Archive for June, 2009

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Forensic Nurses Helping Abused, comment

June 30, 2009

The SANE nurse, for me, was always a godsend. As a male working nights with only one other RN on duty, it was a relief for me to be able to call in reinforcements. Not that I couldn’t or wouldn’t care for these women. I have and will continue to do so without question. I have, however, noticed a trend in rape and abuse victims to have a "decreased" capacity for trust, even though I am a nurse. I always was non-judgemental, coming from abuse myself, and offered as much safety and trustworthyness as I was able. My major downfall; being male during a time when a female would, by her very presence, offer comfort and safety. Having a SANE allowed me to better care for a patient population that is difficult even for female RNs.

Original Post:
June 15, 2009
Title; Forensic Nurses Helping Abused
Who doesn’t know someone that keeps going back to an abusive relationship? They wear you down with their drama and pain, but keep going back. They want to believe that the person they need to leave will change. Repeated beatings, stealing, sleeping around with other people, using drugs and/or alcohol. And then abusing the children that are almost always another factor in the morass of their lives. And the abused woman lets them. This is where society blames the victim. Is it fair? No. Is it a normal response? Yes. Our capacity to absorb others pain is not limitless. And being the third party sets some distance for more objective thinking than the victim is capable of. Of course they eventually alienate all their friends and family. Then they are isolated as they abuser wants. Why are women so stupid? They expose their children to men they don’t know and leave them in their care. They go and move in with a man that has had multiple wives disappear or die with no explanation. They date and co-habitate with men that have got off on murder charges with technicalities…..why are women so stupid? Recognizing these women is not always easy. They are not always of the lower socio-economic status. They are not always uneducated. The one common denominator is low self esteem. No woman that valued herself as worthy would tolerate that kind of behavior. This is probably one of the most common cases that the forensic nurse deals with in the emergency room. How frustrating and heart wrenching to see someone that has allowed their self to be so mistreated. It would take a certain amount of distancing to deal with this on a regular basis. Could they render a real service and save lives? Of course. But what a challenge. The forensic nurse would also be the one to help organize the appropriate services around this patient. Legal for protection and restraint orders. Social to assist with placement (hiding at times) and a combination of social and psychiatric to deal with the remainder of this person’s ego, should any remain. Children involved? Then so CPS will be involved also. It remains that this could be a hugely rewarding, though challenging job.

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Forensic Nursing Employment

June 29, 2009

How can I start at the ground level in Forensic Nursing, try it out, then work my way up?

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Knowing your limits

June 29, 2009

How many times have you ever heard over the phone a doctor tell you "do whatever you have to do, I will be there as soon as I can." What does that mean? How far is our limit? Will I get in trouble if I do this or that? I have been witness of many of these situations, having worked in a critical care of the past 5 years and been part of code teams, the best advice I can give you is to know your limit. On a specific situation a doctor told a nurse over the phone to do whatever she needed to do to intubate a patient with respiratory failure, she administered paralytics without a doctor at bedside. To make a short story of this, they were unable to intubate the patient, the patient died, and so on. The nurse should have asked specific questions/orders of what she can do and she should have known her limits. What I am best trying to say is, that one should know his and her own limits and just because a doctor tell you "do whatever you have to do to save the patient’s life" we still have limits and knowing our limits should be a big part of our nursing skills.

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Staphlycoccus Scalded Skin Syndrome

June 26, 2009

While reading through the section on Skin, Hair and Nails, I began thinking about a discussion that was raised in my Microbiology class a few years ago. The discussion that I am referring to deals with SSSS, or Staphlycoccal Scalded Skin Syndrome. My professor displayed a picture of a child who was covered in what appeared to be 2nd and 3rd degree burns. Then one of my peers asked what this child being covered in burns had to do with Microbiology. That’s when he introduced us to the term, Scalded Skin Syndrome, and informed us that this is caused by the bacteria staphlycoccus. He also told us that in the nursing field we would have to be knowledgeable in being able to differentiate between true burns and SSSS so that we did not accuse the innocent and let the guilty go free. It’s hard but if you are at the top of your assessment skills then you should at least be able to take into consideration all of the factors that could lead you one way or the other and help make your decision more accurate.

