Archive for August, 2009

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The Effects of Stalking

August 27, 2009

Stalking is an act of imposing unwanted behaviors such as constant threats, frequent calls and vandalized acts that usually intimidates or threatens ones physical or mental well-being, which can effect the overall health status of the victim. Because of its negative consequences on one’s heath status stalking is considered a major public health issue. A stalker’s actions are to instill fear, control or manipulate their victims, who are in some cases the ex-intimate partner usually who were also, usually subjected to violent encounters during the relationship. In some situations, stalking has been known to escalate and become violent and fatal. The effects of stalking infringes on human rights by destabilizing ones physical and mental status such as the lost of a sense of  feeling safe which can cause these individuals to isolate themselves or make dramatic life style changes to compensate for the lost. A lot of the emotional/physical/mental health effects are the result of stress and fear secondary to the stalking behavior, for example many are diagnosed with panic attacks/anxiety disorders, hypertension and GI disorders. It destroys the individuals’ spirit to a point of becoming suspicious and distrustful toward society or and developing anti-social behavior such as violence tendencies, substance or alcohol abuse. Knowledge of forensic principles/ guidelines and the use of universal screening arm nurses with assessment skills which enables in identifying patterns or signs of abuse and address any health and safety issues that may accompany the victim. Proper documentation of findings and collection of evidence, reporting occurrences to appropriate authorities and connecting victims with appropriate referral/resources are efforts on the part of the forensic nurse in seeking justice for the victim and curving or decreasing the cycle of violence/abuse.

Legal Services regarding stalking

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Ethics, comment

August 26, 2009

I consider myself a very ethical person and when faced with the realization that many of the nurses in the facility where I work did not care one way or the other about the people placed in their care. I work at one of the largest county jail in the country and although these human beings have committed some type of crime, there is no excuse for not being given respect and the proper medical care as indicated in a timely manner. Daily I noticed that when it was announced that there was some type of emergency involving an inmate, the nurses would just sit there and look at each other, it seemed like whichever one drew the short straw was the one who would have to go and check on the inmate. During many of these cases the only respondents to the area was me and a deputy, then a few minutes later a nurse would come as slowly as possible with the crash cart would stand and just stare at the inmate before ever touching them. I finally had seen enough neglect and notified my program manager who notified the nurse manager of these nurses which made no difference in their performance. My next step was to notify the board of nursing who took forever to investigate the incidence without ever finding fault or reasons for disciplinary actions. To this day the neglect continues but I have been removed from the area (which was not my idea) and now work where I do not have to be exposed to this hypocrisy daily. To me this was a slap in the face to all the people who are there to do the best job possible regardless of who the patient is or is not. It seems ethics takes a back seat for these nurses once they enter the job-site, but then again a leopard cannot change his spots. Original Post August 26, 2009 Title: Ethics Really enjoyed the chapter on ethics from my textbook in Dr. Johnson’s class; I was lucky enough to attend a 2 day seminar in Ottawa that was mostly focused on ethical dilemma’s in the workplace. We presented different scenario’s which were really useful for future guidance. Of particular interest was the Nurse-Doctor relationship; when to step out of bounds as a patient advocate. We are often faced with difficult decisions regarding treatment of our pts. Do we agree or disagree with what the Dr. has prescribed? In one case I knew if I followed through on the treatment plan that the pt. could suffer undue harm therefore I was left with no choice but to report the problem to a senior medical advisor. It caused an uncomfortable situation for the Dr., and myself however after much discussion he was able to understand I was only acting on behalf of the pt. The chapter really gave me some knowledge of how to handle these situations. Forensic Nursing Online Introduction Course Forensic Nursing Online Certificate Program, , , , ,

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Ethics

August 26, 2009

Really enjoyed the chapter on ethics from my textbook in Dr. Johnson’s class; I was lucky enough to attend a 2 day seminar in Ottawa that was mostly focused on ethical dilemma’s in the workplace. We presented different scenario’s which were really useful for future guidance. Of particular interest was the Nurse-Doctor relationship; when to step out of bounds as a patient advocate. We are often faced with difficult decisions regarding treatment of our pts. Do we agree or disagree with what the Dr. has prescribed? In one case I knew if I followed through on the treatment plan that the pt. could suffer undue harm therefore I was left with no choice but to report the problem to a senior medical advisor. It caused an uncomfortable situation for the Dr., and myself however after much discussion he was able to understand I was only acting on behalf of the pt. The chapter really gave me some knowledge of how to handle these situations.

