Archive for the ‘Psychiatric Forensic Nursing’ Category

Psychiatric Patients

February 19, 2013

Forensic nursing involves the application of science and nursing in legal situations. Psychiatric nurses care for patients with mental illnesses. Forensic psychiatric nurses are employed in institutions such as a juvenile homes or prisons where a majority of the residents require treatment for mental conditions. Many of theses patients also struggle with the dual problem of mental illness and drug abuse. Patients who abuse drugs present with the additional complications of addiction, dangerous behavior, withdrawal symptoms, etc. It is interesting to consider that people who abuse drugs frequently also have a mental disease, which may or may not be diagnosed. For this reason all healthcare providers should be at least basically prepared to identify and care for patients with such conditions as they may not always be found under the strict care of a mental health facility and could present for treatment in emergency rooms and doctors’ offices.

Links
Healthcare Online Education Consultant
Forensic Nursing Online College Professor Teacher Instructor Available
Forensic Nursing Online Tutor
Nursing Nurse Online Tutor

For Helpful Links and more information, click here

Advertisements

Postpartum Depression, comment

April 9, 2010

I would like to respond to the 9/16/2006 post regarding postpartum depression. I think this is an area that a thorough nursing assessment can assist with for increased preventative treatment for women who have the signs and symptoms of postpartum depression. As stipulated in the article, 10-15% of woman suffer from depression following the birth of their children, it is our responsibility as health care professionals to ensure women are appropriately being assessed to prevent future cases like Andrea Yates. One of the questions I asked myself when this case had come up in the media, was this woman’s postpartum visit including a depression screening tool and how was the assessment performed on this woman I think it is key to detect the potential of women suffering from this severe mental illness as soon as possible. A simple depression questionnaire such as the Goldberg Screen, which is 18-question self-test, may help a practitioner become aware of some signs and symptoms of depression and facilitate earlier treatment to decrease greater potential of fatalities in severe cases such as with Ms Yates. I believe it would be effective to present this screening as a tool at the six week check up for all patients which will decrease the number of woman suffering form this disorder.

Original Post
September 16, 2006
Title: Postpartum Depression
What is postpartum depression? According to American Association for Marriage and Family Therapy (2002), “Postpartum depression is a biological illness caused by changes in brain chemistry that can occur following childbirth. During pregnancy, hormonal levels increase considerably, particularly progesterone and estrogen, and fall rapidly within hours to days after childbirth. Also, the amount of endorphins, the feel-good hormones that are produced by the placenta during pregnancy, drop significantly after delivery. Even the thyroid gland can be affected by the enormous hormonal changes that are associated with pregnancy and childbirth, leaving women more at risk for depression.” Additionally, AAMFT (2002) states, that “for 10 to 15% of those women, the period following childbirth becomes a nightmare as they experience sleeplessness, confusion, memory loss, and anxiety during the already stressful adjustment to motherhood.”
Source:
American Association for Family and Marriage

What comes to mind is the Andrea Yates case in which she murdered her children. A very notable forensic case that has been in the headline in the past but has recently come to light again as the Andrea Yates murder trial begins. In which she has claimed postpartum depression as the major reason she murdered her children. World Wide Web CNN- July 12, 2006, “Yates, 42, is being retried because her 2002 conviction was overturned by an appeals court that ruled erroneous testimony might have influenced the jury. She has again pleaded innocent by reason of insanity. Her attorneys say she suffered from severe postpartum psychosis and did not know that killing the children was wrong.” (www.cnn.com) this is a fascinating case, in the aspect that Yates had been in and out of psychiatric facilities for mental illness and depression prior to the murder of her children, so why did the psychiatrist not see this coming?

Today, with the many publicized murder trials of women who have murdered their children supposedly due to postpartum depression as the potential root cause, have encourage healthcare providers, nurses, and even new mom’s to look for the possible signs of this mental health condition. As a nurse, it is part of our nursing assessment skills in looking for potential signs that might indicate a new mom might need further assessment to rule out postpartum depression.

