Archive for March, 2008

Medicare Supplement Fraud

March 21, 2008

I am glad to know you offer a program to help senior citizens. Even though your help is indirect, I plan to participate in your course. I will be taking Forensic Nursing so I may help senior citizens who are prey to Medicare Supplement fraud. I understand part of your program deals with Healthcare Computer Forensics and Elder Abuse. Any other suggestions will be greatly appreciated.

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The Correlation Between the Health Assessment and Forensics Nursing, comment

March 21, 2008

I am writing in respond to the article titled “The Correlation between the Health Assessment and Forensics Nursing.” My job is performing assessments on patients for surgery, which in some way is similar to an assessment used in forensics nursing. I am not involved in forensics, but have read materials related to the assessment. I totally agree that as soon as I meet my patient, I start my assessment based on appearance, speech, skin color and facial expressions. Anesthesia assessment involves collecting all types of data that identifies the patient’s physiologic status, risk factors, knowledge and past health and anesthesia history. The most difficult challenge is keeping the patient focused and answering questions completely without omitting details, I can associate this also with a forensic assessment.
Once the subjective data is obtained, we do gather objective data to be complete. An example would be labs, EKG and x-rays which is also used in an investigation.

Subjective and objective data are the two primary components in performing a health assessment, whether it is any type. They both work together, if patient is unresponsive or unable to communicate, it does present a challenge. I than rely on family history or previous medical records. I agree with the last item in the article, “giving our clients a voice”, practicing as a nurse you must always assume the role as a patient advocate. Communication to physicians and other members of the health team is to ensure putting the patient’s best interest first. That is one reason I choice to become a nurse.

Original Post:
November 1, 2007
I think that performing a health assessment is very similar to a forensics investigation. The forensics investigator starts gathering evidence as soon as he enters the scene. The fractioned also gathers evidence as soon as she enters the examination room. Does the client answer questions appropriately, is her posture straight, is she tearful, guarding a certain area of her body. What about hygiene, is well groomed, or wearing stained, mismatched clothing. The forensics investigator uses many senses while investigating a crime scene. Smell, touch, sight, and the 6th sense about what seems to be not quite right. The fractioned doing the assessment uses the same senses. Smell can clue the fractioned into some diseases, for example some malignancies. The sense that something is not quite right is another skill that the fractioned develops. The client that says she is eating, yet losing weight leads the fractioned to follow-up with other questions. Is the client diabetic, bulimic, or an elderly patient unable to afford food?

The forensics investigator uses laboratory data to support his theories. Laboratory is a tool that the fractioned also uses. Is the chest pain cardiac with elevated cardiac enzymes and EKG changes? Is weight loss due to a malignancy, diabetes, poor nutrition?

Forensics investigation and health assessment share one more very important trait. Forensics investigators give the victim a voice. As health practitioners, our clients too, will often need us to give them a voice. This includes the very young, the very old, the cognitively impaired, and the victims of abuse.

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Forensic Nursing Physical Assessment

March 13, 2008

I have been an RN for 37 years, a graduate of a diploma program in 1970. Advanced Physical Assessment is part of my BSN curriculum. Interestingly I have always had a strong interest in Forensics, starting with watching Quincy and moving on to the writings of Patricia Cornwell, Kathy Reich, and other shows like CSI and Bones. I had participated in SA exams long before attending the course and really was more interested in the techniques and clues of observation, examination, evidence-collection and just putting all the pieces together. I always had keen observations skills, once sending police back to a scene to look for pills or other toxic evidence because of the odd breath odor from an unconscious male; determining right or left hand dominance to figure out self inflicted or someone else pulling a trigger gun shot wounds, injuries consistent with being driver or passenger and exactly how does a one year old fall on an iron. Forensic Nursing courses including Forensic Photography, articles, seminars and membership in Forensic Nursing Association only sharpened my assessment skills. As Manager, I encouraged several staff to attend SANE classes whether interested in becoming a SANE nurse or not and Forensic Photography courses. They all reported an increase in assessment skills. Many became SANE nurses others said they just became better nurses. In the course of a regular day many ED patients give vague histories regarding the events that caused their visit; legal (DUI, driving on suspended license, etc), memory deficits due to age or disease process, and fear of embarrassment because Nurse, “I did something really stupid.” Others may present obtunded or intoxicated or high, so assessment skills become even more important to provide safe and expedient care. My new role as an Informatics Nurse hasn’t stopped the clinical practice side of my brain as I do perdiem in our ED. I want to keep those skills sharp because who knows what the future will hold, and I owe it to my patients to be the best I can be. Dr Johnson, now I want to take your Forensic Anthropology course?

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Medical Identity Theft, comment

March 6, 2008

We teach our students who are studying the combination of Forensic Nursing and Public Health Nursing about medical identity theft. We encourage them to share with their clients about preventing the theft of medical identity. This prevention can occur by locking sensitive medical information. The lock can be a physical lock within the place of residence, a safe deposit box, a password-protected computer, and/or a password-protected section on a computer. Prevention can also occur via medical identity theft monitoring. The monitoring can be done by one of many different companies that offer this service. The easiest way to obtain medical identity theft monitoring is to seek a company, which offers identity theft monitoring. Thus, medical identity theft monitoring will be a part of the identity theft monitoring service. The client should seek a company that also offers medical identity theft resolution and restoration. By letting the company handle the resolution and restoration, a client can save themselves much time and much money.

Original Post:
February 27, 2008
I notice you deal with the subject Computer Forensic Science. What do you teach Forensic Nursing and Public Health Nursing students about preventing medical identity theft? This is regarding the public and clients that I communicate with during my Public Health Nursing duties.

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Protection of Healthcare Information

March 5, 2008

Patient information can now be found on paper as well as in the computer. The computer has made it easier for doctors and medical personnel to access patient information. A doctor can pull up labs, x-rays, etc right from his office or home. Our physicians have PDA’s and can look up information at lunch. While this makes the information more accessible, it also makes it a target for liability issues. Nurses have been terminated for looking up labs on a co-worker. With the right code you can pull up about anything. Hospitals and medical offices have had to implement rules concerning discussing patients in emails, etc. Most hospitals now have policies regarding looking up information on the computer to where you can not even look up your own information. Computer information has made patient care quicker and easier, but we have to make sure it is not costing our patients their right to privacy.

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Medication Errors

March 4, 2008

While I am in strong agreement that inadequate systems are to blame for many of the errors made in medicine, I also believe that the culture of medicine is to blame. In order to protect themselves and their loved ones from such errors, patients must start taking some responsibility for their own health care. Nurses and doctors must welcome questions and provide adequate answers. I have taken care of that patient or family who was always questioning, always double and triple checking up on me and all of the other providers. I have also made errors, but not on that patient.

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