Archive for October, 2007

Organ and Tissue Procurement

October 31, 2007

The Louisiana Organ Procurement Agency (LOPA), now utilize data bases of individuals who have expressed a desire to donate organs and tissue in the event of their death.

The primary means of acquiring the information needed for the data base is through the state Motor Vehicle Department. Each citizen acquiring new licensure or renewing licensure are asked if they would like to be included in the program.

All deaths occurring in the state must be reported to LOPA for screening. With the use of this database, early recognition of donors may be accomplished. This allows for rapid blood typing which is needed to match donors with recipients as organ and tissue rejection would occur otherwise. Transplant rejection occurs when the immune system of the recipient of a transplant attacks the transplanted organ or tissue.

Donor medical history is also closely scrutinized as auto immune disorders, history of cancer, HIV, hepatitis and other disease processes prevent participation as a donor.

To ensure that a potential donor meet the criteria for the harvesting of organs, a representative of LOPA reviews the database, lab studies, and approaches any family members that may be needed to consent.


Forensic Nursing with Health Promotion & Disease Prevention

October 30, 2007

You are correct; prevention is discussed in this weblog. The program Forensic Nursing deals with prevention. If you have not taken this program, you can sign up by clicking on the link on the right side of the main page of this weblog. The link is titled “Online Forensic Nursing Certificate Program at Canyon College.” Nurses needing both (1) Forensic Nursing and (2) Health Promotion and Disease Prevention can enroll in these courses by clicking on the two applicable links on the right side of this blog’s main page.

Question posted October 19, 2007
I notice many of your posts have writings about prevention. I am a nurse who works in Health Promotion and Disease Prevention. How can I combine my area of work with Forensic Nursing?


World Wide Spread of Diseases

October 26, 2007

Did you ever read the book “The Stand” by Stephen King? It was about a post epidemic world with lots of biblical implications. The epidemic was a “super flu” that was made by the army and it spread easily all over the world because of mass air travel and a world wide market. The BBC had an article by the WHO that warns of global epidemic risk. And that risk is based on massive air travel by populations all over the world and a world wide market in live animals. I live in Virginia. A Virginia ham is very salty, it is a local thing and we have always been proud of this ham. Then there was recently an article in the local paper about an outbreak of something like foot and mouth disease in Romania. Well, what the heck did that have to do with our hams? Turns out, the hams for Smithfield hams are raised in Romania. Is that weird? As it turns out, not so much. I knew companies in this country outsourced all kinds of things, but it turns out it is more extensive than I would ever have guessed. They can get these poor people to work for pennies a day and make a bundle that way. Aside from a poke in the eye at the abuse of capitalists, this certainly has large implications in the spread of disease. We have already seen a return of resistant forms of TB. And a recent event of one dippy lawyer that went international with his airborne illness (smart enough to pass boards for law but too dumb to understand the word “contagious”). There are other diseases making a come-back because of urbanization and mass travel. Cholera is back. Malaria is back. The hemorrhagic fevers are traveling further. SARS scared enough people but thank heavens, was not as virulent as initially assumed. But, there are outbreaks of flu that mutate and travel quite easily. Given the ease of movement of SARS, this may turn out to be scarier than a Stephen King novel.


Psychiatric Mental Health Nursing Assessment and the Electronic Medical Record

October 25, 2007

I am in agreement that the electronic medical record is not always ideal for charting a patient assessment. It takes thought to actually write down notes whereas sometimes in computer documentation you can get away with pointing and clicking. There is not always the correct symptom or description to fit what you are wanting to say. Today I assisted with a patient on my unit (in for a dislocated hip) but was apparently withdrawing from something. There was nothing in the computer to describe what this patient was exhibiting. She was screaming that someone was murdering her family, the next minute she was in church having revival. I am interested in looking tomorrow at what the nurse charted. We are also on electronic documentation. I think it is worse for nursing. The doctors at least have to write a progress note. The physical therapy notes include a lot of annotations. Computerized charting may be quicker, but I am not convinced it gives an accurate picture.


Sexual assault nurse examiners – comment

October 24, 2007

We have a SANE program at our hospital. The course is very extensive, 40 hours didactic, followed by clinical hours, including riding with the police department. The didactic component addresses the physical and emotional assessment, legal ramifications, counseling, and protocol. We have practioners and nurses on the team. Each team member is committed to 12 hours on call each week. There is a special room at the hospital dedicated to rape victims. The nurse undergoing this training must be committed to the program. Not only is she viewed as the first caregiver; she also is a voice for the client in the courtroom.


Forensic Nursing with Health Promotion & Disease Prevention

October 19, 2007

I notice many of your posts have writings about prevention. I am a nurse who works in Health Promotion and Disease Prevention. How can I combine my area of work with Forensic Nursing?


