Archive for November, 2009

H1N1 Pandemic

November 30, 2009

Central California has been hard hit by the H1N1 influenza. We have had two deaths in our ICU due to this virus but two weeks ago. When we received our first doses of the vaccine, more than half of the nurses in my unit refused to be vaccinated. The reasons were varied. Some never got annual flu vaccines, others thought that they would get the flu from the vaccine, and still others felt like they had the H1N1 flu already and had natural immunity. The physician population had similar excuses. Attempts to educate and alleviate fears fell on deaf ears. I’m puzzled to watch healthcare professionals choose to not be vaccinated while they care for a much younger population suffering the sometimes deadly consequences of this novel flu. Freedom of choice appears to be a stronger motivator than fear. Are we teaching the general public and patients our fears and beliefs.

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Second puzzling case of autism reported, comment

November 26, 2009

As governmental funds for researching the causes and eventual cure of Autism increase, it has naturally gained more attention from the public. I agree that this has its pros and cons. More parents are considering the possible ramifications of dosing their children with multiple vaccines. Parents are becoming more proactive and accountable when it comes to decisions regarding the medical care of their children. It is shedding light on a disease that has been, up until recently, misunderstood by most. On the flip side there isn’t a whole lot of concrete evidence linking autism directly to vaccine administration, yet there is a multitude of evidence that suggests that vaccines have saved lives, prevented the spread of potentially fatal disease and in some cases has eradicated the disease all together. I have a family member that became adamant that her children were never going to receive any type of vaccine – she executed extensive research on vaccines and homeopathic alternatives. To date her children have not received a single vaccine, they take multiple vitamins and herbal supplements on a daily basis and their diet is quite restricted. Sadly and ironically, her 13 year old son was diagnosised with autism at 3 years old.

Original Post
July 1, 2009
Title: Second puzzling case of autism reported
Federal health officials at an upcoming conference the controversial cases of a 9-year-old girl who became autistic after receiving numerous vaccinations. In January a 6-year-old girl received a flu vaccine and a week later became ill requiring hospitalization and ultimately died. Study after study has failed to show a link between vaccines and autism but many parents of autistic children claim that childhood vaccinations they received are responsible. In 1986 a National Vaccine injury compensation program was introduced to compensate injured children from vaccines. Many deadly epidemics have been prevented by vaccination. For the parent of a child injured following vaccination, grief and ambivalence would prevail. The questions that continue regarding these very complicated situations cause great concern for parents trying to decide whether to immunize a child.

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Forensic Psychiatric Nursing and the Transgender Patient

November 25, 2009

At some point in our forensic psychiatric nursing career, we will be called upon to care for a transgender individual. We must be able to care for these vulnerable and highly stigmatized individuals in a culturally sensitive and medically competent manner. You may ask, what exactly does transgender mean anyway? The official DSM IV diagnosis is “Gender Identity Disorder”. Gender identity disorder can be described as a person who has strong, persistent cross gender identification. The person has a discomfort with their body and their secondary sex characteristics.  This discomfort causes significant distress in social, occupational, and other areas of life. It is now recognized that these individuals experience varying degrees of distress associated with their perception that their gender identity is inconsistent with their biological and social gender assignment. It has been only in recent years that the scientific study of this complex and stigmatizing phenomenon has brought together the fields of psychology, sociology, endocrinology, psychiatry, general medicine, and reconstructive surgery into a comprehensive field of sexual research (Diamond, 1999). Nurses may encounter individuals in different stages of gender consolidation, and therefore must be aware of the special interpersonal and medical needs of these individuals. What constitutes gender consolidation, and thereby the removal of mental discomfort, is very individualistic. Gender consolidation may be dressing and living as a woman. Whereas, for another individual, it would involve surgery to fully change to the desired body characteristics and genitalia. Examples of possible surgeries are: orchiectomy, penectomy, clitoroplasty, labiaplasty, neovagina, hysterectomy, salpingo-oophorectomy, vaginectomy, metoidioplasty, scrotoplasty, urethroplasty, testicular prostheses, breast surgery, and facial reconstructive surgery. Therefore, it is best to proceed with caution, assume nothing, ask the appropriate professional questions, and assess the individual’s comfort level prior to the actual physical assessment.

