Archive for September, 2007

Nursing Assessment Liability – 11/2/06 comment

September 28, 2007

In today’s “sue happy” culture, could the case be made that this patient’s fatal massive heart attack might have been prevented if a more thorough assessment was done? Medical care costs are always taken into account, but at what point do we not test for possible underlying problems? It is certainly reasonable that “no way anyone could have known this was going to happen on that very morning” anymore than I know I’ll be killed in an accident on the way to the grocery store today. When I read stories like this, it reminds me of all the OB/GYN’s who get hauled into court each year for not producing perfect babies and complication-free deliveries for mothers. Are we at the point where nursing assessments are done more for legal protection instead of actually helping the patient?


Review of Discussion Topic – Medication Errors

September 27, 2007

While reading the Basic Pharmacology for Nurses manual, it continuously indicates the need to follow the FIVE RIGHTS OF MEDICATION PREPARATION AND ADMINISTRATION – right patient, right drug, right route of administration, right dose and right time of administration. Many medication errors can be alleviated if all nurses take the extra time to follow these RIGHTS.

The SIXTH RIGHT is RIGHT DOCUMENTATION. Documentation of the date, time, drug name, dose, site and route of administration is crucial in post medication administration. It is a legal document and can be used in court when pertaining to evidence accumulated by Forensic Nurses for documentation towards investigation of trauma and/or deaths of patients.

As a nurse working in the ER, many errors are made due to the activity in the department, disruptions from visitors, interruptions from patients using the call bells, and verbal orders from physicians.

Nurses must continue to practice the rights of medication preparation and administration in order to decrease medication errors in their hospital setting.


OUCH! – Pain control and nursing related issues

September 26, 2007

The last decade or so the medical field has been placed under greater than normal scrutiny with issues concerning pain control. Now considered the “5th vital sign” nurses are expected to be even more of a patient advocate in assessing and treating pain. I think it’s great that there is a large emphasis placed on the comfort of patients experiencing pain, but there are some problems associated with this extra pressure. For example, a nurse might be afraid of being sued now for not giving a patient enough pain control, when worried about that said nurse might be more apt to giving TOO much pain medicine. I used to work in the post anesthesia care unit of an OR department. This is a unit where pain control is a major issue anyway. I recall being in several situations where a patient was barely conscious but rating pain level 9-10. What is a nurse supposed to do? Of course if I felt like respiratory depressing was becoming an issue I would hold the pain meds, but I could not help but feel I might get in trouble later for doing so. Pain is terrible, but scaring nurses with legal tactics or threats of lawsuits is probably not the answer.


Extra paper work and assessments

September 25, 2007

It is becoming an ever-increasing problem trying to document all of the assessments and exams that a staff nurse has to perform. Not only are we required to do the physical exam on our patients but also all of the nutritional, abuse of both physical and substance, suicide prevention examinations, medication reconciliation forms. This is not to mention if for some reason you actually find something wrong and then the required paper work just to report it. It is a wonder that nurses even have time to treat our patients and give them the time and attention they deserve.

Do any Forensic Nurses have suggestions for the non-Forensic Nurses?

Medication Error

September 24, 2007

In 2006, a Wisconsin nurse administered the incorrect medication to a 16-year old girl who was in labor. The medication killed the girl almost instantly. The nurse had been working in the field for 15 years and was described as very competent. Following this incident, it was determined that the medication was labeled incorrectly. The nurse was subsequently charged with involuntary manslaughter.

In reading about the 6 Rights of Drug Administration, I couldn’t help but think of this case and so many other cases with similar circumstances. Any system is going to have flaws as humans are the ones designing the system and entering the data into the system. The 6 Rights can be adhered to, which will greatly reduce these types of occurrences, but they won’t be eliminated.

The charges against the nurse were dropped, but it’s something that she will have to live with for the rest of her life…that’s more punishment than any court could have imposed on her.