A great example was the other day a new mom of 4 months called the physicians office asking if there was a blood test to test if one might have postpartum depression. The woman claimed that she has noticed recently that she was having a few “sad days” and did not think she needed psychoanalysis but just wanted a blood test to check her hormone levels. When consulting with her physician, he stated that there is no specific blood test to find out if someone’s hormone levels are abnormal that would indicate postpartum depression and the only way to determine if the patient was truly having postpartum depression was an in-person evaluation, which a series of questions and lab work might be obtained. When the patient was advised of the physicians response to her questions, she agreed to a next day appointment but not before the nurse assessed if she was in any danger of hurting herself or anyone else.

Tags: , , , ,

Nursing satisfaction and work-related stress

March 18, 2010

Satisfaction and happiness by definition are closely related. In adults, satisfaction is usually a derivative from two major spheres, work and family. However, both are frequently sources of stress too (Tennant, 2001). In today’s ever-changing work environment, work-related stress and distress is becoming more and more common every day and quickly taking a toll on our workforces and their lives. Sadly, work satisfaction and happiness is swiftly becoming a thing of the past. The implications of these stressors are of significant importance to both employees and employers alike. Negative bodily and emotional effects of work related stress in nurses are plentiful. Previous research shows positive relationships between chronic work stress and negative health outcomes (McNeely, 2005;R & T., 1990;Sauter, Murphy, & eds., 1995). According to Olson (2008) in Forbes, America is in the top 10 for hardest working countries in the world. Americans on a whole, work about 1,797 hours per year (Olson, 2008). That is about 5 hours every day for the rest of one’s life. One may equate this with increased productivity, however not directly because it depends on many more factors (Sharma, 2007). Yet studies have shown a positive relationship between overtime and extended hours with increased incidence of hypertension, cardiovascular disease, fatigue, stress and many other ailments (Dembe et al.,2005; Schaufeli et al., 2008; McNeely, 2005;Karasek & Theorel, 1990;Sauter, Murphy, & eds., 1995). The healthcare setting is no different, but special circumstances, apply. Nursing, in hospitals, is the largest part of the labor force (Stone, et al., 2007). The literature is quite extensive on the stress and emotional burden of managing illness, suffering and death (J.F., 1987; Poncet, et al., 2007; McNeely, 2005; Marine, et al., 2009; Stone, et al., 2007). In fact, studies show that levels of work related distress, dissatisfaction and burnout are quite high in healthcare workers. Healthcare workers, particularly nurses, additionally experience elevated job-related stress resulting from high expectations, inadequate time, resources and/or support. These stress factors enhance health dangers and lead to dissatisfaction and burnout among nurses (Marine, Ruotsalainen, Serra, & Verbeek, 2009). Consequently, negative effects on mental and physical health, ultimately, leads to absenteeism, turnover, associated economic costs and finally, employer liability related to patient safety (Tennant, 2001; Marine et al, 2009;Stone, et al., 2007). Therefore, the health and mental well-being of nurses directly affects organizational and patient outcomes. Awareness of stress dynamics can lead to improved employee health, productivity, patient safety and overall organizational outcomes. Recognizing signs and symptoms of distressed and unsatisfied employees can help identify nurses with potential risks. A hospital’s largest labor force directly influence larger outcomes, thus, making it the organizations greatest asset or biggest liability. Identification and understanding of the dynamics behind work related stress in nursing is critical and should be a focus for hospitals, clinicians and other institutional leaders.

Tags: , , , , ,

POST TRAUMATIC STRESS DISORDER

March 11, 2010

Post traumatic stress disorder or PTSD is an anxiety disorder that can be triggered by witnessing or experiencing a traumatic event. PTSD is a medical diagnosis that applies when some one has difficulty coping with the after effects of trauma to the point where it disrupts their lives months or even years after the trauma occurred.

