Posts Tagged ‘Human Rights’

Perception of Coercion

May 13, 2013

I believe that Ukraine should allow a neutral international team of forensic nurses and experts speak with and exam Yulia Tymoshenko. She is the ex-prime minister who has been jailed since 2011 in Ukraine. I would be happy to take a trip from America to Ukraine to be part of the international team. I would ask for an office for rent in Kharkov and one of the short-term apartment rentals in Kharkov.

The importance of the material covered on health history interviewing cannot be over emphasized in forensic psychiatric nursing. The ability to communicate with accurate empathy, non-judgment and skillful use of specific techniques is essential for accurate risk assessment and monitoring of mental status changes. People who are impaired with paranoid delusions, mistrust, and extreme sensitivity to the motives of others (such as the government of Ukraine), are more inclined to provide information to clinicians that they perceive to be competent. Monahan and colleagues at the MacArthur foundation found that the manner in which providers communicated affected the recipient’s perception of coercion for better or for worse. That is, even when recipients were being subjected to involuntary treatment, their scores on the “Perception of Coercion” scale were lower when the clinician communicated with empathy and respect. Violent events in psychiatric settings can be reduced when staff is competent in assessment and forming working alliances with the patients.

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Informed consent, comment

February 18, 2009
I read in the blog some discussion of informed consent. As a consumer
of medical services I rarely get much out of the informed consent
documents, and will admit that I rarely read them in much detail.
Granted, if we were talking about more than just a general doctor’s
visit I would take a little more notice.
I have also participated on several research studies and have written a
number of IRB applications, including drafts of the informed consent
documents that are given to participants. While I have tried to make
these the most accessible to the participant as I can, the university I
worked for required certain headings and certain, stock legal language.
The purpose of the documents from the IRB’s side didn’t seem to be
“make the participant aware” and the purpose from the principal
investigator’s perspective was “get it through IRB” (and typically
after the research activity had already begun).
I won’t even go into the issues around working with a non-English
speaking population, where while translation is required actually
putting time and resources into achieving a translation that actually
communicates meaning is definitely not the priority. Rather, the
priority is having a document where the written word is in the language
desired regardless of the meaning communicated.
As a massage therapist, I am working directly with clients to provide a
service. There are legal concerns to be addressed, definitely, with the
informed consent. There are also scope of practice issues to be
clarified. Finally, and most interesting to me, are the issues around
getting the client to understand what the purpose of the service is and
how s/he may contribute. I found the one poster’s comments about a
“teach-back” approach intriguing, and will look more into this. While
not brain surgery, a client has the right to understand what they are
about to participate in and having them tell me “in their own words”
what it is–the legal issues, the scope of practice issues, and their
contributions to the outcome–sounds like a great strategy.

Original Post:
February 6, 2009
Informed Consent: Is it really understood?
I find the articles regarding informed consent exceedingly interesting.
It was a subject that was recently brought to my attention regarding
Radiography Techs and consent for IV contrast. For years, RT’s were
able to witness consent, then all of a sudden they could not. Being the
only RN in a busy Imaging Department, this became a huge burden. I did
some research recently and found articles from ARRT that describes the
RT Scope of Practice. Their scope of practice specifically states that
they are to “verify” that consent was obtained. Now comes another
wrench. There is no definition of “verify” and in our department, it
had become a bone of contention among the Radiologists that the
ordering provider was responsible for “Informed Consent”, to include
risks, benefits, options, etc. Now comes the fun part: Some
practitioners don’t even order the proper tests. Try convincing a
steadfast NP that by ordering a CT Thorax WITH CONTRAST, they were
actually prescribing the contrast. She did not appear to get what I was
trying to explain to her. (She must have finally, because she began to
order tests without contrast, which is a questionable practice because
it may not always be the best exam for a patient and they have a delay
in care or another CT with contrast) I even went so far as to go to the
ANA website and download the RN Scope of Practice, which explains
consent is again “verified”, not witnessed like we do. Both the NYS DOH
and DOE do not specifically state whether an RN or an RT respectively
can or cannot witness consent forms. It has come down to many crucial
conversations between patient and staff and the knowledge of the
patient regarding testing. If this wasn’t my job, I would find it
rather humorous and ironic, all these issues that arise that are truly
not addressed in the RT or RN Scope of Practice.

Original Post:
February 2, 2009
Informed Consent: Is It Really Understood?, comment
I
work in a Liver Failure Clinic and have end stage liver failure
patients. I perform paracentesis procedures to remove fluid from some
of these patients peritoneum. The patients are in pain need fluid taken
of their peritoneum NOW so they can breathe.
The patient has to be able to make decisions to sign the consent.
We inform the patient they may need blood if a vessel was punctured. We tell them they may get an infection and even die.
We have the patient sign on a pad that transmits the signature to a computer. A witness and I sign it also.
 All of this is before the procedure is done.
Never
has a patient not wanted the procedure even when death, bleeding, pain
and infection were mentioned in the informed consent.

I agree
that it is important to have an informed consent. It takes time and
sometimes the patient’s signature is almost unrecognizable.
There is
pressure on the patient and staff to get this signature. I agree that
sometimes the patient does not really know what is going to happen
because they are in need of the procedure now. We explain the entire
procedure to them before the procedure but just how much is really
understood is questionable.