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Horrific Accident on Taconic Parkway gives way to proposed legislation

August 24, 2009

On July 26, a horrible accident on the Taconic Parkway claimed the lives of seven people and that of the driver of suspected vehicle. Diane Schuller‘s accident was initially thought to be just that, an accident. When first looking at the picture of Diane Schuler, you immediately one might think, what could have caused this terrible tragedy. Was it the road, did she have a medical problem like diabetes or epilepsy? The NYS Police even thought that during the initial investigation, they ‘have no reason to believe that Diane Schuler was intoxicated or impaired by drugs in any way’. They were not even factored into the equation. However, three days later, State Police released toxicology results, showing that she had a blood alcohol level of 0.19 percent. They also release that she had alcohol in her stomach that was not even metabolized.  Another devastating piece of evidence- a broken 1.75 liter of Absolut vodka was found in the minivan she was driving.  If that was not enough, high levels of a chemical found in marijuana were pinpointed her last use to 15 minutes to 1 hour before the fatal crash.

Many questions surrounding the accident began to swirl around her, her husband and perhaps marital problems, and the possible reasons for her to consume such high levels of alcohol, began to engulf the local papers and Internet. None of that made any difference anymore; it was pure speculation on everyone’s part.

 A couple of days following the release of the toxicology reports, Gov David Paterson proposed legislation that ‘would make it a felony to drive while drunk or high on drugs when a passenger under the age of 16 is in the car’.  One out of 7000 people injured related to driver intoxication. The NY Times is quoted, “of the 344 who lost their lives, 200 were under the age of 14.”  Thirty-five states have child endangerment laws that would impose much higher penalties against anyone driving drunk with children in the cars. Presently in NYS, the law does not treat those who drive drunk with a child any differently. Denise E.O’Connell, commissioner of the NYS Division of /criminal Justice Services says, “Gov Paterson’s legislation gives children a voice that should be heard loud and clear by anyone who would dare to transport a child while they are under the influence of alcohol or drugs”.

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What is being done with DNA and its future?

August 20, 2009

Almost 20 years ago, there was a brutal attack on a high school young student who was raped and murdered in my small town. It seemed to take forever at that time for the police to make an arrest-almost two years. Since the knowledge of DNA and DNA testing was just in its infancy stages when the murder occurred, the investigators at the time did not realize just how easy it was to have their DNA contaminate evidence that they handled. The investigators collected evidence much differently back immediately were no policies or procedures in place to ensure that they did not put their own DNA on the evidence. At his trial, prosecutors found similar hair to that of the victim and dirt on his tires was "similar" to the dirt found at the crime scene. The purpose of DNA testing is to eliminate any genetic material found on the clothing or belongings that could have been left behind by anyone other than the person or persons responsible for her death. The evidence and testimony of "witnesses" was circumstantial, and everything "pointed" to this young man who was seen with the girl on occasion, had words with her but he maintained his innocence right until he was convicted of the charges and sent to prison. It was in 1993, when watching an episode of the Phil Donohue show, that The Innocence Project and DNA testing became very interesting to this man. He contacted his mother and friends to find more about DNA testing and the Innocence Project, who later contacted the County district attorney who further pursued it. They obtained DNA from the evidence and the young girl’s belongings that he mother reluctantly gave. From that, it was determined that he was not the murderer or did he have anything to do with it by the DNA that was tested. He was quickly released from prison. At the time that he had notified the Innocence Project-his was only the eighth case that the organization had taken. Since then, 235 people have been released from prison. This young man, now 43, works for the district attorney’s office, going from place to place, lecturing on the Innocence Project. He candidly speaks about many of his experiences in jail. He states he is not bitter, but gives his opinion of the justice system and discusses that "junk science" that dominated the courtrooms before DNA came to be. DNA testing definitely plays a huge role in today’s courtrooms across the nation. In the case of the 1985 murder and rape, and exoneration of this adult man, a task force has been established to re-investigate her death. The DA has had at least 300 leads he is now following up with. Two of the original investigators are back on the case full-time on the case. Forensic evidence is still being analyzed in laboratories and samples are continued to be collected from various people to eliminate them as potential people of interest. The DA wants to solve this crime as does the man who spent all of his young adult life in prison; it may not be this week, two months from now or even ten years-we will solve this case and a man has been freed.