As a nurse, I have provided care for several individuals that have considered themselves transgender. When I have asked them what special needs that they may require and how they would like to be taken care of, every individual to a person has referred me to the “Harry S. Benjamin Standards of Care”. This is a very good reference that should be read prior to caring for transgendered individuals, and can be accessed at http://www.genderpsychology.org. The Harry S. Benjamin Standards of Care (HSBSC) were originally written in 1979 and have been revised as needed. The HSBSC reflect the current thinking of the professionals in the field. The purpose is to “articulate professional consensus about psychiatric, psychological, medical, and surgical management of gender identity disorders”. The goal is to help individuals with gender identity disorder to achieve “lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment” (Meyer, et al, 2001, p. 1). These standards describe the triadic therapy of hormones of the desired gender, the “Real Life Experience”, and surgery to change genitalia and sex characteristics. There is detailed information about eligibility requirements and readiness criteria for each step.  Knowledge of these standards is mandatory for the application of culturally-informed approaches to care, where the nurse seeks to understand and assist without judgment.  The obligation to “do good” and “do no harm” call for nurses to approach transgendered individuals with the utmost professionalism and interpersonal competency.

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Correctional Nursing, comment

November 24, 2009

I have to agree with the author on the view that some correctional nurses do not treat the inmates as they would a patient in a healthcare setting. The prison population in or area is pretty extensive. In addition to the two local county facilities, we have a state hospital for the criminally insane, level three sex offender unit, three medium level state correctional facilities and one minimum prison. Our prison system is our biggest employer. I do have several friends who have left healthcare for the benefits of a state facility – insurance, overtime, vacation. As I listen to them discuss their day – I often would like to point out the fact that they all sound miserable and loathe the very people they care for. Speaking as a wife of a correctional officer, it’s almost as if the very environment of the prison system breeds contempt. If anyone shows even the slightest act of compassion they are looked at as a traitor or weak – this carries over to the medical staff as well. Sadly, it appears the staff of such facilities are just biding their time as well as the inmates.

Original Post
August 26, 2009
Ethics, comment
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, , , , ,

Are we ready for a Pandemic? (comment)

November 24, 2009

I have mixed emotions on this topic as well. When our NYS hospital mandated every employee be immunized against influenza, I was far from thrilled. I have never -in 20 years of healthcare – ever had a flu shot. I realize that as nurses, educators, leadership – we should set the example and think in the best interest of the patient…but I also feel that government does have a way of trying to control. As a member of Nursing Leadership I helped man the flu clinics and I did receive my vaccine – the day before the temporary retraint was approved. More recently we have held flu clinics for employees opting to have the H1N1 vaccine. Our area has been hit with several cases of "swine" flu in the schools and community. Luckily we haven’t had any fatal cases, but some of these individuals have been seriously ill. There is room for debate, but what truly is the lesser of two evils?

Original Post
November 2, 2009
Title: Are we ready for a Pandemic? (comment)
I couldn’t agree more with the writer of the previous forum about the mandatory immunization of nurses in NYS. I feel it is irresponsible and unprofessional of nurses not to get immunized against the flu. We as nurses are responsible to our patients to not get them sicker while we care for them. Studies have indicated that when tested, 33% of healthcare workers in one study tested positive for the flu last year but showed absolutely no flu symptoms. It is commendable that the nurses who say they don’t want to be immunized would agree to stay home if sick but unfortunately it is not in the nurses natures to think they are sick and as the study indicates many showed no signs of sickness but were contagious. We are required to have yearly Tb tests and I don’t hear people screaming about that. I am confused as to why we don’t want to do what is best for our patients.