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Actions required when skeletal remains are discovered

June 23, 2009

When skeletal remains are discovered there is a clear need for expert involvement. The expert required is a forensic anthropologist. After discovering a scene containing skeletal remains there are eleven actions that need to be taken.

  1. Secure the site – if the remains are discovered during the night – wait until morning to start the investigation
  2. Initiate a full investigation as discovered skeletal remains are to be considered a homicide until proven otherwise

    1. Select the most experienced investigators
    2. Limit the number of people at the scene
  3. Photograph the scene with the skeletal remains in place and create a map which outlines the location details
  4. Create a detailed plan on how to proceed
  5. Search the surrounding area for other bodies, artifacts and clues
  6. Review the area immediately around the remains
  7. Take detailed photo’s of each skeletal remain before removing any portion
  8. Collect the individual bones and label them before packaging them
  9. Sift the ground under and around the skeletal remains
  10. Collect and label everything you find at the scene and photograph it prior to removal
  11. Get professional help to tell you more about the skeletal remains, which means getting in touch with a forensic anthropologist

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Estimating the time of death – science or art?

June 23, 2009

A reliable estimate on the time of death can only be made during the first one to two days after death and even during that period there is a pretty wide margin of variance. After this period we are all well advised to not make exact claims on when death occurred.

One of the more accurate ways to estimate the time of death during the first 24 hours post mortem is based on body temperature. After death the body temperature will slowly decline towards the ambient (surrounding) temperature. An excellent tool for estimating the time of death prior to the body reaching the surrounding temperature is the easy to use Henssge Nomogram. Based on the rectal temperature of the deceased, the ambient temperature and application of corrective factors (size of the body, clothing and coverings, movement and humidity of air, immersion in water) the time of death can be estimated with a permissible variation of 95% in most instances assuming normal body temperature and surrounding temperatures ranging from 14 to 95 degrees Fahrenheit.

 The other tools used during the early post-mortem period are establishing the levels of rigor mortis (RM – generalised muscular stiffening) and livor mortis (LM – dark purple discolouration of the skin resulting from the gravitational pooling of blood in the veins and capillary beds after circulation has stopped).  Changes related to the body based on these physiological processes are far from accurate, but they do give us some additional indications concerning the time of death during the first couple of days.

The important facts to remember (when dealing with air exposed bodies) is that rigor mortis is complete after about 8 hours and disappears in 24-72 hours – providing at least a time window during which RM is present, which can be combined with the fact that LM discolouration can not be blanched (whitening of the skin when pressed) after about 8 hours.

Beyond the 48 hr point in time estimation of the time of death becomes an artful science with a wide range of error

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Child Abuse in Cultural Diversity Context, comment

June 22, 2009

At what point in time did spanking become abuse. It would have been nice if the writer had defined spanking in this article. Being a father of 2, I have spanked both of my children and never once questioned that what I was doing was wrong. An open-handed slap on the butt and a marching to a corner or one’s room is an appropriate response to certain behaviors. A slap on the hand is very effective, along with some words indicating why the slap occurred. Pulling of hair, punches to the face and stomach, the slamming heads against walls, throwing of objects that cut the face and then being told " I love you"; now that is child abuse. But spanking, come on. And while some children who were abused during childhood turn into abusers themselves, not all do. And who are we to question a society’s following of a religion THAT WE INTRODUCED TO THEM?

Original Post;
June 4, 2009
Title; Child Abuse in Cultural Diversity Context
While studying the chapter on cultural diversity, it made more sense to elaborate on some aspects of cultural diversity which still has a fine line between child abuse and cultural practise. One significant area is the right of African culture where parents make use of spanking as a means of corrective action or discipline. In Nigeria for instance, spanking takes the form of stroking with sticks,ruler or any linear object. Blending this tradition into the American context is another issue altogether. Law enforcement in America sees this type of traditional practice as child abuse and often send social services and child protective cases after parents. Many African families are in dilemma as to how to raise their children when it comes to drawing the line between discipline and child abuse. On observation so far, many families are forced to send their children back to Africa where the society upholds the saying "spare the rod and spoil the child". In recent social gatherings, African families are still debating over this controversy. They believe that the end result is better off if the parents spank the children rather than have the children sent to juvenile camps when their actions get criminal or turns into felonies. They often cite examples from the Bible as the foundation of wisdom and authority when it comes to raising responsible children in today’s society.