Original Post:
July 10, 2008
Informed Consent: Is It Really Understood?
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 inf
ormation 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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Informed Consent: Is It Really Understood?, comment

February 6, 2009
I find the articles regarding informed consent exceedingly interesting. It was a subject that was recently brought to my attention regarding Radiography Techs and consent for IV contrast. For years, RT’s were able to witness consent, then all of a sudden they could not. Being the only RN in a busy Imaging Department, this became a huge burden. I did some research recently and found articles from ARRT that describes the RT Scope of Practice. Their scope of practice specifically states that they are to “verify” that consent was obtained. Now comes another wrench. There is no definition of “verify” and in our department, it had become a bone of contention among the Radiologists that the ordering provider was responsible for “Informed Consent”, to include risks, benefits, options, etc. Now comes the fun part: Some practitioners don’t even order the proper tests. Try convincing a steadfast NP that by ordering a CT Thorax WITH CONTRAST, they were actually prescribing the contrast. She did not appear to get what I was trying to explain to her. (She must have finally, because she began to order tests without contrast, which is a questionable practice because it may not always be the best exam for a patient and they have a delay in care or another CT with contrast) I even went so far as to go to the ANA website and download the RN Scope of Practice, which explains consent is again “verified”, not witnessed like we do. Both the NYS DOH and DOE do not specifically state whether an RN or an RT respectively can or cannot witness consent forms. It has come down to many crucial conversations between patient and staff and the knowledge of the patient regarding testing. If this wasn’t my job, I would find it rather humorous and ironic, all these issues that arise that are truly not addressed in the RT or RN Scope of Practice.

Original Post:
February 2, 2009
Informed Consent: Is It Really Understood?, comment
I work in a Liver Failure Clinic and have end stage liver failure patients. I perform paracentesis procedures to remove fluid from some of these patients peritoneum. The patients are in pain need fluid taken of their peritoneum NOW so they can breathe.
The patient has to be able to make decisions to sign the consent.
We inform the patient they may need blood if a vessel was punctured. We tell them they may get an infection and even die.
We have the patient sign on a pad that transmits the signature to a computer. A witness and I sign it also.
 All of this is before the procedure is done.
Never has a patient not wanted the procedure even when death, bleeding, pain and infection were mentioned in the informed consent.

I agree that it is important to have an informed consent. It takes time and sometimes the patient’s signature is almost unrecognizable.
There is pressure on the patient and staff to get this signature. I agree that sometimes the patient does not really know what is going to happen because they are in need of the procedure now. We explain the entire procedure to them before the procedure but just how much is really understood is questionable.

Original Post:
July 10, 2008
Informed Consent: Is It Really Understood?
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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Informed Consent: Is It Really Understood?, comment

February 2, 2009
I work in a Liver Failure Clinic and have end stage liver failure patients. I perform paracentesis procedures to remove fluid from some of these patients peritoneum. The patients are in pain need fluid taken of their peritoneum NOW so they can breathe.
The patient has to be able to make decisions to sign the consent. 
We inform the patient they may need blood if a vessel was punctured. We tell them they may get an infection and even die.
We have the patient sign on a pad that transmits the signature to a computer. A witness and I sign it also.
 All of this is before the procedure is done. 
Never has a patient not wanted the procedure even when death, bleeding, pain and infection were mentioned in the informed consent.

I agree that it is important to have an informed consent. It takes time and sometimes the patient’s signature is almost unrecognizable.
There is pressure on the patient and staff to get this signature. I agree that sometimes the patient does not really know what is going to happen because they are in need of the procedure now. We explain the entire procedure to them before the procedure but just how much is really understood is questionable.

Original Post:
July 10, 2008
Informed Consent: Is It Really Understood?
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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Informed Consent: Is It Really Understood?, comment

January 22, 2009
In regards to the article Informed Consent:  Is it really understood? Thursday, July 10,2008.  I appreciated the topic and readings which brought forth important education issues that must be addressed to the patient prior to any procedure or treatment.  As professionals to understand the treatment or procedure being performed in order to assist the patient with questions he or she may have.  In view of the hospital setting where surgeries must happen quickly, I view education performed by the health care system as short.  With our main focus is making sure the patient signs the consent form. Shock is the first sign I see from the patient and families.  An inability to absorb very little.  I agree with an easy-to-read form and a teach back method.  In order for the patient/family to reinstate as to what they heard and for us nurses to be a patient advocate in this situation.  To report any doubts about the patients understanding or any concern.

Original Post:
July 10, 2008

Informed Consent: Is It Really Understood?

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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Prisoner and Detainee Protection

December 4, 2008

An interesting topic was brought up in Chapter 45 of International Law concerning prisoners. The following sources were given in the book on page 477 regarding the international legal standards for prisoner and detainee treatment: Standard Minimum Rules for the Treatment of Prisoners from the UN Principals of medical ethics relevant to the role of health personnel, particularly physicians in the protection of prisoners and detainees against torture and other cruel, inhuman, or degrading treatment or punishment as per resolution of the UN General Assembly. UN Convention against torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, enacted in 1987. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Informed Consent for Children

December 4, 2008

Informed consent is readily understood for a person of sound mind and legal age. But what of the little ones who are suddenly abandoned? In this case, especially in a case of suspected child abuse, the state will provide temporary custody of the child and provide consent. Under no condition would a child be refused medical treatment if he or she was in need and alone. (This is according to NYS law.) The child’s assent can be further obtained before collecting evidence for forensic purposes. Even though he may not fully comprehend, he is given the opportunity to participate in the process and he is made aware of the importance of the decisions in which he is participating in. this gives him both autonomy and credibility and perhaps a new-found start at once again trusting adults. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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