Original Post
October 19, 2009
Title: Are we ready for a Pandemic
I thought my state had the right idea in preparation for the seasonal flu and the H1N1 flu that has begun to hit our schools and will inevitably be hitting our hospitals and nursing homes. The NYSDOH (New York State Department of Health) had mandated an emergency regulation, which mandated annual flu vaccinations for all healthcare personnel by Nov 30. This is no different to the already in place regulation of requiring mandatory vaccinations of healthcare workers for measles, mumps, rubella and TB testing. As an educator, I also must regulate the company representatives and vendors coming into our organization, that they also must have all the necessary immunizations prior coming to our surgery department. This is not only to protect our patients, who are already at a compromised state, but also to protect them from contact of our patients. We as educators and leadership began to immunize our healthcare workers to proactively prepare for what was to come. As of last week, we had immunized well over 75% of our workers. We know our hospitals have shortcomings in that we ask our workers to stay at home if they contract symptoms or they must stay home with their children, but on the other side of the coin, we reprimanded them if they are sick longer than three days, as they do not have a note from their doctors, as they cannot go to the doctors offices for fear of spreading the disease. As in everything we see each day, we began to hear grumblings from some of our own nurses. "No one is going to make me get a vaccine". They were going to go to our state capitol to argue and try to block the mandatory flu shots-as the subsequent lawsuit stated it was to "protect the rights of nearly 60,000 medical workers" in New York State. As of today, there is a temporary restrain order blocking this mandate. What is the question here? Do the nurses not want to be vaccinated? Do they not want to be "mandated to be vaccinated"™ I think the state made a gutsy move attempting to be proactive in the wake of a possible pandemic. I went into healthcare many years ago to help people, to care for the sick and dying. I participated in a smallpox inoculation workshop, when the threats of bioterrorism and chemical warfare hit home. What is wrong with these nurses- are they more concerned with going to their unions than they are about their patients? During the legal turmoil that will probably take weeks. I read in the paper just yesterday, that the flu virus has claimed eleven deaths of children and teens during the last week-eighty-six in all. Its effects are now seen in forty-one states. Who is going to care for the very sick people that are going to be coming into our organizations? Did you not learn anything from the HIV virus?

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Clinical Scene Investigation and Assessment Skills

November 17, 2009

In the same vein as TV’s Crime Scene Investigation show, health care organizations are turning to specially trained teams to investigate severe patient incidents. These teams, titled Clinical Scene Investigators (CSI) are responsible for investigating events that result in permanent patient harm or even death. The investigators gather details about the event from the participants and patient charts and may even sequester equipment as the situation warrants. They look at all the details which lead up to the incident, how the situation occurred and then look for opportunities for process improvement. In situations like these, thorough documentation on the healthcare workers part is paramount. Was the caregiver aware of the pending situation and were appropriate actions taken? In addition, the CSI team members must have superior assessment skills, solid investigatory abilities and excellent communication skills. They must be able to paint a picture in order to determine if more investigation is required.

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Narcotic Drug Diverson by Nurses

November 10, 2009

Nursing staff have enormous access to potent narcotics, Diversion of these drugs is not a complicated process. Controls are not tight and often the diversion goes unnoticed for quite a while. Many times the diversion is not for the nurse but rather a significant other or sometimes even to sell for additional income. I believe the advent of computerized Pixus etc may help to decrease the diversion because of improved tracking.

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Alcohol Abuse

November 10, 2009

Alcohol Abuse is often noted to be a problem with healthcare providers. The responsibilities that accompany caring for the health and well being of patients is a contributing factor. Blend this with the human factor of constant potential for error, often healthcare professionals self medicate with alcohol to cope. What begins as a drink after work with friends sometimes leads to drinking before and sometimes after work to deal with the stress. It is imperative that employers of healthcare professionals do not judge but protect both the patient and the health care professional.

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Effective Measures Towards Pain Management, comment

November 9, 2009

Being culturally sensitive is paramount in the assessment and treatment of pain. It begins before any contact with the patient. It begins with self awareness of how the nurse views pain and the understanding that the nurse’s beliefs are formed by his/her own culture. By self actualization, a nurse is better prepared to interact more therapeutically in the patient’s behalf. The Joint Commission requires that a patient be assessed and reassessed ongoing to pain relief, taking into account the patient’s cultural, spiritual and ethnic beliefs. According to McCaffery (1999), pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does. It is a combined phenomenon with sensory, emotional, cognitive and physical parameters. Pain assessment and pain relief however, may be different for every patient. Nurses should educate their patients and families to report the pain, and to expect relief. It is far more likely that a patient’s pain will be under treated due to withholding or inappropriate prescribing of opioids. The nurse should very familiar with the pain tools and use them consistently, taking into account cultural differences. The signs and systems of pain should be assessed carefully. The nurse should not second guess the patient or family and should not dismiss what is being said. They should also listen carefully to their patients and look for contributing factors. The nurse will want to ask the patient regarding their belief about pain and satisfaction with the current pain level. This information will direct the actions that the nurse will take, both pharmacologically and in providing comfort measures.