Back pain in the emergency room

September 20, 2007

The health assessment for back pain in the Emergency Room (ER) is an interesting assessment. The assessment usually begins as a visual watching the patient walk into the examination room after observing them get walking in form the parking lot not knowing that the practitioner is watching them. The chronic back pain caused from some sort of an on the job injury (OJI) usually does not pass the test of true and unrelenting pain. The client walks normally from the car but then starts stooping or limping or other symptoms just to make the “pain” look good. On the other hand, the acute injury or true pain is very obvious just by the outward visual exam. The physical exam on the person seeking continued pain medications or work disability shows that almost any suggestion of something hurting produces pain whether it should or not. The conclusion that we are coming to is that OJI for back pain lasts much longer without resolution then it should.


Nurse To Patient Ratios

September 19, 2007

There are 2 distinct sides to one of the most controversial dilemmas facing nurses today. First, the patients deserve to have better care from their nurses who don’t already have 9 other patients to take care of. If a nurse is responsible for 8-10 patients on a typical med-surg floor how can they be expected to provide the best possible care, or even just the standard of care? The more you spread a nurse out the less attention one single patient is going to receive. This puts them at greater risk for nosocomial infections, medication errors, incorrect or omitted assessments, the list could goes on. Even if a super nurse is able to accomplish this inhuman standard in their occupation what harm will be done to the nurse? A nurse, the backbone of the medical industry, does not deserve to be worked like a dog, to put these kinds of physical and mental demands that ultimately will harm their ability to take care of themselves and their patients. A standard in setting how many patients a nurse can be assigned to is a top priority for are already overworked nurse workforce.
Of course, you have valid arguments provided by hospital administrators and government agencies, but they are not strong enough arguments to persuade this nurse to think any different. The costs are too high, there aren’t enough nurses to staff this way. This is the mentality the non-nurses elect to have. If there are not enough nurses to staff a set ratio then it just supports the fact that nurses should be respected and not overworked to the point where they have to quit nursing. When aspiring nurses see how very little the hospital administrators actually care for their then the smart ones will choose another field and only add to the nursing shortage. The costs are high now because of law suits and problems that arise from not having a healthy ratio standard in place. By reducing errors caused now by not staffing patients well should reduce the unexpected costs that hospitals have to eat on a regular basis.
Really when it comes right down to it the golden rule should be considered by all. Would you want to be just another vulnerable patient that is one of 10 total care patients that the same nurse has to juggle?


Education in Conflict Management

September 18, 2007

Chapter 4 of the textbook “Health Promotion Through Out the Life Span” discusses the importance of the communication process. However, it does not discuss the conflict management aspect of communication.
Recent articles that I have read state that nurses experience 3 times more violence in the work place than any other service workers. Another report I read stated that of nurses surveyed, 30% reported being victims of work place violence. Patients, physicians and other staff members incurred the violence that included both physical and verbal aggression. As a supervisor in a hospital I have seen and heard of many acts of violence in hospitals. Some have caused permanent back injuries among other physical injuries. Although violence should not be tolerated in the work place, I do not believe there is enough education in conflict management in the schools of nursing.


Sexual Assault Nurse Examiners

September 17, 2007

From the statistics I read about, the majority of sexual assaults are perpetrated by males upon females, and unfortunately many go unreported. I have never understood the reasons how or why this violent part of humanity takes place or other forms of violence for that matter, but that’s how my mind works – I guess its part of my utopian brain. In any event, as a male nursing student I wonder how and if I would be able to help a female sexual assault patient since the likelihood of a male perpetrating her crime is very high. Would I be permitted to help, or would the female patient’s condition be compromised since I am a man? Are most SANEs female for this very reason? Just some questions from a guy nursing student that would like to help these patients if it’s possible.



September 14, 2007

The importance of health assessment is as evident in forensic nursing as any other aspect of nursing. Proper assessment and identification of abuse victims can possibly prevent further abuse to the patient, and could possibly stop the cycle of abuse. Duties of forensic nurses include examination of victims of abuse, assault, violence, trauma, and even death. The nurse may also collect evidence for alcohol or drug testing. She/He must also provide emotional support to both the victim and their family. Victims are often scared or confused and may even deny being abused. The careful assessment and recognition skills of the nurse are vital to this population of vulnerable patients.


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