Archive for January, 2009

Introduction into forensic nursing

January 22, 2009
I appreciate the introduction into forensic nursing.  Upon reading Dr. J. Johnson’s articles and researching, it has become apparent that the need for forensic nursing education is an imperative part of our role as nurses.  Health care providers’ are at times the first line of defense.  With training, we are able to identify both victims and perpetrators of crime.  We should have the assessment tools and nursing interventions that will interrupt and help prevent the cycle of abuse. Both the Centers for Disease Prevention and the Joint Commission on Accreditation of Health Care organization recommend screening for family violence in hospitals and clinics.  In statistics it has shown thus far that since forensic skills have become more widely used among health care professionals, the number of identified cases of abuse has increased.  Health care providers’ are learning to become more aware of abuse and the questions to ask and what to do with the answers.  It appears to be another educational tool we can all use to help others.

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Informed Consent: Is It Really Understood?, comment

January 22, 2009
In regards to the article Informed Consent:  Is it really understood? Thursday, July 10,2008.  I appreciated the topic and readings which brought forth important education issues that must be addressed to the patient prior to any procedure or treatment.  As professionals to understand the treatment or procedure being performed in order to assist the patient with questions he or she may have.  In view of the hospital setting where surgeries must happen quickly, I view education performed by the health care system as short.  With our main focus is making sure the patient signs the consent form. Shock is the first sign I see from the patient and families.  An inability to absorb very little.  I agree with an easy-to-read form and a teach back method.  In order for the patient/family to reinstate as to what they heard and for us nurses to be a patient advocate in this situation.  To report any doubts about the patients understanding or any concern.

Original Post:
July 10, 2008

Informed Consent: Is It Really Understood?

It is good to see the topic of informed consent included in the text book Health Promotion Throughout the Lifespan. As a nurse, who practiced for twenty plus years in the acute care field, this topic is of vital interest to me. It was not often enough that I felt patients fully understood what they were agreeing to. Now, with mounting concerns about patient safety and lawsuits arising out of botched communications, the area of informed consent is drawing national attention. Informed consent is one aspect of patient autonomy. Informed consent occurs when with “substantial understanding” and without substantial control by others an individual authorizes a professional to do something. As a witness to the typical “informed consent” process, in the acute care setting, it is no wonder that breeches in patient autonomy are realized and being awarded financial remuneration following legal action. In my opinion, critical flaws in the current system include; the patient condition at the time information is being provided, lack of complete information including treatment alternatives, lack of patient education prior to procedures including the recovery phase, lack of time to process information, cumbersome written consent documents, language and other communication barriers. The Centers for Medicare and Medicaid Services have now called upon hospitals to design patient-friendly informed-consent processes. Theses processes are now required to include treatment alternatives and the consequences of declining recommended therapies. The Joint Commission, which accredits hospitals, is advocating the use of easy-to-read forms and the use of “teach-back” methods, which involve asking patients to repeat back what they have been told about the proposed treatment, risks and benefits. The Department of Veterans Affairs (VA) hospital system is conducting several new studies in the area of informed consent utilizing the “teach-back” method to determine patient understanding. It is the beginning of what I believe to be a long overdue focus in healthcare delivery. Hopefully, the information gained will be utilized in a standardized approach to increase patients understanding of proposed treatments with the outcome of preserving patient autonomy.

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Drug abuse co-occurring with chronic pain, comment

January 11, 2009

I do agree that physicians are obligated to try to relieve the pain to there fullest power, however, one person may continue to experience pain and the physician should not always be held liable. It is the responsibility of the physician to do all that is in their power, but sometimes despite attempts at pain relief, some patients who have been addicted to drugs in the past end up with chronic pain. I do not think that one should be judged by their past experiences with drugs nor do I think this is a reason to keep pain medications from them. They have the right to treatment. Sometimes one of the barriers is that when a person has done drugs in the past, they have a higher threshold, meaning that they may require more of a substance than the physician who is treating them is willing to prescribe. Some past drug addicts require mega doses of morphine for pain, and some doctors do not feel safe in prescribing this. As an overdose could end fatal. One of the things that Naturopaths can do is to help the patient focus on other things instead of the pain. Try relaxation techniques and try to help the patient focus on healing instead of feeling the pain. While this will not work for all patients, this will work for some.

Original Post:
October 16, 2008
Drug abuse co-occurring with chronic pain
Physicians are obligated to relieve chronic pain. What should the professional do when chronic pain is present, but substance abuse is a concealed co-occurring disorder? When addicted patients experience any type of pain, the goal is to treat the pain; the addiction treatment in not the priority while patient is in pain. If drug abuse is unknown in the patient it’s the nurse’s job to suspect abuse when normal doses of analgesics do not relive the patient’s pain. If the nurse can determine the drug that is being abused and the amount being used, it is best to avoid exposing that drug to the patient and have an alternative drug.

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Autistic boy, 5, dies after controversial therapy; comment

January 9, 2009

It is my understanding that chelation therapy is a safe and effective method for drawing out toxins and heavy metals. There are screening protocols in place to insure that the patient is in good health. During the therapy, blood pressure and lab values are checked, if indicated. Although the article doesn’t give the cause of death, it is hard to believe it was caused by chelation therapy.

Original Post:
September 1, 2005
Autistic boy, 5, dies after controversial therapy
taken from:
The Florida Times Union, August 26, 2005

An unproven treatment for Autism was given to a 5 year old boy that subsequently died from cardiac arrest after receiving the treatment. Though some people believe this treatment may cure this condition, it has not been proven.

The treatment is chelation and the boy had received his third treatment right before the cardiac arrest. CPR proved to be unsuccessful and more tests will need to be done to determine the exact cause of death. Many people believe the autism is linked to preservative containing mercury that is used as a preservative in vaccines used in childhood. The belief in this theory has led to people advocating the use of chelation. This substance causes heavy metals to be excreted in the urine.

This is a great article that combines ethics with FDA testing of new medications. Forensic examination may not only identify the cause of death, but the effects of the chelation on the body in general. The outcome of the tests and autopsy results in general may lead to criminal charges since this drug was unproven to help

Chelation therapy is used in the treatment of toxic levels of heavy metals. These heavy metals include iron, arsenic, lead, and mercury. Chelation binds these metals so they can be excreted in the urine. High levels of mercury are thought by some to be related to the development of autism, thus the unapproved use of these drugs in the treatment of autism.

Chelation use is not without its problems. The levels of magnesium, zinc, and potassium should be checked on this child. A decrease in the levels related to the chelation therapy can cause serious fatigue and the effects of hypokalemia could be implicated in the cardiac arrest of this child.

Hypotension is another serious effect from the therapy, and sources cite giving the aminoacid tyrosine to counter that effect. A tyrosine level may also be indicated along with levels of the heavy metals to assess if there was an initial mercury problem prior to therapy. There can also be chelation of essential minerals such as iron, copper, and zinc. All of these levels should be checked, as well as levels of the chelation medication that were identified as remaining in the body.

There are dangers of kidney damage during this therapy, especially if dehydration is present. The kidneys should be evaluated carefully during the autopsy. There is also an established physician protocol, and the manner of administration should be compared to this standard.

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