PTSD was once associated mainly with the survivors of war ,but today it is used to describe a wide range of trauma survivors –rape, crime, and torture victims; survivors of natural catastrophes, vehicular accidents, and technological disasters; and abused women and children. Also at high risk for PTSD are rescue squad workers, police officers, firefighters and nursing personnel who witnessed or experienced a traumatic or life threatening event that had the potential for bodily harm. Even people who had a miscarriage or experienced job loss may suffer from PTSD.

A clinical definition
Individuals must meet all the following criteria for a diagnosis of PTSD-
-Experienced or witnessed at least one trauma or life threatening event that had the potential for bodily harm to which they responded with fear, helplessness or horror.
-Continued reliving the trauma in the form of what is referred to as re-experiencing phenomena –nightmares, flashbacks and intrusive thoughts about the traumatic events.
-Numbing of emotions and persistent avoidance of situations reminiscent of the trauma
-Symptoms of physiological hyper arousal including startle response, difficulty falling asleep, irritability and hyper alertness.
-Persistence of symptoms for at least one month following the event.
-Evidence of clinically significant distress or dysfunction in social, occupational or other important areas of functioning.

Primary symptoms of those who suffer PTSD include insomnia substance abuse, night mares anxiety, depression, anger and fear that the horror will return. Because emotional distress can be overlooked in injured patients, researchers in a recent study of injured and uninjured soldiers caution caregivers to pay more attention to psychological aspects of patients conditions in general and to the early symptoms of PTSD in particular, both during hospitalization and after discharge.

REFERENCES
Helia your guide to healthy decisions http://www.helia.com
http://www.carolynchambersclark.com post traumatic stress disorder part 1

Online Introduction Forensic Nursing Course

Online Forensic Nursing Certificate Program

Online Nursing Assessment Course

Online Advanced Nursing Assessment Course

Post Traumatic Stress Disorder Attorney Lawyer

Tags: , , , , , , , , , ,

Interesting reading

February 8, 2010

Review of Forensic Nursing, by Virginia A. Lynch.

I found it interesting in chapter 3 when they stated forensic pathology lays the foundation for all clinical medicine (why people die). Forensic psychiatrists, behavioral scientists, and criminologists who study and evaluate crimes and criminal behavior (why people commit crimes) lay the foundation for the prevention of crime. I found this interesting to think we could prevent crime. If we could truly get inside a criminal mind we could prevent crime. Could science take us that far? Maybe one day!

Forensic Nursing Online Certificate Program

Forensic Nursing Online Introduction Course

Tags: , , , , , ,

William Eckert the father of “living forensics”

February 8, 2010

Forensics when it first began as we well know only cared about the dead. But as time grew we found out thanks to people like William Eckert, that the living have much to offer in the way of evidence. By studying the living both victims and criminals alike we can make headway into the criminal mind so that maybe we may prevent crime. The living have so much to offer.

Tags: , , , ,

Mental Health

January 28, 2010

Mental health is one of my favorite subjects. Maybe because we are all at risk for a psychological breakdown. Maybe because I have seen and experienced many mental health problems in my own environment. Friends and family have been afflicted with chemical dependency, depression, bi-polar and risk for suicide. I find it curious, though, that the designer condition, among my friends’ children, especially teen girls, seems to be bipolar or borderline. These girls all know the terms and almost seem to enjoy "schlepping around" (hanging around) the psych unit in their PJs. I wonder about some of these privileged girls and if psych care and diagnosis makes them even more coddled?

