Archive for September, 2008

Pandemic influenza (H5N1)

September 25, 2008

I work in Alaska on the Aleutian island occasionally.
Recently a village had a ‘dry run’ to practice giving immunizations incase the pandemic flu strikes here. Alaska is a threat because of migration of birds. It is felt that Alaska will be one of the first hit with the avian flu.
This small village was able to immunize 68 people in 4 hours.
The staff was eight people but they probably could have done it with six because they used two people to evaluate and work on spousal and child abuse issues with the ‘dry run’
One person was an intake at the door of the community center to guide the people through and help fill out forms.
Two people took vital signs and screened to make sure the person receiving the immunization had never been allergic to other flu shots or allergic to eggs.
Two people gave the vaccines; one person helped the person go out of the clinic and answered any other questions.
The village thought this ‘dry run ‘ was a success.

Original Post:
November 29, 2007
If/when a pandemic takes place, clinical nurses will need to use advanced assessment skills to recognize those who have been infected as well as those at risk. The symptoms of H5N1 have been shown to mimic the pandemic flu of 1918. Early symptoms of H5N1 mimic that of regular seasonal flu. However, the disease process of the H5N1 appears to be more inflammatory in nature leading to a mortality rate >50% affecting those with healthy immune systems. There is no rapid method to test for H5N1 and no vaccine. A person with seasonal flu or a regular cold has upper respiratory symptoms and an increased WBC count. A person with H5N1 has upper respiratory symptoms and a low WBC count. Could these clinical markers be used as an effective screening tool to triage and disperse available treatments (anti-virals, ventilators, etc.) in the throws of a full blown pandemic? If/When H5N1 mutates to develop human-to-human transmission initiating the pandemic, could the virulence decrease?

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Idenification of an Individual

September 25, 2008

Identification of an Individual;
Forensic Medicine http://www.forensic online.com Aurthor ; Joseph I. Cohn M.D. Pathologist. General Information for Individuals.
Posted: Dec. 22 2007,15:43

This information was informative and possibly all of us have seen forms of this identification on movies and television. I watched a forensic medicine show that showed how one homeless person was identified. The body was almost mummified with no identification no teeth. No one around that could identify the body. The forensic physician took one of the mummified fingertips and injected it with saline. After the tip was inflated with saline he could roll a fingerprint and found the unidentified homeless persons’ name.
So many wonderful skills have been developed to help identify people. Another skill is the forensic facial reconstruction that can reconstruct a face from even broken skulls.
Many other identification methods have improved with computers. Now 2D and 3D reconstruction of the skull using computers can approximate the person found with a few facial bones and again the skull.
Forensic medicine is leaping forward to help humanity understand the past and find people who have been lost.

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Verbal cues for evidence collection

September 24, 2008

The process of collecting data for evidence in regards to abuse must be a daunting task. We as Nurses are well trained in assessing physical clues but what about verbal cues. As I progress through each chapter of “Forensic Nursing” by Lynch I am reminded to constantly be alert to what the client is trying to tell you. This past week I had a client in my clinic for routine immunization, I performed a TB test and 48 hrs later when she returned she was angry, became upset with me because I pronounced her name wrong. I have seen this particular client on several occasions and she is usually happy and positive and actually seems timid at times, I was quite shocked by her outburst. Without going into particulars I found out later that day after discussing the situation with one of the Drs. that this particular individual had reported domestic violence to our social worker earlier that morning. I knew her behavior was out of the ordinary so it prompted me to investigate further. We can either choose to get angry with the client ourselves or look further into the change in behavior. I am glad I chose the right way.

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Nursing Care For Inmates

September 24, 2008

Providing quality healthcare to patients is challenging, especially when those patients are inmates; housed in an environment completely unsuitable for healing. Nursing theorists have long taught the importance of having basic health needs met. Hygiene is one of the most significant interventions, as this begins with a person’s ability to fix oneself in a clean environment. The patients I have cared for are inmates in a jail. A facility that houses people in tight living quarters, limits the use of showers and restrooms, and generally is comprised of people with a history of poor hygiene practices. Secondary infections prevent primary wound healing; contagious diseases are rampant (especially for the immunocompromised). This is when it is important for the nursing staff to be diligent to encourage good habits, educate based on education level, and work with correctional staff for the potential of the facility to be reached. This is the kind of nursing that started to save lives in the beginning, and it is these concepts that all nurses must acknowledge from time to time. Nurses must have a strong foundation in the basics to make all interventions capable of working.

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Rape is serious

September 23, 2008

Our American society takes rape seriously. Third world countries do not. The female anatomy and examination can be crucial to trial proceedings and the definition of innocence or guilt in a rape trial. The nursing assessment and collection of evidence is often performed by an emergency department nurse. Omission of an important feature can win or lose a case. In my organization, only specially trained Emergency Department RNs are allowed to utilize what we call the “Rape Kit.” This assures proper collection and assessment is performed to protect the client.

