undermined the independence and impartiality of the court. This in turn caused the first presiding judge to resign and blocking the appointment another, and the court failed to take measure to protect witnesses and defense lawyers, three of whom were assassinated during the trial. It is documented that Saddam Hussein was denied legal council during the first year of his arrest. Amnesty International is also against the death penalty. They do feel strongly that Saddam needed to be held accountable for his abuse of human rights. They also feel that he was entitled to a fair trial.
I personally am not against the death penalty. However I do feel that whatever the crime, people are entitled to a fair trial. I feel that the atrocities committed by Hussein were close to the atrocities committed by Hitler in WWII. As civilized a world that we live in today I find abuse of human rights is deplorable and unacceptable at any level. People should not have to live in fear of voicing their opinions. I hope that some day we can live in a world where all people are treated and respected the same.

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Female Genital Mutilation/Female Circumcision

March 11, 2007

I am in Dr. Johnson’s class, Forensic Nursing. We are reading “Forensic Nursing” by Lynch. After having read the chapter on Female Genital Mutilation/Female Circumcision (FGM/FC), I was somewhat confused about what I had read. I began to think and wondered why anyone would do this to his or her body. I had heard a little about FGM but had never experienced it in my nursing career. I got on the Internet, Wikipedia encyclopedia online, and did some research. I found out some interesting facts.

The article refers it the practice as female cutting. This is defined as “the amputation of any part of the female genitalia for cultural rather than medical reasons. The text book describes the different type of FGM. The different type are 1) Clitoridotomy, is the removal or splitting of the clitoral hood, 2) Clitoridectomy, the partial or total removal of the external parts of the clitoris, 3) Infibulation or pharaonic circumcision, includes the removal of the clitoris, labia major and the labia minora. The most severe of all of the four different types, 4) is an unclassified type which can include pricking, piercing, cutting, and scraping of the vaginal wall or incisions to the clitoris and vagina, and burning, scarring or cauterizing the tissue.
Historically the practice of FGM dates back to the 5th century B.C. and is believed to have originated in Pharaonic Egypt (hence the name “Pharaonic circumcision”). It has been found to have crossed different religions. It is found among Muslims and Animists. Today FGM/FC is practiced mainly in African countries. It is commonly in a band that stretches from Senegal in West Africa to Somalia on the east coast, as well as from Egypt in the north to Tanzania in the south. It is estimated that in these regions about 95% of all women have under gone this procedure. The practice is also preformed in the Middle East, though it is veiled in secrecy. In the parts of Africa it is practiced openly. Estimates by Amnesty International predict that over 130 million women world wide have been affected by these procedures. Amnesty International estimates that over two million are performed yearly. This practice usually occurs to young women between the ages of 7days to 14 years old.

Female genitalia mutilation is performed for many reasons, which include sexual, sociological, hygiene, and health. Sexually: men of the community feel that it controls or reduces female sexuality. Sociologically: it is used a form of initiation for girls into womanhood. Hygiene; is believed by certain cultures that the female genitalia are dirty and unsightly. Health reasons are the belief that it enhances fertility and child survival.

Female genitalia mutilation has short term and long-term consequences. The short term and most common consequence is that the person can go into shock and bleed to death or die from infection secondary to unsterile procedure. The procedure is very painful as it is usually done without anesthesia. The long-term affects are recurrent urinary tract infections, painful urination, and painful menstrual cycles. Another complication is urinary hesitancy or incontinence. The women can over a period of time develop cyst or abscesses in the vaginal region secondary to the blockage of the Bartholin gland. The skin in the vaginal area becomes very tight and can cause extensive tissue damage during childbirth. The women can develop vaginal/anal fistulas or vaginal/urethral fistulas. The consequences that go with procedure are life long or require extensive surgeries to correct.

Nurses have to have the ability to educate the women that have had this procedure. Most importantly nurses have to be sensitive to the cultural background of the patient and her parents and be respectful to the tradition. The information that should be given to the patient when teaching is a detailed explanation of the female genital anatomy and function. If the parents bring their daughter to have the procedure the nurse should be prepared to explain the adverse side affects and the long-term consequences.
The nurses should also be prepared to know the laws in the United States for performing this procedure to any female under the age of 18. The law states that any one who performs any form of female genitalia mutilations will be charge with a crime and can be fined or be sentenced to a minimum of 5 years in prison, or both.

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Reference to article “Forensic Nursing In Prisons”

March 10, 2007

I find this article very interesting due to the fact that I am a nurse in a correctional setting and it is difficult at times to have a nurturing personality as a nurse and be in an environment that encourages “non caring behaviors.” I constantly have to remind myself of where I am and the inmates are most of the time playing their childish games to see if you respond or to get a “get out of jail free card.” There are a lot of mind games played in a correctional setting. I believe the Forensic Nursing class taught by Dr. Johnson is going to further my assessment skills for inmates that have been victimized or traumatized themselves and to preserve and gather evidence of crime. There has already been several times I have had to gather evidence and preserve it until a detective is able to get back to the jail. The officers and I as the nurse work together with the inmates to ensure consistency among the inmates and security for all levels. There are a lot of times that I may notice something suspicious and report it to the officers and they do the same for me when the officers have found someone hoarding their medication. I would eventually like to begin working with the detective division part time to further my forensic nursing career and not remain inside the jail full time.

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