Tags: , , , ,

Suicide, comment

January 11, 2010

Over 90 percent of the people who die by suicide have a mental illness at the time of their death. Examples of the mental illnesses include depression, schizophrenia, and bipolar disorder. Unfortunately, most of these mental illnesses are undiagnosed. Untreated depression is the number one mental illness associated with suicide. Also, people with genetic disposition to depression may manifest no signs or symptoms of depression, but may still commit suicide. The question, tragically, is why were these illnesses undiagnosed? Where were the comprehensive health assessments? We are taught our first semester in nursing school to always obtain a comprehensive assessment at the client’s initial visit. This includes a family history, personal history, and social history. The family history section identifies illnesses of genetic, familial, or environmental nature that may affect the client’s current or future health. History of mental illness is one of the questions in this assessment. The personal history section asks the client for a general statement of feelings about themselves, and the family and social section asks about general satisfaction with interpersonal relationships, including significant others, other people in the house hold, etc. Questions are asked about diet and nutrition and changes in eating habits. Mental health questions are asked to assess stress, depression, irritability, etc. As an adult, I have no recollection of ever answering questions of these types for any doctor/clinic/medical facility I have visited.  If a comprehensive health history had been correctly administered to the over 90 percent, would they have remained alive? We as healthcare providers need to remember that the information we are taught in classroom settings is not intended for regurgitation on an exam. It is designed to be a tool in increasing the wellness of our clients – even to the point of saving their lives.

Original Post
July 14, 2009
Title: Suicide, comment
Suicide is known to be associated with mental disorder. It may be in form of major depression or some sudden trigger which causes an individual to act irrationally. The ideation of suicide can be very subtle especially when nurses do not detect the signs. some patients are very crafty and may disguise very professionally as well. So the duty is on the nurses to pry deeply on the patients when assessing life stressors which may likely make patients to contemplate suicide. Often, known patients with mental illnesses are protected by HIPPA except cases that are already committed to psychiatric settings. For adolescents, they often display their emotions which helps nurses to quickly act on the information observed or stated but when it becomes a case of prolonged ideation for which the patient has had a means and time to do the act then nurses must still be vigilant. One cannot overemphasis the pivotal importance of detailed assessment and constant reevaluation of any event or attitude which may suggest that a patient is in danger of committing suicide. Once at a psychiatric hospital, a room mate committed suicide suddenly. Nurses were surprised because the patient most have acted within the spur of the moment while disguising the traits associated with suicide ideation. Quality and risk analysis in hospital settings are still open to these investigations. Nurses can also use support groups as well.

Original Post:
June 5, 2009
Title: Suicide
Suicidal ideation is more common than completed suicide. Most persons who commit suicide have a psychiatric disorder at the time of death. Because many clients with psychiatric disorders are seen by family physicians and other primary care practitioners rather than by psychiatrists, it is important that these practitioners recognize the signs and symptoms of the psychiatric disorders (particularly alcohol abuse and major depression) that are associated with suicide. Although most patients with suicidal ideation do not ultimately commit suicide, the extent of suicidal ideation must be determined, including the presence of a suicide plan and the patient’s means to commit suicide.
Many clients who commit suicide have seen their primary care physician within several months before their death and many of these physicians were unaware of the clients’ intentions or that the clients had previously attempted suicide.
The best way to prevent suicide is to ask clients with symptoms of these disorders more specific questions about recent stressors and their thoughts about suicide, excellent history taking is essential to help diagnose clients with suicidal ideation. Reviewing the clients medical history for chronic illness, obtain a drug history and ask the client about family…listen for clues!

Online Advanced Nursing Health Assessment Course

Technorati Tags: , , , , , ,

Suicide, comment

December 24, 2009

Suicide is a very serious issue which needs to be treated with great precaution when the possibility of suicide is suspected. Around the time of the holidays suicide rates often rise. This is typically attributed to the stress many people feel around this time of year. My younger sister’s best friend’s father committed suicide last month and greatly affected my family personally. The girl’s father had been diagnosed with bipolar disorder and was being treated with medication but had recently been laid off from his job and ceased his medication treatment and ultimately committed suicide leaving three children and a wife behind. When I heard this news it struck me as extremely sad, as any suicide does. However this seemed even more upsetting to me because it was known that the man suffered from a mental disorder which was being treated. It brought to my attention how crucial it is that people have a strong support system they can turn to at all times, especially those who are treated for mental illness. It is important for signs of suicide to be taken with the utmost seriousness. Bipolar disorder is a chemical imbalance in the brain and may be caused by varying function of the structure and function of certain brain circuits. Bipolar disorder is highly associated with suicide and it is important to look for signs of depression or suicide so as to help the person as soon as possible.