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Medication Safety

September 23, 2008

I have been touched by the many recent news headlines of medication errors, especially those involving newborns. In yesterday’s news covering a Las Vegas malpractice case, a sobbing pharmacist was apologizing to the parents of a deceased infant who was the recipient of a drug overdose prepared during her watch. The pharmacist was so distraught that the mother of the deceased infant left her seat in the court room to comfort her. Our text discusses the potentially harmful effects of medications during pregnancy, during Iabor, and to newborns. In watching the coverage and reading the text, I was reminded of the many times during my career that I have witnessed errors and myself experienced serious near misses with medication administration. It is devastating when such events occur to both the patient and the health care practitioner. Safe administration of medications has always been the goal of healthcare providers, but it seems that despite all of the resources available, errors continue at alarming rates. This is so much the case that The Joint Commission has charged hospitals to improve the safety of medication administration in their National Patient Safety Goals. Information regarding dosing, drug interactions, etc. is readily available in many formats to those preparing and administering medications. We have medications provided in unit dose increments and dispensed by machines. As a standard of nursing care, we perform a minimum of five checks before administering medications. Some medications require two nurses to verify the dose. We have changed our practices with patient identification to reduce the likelihood that medication is given to the wrong person. Yet, with all of the available information and redundancies built into the system, life threatening errors occur. There is a federal movement underfoot for all healthcare organizations to have electronic medical records in place. A medication administration record that does not require manual transcription would be an adjunct in reducing transcription errors. However, the data base is only as good as the information that it is provided with, leaving the potential entry for errors. Electronic data bases provide very useful information for tracking, measuring and determining clinical quality. This would help us evaluate process errors and to revises processes based on the knowledge gained. At the end of the day, with all the tools and information at hand, it is the end user who is the last and most important stopgap in safe medication administration. The available tools are like a hammer. A great hammer still needs a skilled carpenter to achieve a great outcome. It is my belief that our focus should be in development of the “carpenter” and the processes used by the “carpenter” with regard to medications. This would involve more training with medications; time to recalculate what is prepared in pharmacies, and an evaluation of the environment, including patient assignments and ratios. The costs incurred would be minimal compared to the cost of a human life or a lawsuit related to negligent practice.

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Medication Errors, comment

September 17, 2008

I don’t think medication errors are being reported as much as they occur. Nurses have a tendency not to report for fear of disciplinary action. We need a way to assure the nurse that she/he will not receive discipline but allow them to take the experience to learn from. To provide quality care we must report these incidents. I have always felt that if I make a mistake and no harm has come to anyone this is an opportunity for me to grow and share the experience with others. I feel even the smallest medication error should be reported so we can do a root/cause/analysis to improve the process so that the same error doesn’t happen again. It is my responsibility to report any error that I make to assure the safety of my patients. No one is perfect but we need to take responsibility for our actions.

Original Post:
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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Disaster management and forensic nursing

September 17, 2008

The chapter on disaster management was particularly informative in applying the principles of forensic nursing. In order to apply the preventive measures after disaster to prevent further destruction it is important for the community orientated Nurse to apply the science of forensic nursing. She or he must be alert to environmental clues or other factors that may be causing ongoing disease, disability, or death. Forensic nursing is definitely an area of I will pursue in the future.

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Use of Technology in Nursing

September 16, 2008

I agree with the person who said much of nursing notes and documentation not being looked at by doctors. It seems like a lot of our charting is overlooked or not even looked at period. It seems that it should be a lot safer and practical for everything to be computerized, including medication reconciliation sheets, but it is often not checked carefully and errors do occur because time is not taken to look over the notes and information collected by the nurse. It is true that nurses are responsible for more and more paperwork or charting, which takes more and more time away from our bedside care. Even though the physicians do not look at my charting, it is important to chart thoroughly and diligently because it can and will be looked at in the event of a lawsuit or legal action.

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Massage Pathology and Forensic Nursing Courses, comment

September 16, 2008

You may find the tuition and fee information by going the right side of this website. Go to the section “Forensic Nursing Resources.” Click on “Online Forensic Nursing Certificate Program at Canyon College.” Click on “Admission Policies” at the very top of the page. Click on “Tuition” and “Fees.”

Next, go to the “Online Education” section on the right side of this Forensic Nursing Chronicles site. Click on “Massage Pathology Course, Undergraduate & Graduate.” Click on “Fees.”

For both Massage Pathology and Forensic Nursing Courses, you will find the information you seek.

Original Post:
September 9, 2008
What is the cost of the Forensic Nursing and Massage Pathology Courses?

Original Post:
September 3, 2008
Forensic Nursing courses are not required to prepare for the NCETMB, NCETM, or MBLEx. However, Forensic Nursing students say they see Massage Pathology in a new light. They are able to remember Massage Pathology facts and concepts better and do better on Massage Pathology exams. One does not have to be a nurse to take our Forensic Nursing course. We have one course open to nursing students and non-nursing students. We have another course open to only nurses.

Of course Massage Pathology is required to sit for the NCETMB, NCETM, and MBLEx. A Massage Pathology course can be used along or with a Forensic Nursing course. Our Massage Pathology class does fulfill the requirements of the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) for a student to take (1) the National Certification Examination for Therapeutic Massage and Bodywork (NCETMB) and (2) the National Certification Examination for Therapeutic Massage (NCETM). Our Massage Pathology class also allows students to take the Massage & Bodywork Licensing Examination (MBLEx) according to the requirements of the Federation of State Massage Therapy Boards.

Original Post:
August 27, 2008
Does your Massage Pathology course fulfill the requirements of the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) to take the National Certification Examination for Therapeutic Massage and Bodywork (NCETMB) and the National Certification Examination for Therapeutic Massage (NCETM)?

Does your Massage Pathology course fulfill the requirements of the Federation of State Massage Therapy Boards to take the Massage & Bodywork Licensing Examination (MBLEx)?

Will your Forensic Nursing course assist me in preparing for and taking the exams listed above?

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