Archive for November, 2008

Government, the Law, and Policy Activism

November 26, 2008

Two legal aspects of concern to nursing are professional negligence and scope of practice. All nurses, community public health, informatics, and forensic nurses must consider the legal implication of their own practice in each patient encounter. According to the text the issue of scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other healthcare providers. Professional negligence or malpractice is defined as an act or a failure to act that leads to injury of a client. Despite the legal theory of sovereign immunity and the Good Samaritan law all nurse should carry their own professional malpractice liability insurance. (Stanhope: Community and Public Nursing Chapter 8)

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Cultural Diversity and Community Oriented Nursing Practice

November 26, 2008

Culturally competent nursing care is guided by four principles (AAN Expert Panel, 1992). One of those four guided principles addresses sensitivity. Cultural competent nursing care entails providing care with sensitivity based on the cultural uniqueness of your patient. Sensitivity would be of utmost importance in the field of forensic nursing. One subspecialty of forensic nursing is the care of sexual assault patients. As a sexual assault nurse examiner cultural competence must be demonstrated as a caregiver as you observe, recognize and collect evidence in legal cases for traumatic sexual assault injury. Because we live in such a diverse society it is essential that the nurse demonstrate cultural competence in the care of all patients but especially sexual assault patients. (Stanhope: Community and Public Nursing Chapter 7)

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Ethics in Community-Oriented Nursing Practice

November 26, 2008

Ethics decision making has application to healthcare professional both in community-oriented nursing and forensic nursing. Webster’s New World Dictionary defines forensic as 1) characteristics of, or suitable for a law court, public debate, or formal argumentation. 2) specializing in or having to do with the application of scientific, esp. medical knowledge to legal matters, as in the investigation of crime. Forensic nursing makes application of the science of nursing to the administration of justice. The International Association of Forensic Nurses, code of ethics states in part that the association expects its members to adhere to the highest standards of ethics. Forensic nurses have professional obligations to colleagues, to science, and to the public, and especially to those members of the public who are demonstrably disadvantaged. Accordingly, the International Association of Forensic Nurses expects its members and associate members to abide by its Code of Ethics as a condition of initial and continued membership. So just as the ethical principles and approaches to community oriented nursing are enduring and dynamic so to with the ethical principles that apply to forensic nursing. (Stanhope: Community and Public Nursing Chapter 6)

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Inflammation

November 25, 2008

Inflammation could relate to forensic nursing in that forensic nurses sometimes take tissue samples from the bodies they are performing autopsies on or patients they are working on that may be criminals or victims for evidence of a crime that has been committed. If the mechanism of injury or death was from trauma, there may be lasting evidence of acute inflammation in the tissues. Some signs of acute inflammation are swelling, redness, pain, heat, and loss of function. Obviously if someone is dead, they would probably no longer have those signs I just mentioned. They may however have increased neutrophil or eosinophil levels and possibly an increased amount of macrophages out of the venules and into the interstitial tissues. If there is evidence of MBP (major basic protein) present, that could serve as evidence that the person’s body was trying to fight off a parasite.

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Contrast of forensic nursing and public and community health nursing

November 25, 2008

Forensic nursing, literally meaning nursing as it pertains to the law, combines the health care industry with the judicial system. It is a fairly new specialty of nursing that involves providing care to victims of crime and patients within the prison system. Forensic nurses not only provide direct care to victims, but also collect evidence for law enforcement agencies. The term “forensic nursing” was coined in 1992 and the American Nurses Association officially recognized the field beginning in 1995. The professional organization for forensic nursing is the International Association of Forensic Nurses (IAFN). IAFN has more than 2,400 in the United States and abroad. Community and public health nursing in contrast has a long rich history. The National Organization for Public Nursing founded in 1912 provided essential leadership and coordination of community and public nursing. The field of nursing continues ever evolving and diverse. (Stanhope: Community and Public Nursing Chapter 2)

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Community health nursing and forensic nursing

November 24, 2008

Community health nursing coincides with forensic nursing in the area of assessment. Assessment is one of the core functions of the public health system. Forensic nursing requires effective assessment competence. Community and public health assessment refers to systematic data collection on the population, monitoring of the population’s health status, and making available information on the health of the community. The role of a forensic nurse would also require the assessment along with clinical investigation skills. (Stanhope: Community and Public Nursing Chapter 1)

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Benadryl, comment

November 21, 2008

How do we combat the abuse of drugs that are unable to be detected through any toxicology tests? The fact remains that people, especially young teenagers, will try almost anything to attempt to get high. It becomes almost impossible for law enforcement to prevent such actions and therefore lies solely on the parents. It is definitely time to be involved in the lives of your kids and know what they are doing.

Original Post:
November 12, 2008
Benadryl, comment
I have a response for the blog entry from November 10, 2008 entitled Benadryl. In the emergency department I work in we had an adolescent arrive in a psychotic state. He was hallucinating, was manic, combative and then would calm down and become very docile. He was slightly tachycardic and at times tachapneic and his blood pressure wavered between normo to slightly hypertensive. He didn’t have a diagnosed mental disorder. Our toxicology screens all came back negative and so we were getting ready to transfer him to an inpatient mental hospital when one of his relatives came in with Benadryl wrappers and opened capsules of Benadryl found in his waste basket in his room (they think he may have smoked it on a cigarette or joint). The kid overdosed on Benadryl. Not because he wanted to die, because he wanted to get high. Benadryl doesn’t show up in a tox screen and all his other labs were pretty normal. He ended up going to our ICU for a day and was discharged.

Original Post
November 10, 2008
Benadryl, an antihistamine often used for its sedation effect in adults, can cause paradoxical central nervous stimulation in children with effects ranging from excitation to seizures and death. Teenagers have discovered Benadryl, an over-the-counter medication, which is easily obtainable and affordable. The effects of Benadryl produce a “High.” Benadryl in this population is also taken with alcohol and high energy drinks. Parents also give their infants Benadryl to produce sleep and the outcome has been fatal intoxication. I have been made aware of Benadryl and its deadly side effects when a 10-year-old child was told by his mom to take a Benadryl tablet for his allergies. The child unfortunately took an overdose and was placed in the hospital for 2 days to withdraw from medication.

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Stages of Exhumation

November 19, 2008

Exhumation of a forensic scene must be done meticulously to preserve evidence. Briefly, the steps are outlined here:

A. Exhumation strategies and recovery methods – All logistical details should be worked out before starting groundbreaking – Exaction grid is placed around the site and proceeded through in an orderly manner – Never mark directly on the evidence; always on the container – Record specific information on each photographic exposure including date, time, and personnel involved.

B. Postmortem identification of remains – Bodies and remains are transported to the lab where they are first radiographed before forensic autopsy – Goals of autopsy are identification, documentation of injury, determination of cause and manner of death.

C. Reconstructing crime scene and criminal events leading to death – It must be determined whether assault took place at the grave or if the bodies had been moved to the grave site after death occurred – 3 stages of change after death: early, late and tissue changes.

D. Identifying and prosecuting the criminal – Obtaining physical evidence.

References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Excited Delirium Syndrome

November 19, 2008

Excited Delirium Syndrome is a cause of sudden death on an individual who is confused, irrational, delusional and violent. They may present high risk in this manner: a. A prior episode of excited delirium b. Violent and aggressive behavior c. Use of medication that increases the release or blocks reuptake of norepinephrine d. Cardiac disease e. Asthma or any pulmonary disease involving restriction of airway f. Epilepsy g. Use of stimulants such as cocaine and methamphetamine Age is not a factor. Behavior characteristics are: a. Verbal threats of violence b. Screaming, swearing, shouting at others c. Breaking or throwing objects d. Motor agitation, rigid/taut body expressions with poor concentration e. Projecting angry emotions onto another (e.g. blaming) f. Nonverbal behavior of rejecting others g. Pacing, restlessness, inability to sleep or eat, hyperactivity, history of violent behavior with need for physical restraint h. Delusions and confusion of mental state i. Defiance j. Bullying others k. Using stimulants (e.g. cocaine, methamphetamine) l. Paranoid behavior with auditory hallucinations. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Taphonomy

November 19, 2008

Taphonomy is the fascinating science of the study of human remains after death. It has been used both as an anthropological sense such as “the Ice Man” from 5300 years ago and King Tut’s remains from 1343 BC. It is also useful as a forensic tool. Anthropologists, archaeologists, botanists, naturalists and climatologists are all team players involved in the process. The key questions that anthropologists must answer are: a. Are the bones from an animal or a human? b. If human, what are the approximate age, race, gender, and stature of the individual? c. Have scavenging animals disarticulated the body or damaged bones? d. If there are defects in the body assemblage, were they caused by premortem or postmortem events? e. What effects have plants, animals, weather, and climate had on the body over time? References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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