Original Post
July 15, 2009
Title: Suicide, comment
Suicide is known to be associated with mental disorder. It may be in form of major depression or some sudden trigger which causes an individual to act irrationally. The ideation of suicide can be very subtle especially when nurses do not detect the signs. some patients are very crafty and may disguise very professionally as well. So the duty is on the nurses to pry deeply on the patients when assessing life stresssors which may likely make patients to contemplate suicide. Often, known patients with mental illnesses are protected by HIPPA except cases that are already committed to psychiatric settings. For adolescents, they often display their emotions which helps nurses to quickly act on the information observed or stated but when it becomes a case of prolonged ideation for which the patient has had a means and time to do the act then nurses must still be vigilant. One cannot overemphasis the pivotal importance of detailed assessment and constant reevaluation of any event or attitude which may suggest that a patient is in danger of committing suicide. Once at a psychiatric hospital, a room mate committed suicide suddenly. Nurses were surprised because the patient most have acted within the spur of the moment while disguising the traits associated with suicide ideation. Quality and risk analysis in hospital settings are still open to these investigations. Nurses can also use support groups as well.

Original Post:
June 5, 2009
Title: Suicide
Suicidal ideation is more common than completed suicide. Most persons who commit suicide have a psychiatric disorder at the time of death. Because many clients with psychiatric disorders are seen by family physicians and other primary care practitioners rather than by psychiatrists, it is important that these practitioners recognize the signs and symptoms of the psychiatric disorders (particularly alcohol abuse and major depression) that are associated with suicide. Although most patients with suicidal ideation do not ultimately commit suicide, the extent of suicidal ideation must be determined, including the presence of a suicide plan and the patient’s means to commit suicide.
Many clients who commit suicide have seen their primary care physician within several months before their death and many of these physicians were unaware of the clients’ intentions or that the clients had previously attempted suicide.
The best way to prevent suicide is to ask clients with symptoms of these disorders more specific questions about recent stressors and their thoughts about suicide, excellent history taking is essential to help diagnose clients with suicidal ideation. Reviewing the clients medical history for chronic illness, obtain a drug history and ask the client about family…listen for clues!

Technorati Tags: , , , ,

Can An Exercise Program Be Effectively Implemented For Severely Mentally Ill Patients In A Locked Down Forensic Psychiatric Facility?

December 16, 2009

It is widely reported that exercise can have positive cardiovascular health benefits for the general public. In reviewing information on the Internet, studies indicate that exercise is now recommended for all overweight and obese patients that are taking antipsychotics. Exercise may also have the potential to decrease hallucinations, improve self-esteem, and improve sleep (Faulkner & Sparks, 1999). Most psychiatric nurses would feel that with these potential benefits, it may be important to incorporate exercise as part of patient treatment. The first question that comes to mind is “how would I get my patients to comply?”  Tetlie, et al. 1999 conducted a study using exercise on fifteen severely mentally ill patients in a locked down psychiatric hospital. The data revealed four themes that were most important to patients and staff for an effective exercise program.  These themes include therapeutic relationships, mandatory participation in the exercise program, positive reinforcement by staff, and qualified instructors. The staff actually exercised with the patients one to one, and were able to build a therapeutic relationship in this manner. It was also deemed necessary by both staff and the patients that the exercise program be mandatory. For the most part, the patients stated that many times they would have not participated if it were not required. After the fact, most patients were glad that they did. According to the patients and staff, it was also necessary to have a staff member to exercise with that could balance his authoritarian leadership role with the ability to give positive feedback. The last requirement was to have a staff member that was familiar with the necessary techniques for each exercise. The most important of the four themes was the establishment of a therapeutic relationship.  It will serve us well as psychiatric nurses to keep the value of a therapeutic relationship in mind as we work with our patients on a daily basis.

Tags: , , ,


%d bloggers like this: