Posts Tagged ‘Forensic Nursing Human Rights’

A Petition for the review of “Stand Your Ground” laws

August 12, 2013

Please sign the petition regarding U.S. justice for Trayvon Martin and the review of the “Stand Your Ground” laws in several states.

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President Obama will not release public pictures of the dead Osama bin Laden

May 5, 2011

Is President Barack Obama correct on this decision not to release disfigured photos of the dead Osama Bin Laden? Yes, he is.

The spirit of international and US laws prohibit the public release of photos of the deceased. Note that the US is unhappy when pictures of dead Americans are broadcasted publicly.

Morally speaking, most Americans would not want pictures of their disfigured passed away loved one broadcasted publicly. The moral, social and spiritual beliefs of a victim and family members should be taken into account. Also the moral, social, and spiritual belief of the country in possession of the pictures should be taken into account.

Ethically speaking, members of the Forensic Medical and Nursing profession are not permitted to show public pictures of the deceased. This brings me to another point. Forensic physicians, nurses, and personnel should be involved with the handling of Osama bin Laden and others. Forensic healthcare personnel are trained to be objective. They will confirm the cause of death, the time of death, the identification, and identify extra factors. The forensic healthcare personnel are removed from political and military biases. Their training includes caring for victims of war on both sides and innocent bystanders.

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Torture define per UN Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment

November 18, 2008

This UN article is interesting to me. (pg 38) If I understand this correctly, this article states that any act to extract information or a confession by use of force, either physical or mental is not lawful. Since this is supported by the UN, and assumably accepted by many nations, how does the United States justify the use of torture of Iraqi prisoners? In identifying these alleged abuses were forensic nurses used?

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Determination of decisional capacity in patients exhibiting psychiatric symptoms

October 2, 2008

I currently work as a psychiatric liaison for a large general hospital. I am responsible for conducting psych-social evaluations on patients who, while on the medical floors, exhibit psychiatric symptoms. I am also an active member of the hospital’s Bioethics Committee. As part of my job, I receive requests for evaluations to determine a patient’s decisional capacity. During the past few months I have seen an increase in requests to determine a patients capacity to provide informed consent for medical procedures. I decided to discuss this issue because it has great ethical and legal implications for all involved. In the hospital, primary physicians order evaluations to determine whether their patient has lost capacity to make their own decisions. The implications of the results of these evaluations are very serious, often controversial and could mean that a patient may end up having a procedure they did not want. These evaluations often raise ethical questions regarding a patient’s right to choose. These evaluations can also lead to disagreements and discord among the healthcare professionals involved in the care of the patient. I have noticed that physicians and other medical professionals are often quick to judge patients as lacking capacity to make decisions. Physicians sometimes assume that psychiatric symptoms equate with limited decisional capacity. I have found, while interviewing patients, that they may lack a basic understanding of the risks, benefits and alternatives of a procedure even after their doctor has explained the procedure to them. I also find that patients are often afraid to ask their doctor questions or seek clarification. In closing, I feel that the issue of decisional capacity could provide a great opportunity for healthcare professionals with expertise in this field to educate staff and patients and to offer clarification when questions arise regarding a patient’s decisional capacity.

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Recent events at my place of employment – legal and documentation concerns

September 4, 2008

I am a correctional nurse; I work in jails and prisons. Working in this environment medical staff must not only be vigilant of medical needs for our patients, but also for legality issues and security threats.
Last week a female inmate was being housed in a disciplinary unit by correctional staff. During this move the inmate’s roommate notified an officer that she had stuck contraband (in this case a crack pipe) in her vagina. The inexperienced sergeant insisted that medical staff on duty do an x-ray or cavity search of some kind. They never should have asked that of the nursing staff, it is a standard that corrections are responsible for any kind of security threat or contraband search. Unfortunately the officers were apparently so intimidating that the medical staff ( 1 LPN, 1 charge RN, and 1 Physician’s Assistant) agreed to do so. With the help of several officers, some of them male, they held the inmate down, and the PA digitally searched her vagina for a crack pipe. The legal ramifications are of course atrocious. According to the medical records/notes that I reviewed as a manager:

1. The inmate verbally was refusing the examination to be performed.
2. Males were present during the examination (there are plenty of qualified female officers present to handle these types of situations with female inmates).
3. The documentation was poor at best from both corrections and the nursing staff.
4. I have to discuss the possibility with staff and my superiors that this is possible a violation of a person’s 4th amendment rights.

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Informed Consent: Is It Really Understood?

July 10, 2008

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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Laughter as stress management; Laughter is not a crime

April 2, 2008

As a new nurse, the very first time that I was involved in a real “Code Blue” situation I was appalled at the disgusting jokes and remarks made by this team of professionals. There were no family members at the code to over hear the horrid jokes and remarks but it weighed heavy on me for several days. I did not know how such a team of professionals could be so crude a time of stress and heartache. Not mentioning any names, I discussed this with one of the Sisters at the hospital. She explained to me that sometimes humor is the way that some individuals deal with stress. That they were not as “cold hearted” as they appeared. Over the years and many Code Blue situations behind me, I find myself at times being that professional that I was so appalled at, in the beginning my career. When I stand back and view the situation to try to understand why I would say such a silly unprofessional remark, I realize that “if I didn’t laugh at that time, I would probably cry. This was no time to cry because the Code Blue Team was depending on me at this time of stress.

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Women from many different cultures

October 18, 2007
The forensics nurse is called upon to take care of many women from many different cultures. Rape and abuse happen every day. Women of all ages, from all cultures are victims. Providing culturally competent care in forensics nursing happens at many levels.
To begin with, the provider must understand her own feelings about different cultures, and acknowledge that one’s life experiences reflect the way in which one reacts to the world. Did the provider grow up in a tightly knit, excusive community? Was she exposed to many cultures prior to working in the health care setting? What messages did she hear as she was growing up?
The second step is to look at her own feelings working with cultures different from her own. Does she find it difficult and awkward, or does she approach each encounter as a learning experience? Stepping outside the box helps. The culture that condemns female circumcision needs to understand that other cultures may condemn the male infant circumcision. Also, try to visualize what it would be like to seek care and not be able to speak the language or understand the customs.
The third step is knowledge. The provider who learns about different cultures on many different levels is open to new information and ways of doing things. Ask questions. Are there certain personal or religious beliefs the client observes? Are there healers from different cultures who can do an inservice?
The fourth step is understanding basic human rights. Look into your client’s eyes, use touch and acknowledge that she is above all a woman of the human race. With the basic human right comes the right for privacy. Although it may seem easier to use the support person for an interpreter, this can be disempowering for the client. Have a good working knowledge of how to contact the interpreter and explain that the interpreter is specially trained. Some cultures require a female attendant. Know how to access this before the situation happens. If the partner seems reluctant to leave, have a plan worked out for a fellow nurse or medical secretary to find a reason to have him or her leave the room.
Lastly, ask the client if there is anything you could have done different. Reflect on the situation and learn from each case. Share information with your colleagues (maintaining confidentiality).

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OUCH! – Pain control and nursing related issues

September 26, 2007

The last decade or so the medical field has been placed under greater than normal scrutiny with issues concerning pain control. Now considered the “5th vital sign” nurses are expected to be even more of a patient advocate in assessing and treating pain. I think it’s great that there is a large emphasis placed on the comfort of patients experiencing pain, but there are some problems associated with this extra pressure. For example, a nurse might be afraid of being sued now for not giving a patient enough pain control, when worried about that said nurse might be more apt to giving TOO much pain medicine. I used to work in the post anesthesia care unit of an OR department. This is a unit where pain control is a major issue anyway. I recall being in several situations where a patient was barely conscious but rating pain level 9-10. What is a nurse supposed to do? Of course if I felt like respiratory depressing was becoming an issue I would hold the pain meds, but I could not help but feel I might get in trouble later for doing so. Pain is terrible, but scaring nurses with legal tactics or threats of lawsuits is probably not the answer.

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Organ Donation

September 10, 2007

Yes, in Ohio we are asked that question of “do you want to donate your organs”. This does seem rather cold and heartless. There is no follow up to that question if it is answered yes. There is no counseling. You have people at the BMV/DMV asking you. Not medical/forensic personnel who know what they are talking about. I could have said yes at the age of twenty and now I’m forty and my family might not know anything about that decision I made a long time ago. I had a baby on my unit that was terminal and on life support and it took the family weeks to come to a decision. The “loop” team was involved and talking with the family. But they did seem a little “pushy” about getting those organs. We just instituted a new policy at my hospital stating that if one went to the OR to harvest organs then the ethics committee would have to be on standby and come in as a “double check” for the family. Just to make sure they understand what they are deciding upon. If one says yes to organ donation at the BMV/DMV there should be information given/sent by forensic nurses/team so the person saying yes has a more informed consent.

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