Forensic Nursing Introduction Course

Forensic Nursing Certificate Program

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Abuse

August 20, 2009

There was only brief mention in a few places in our Nursing Assessment text about the identification of abuse, and I think this is a topic worth covering. Whether it is elder, child, or spousal abuse, I feel this is just as important a skill as many covered in the text. As health professionals we are constantly coached to be impartial and objective. Also, we have become a society that values personal rights to a degree that we often allow injustices occur right before our eyes. To ask probative questions regarding the mechanism of injury or to involve CPS in a case that we feel strongly about also something clinicians should be trained and coached in.

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Forensic Nursing Field

August 20, 2009

Forensic nursing is a field that has become of great importance in today’s healthcare. It is an intense and serious field that requires proper training and dedication. Nurses in this field help patients recover from any type of assault neglect or abuse both emotionally and physically. The nurses in this area also may work in crime investigation scenes along with law enforcement or work as detectives in healthcare settings. Thus the role of the forensic nurses is vast and diverse. Nurses must possess great assessment skills and documentation is key. Often times these documents will be reproduced in the court systems, which is why accurate documentation is essential. I am happy to see nursing delve into this area of patient care in a more extreme way than before. Specialty nurses with these cases are needed to assist patients in the most beneficial way.

Forensic Nursing Introduction Course

Forensic Nursing Certificate Program

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Abdominal trauma in forensic nursing, comment

August 20, 2009

This article speaks a lot of truth for the field in which I currently work in. As a Critical Care Nurse in a Trauma 1 hospital I see a lot of abdominal issues that may or may not be trauma related. However the assessments and sequence of assessments tend to be the same (if indicated.) We see a lot of GI bleeds which may or may not be extremely painful. Auscultation of bowel sounds, palpation etc are all part of our core assessment. Using forensic assessment is almost 100% of the assessment process as well. Its funny how we do things out of instinct and training now, then read an article that reminds us of where we learned it from previously, as part of our education.

Original Post:
July 31, 2009
ABDOMINAL TRAUMA IN FORENSIC NURSING

  The primary components of health assessment are the health history and the physical examination. Since forensic nurses may need to perform specific exams related to each individual case, abdominal assessments may be indicated where there is some nature of trauma involved. Subjective and objective data are utilized in order to obtain data required for the specific case involved. Just as nursing assessment are used in hospitals, the same assessment is utilized in forensic nursing assessments.

  Forensic nursing assessment as with general nursing assessment is initiated by observing the client’s general behavior and position. The nurse assesses the client for any marked restlessness, rigid posture or knees drawn up. Facial grimacing and rapid, uneven or grunting respirations are also noted.

  The abdomen is observed to detect any erythema or bruises. The nurse also documents any signs of abdominal distention, tautness, scars, lacerations or open wounds. Auscultation is then performed to assess if bowel sounds are present or absent. Percussion of the abdomen, liver and spleen are indicated in order to assess the level of trauma sustained. Palpation of the abdomen, umbilicus, liver, gallbladder, spleen and kidneys are noted to assess any tenderness, hypersensitivity or rigidity. The client may respond to pain by using muscle guarding, facial grimaces or pulling away from the nurse. Spleen and kidney tenderness may indicate trauma.

  The nurse should use a pain scale in order to assess the degree of pain the client exhibits. Examples of pain scales can include descriptive or numeric pain intensity scale. The McGill Pain Questionnaire is another resource to indicate pain quality descriptors using 4 major groups ie: descriptive, affective, evaluative and miscellaneous which aids clients in describing their pain.  These groups are then totaled in order to indicate the description of pain the client is experiencing.

  Although all assessments of abdominal trauma are useful in determining the degree of trauma sustained, the nurse should be aware that findings detected during an exam may warrant the use of additional tests. The client may need to be transported to the nearest hospital for further evaluation.

  Abdominal assessments regardless of injury should be performed in a setting that is conducive to the client’s safety, privacy and dignity.

  Abdominal assessment techniques utilized in Chapter 20 of Health Assessment for Nursing Practice, Wilson & Giddens is an excellent resource for any nurse to familiarize themselves with the proper sequence of assessments.