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Suicide Risk Assessment in Nursing Practice, comment

June 22, 2009

Suicide is not the only data that nurses are "afraid" of collecting. Nurses are also afraid to ask the "sex’ question when appropriate. When triage nurses ask these types of questions, maintaining a level of professionalism by the interviewer and allowing the interviewee a level of comfort with appropriate questions is profoundly necessary. We as nurses cannot pick and choose what questions we are required to ask, but we can pick and choose how we ask them and when. When interviewing the suicidal patient, take the focus away from the real issue if the situation is becoming uncomfortable, then after establishing a relationship with the patient, reintroduce the issue in a nonconfrontational manner. Look for clues while observing the patient. Look for clues to answers to other questions. Make the patient comfortable. Allow time for the patient to respond. Do not rush the patient; it will only shut them down. Remain calm and focused, for the patient, and elicit as much as you can.

Original Post;
May 26, 2009
Title; Suicide Risk Assessment in Nursing Practice
I wanted to briefly address the need to emphasize suicide risk assessment in the acute care setting. I see in this inpatient setting a hesitancy by many nurses to assess patients for suicide risk. As acute care nurses, we often overlook the psychiatric components to our patients health and as a result, do not give the care often needed by our patient population. As psychiatirc illness can play the role of contributing factor in some physical illness, I do see it as necessary to not forget this aspect of our nursing assessment, espcially on patient admission. We are often afriad of offending or creating an awkward introduction to our patient/ nurse relationship, however I do see this as an obstacle that we, as nurses need to overcome to provide adequate care to our patients. The more open we are in addressing psychiatric needs, such as suicide risk or other chronic psych illnesses, the better trust we will build with our patients.

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Substance Abuse in Pregnant Women

June 22, 2009

I currently work on a maternity unit and I am shocked on almost a daily basis by the drug use/abuse of our pregnant women. I live in a small hometown community and work at a level one hospital. A question on our admission assessment is , "When was the last time you used street drugs?" When this was first added to our assessment I thought it was ridiculous as I did not think we had a population that used street drugs, especially not while pregnant. My mind has been changed. Not only are these women using but they seem to be proud to announce it. They also seem to know that there are no repercussions. Even when the baby comes back testing positive, it is not removed from the home. Several of these women and their significant others just laugh and tell us that they know they are going to have to take a parenting class but its worth it if they get to keep the kid and continue to do their drugs. Best of both worlds they say. The most abused drug seems to be marijuana but it is closely followed by heroin. It does not seem to only be the younger generation but spans several generations that consider drug abuse the norm. I try to understand and try to teach/not preach but it is very difficult for me. Even when armed with the knowledge that these drugs are detrimental to their babies they really don’t seem to care. I even had one mother tell me that we as the medical community can just "fix" her baby after it is born due to all of the breakthroughs in modern medicine. Amazing!

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Medication Errors, comment

June 22, 2009

I also believe that many medication errors can be prevented by nurses and doctors listening better to patients. However, patients also hold some responsibility for their own care. Many times patients claim allergies to specific medications that they simply do not like the side effects of. When a physician is trying to choose the most appropriate care for a patient it is difficult when the patient "shoots down" the most appropriate therapy as they don’t like the fact that the medication makes them sleepy or causes nausea. A true allergy is very different from a medication side effect. Patients need to keep close tabs on their own medical history and actually be able to inform the physician what the allergy reaction is, instead of "I don’t know what happens when I take it, someone told me I was allergic though."

Original Post;
June 17, 2009
Title; Medication Errors
Medication errors are a major problem in hospitals, nursing homes, and clinics everywhere. There are many steps taken to avoid these errors, but they still happen. It can be an accident which could cost a person their life. Nurses need to be sure and follow the steps to avoid making errors and listen to the patients concerns about a medication. I have had a first hand experience with being given a wrong medication. I have a severe allergy to penicillins. I repeatedly told the nurse and the doctor about it and even witnessed the nurse close the medication allergy alert that popped up on the computer screen. When I questioned the nurse about the medication she told me that it was not in the penicillin "family." I went home, took the medication and ended up in the emergency room. If the nurse and doctor would have taken the time to listen to what I was saying my trip to the ER could have be avoided. The nurse always should be an advocate for the patient and always check whatever it is the patient is questioning.

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