Original Post
September 8, 2009
Title: Effective measures toward pain management, comment
This post reminds us that the measurement of pain is primarily subjective. As providers, we must always remember that people respond to and express pain very differently. We must be culturally sensitive when assessing and treating pain. Pain is the 5th vital sign. Pain affects the physical and psychological well-being of our patients. It is our responsibility to ensure that our patients’ pain is being well managed. We must know our own biases and misconceptions and leave them at the door.

Original Post
September 2, 2009
Title: Effective measures toward Pain Management
Pain is an alteration in ones comfort level, which can significantly impact the physical, emotional, and psychological well-being. Pain is a subjective experience that can only be explained by the patient. Cultural and ethnicity are a few factors that influences patients response to pain, to improve outcomes nurses must be able to understand pain from a cultural perceptive. People respond to and view pain differently. Among various groups for various reasons emotions may or may not accompany pain it is viewed by some as an act of punishment or as a spiritual test. Having knowledge of patient’s views and how they define pain is very valuable in that it can assist the nurse in achieving positive outcomes by incorporating this information in the plan of care. Nurses who ignore or refuse to develop cultural sensitivity not only do they violate patients’ rights but also a chance of having a trustful relationship and without this you can expect poor outcomes. Pain is often poorly assessed and poorly managed due to reasons like misconceptions and nurses lack knowledge. This usually leads to under medications and poor outcomes, such as the post-op abdominal surgery patient that develop pneumonia because is unable to perform cough and deep breath exercises every 2hrs secondary to pain because of the nurses’ misconceptions about administering pain medication to a patient with history substance abuse. To achieve goals of effective pain management nurses must first be aware of their values and personal beliefs concerning pain and the behaviors associated with it, this will assist in developing an awareness and sensitivity to the patient’s need. Nurses must be knowledgeable and skilled in collection of both subjective and objective data (by accepting the patients’ assessment of pain by using pain assessment tools and observation of emotional behaviors such as crying or moaning), which will assist in identifying the intensity of patients’ pain and promote better outcomes. Misconceptions must be explored and addressed because these also impact outcomes, such as administering pain med on regular basis will lead to addiction or those who abuse drugs usually over exaggerate their pain, by acknowledging these misconceptions nurses will be able address patients’ pain related issues more professionally and improve steps toward effective pain management.

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Legalization of Marijuana, comment

November 6, 2009

The debate over the legalization of marijuana has been a heated one for decades. Most recently a ski town in Colorado – Breckenridge – voted to legalize marijuana by a greater than 72% majority rule. The ruling will allow adults 21 years and older to have in their possession up to one ounce of marijuana. While this is a symbolic triumph for advocates of legalized marijuana – possession of pot in the state of Colorado remains a crime for individuals without medical clearance. Although there are many credible resources, outlining the scientific research detailing the pro’s of medical cannabis – I think there has to remain stringent government regulations allowing it’s use. It may not be as addicting as alcohol – but as I think back about 20 years to a college dorm room…can we really argue that someone under the influence of such a substance would make a good school bus driver, medical practitioner, teacher, truck driver? Medical use is one aspect – recreational use is quite another.

Original Post
November 2, 2009
Title: Legalization of marijuana
I was reading my local paper today and there was an article about the legalization of marijuana written by a former police officer. He was fully supportive of such an endeavor. He made great points about how difficult it is to close down an illegal drug dealer but how much easier it would be if we made them legal dealers and had some control over their operations. The government could make billions off of legalization of marijuana. If we take the power of money away from the illegal dealers it will not hold the same draw for them. Alcohol, which is legal and a billion dollar industry, causes many problems for those who use it. Marijuana is not physically addicting like alcohol but it is still illegal. I used to be surprised at the extensive use of marijuana in our society. If we know it is not physically addicting and no worse than alcohol why is it taking our society so long to decide that it is helping a lot of people.

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