Women from many different cultures

October 18, 2007
The forensics nurse is called upon to take care of many women from many different cultures. Rape and abuse happen every day. Women of all ages, from all cultures are victims. Providing culturally competent care in forensics nursing happens at many levels.
To begin with, the provider must understand her own feelings about different cultures, and acknowledge that one’s life experiences reflect the way in which one reacts to the world. Did the provider grow up in a tightly knit, excusive community? Was she exposed to many cultures prior to working in the health care setting? What messages did she hear as she was growing up?
The second step is to look at her own feelings working with cultures different from her own. Does she find it difficult and awkward, or does she approach each encounter as a learning experience? Stepping outside the box helps. The culture that condemns female circumcision needs to understand that other cultures may condemn the male infant circumcision. Also, try to visualize what it would be like to seek care and not be able to speak the language or understand the customs.
The third step is knowledge. The provider who learns about different cultures on many different levels is open to new information and ways of doing things. Ask questions. Are there certain personal or religious beliefs the client observes? Are there healers from different cultures who can do an inservice?
The fourth step is understanding basic human rights. Look into your client’s eyes, use touch and acknowledge that she is above all a woman of the human race. With the basic human right comes the right for privacy. Although it may seem easier to use the support person for an interpreter, this can be disempowering for the client. Have a good working knowledge of how to contact the interpreter and explain that the interpreter is specially trained. Some cultures require a female attendant. Know how to access this before the situation happens. If the partner seems reluctant to leave, have a plan worked out for a fellow nurse or medical secretary to find a reason to have him or her leave the room.
Lastly, ask the client if there is anything you could have done different. Reflect on the situation and learn from each case. Share information with your colleagues (maintaining confidentiality).

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Forensic nursing and understanding normal child development

October 17, 2007

Behavior in a physically abused child is an illustration of how abuse inhibits the normal progression of stages which Erickson believes is important to becoming a self-actualized adult.
“Behavior in a physically abused child can cover a wide range and depends on his developmental level and the severity and duration of abuse” (Mulryan, et. al.)
Erickson describes the psychosocial task in infancy as “basic trust versus basic mistrust” A young child who is being abused “may be wary or cling to strange adults, and he may become upset if another child begins to cry” (Mulryan, et. al). This behavior illustrates the fact that the child has never accomplished the basic tasks of infancy.
During older childhood, Erickson defines the development task as Industry vs. inferiority. An older child who is being abused “may seem fearful around his parents and other adults/ his behavior could range from passive and withdrawn to aggressive” (Mulryan, et. al). The child has never developed confidence and the ability to make friends.
An adolescent who is being abused may exhibit antisocial behaviors, such as truancy, running away from home, stealing or substance abuse. (Mulryan, et. al.) Role confusion develops and the adolescent is unable to develop a sense of his identity.
The provider who has a comprehensive understanding of normal developmental milestones has an invaluable tool at her disposal. Deviations from normal will send up red flags, cautioning the provider to stop and explore the situation further.

Mulryan, K., Cathers, P., and Fagin, A. “ Learn How to Identify and Help Victims—and What You Can Do to Prevent Abuse in the First Place,” Lippencott & Wilkings, Inc. 34(10): 52-57, October 2004.
Wilson, S, and Gideens, J. Health Assessment for Nursing Practice. St. Louis, Mo., Mosby, 2005.

Behavior in a physically abused child can cover a wide range and depends on his developmental level and the severity and duration of abuse. A young child may be wary or cling to strange adults, and he may become upset if another child begins to cry. An older child may seem fearful around his parents or other adults; his behavior could range from passive and withdrawn to aggressive. A preteen or adolescent may exhibit antisocial behaviors, such as truancy, running away from home, stealing, or substance abuse. Problems are easier to recognize if you understand the child’s emotional and social development and are familiar with his typical behavior patterns.


Forensics and the nursing process

October 16, 2007

Forensics is an integral part of the nursing process. Through forensics, a focused assessment can evolve into a comprehensive assessment. Part of the nursing assessment process is being open to clues given by what is not being said, marks on the body, and a partner who answers questions for the client. A busy practioner in an acute care setting can find that her focused assessment can quickly become a comprehensive, even life saving assessment. To illustrate this point I will pull from a case during my experience in Women’s Health. A client comes into the acute care area of a Women’s Hospital. Her complaint is menstrual cramping with severe pain unrelieved by Ibuprophen. During the interview process, collecting subjective data, the practioner notices that the client’s partner answers the questions for her, and that he does not leave the client’s side. Collecting objective data, the nurse notices unusual bruising along the client’s inner thighs, and upper arms. When the practioner says that she is going to do a pelvic exam and do screening for STDs, the client refuses. This could be a client who is very private with a very protective partner, or the victim of abuse. It is part of the skills gained through learning the nursing process, enhanced by the forensic ability gleaned through years of experience which will guide the practioner to giving her client optimal care.


Sexually Transmitted Diseases: Forensic Nursing in the ER, comment

October 15, 2007

RE: Sexually Transmitted Diseases: Forensic Nursing in the ER
Forensic Nursing Chronicles: August 2005

Having worked in a busy city ER, I have seen case after case of STD’s in young females. They come in for treatment, and are on their way. If rape is reported, (as in the case of LM), it can be challenging at best to get a teenager to report it. In the case of LM she changed her mind in the end and stated that it was consensual.
It is a shame that the man will be going around spreading several STD’s to each unsuspecting female. You would think he would be uncomfortable enough to seek treatment, with four STD’s.
Unfortunately LM will be reminded of the rape every time she has a herpes outbreak.


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