Forensic Nursing Certificate Program that includes Health Assessment

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Care of torture victims

August 20, 2009

Torture is a dehumanizing experience that violates human rights. Victims are subjected to a variety of mental and physical suffering such as solitary confinement, witnessing torture to others and beatings. This act is usually performed for the purpose of intimidation, a means of extracting information and as a form of punishment. The effects have created many negative consequences on nearly all aspects of the victim’s life, such as the effects of disfigurement and chronic pain from repeated beating has a negative impact on the mental and physical well-being, also directly influence the socioeconomic status by impairing the ability to emotionally and financially care for self and family. The psychological affects of torture can be pretty devastating for the victims, and the rate of post traumatic stress disorders are significant. The minds and souls of these individuals are constantly haunted by the past events so they sleeping disorders and nightmares are serious concern of theirs. If treatment is not received, and there are many who are reluctant in seeking treatment due to sense of betrayal and distrust toward society in the aftermath, their problems can result into more serious conditions such as depressive and sociopathic disorders. Forensic nurses/multidisciplinary team are well equipped to address issues of torture and abuse. By acknowledging the declaration of human rights and the concept of justice as being an integral part of the victims healing process, the forensic nurse/team can assist victims in restoring trustful relationships and re-establishing a sense of safety. Compassionate care is also helpful in achieving these goals. In performing forensic examination, a thorough assessment is done of the victims physical/psychological problems, these problems are addressed and treated, accurate documentation of findings and proper collections of evidence are all a step toward justice for the victims.

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Women’s Health and Fertility Concerns

August 19, 2009

A few of these chapters brought back memories of my four-year experience with infertility some ten years ago. Keeping my follicular and luteal phase exactly on schedule before each of the seven inseminations, which were followed by four Invitro procedures, created a world-wind of anxiety and hope. With many fertility medications also taken over this timeframe, precautions, side-effects and possible future cancer diagnoses were discussed with my fertility doctor. According to Lehne, (2007), "Regardless of whether estrogens cause breast cancer, there is no question they promote the growth of certain cancers that have estrogen receptors" (Pg. 705). Other side effects that remain vivid in my mind included hot flashes, swollen and sometimes very painful ovaries resulting in ovarian hyperstimulation syndrome, mood swings and weight gain. According to Lehne (2007), "Mild to moderate ovarian enlargement is common, occurring in about 20% of patients. This condition is benign and resolves spontaneously after discontinuing drug use" (Pg. 740). Unfortunately, I was one of those patients experiencing ovarian hyperstimulation syndrome and it did resolve itself once the drugs were eliminated. Frequent sonograms were necessary to monitor my ovarian enlargement and egg stimulation. The drug mostly responsible for this significant discomfort is human chorionic gonadrotropin (hCG). During this drug induced time span, I was diagnosed with painful gallstones resulting in a cholecystectomy at the age of 32. Lehre (2007) noted, "The incidence of cholecystectomy among hormone therapy users was 48% higher than among nonusers" (Pg. 713). After reading this section with regard to hormone therapy for menopausal women, a prospect on which my fertility doctor did not comment, I concluded that the fertility estrogen-based drugs may have indeed contributed to the gallstone diagnosis. Lehne (2007) stated, "Birth control can be accomplished by interfering with the reproductive process at any step from gametogenesis to nidation (implantation of a fertilized ovum)" (Pg. 720). Using the pill for the regulation of my cycle was a mandatory part of the Invitro procedure, as well as drawing daily blood to monitor and evaluate levels to determine when I would be ready for retrieval of my harvested eggs. After finally becoming pregnant after the fourth Invitro, memories of not enduring these fertility drugs was such a relief. Fifteen months later, I became pregnant naturally with my second child without any medical intervention. When looking back on why and how hormone levels are effected, it seems clear that stress and how to manage it, can have a significant impact on our human body. Over a four-year infertility journey that created uncertainty as to exactly why I was not becoming pregnant, stress was mentioned as a possible factor. While a meditation course was also offered to all infertility patients prior to Invitro procedures, questions on marital relationship difficulties were never discussed. Though some patients are in desperate need of fertility drugs to become pregnant, how many of these women are counseled for stress that results from abusive relationships? It is my hope to clinically address the interrelationship between infertility and domestic violence issues, suggesting evaluation of spouse(s) personality type. This approach might help determine the real causes of infertile patients prior to their receiving a prescription for infertility drug treatment. References Lehne, R. A. (2007). Pharmacology for Nursing Care (Sixth Edition). Pgs. 70

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